I had the honor to present my thesis, Nurse Leader Rounds, Effect on Nurse-Related Patient Satisfaction Scores on Two Post-Surgical Units in an Acute Care Facility, to a global audience, at the 20th World Nursing Education Conference, in Osaka Japan (see presentation section). This was a wonderful opportunity to learn about Transformational Nurse Leaders from all over the globe! They reinvigorated my love for nursing and earned my admiration for their inspiring work. Also contributing to this spirit was the Japanese culture where caring and sharing are part of thier core values.
Transformational Nurse Leaders are not as rare as you might think, they are all around us making a difference everyday, charting the future for healthcare delivery.
Transformational Leaders, that have high ideals and moral values, can motivate followers by appealing to their moral compass. This leads to followers acting to improve the greater-good, rather than their own self-interests. Followers can then provide a supportive environment where responsibilities are shared.
There are four components of Transformational Leadership that can be applied to nursing to initiate this environment:
1) Idealized influence
2) Inspirational motivation
3) Intellectual stimulation
4) Individual consideration
But traditionally, nurses have been over-managed and led inadequately. Today, Nurse Leaders and their organizations face unprecedented challenges that require adaptive and flexible leadership skills to be applied. This type of adaptive leadership is referred to as “Transformational Leadership” where an environment of shared responsibilities create a new a way of learning and leading.
Saint Barnabas Hospital (SBH) primary service is located in the heart of New York State’s 15th US congressional District, which is very diverse. Hispanics comprise 65.3 % of the district and African Americans 28.6 %. Immigrants have a large presence, as 34.1 % of residents are foreign born. The communities served by SBH face severe health challenges, as the rates of asthma, obesity and diabetes rank among the highest in New York State. A 2017 study published by the University of Wisconsin and the Robert Wood Johnson Foundation (County Health Rankings & Roadmaps) analyzed the quality of health in New York State by providing a county-by county comparison of “health outcomes” (how healthy a county is overall) and “health factors” (specific influences on the health of a county). The Bronx ranked last among New York 62 counties in both groupings in each of the seven annual County Health Rankings and Roadmaps that have been published.
To address the broad and acute health needs of the communities it serves, SBH delivers a full continuum of services for people of all ages, from infancy to the end of life. Every day I go to work with people who are passionately dedicated to serve this underserved population. But, we are not the first generation of nurses to lead in a selfless manner. I’d like to take you back in time to learn about Nurse leaders in history.
NURSING PIONEERS A PROFESSION AND PASSION
DOROTHEA DIX (1802-1887) – was one of the leaders behind the First Mental Asylum in the U.S. Her reputation was earned by her fearless fight for the rights of the mentally ill in front of the Massachusetts legislator and then the US Congress. While teaching inmates in prison Dorothy witnessed the miserable conditions of mentally disabled people. She immediately brought this matter to a local court, where she won many battles using careful and extensive documentation of these inhumane conditions.
Her advocacy turned to national efforts, although President Franklin Pierce vetoed her effort to create a facility for the people with a mental disability, it had been approved by both houses of the US Congress. This failure never stopped Dix from speaking up for the disadvantaged. She made notable changes in the way insanity was treated in Europe in just 2 years. In 1881, the Trenton State Hospital, in New Jersey, was built through her efforts and ideals. The benefits of Dorothy Dix’s advocacy for the mentally ill and as well as Nursing are still evident today.
HARRIET PATIENCE DAME (1815-1900) – hers’ is the first portrait of a woman, hanging in the NH State House and serves as one of the many honors earned for her efforts on the frontlines of the Civil War. She was a nurse that cared for soldiers without discrimination, any wounded soldier was immediately a patient to her.
On May 12, the final day of National Nurses week, we celebrate the 197th birthday of the founder of modern nursing, Florence Nightingale affectionately known as “the lady with the lamp”. Nightingale remains a role model for nurses in the 21stCentury. Her care of soldiers during the Crimean War is legendary, and her thoughts on nursing, ethics and various other topics still resonate today in her published works and letters.
FLORENCE NIGTINGALE (1820 to 1920) – on May 12, the final day of National Nurse week, we celebrate the birthday of the founder of Modern Nursing Florence Nightingale affectionately known as “the lady with the lamp” remains a role model for nurses in the 21stCentury. Modern nursing started in 1849, when Florence Nightingale began her first formal nurse training at the Institute of St. Vincent de Paul, in Alexandria, Egypt. She had additional training in Germany, France, and England. The knowledge and skills Nightingale gained from these experiences equipped her to overcome challenges in tending to the British military victims during the Crimean War. After improving sanitary conditions, she and her team of nurses reduced the death count by two-thirds, while at a military base hospital.
