Transformational

Leadership Theory:
What Every Leader Needs to Know
Paula Rolfe, BSc, MSc, RN, BN, MN

H
adapting to
1
ealthcare is complex and requires effec-
tive leaders skilled at leading and
change. The Canadian Nurses
leadership, no definitive theory has emerged to
guide leaders.2 Nor is there evidence available on
what theory is most effective for the new leader.
Association states, Leadership plays a pivotal role Compounding these problems is the massive amount
in the lives of nurses and Nursing requires strong, of literature available on leadership that a new
consistent, and knowledgeable leaders. Obtaining leader must sift through to acquire the knowledge to
this knowledge and skill is difficult. Although determine which leadership style to adopt and
numerous studies have examined and explained implement into practice.

54 Nurse Leader April 2011

T he impetus for writing this paper was to share my per-
sonal journey in nursing leadership. In my first leader-
ship position, I remember feeling overwhelmed and
incompetent because of insufficient leadership skills, and I
realized this was detrimental to my effectiveness. I knew
that if I did not get the trust of my fellow followers, I was
not going to be an effective leader, nor would I be able to
inspire a better work environment or make a positive
impact on the care that patients receive. My first attempt at
management had minimal success.
For my second attempt, I was better prepared. I researched
leadership theories, implemented a style of leadership that
was recognized as effective, established a relationship with my
fellow followers, and encouraged them to succeed. Problems
that seemed insurmountable gradually melted away. We were
all empowered to work harder, strive higher, and transform
the work environment. This definitely transferred over into
their personal lives, as their partners anecdotally commented
on how they enjoyed going to work now and there was less
stress at home.
Because of family commitments, my career path changed,
and I entered nursing education. In this role, I can continue
to instill my love of leadership into the moldable minds of
students so that they will become great followers, bursting to
be great leaders.
While many leadership theories exist, I found that transfor-
mational style, from transformational leadership theory (TLT),3,4
was effective for me as a new leader. Endorsements for this style
included the Registered Nurses Association of Ontarios5 best
practice guidelines for developing and sustaining nursing leader-
ship and British Columbia in recognizing the importance of
having well-skilled nursing leaders by providing new leaders
with a formal leadership development program that endorsed
transformational leadership augmented by transactional leader-
ship.6 Unfortunately, not all organizations offer such programs,
yet new leaders require preparation to lead.Therefore, being
familiar with a known effective style is critical, and having per-
sonally found this style valuable, I thought it was important to
simplify it and share it with new leaders.
The purpose of the article is to present TLT using the
three common themes (relationship, leader, and environment)
extracted from the literature, augmented with personal strate-
gies for implementation into practice. The article reveals that
TLT, although not perfect, is an effective leadership theory in
todays changing environment because of its ability to trans-
form organizations through its people while generating
desired outcomes.
TLT THEMES
TLT can bring about significant change in both followers
and organization.2(p 356) Incorporating TLT beliefs and prac-
tices into the new leaders behaviors will enhance success. This
can be accomplished through an understanding of TLT
themes, their interrelationships, organizational requirements,
and leader-follower interdependence, as illustrated in Figure 1.
www.nurseleader.com
Relationships
TLTs basic premise is that the leader possesses the skills to
develop successful relationships with followers in an envi-
ronment where both leader and follower strive to meet
organizational goals necessary to fulfill the vision.2 A recip-
rocal and interdependent relationship follows, increasing
trust and a sense of belonging.2,7 Because followers have
input into the vision, they feel valued and the relationship is
enhanced. This energizes and motivates followers to develop
ownership of the shared vision and move toward its actual-
ization. Morale increases and followers become empowered
to develop their own leadership skills.
Unfortunately, TLT does not address all relationship situa-
tions. Some management requirements of the leaders job can
negatively affect this relationship.8,10 Addressing issues such as
sick time abuse and conflict within the work environment are
negative to the relationship-building process yet are essential
to being an effective leader. Naysayers are also challenging
to transform, and developing relationships over vast
geographic areas can be taxing.
Authors Strategies. Developing relationships is time-con-
suming and challenging. Treating others the way you want to
be treated is key. Treat everyone with respect, value what they
say, and genuinely care about them.You can demonstrate this
by acknowledging individual achievements, asking about their
workday, including them into decisions (vision development,
strategic plan, etc), involving them on committees, etc. Most
importantly, you must show followers that you are not only
listening to them but that you are hearing them and genuine-
ly interested in what they are saying.You will not always
agree, but you can come to a consensus.
When things are beyond your control and you are
required to implement difficult decisions that impact the
followers, you should be honest and open and collaborate
with them to develop a plan that will affect them the least.
This allows them to have some control over the process on
how the enforced change is achieved. They will trust and
respect you for including them in even the smallest decisions.
To do this you must show a presence on the unit.You must
know the organizations vision and strategic plan, since they
are what you will be communicating to followers. If followers
suspect that your vision is misaligned with the organizations,
they will mistrust you, and the relationship will be severed.
You do serve a dual function, and some decisions will be
unpopular. Being upfront, honest, fair, consistent, and transpar-
ent will benefit you as you rebuild relationships. When you
interact with naysayers who do not want to follow or believe
in the vision, you should try to build a relationship. If your
attempt is unsuccessful, treat them with respect and compas-
sion but forge ahead with the majority, collectively moving
