Leadership Model
Leadership model focuses on RN's authoritative role to boost uniformity, job satisfaction

By Kathy Malloch, Ph.D., MBA, RN
April 1, 2003

You could say it's a vicious cycle. With a nationwide shortage of nurses, hospital environments are becoming more chaotic, which is turning more nurses away. But a team of nurse leaders in Arizona believes it has developed a solution-a new model that emphasizes the leadership role of every nurse, regardless of the nurse's position.

Whether nurses are caregivers, managers, leaders or educators, the team says, nurses must develop certain leadership competencies to perform their jobs better-which will elevate the nursing profession and help nurses feel more satisfied with their jobs. And more job satisfaction means increased nursing retention.

Kathy Scott, MPA, RN, a doctoral student studying leadership and former chief operating officer, describes the Arizona Nurse Leadership model as a "comprehensive tool that represents the role of the nurse in all arenas and speaks to nurses … from novice to expert.

"Just imagine if every nurse learned the performance competencies of leadership and internalized them in their work," she said. "Not only would we be able to speak a common language, use common measures and collectively mentor those new in the profession, but we would create a uniformity that would empower nursing in all arenas."

Betty Falter, MS, RN, consultant and educator at the University of Arizona, agrees. Since most leadership roles have been reserved for advanced practice nurses and nurse managers, Falter said, this model is valuable because it achieves "vertical and horizontal integration of leadership skills, from the staff nurse at the bedside to the nurse executive."

The ANL model consists of six leadership competencies: conceptual, technical, interpersonal, commercial, political and governance. According to the ANL team, nurses with conceptual competence know how their services and specific roles fit into the organizations they work for, as well as how they fit into society at large.

On the other hand, some nurses are unsure of expectations or the boundaries of their responsibilities.

Technical competence refers to the work nurses do to support practice or educational processes, such as planning, designing, assessing needs and measuring performance. By comparison, some nurses are unable to plan and manage a patient care assignment.

Interpersonally competent nurses have the know-how to lead others on the job and in the classroom, and possess skills such as team building and conflict management.

Some nurses, however, would focus on blaming the system, express no control over what happens or not be able to modify their environments.

Commercially competent nurses identify and provide care that makes a difference in patient outcomes within the boundaries of available resources and know the value of their work from the patient's perspective.

Other nurses would focus on financial goals to minimize spending at all costs or would be unaware of service costs and reimbursement levels.

Finally, politically competent nurses can determine how public and private policies affect patient care and teaching, as well as influence public policy-making at the state and federal levels, while nurses with governance competence can provide care that's consistent with the organization's vision and create a culture that realizes that vision.

Standard issue

The model was developed by major health care players in Arizona: members of organizations that employ nurses, educational institutions, professional nursing organizations, professional health care organizations and private companies that provide continuing education services.

Arizona nurses don't see ANL as just another project or as an exercise to collect dust on the shelves, but as a work in progress that may improve the effectiveness of every nurse.

"The model is workable and is not just fluff; it is more than theory," said staff nurse Darcy Walker of Yavapai Regional Medical Center in Prescott, Ariz., who also describes the model as "logical."

"[It] spells out what is expected from each nurse in his or her role."

Cynthia Russell, DNSc, RN, dean of Grand Canyon University in Phoenix, is excited that the model provides nurses with a common and practical language to discuss a critical need, regardless of the nurse's practice area.

By applying the model, she said, nurses in Arizona will be able to develop future nurse leaders at all levels of the health care system.

Russell points out that the model can be used in the development of research studies, as well as to help students recognize the more comprehensive role of nursing and envision future roles of nursing.

Rhonda Anderson, MS, RN, chief operating officer at Desert Samaritan Medical Center in Mesa and a faculty member at Grand Canyon University, uses the ANL model in her RN-to-BSN leadership class.

Students like the model, she said, because they understand it and it applies to all levels of leadership. Anderson said that classroom dialogue focuses on applying the model's principles to daily situations so that students can manage the situations more effectively in the future.

"The model provides clarity as to the role of the nurse and the value of her role to the patient, to other peers and to the system in which she works," said Mardy Taylor, MBA, RN, chief nursing officer and former president of the Arizona Organization of Nurse Executives.

"This model can lead to hospitals and educational professionals working together and sharing resources to develop standardized education for nurses in Arizona while using variable teaching techniques."

The model is also an important support for achieving Magnet status, said Colleen Hallberg, MS, RN, interim CEO at Banner Health's Thunderbird Samaritan Medical Center in Glendale, Ariz. Magnet program standards recognize the importance of nurse empowerment and nurse autonomy, both of which lead to increased nurse satisfaction and retention.

In the ANL model, interpersonal and political competencies are essential to successful collaboration, negotiation and advocacy.

Staff nurses who possess these competencies will be successful and satisfied as they work with nurse leaders in making decisions that affect clinical practice and professional work life, Hallberg said.

"ANL is relevant to every type of nursing-and it recognizes that nurses are doing more than taking care of the patient," Walker said.

Contact Kathy Malloch at kmalloch@msn.com