Leadership strategies for uncertain times.

The growing global shortage of health care workers, nurses in particular, is acknowledged by all. The projections for future needs are dire. When nursing workforce needs are discussed and strategies are being developed to deal with the growing demand, the focus tends to be on clinicians only. Yet the issue of a growing need for clinical leaders is equally as compelling and often overlooked. At the same time that demands for well-prepared clinicians are increasing, leadership for clinical practice in nursing has been identified as at risk. The Institute of Medicine study reports that strong nursing leadership is needed at all levels of the organization, from the bedside to the boardroom. And little is being done to address this (Page, 2004). While it is understandable in the growing market shortage of nursing that primary efforts are focused on employing sufficient nurses at the bedside, it is also shortsighted not to be addressing the preparation of present and future leaders in clinical practice environments. The aim of leaders is to create and direct organizations that are effective, resilient, and successful. Several resources exist that identify essential competencies for clinical and organizational leadership. The American Organization of Nurse Executives (2005) has identified competencies for executive level practice. The Center for the Health Professions has developed key competencies for all clinical leaders (O'Neil, 2005). The International Council of Nurses presented multiple examples of evidence-based leadership competencies for various nursing practice environments (Rafferty, Maben, West, & Robinson, 2005). Even though competencies for effective leadership are known, in times of uncertainty such as we face today, leaders tend to fall back on command-and-control behaviors. There is considerable evidence that these types of leadership behaviors can have a dramatic negative effect on employee morale, motivation, and productivity (Wheatley, 2006). Given the uncertainty faced in health care organizations and practice environments today, work environments are needed that will engage everyone's energy and intelligence in ways that will solve challenges and crises as they occur and ensure that care of the highest quality is delivered as well. The behavior of leaders can contribute to negative elements in the work environment; clearly, that is not what is desirable in practice environments today. A recent Institute of Medicine study that focused on transforming practice environments for nurses identified several key strategies, all based on evidence, that are consistently associated with the achievement of safety in environments where risk for error is high (Page, 2004). All of these strategies begin with the leadership in the organization. They include strategies that sustain trust throughout the organization and involve employees in decision making around the design and flow of work. Transformational leadership is identified as the essential precursor to creating these kinds of practice environments. Transforming leaders play a critical role in achieving the combined purpose that leaders and followers share in an organization and recognize that leaders and employees are engaged in a common enterprise in interdependent ways. Research indicates that becoming a new leader or manager requires extensive development so that individuals can make the transition from focusing on their own performance to coordinating the efforts of multiple individuals. …