the vision forward. The naysayers can stagnate without input
into their future, or they can join forces, making the group
even more powerful as they move toward the vision.
Leader Attributes
TLT leaders are visionaries, catalysts, motivators, and goal-
oriented, futuristic leaders who invoke group respect,
Nurse Leader 55
shared vision, and improved culture. Eight attributes con-
tributing to their success include self-knowledge, expertise,
authenticity, flexibility, vision, charisma, shared leadership,
and the ability to inspire and motivate followers.4 Of those,
charisma is the most important in transformational leader
influence.10,11 Charisma used appropriately is very effec-
tive12 but can cause destruction when used inappropriately.
The above attributes makes this leader powerful. This
power can innovate, inspire, and motivate followers, leading
to increased loyalty, commitment, job satisfaction, and per-
formance.10,13 TLT assumes that leaders possess integrity
and function within a moral and ethical framework, while
building trusting relationships.9 Unfortunately, this is not
always true, and followers values shaped by such leaders
may be self-serving.14
Transformational leaders are the communication champi-
ons and ambassadors for the organizations vision.2,9,10 As
followers embrace the vision, they acquire the role of selling
it. Sharing this communication role is important as the con-
stant energy9 required to communicate the vision increases
the leaders risk of burnout.
Authors Strategies. Self-reflection and assessment of where
personal growth and change need to occur are difficult but
necessary skills you should learn. Acknowledging and develop-
ing the above attributes will enhance your effectiveness. It will
require time; an assessment of your morals, values, weaknesses,
and strengths; and identification of your own vision and its
alignment with the organization. Ask coworkers, family, and
friends how they see you with regard to some of these attrib-
utes. Being energetic, action-oriented, and positive in your
interactions is important. Being flexible in your thinking and
knowing there may be many ways to achieve the end-result
are important. Developing conflict-resolution skills will help.
You must not talk the talk but practice what you preach and
walk it.You have to be a visible role model, acting as a mentor
and assisting followers to be leaders.
To enhance communication skills, enroll in a public
speaking course. Dont be afraid to try new things, and
when you fail, start again. When you make mistakes, apolo-
gize and say that you are learning and would appreciate
feedback. Ask followers how they see things unfolding in
the organization. Listen to their plans on how this can be
achieved. Through a collaborative effort, implement the
plans. If initially unsuccessful, alter them and try again.
Involving followers into all decisions will enhance leader
and organizational accountability and success.
Perseverance is crucial.You cannot solve all the problems,
and progress toward the goals will be slow, but collectively
you can make a better future. Implement accountability
frameworks at your level to ensure you are acting in the orga-
nizations best interests.9,10 Transparent mechanisms (dissemi-
nating unit reports, including followers on committees, etc)
will accomplish this.
Work Environment
Implementing the Registered Nurses Association of
Ontarios5 recommendations in creating and sustaining
56 Nurse Leader
healthy work environments is one way to provide an effective
work environment. They include continuing to build rela-
tionships and trust, creating an empowering work environ-
ment, supporting knowledge integration in the work
environment, leading and sustaining change, and balancing
competing values and priorities.
Healthy work environments support followers into think-
ing outside the box and envisioning ways to do things differ-
ently. Creating a milieu conducive to learning supports
followers into becoming creative, innovative, and autonomous
decision-makers.8,9 Leader visibility enhances this process by
being available to role model, teach, and coach.9,10
TLT promotes quality improvement environments where
the reciprocal relationship between leader and follower bene-
fits the organization.2 As leaders empower followers, followers
grow and develop into leaders. These empowered followers
have increased organizational loyalty, motivation, and job
satisfaction with decreased absenteeism, promoting a positive
work environment2,10 and building organizational success.8
This makes TLT a great recruitment and retention strategy.15
In fact, leaders implementing TLT have higher rates of reten-
tion, recruitment, and staff satisfaction.16 This benefit is signif-
icant with the world-wide nursing shortage.
Authors strategies. The morale of the work environ-
ment you enter depends on followers past experiences.
Help followers understand that, even though many things
within the organization are beyond their control, they are
in control of the morale on their unit. To improve morale,
create a no-blame environment where followers can
voice their doubts, challenges, strengths, and goals.
Collaboratively explore and implement strategies that can
address their issues. An increase in morale will follow
when followers feel empowered by seeing their ideas
transformed into reality.
Celebrate all small successes as each hurdle is conquered.
Challenge your followers to think differently, do differently,
and aim high. Change may be slow but persevere while mak-
ing small strides toward transforming the environment.
IMPLICATIONS OF ADOPTING TLT INTO PRACTICE
As a new leader, TLT offers a known, effective3,4 leadership style
for you to commence your journey. As you grow, however,
other styles maybe integrated, depending on the situation. TLT
does provide organizations with strategic directions, processes
for quality improvement, solutions for recruitment and reten-
tion, and the foundation for a sustainable future.
TLT can be very powerful for the organization. TLT lead-
ers make positive changes happen in organizations where it
would be difficult to do without committed followers.
Including followers into decisions empowers them to achieve
the vision and become leaders themselves.
While the benefits of implementing TLT outweigh the
problems, an awareness of the theorys limitations is crucial.
Organizations, leaders, and followers must be aware of the
misuse that can occur when incorporating TLT into practice.
Organizations need accountability frameworks9,10 and contin-
uous monitoring incorporated into their reporting structures.
April 2011
Continued vigilance is necessary to ensure organizations are
lead by the best possible leaders.