CLARA BARTON (1821-1912) – founder of American Red Cross and known as the Angel of the Battlefield, organized relief program for the soldiers. Clara Barton travelled with army wagons to distribute supplies and provide aid to Union casualties and Confederate prisoners. She established the Bureau of Records of Missing Men of the Armies of the US to locate missing men, notify families of their status and provided markers on all graves. She was a member of the International Red Cross relief efforts, helping victims of natural disasters. In 1880, she helped establish the American Red Cross and served as its president for five years.
MARY ELIZA MOHONEY (1845 to 1926) – the first Registered African American Nurse, helped to established the National Association of Colored Graduated Nurses (NACGN). This became Mahoney’s instrument in improving the status of black nurses in the profession nationwide. The NACGN created the Mary Mahoney Award in 1936, this award is given annually to nurses that exemplify excellence in nursing.
ELIZABETH GRACE NEIL (1846-1926) – a nurse from New Zealand worked to put in place laws that required nurses to be trained and registered creating the first System of Nursing Registration. She later had the privilege of helping draft a bill aimed to protect the public from nursing malpractice. Later the Midwives’ Registration Act was passed and Neil was instrumental in setting up the very first state maternity hospital, which opened in 1905 and was followed by 3 more in a span of 2 years. Elizabeth Grace Neil’s thorough knowledge of the technicalities of the nursing profession made her a crucial personality in the international nursing politics.
ANNIE DAMER (1858-1925) – she had a "calm, balanced mind" which fitted her for solving the problems of developing the nursing infrastructure and securing "legal recognition of nursing as a profession." Damer served as leader and founding member of several nursing organizations; Board of Nurse Examiners, Buffalo Nurse Association and many others.
LAVINIA LLOYD DOCK (1858-1956) – while serving as a visiting nurse to the poor she complied the first manual of drugs for nurses in 1890. Later she joined the suffrage movement because she felt women needed the power and respect of gender equality to be effective professional nurses.
SADIE HEALTH CABANISS (1863-1921) – she developed the first training school for nurses in Virginia that followed the Nightingale plan, today this is the School of Nursing at Virginia Commonwealth University. Cabaniss created the Virginia Nurses Association and later as it’s representative helped draught a measure to regulate the practice of nursing in Virginia.
MARTHA MINERVA FRANKLIN (1870-1968) – was one of the first to seek changes in the unequal and discriminatory realities of African American nurses in the United States. As the first president of (NACGN) she worked tirelessly to improve professional standards within the profession, to eliminate racial discrimination in the field and to develop leadership among African American nurses.
CLARA LOUSE MAAS (1876-1901) – a graduate of the Newark German Hospital Training School for Nurses, later to be renamed in her behalf, she worked as a Army nurse in Florida, Cuba and the Philippines during the Spanish-American War. Afterwards in Cuba, as part of a study to determine whether filth or mosquitoes caused yellow fever, she volunteered to be bitten by mosquito. After her second exposure she died at the age of 25, from yellow fever.
MARGARET SANGER (1879-1966) – women’s right activist, sex educator, writer and nurse that coined the term "birth control". In 1916 she opened the first birth control clinic in the United States, and established organizations that evolved into the Planned Parenthood Federation of America.
MARY BRECKINRIDGE (1881-1965) – she became registered nurse in 1910 at St Luke’s Hospital in NY and later studied at Columbia University. While working in Europe during WWI she learned about nurse-midwives and thought it would smart to introduce this to rural American communities. She established the Frontier Nursing Service providing midwife care in rural areas. Breckinridge traveled on horseback covering over 700 square miles. Maternal and neonatal mortality rates significantly dropped afterwards. FNS is still serving mothers and children today.
THE REFORMISTS
FLORENCE ABY BLANCHFIELD (1884-1971) – as superintendent of the Army Nurse Corps from 1943 to 1947, and the first woman to be commissioned in the regular army of the United States, Florence Aby Blanchfield was among the most respected nurse leaders of the twentieth century. Devoting a significant part of her illustrious career to serving her country, Blanchfield's military experiences included meritorious service in WWI and WWII.
VIRGINIA HENDERSON (1897-1996) – educated at the US Army School of Nursing and Teachers College, Columbia University where she taught, in addition to Yale University. She was honored with many awards of distinction and published “A Virginia Henderson Reader” in the 1995. Here she details her thinking on nursing which recognized early on the importance of an outcomes orientation, health promotion, continuity of care, patient advocacy, multidisciplinary scholarship, integration of the arts and sciences, and boundary spanning. Later this is to be known as the Nursing Theory. Henderson’s theory that nurses should aid everyone, sick and well, in the quest for better overall health or peaceful death is recognized as a major contribution to the nursing.
