NUR 8320 Module 1 Leadership Styles Paper: Relational Leadership, Burnout and a Nurse Executive's Development Plan Example

Fifty-Two Studies Point the Same Way: Building Relational Leadership in Nurse Managers Across a Monmouth County System

Student Name

Doctor of Nursing Practice, Thomas Edison State University

NUR-8320: Organizational and Systems Leadership I

Mentor Name

Month Day, Year

Fifty-Two Studies Point the Same Way: Building Relational Leadership in Nurse Managers Across a Monmouth County System

The Organizational Problem

Everything about this setting is invented: the system is two hospitals in Monmouth County with 640 beds, 41 nurse managers and about 2,300 registered nurses. Nurse turnover reached 21 percent last year, and engagement survey results show wide differences between units. Units with the highest engagement have the lowest turnover and the fewest falls and pressure injuries; units with the lowest engagement have managers who describe their role mainly as scheduling and budget control. Exit interviews mention managers more often than pay. The DNP-prepared chief nursing officer has been asked by the board to address manager leadership as a system priority.

The data behind that conclusion are worth stating. The system's engagement survey asks nurses whether their manager recognizes good work, keeps them informed, supports their growth and treats them with respect. On the eight units in the top quarter of engagement, turnover averaged 12 percent last year; on the eight units in the bottom quarter, it averaged 31 percent. The bottom-quarter units also had twice the rate of falls with injury. These are associations, not proof, but they match what the published studies describe, and they give the board a reason to treat manager development as a safety and retention strategy rather than a training budget line.

What the Evidence Shows About Leadership Styles

Cummings et al. (2018) screened over 50,000 titles to find 129 quantitative studies that tied leadership behaviors to outcomes for the nursing workforce and work environment. They grouped 121 outcomes into six categories, from staff satisfaction and health to relationships among staff, the organizational environment and productivity. Relational styles, such as transformational, resonant and authentic leadership, went again and again with better results for nurses, higher job satisfaction most of all, which 52 studies reported, whereas leaders focused only on tasks went with worse results. The authors concluded that organizations should invest in developing relational leadership in nurse leaders.

Shanafelt et al. (2015) surveyed physicians and scientists at a large academic organization, 2,813 of whom responded, and asked them to rate their immediate supervisor on 12 leadership behaviors, such as recognizing good work, keeping people informed, encouraging career development and treating people with respect. After adjusting for age, sex, length of employment and specialty, every added point on the combined leadership rating went with burnout odds 3.3 percent lower and a 9.0 percent increase in the likelihood of satisfaction. Although the study involved physicians, the behaviors measured are those nurse managers use every day.

Boamah et al. (2018) surveyed 378 acute care nurses in Ontario and tested a model in which transformational leadership increased workplace empowerment, which then lifted job satisfaction and cut the frequency of adverse patient outcomes, such as medication errors and falls. The model fit the data acceptably. The study was cross-sectional and cannot prove direction, but it outlines a pathway from leadership to safety through empowerment and satisfaction.

Leadership Theory in Plain Terms

Transformational leadership, the style most studied, describes leaders who inspire a shared vision, set high expectations with support, consider each person's needs and encourage people to question old ways. Task-focused or transactional leadership centers on assigning work, monitoring performance and correcting errors. Both have a place; a manager must schedule and budget. The evidence suggests that when the task side crowds out the relational side, nurses suffer and patients may too.

The Development Program

The paper proposes a 12-month program for all 41 managers. It begins with a 360-degree assessment using the 12 behaviors from the Shanafelt study, adapted for nursing, rated by each manager's staff, peers and director. Managers then attend monthly sessions on coaching conversations, recognition, career development, running effective huddles and sharing decision making with staff through unit practice councils. Each manager works with a coach, a senior nurse leader outside their own reporting line, and chooses two behaviors to strengthen. To make room for relational work, schedulers take over routine staffing tasks, and each manager has four protected hours a week for rounding with staff.

Managers are also involved in shaping the program. A design group of eight managers, including two from low-engagement units, reviews the plan, and their main request is fewer meetings. As a result, two standing committees are merged, freeing about three hours a month for each manager. They also ask that directors be held to the same behaviors, so directors complete the same 360-degree assessment, and the chief nursing officer shares her own results with the managers, which sets a tone of learning rather than judgment.

The cost of the program is modest compared with turnover. Coaching time from senior leaders, two scheduler positions and the 360-degree tool cost about $410,000 a year. If turnover on the lowest units falls by a third, the savings in recruitment, orientation and agency coverage would exceed that amount.

Measures

The program will repeat the 360-degree ratings at 12 months and track each unit's engagement score, turnover, falls and pressure injuries. The system expects changes over two to three years and will compare units whose managers improved most with those that improved least.

Limits

The evidence is largely cross-sectional, and the physician study may not transfer fully to nursing. Good leadership cannot fully offset unsafe staffing or poor pay, so the program sits within the system's wider retention plan.

Conclusion

A review of 129 studies shows that relational leadership styles are linked with better outcomes for nurses, a large survey ties specific supervisor behaviors to lower burnout and an Ontario model outlines a pathway from leadership to patient safety. This system's development program builds those behaviors in all 41 nurse managers, frees time for them to lead rather than only schedule and measures the results across units.

References

Boamah, S. A., Spence Laschinger, H. K., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing Outlook, 66(2), 180-189. https://doi.org/10.1016/j.outlook.2017.10.004

Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19-60. https://doi.org/10.1016/j.ijnurstu.2018.04.016

Shanafelt, T. D., Gorringe, G., Menaker, R., Storz, K. A., Reeves, D., Buskirk, S. J., Sloan, J. A., & Swensen, S. J. (2015). Impact of organizational leadership on physician burnout and satisfaction. Mayo Clinic Proceedings, 90(4), 432-440. https://doi.org/10.1016/j.mayocp.2015.01.012