CONCLUSION
As a new leader, the quest to learn about leadership and lead-
ership styles can be met with frustration because the amount
of material and time required to research is excessive. TLT
can be learned and implemented to produce effective leaders.
The skills learned can help advance organizational goals by
transforming its people. The momentum and power of such
leadership can move agendas forward if the relationship,
leader attributes, and environment are developed and con-
ducive to change. This challenging journey that new leaders
embark upon requires patience and perseverance, but in the
end the benefits are apparent to all involved. NL

References
1. Canadian Nurses Association. Nursing Practice: Leadership. http://www.cna-
nurses.ca/CNA/practice/leadership/default_e.aspx. Updated 2009. Accessed
May 4, 2010.
2. Daft RL. The Leadership Experience. 4th ed. Mason, OH: South-Western
Cengage Learning; 2008.
3. Goleman D. Leadership that gets results. Harvard Business Review.
2000;78(i2):90.
4. Ward K. A vision for tomorrow: Transformational nursing leaders. Nurs
Outlook. 2002;50:121-6.
5. Registered Nurses Association of Ontario. Nursing best practice guidelines
program: Healthy work environments best practice guidelines Developing
and sustaining nursing leadership. http://www.rnao.org/Storage/16/1067_
BPG_Sustain_Leadership.pdf. Updated 2006. Accessed May 4, 2010.
6. Macphee M, Bouthillette F. Developing leadership in nurse managers: The
British Columbia Nursing Leadership Institute. Nurs Leadership.
2008;21(3):64-75.
7. Stanley D. Congruent leadership: Values in action. J Nurs Management.
2008;16:519-524.
8. Murphy L. Transformational leadership: A cascading chain reaction. J Nurs
Management. 2005;13:128-136.
9. Tucker BA, Russell RF. The influence of the transformational leader. J
Leadership Organizational Studies. 2004;10(4):103-111.
10. McGuire E, Kennerly SM. Nurse managers as transformational and transac-
tional leaders. Nurs Economics. 2006;24(4):179-185.
11. Feinberg BJ, Ostroff C, Warner Burke W. The role of within-group agreement
in understanding transformational leadership. J Occup Organizational
Psychology. 2005;78:471-488.
12. Davidhizar R. Leading with charisma. J Adv Nurs. 1993;18:675-679.
13. Porter-OGrady T. Is shared governance still relevant? J Nurs Adm.
2001;31(10):468-473.
14. Keeley M. The trouble with transformational leadership: Toward a federalist
ethic in organizations. Business Ethics Q. 1995;5(1):67-96.
15. Walters J. Creating a culture of trust. ECPN. 2005;102:18-23.
16. Casida J, Pinto-Zipp G. Leadership-organizational culture relationship in
nursing units of acute care hospitals. Nurs Economics. 2008;26(1):7-16.

Paula Rolfe, BSc, MSc, RN, BN, MN, has had numerous leadership roles
in acute care nursing and is a nurse educator at Western Regional School of
Nursing at Corner Brook, Newfoundland. She can be reached at
prolfe@swgc.mun.ca.

1541-4612/2011/ $ See front matter

Copyright 2011 by Mosby Inc.
All rights reserved.
doi:10.1016/j.mnl/2011.01.014

www.nurseleader.com Nurse Leader 57