SUSIE WALKING BEAR YELLOWTAIL (1903-1981) – known as “Grandmother of American Indian Nurses” was an extraordinary Native American leader. She embodied wisdom, vision, and the determination to accomplish her goals. Susie tailored her life to serve as a bridge between Native American peoples and non-Indians, so she bring modern healthcare to her own people. She received the President’s Award for Outstanding Nursing Health Care.
LYDIA ELOISE HALL (1906-1969) – was interested in rehabilitative nursing and the role that the professional nurse played in the patient's recovery and welfare. Her Care, Cure, Core Theory was developed through her interest and research in the field of rehabilitation of chronically ill patients. Because of her expertise in rehabilitation, Hall became involved in the creation of the Loeb Center for Nursing and Rehabilitation at the Montefiore Medical Center (MMC) in the Bronx, New York. As the founder and the first director, she was adamant that nurses were in charge of everyday operations. Others in the health team were secondary members.
VERONICA M. DRISCOLL (1926-1994) – in her role as assistant executive director of the New York State Nurses Association's (NYSNA's) economic security program, she helped registered nurses employed in New York City municipal hospitals win increased wages, benefits and improved practice environments. Her leadership in this campaign prevented nurses from resigning en masse.
Driscoll was instrumental in doubling membership, streamlining operations and establishing NYSNA as the largest collective bargaining agent for RNs in the country. She was key to ensuring the enactment of the groundbreaking 1972 New York State Nurse Practice Act.
MARTHA ROGERS (1914-1994) – widely known for her discovery of the science of unitary human beings, Martha E. Rogers provided a framework for continued study and research, and influenced the development of a variety of modalities, including therapeutic touch. Over a long and productive career, she demonstrated leadership skill and a futuristic vision that improved nursing education, practice, and research in the United States and internationally.
A proponent of rigorous scientific study, Rogers wrote three books that enriched the learning experience and influenced the direction of nursing research for countless students: Educational Revolution in Nursing (1961), Reveille in Nursing (1964), and An Introduction to the Theoretical Basis of Nursing (1970), the last of which introduced the four Rogerian Principles of Homeodynamics.
LUTHER P. CHRISTMAN (1915-2011) – was an American nurse, professor of nursing, university administrator and advocate for gender and racial diversity in nursing. In 1967, Christman became the first man to hold the position of dean at a nursing school. He established a premier school of nursing that pioneered the practitioner-teacher role and science-based academic models from the baccalaureate through the doctorate levels. As founder and dean of the Rush University College of Nursing, his name is often linked to the “Rush Model,” a unified approach to nursing education. He was involved in the founding of the National Male Nurse Association, which later became the American Assembly for Men in Nursing.
MARY ELIZABETH CARNEGIE (1916-2008) – exhibited courage, integrity and commitment to the advancement of the nursing profession, as well as to the advancement of black and other minority nurses. She received eight honorary doctorates, countless awards and published nearly 20 books and papers including The Path we Tread: Blacks in Nursing Worldwide.
HAZEL JOHNSON-BROWN (1927-present) – after graduating from the Harlem Hospital School of Nursing she joined the army and eventually became the first African-American Chief of the Army Nurse Corps. Named as the first African-American Brigadier General of the Army Nurse Corps in 1979, Hazel W. Johnson-Brown reached the most honorable rank when she was appointed as the chief of the ANC. She then commanded 7,000 men and women in the Army National Guard and Army Reserves, and overseeing numerous medical centers, free-standing clinics, and community hospitals in Germany, Italy, Japan, Korea, Panama, and the United States.
DIANE CARLSON EVANS (1946- present) – Vietnam War Nurse & Founder and President of Vietnam Women’s Memorial Foundation. She fought for the honor of the women who bravely battled side by side with male soldiers in Vietnam War era. It took 7 years of lobbying before the congress, convincing the legislators to recognize the immense value of 11,000 military women to Vietnam and the 265,000 others in service during the war.
So you see, nurses have been Transformational Leaders for a very long time – we must embrace this heritage and continue to lead and inspire, for the greater good.
Nurses need to continue to speak with a unified voice that underscores the importance of creating a healthy society and community. We must be global stewards to advance healthcare for all. Practice full authority to contribute both legislatively and institutionally. Access must be granted in all 50 states and abroad so that all RNs and APRNs can provide efficient, cost-effective access to healthcare for all people. Because it is our duty as Transformational Nurse Leaders to ensure that our voice is heard and valued, not only for the profession but also for our patients.
