AACN News—February 2007—Opinions

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Vol. 24, No. 2, FEBRUARY 2007

Authentic Means Creating Value

Mary Fran Tracy

“Why do the AACN healthy work environment standards describe leadership for excellence as ‘authentic’? People are having a tough time understanding what ‘authentic leadership’ means.”

I paused when a highly respected researcher of work environment excellence asked that question. The standards have resonated with nurses, administrators, educators and physicians as setting the bar for workplace excellence. But did one of the standards miss the boat? Had we inadvertently introduced needless complexity by associating leadership with authenticity?

A Different Take on Leadership
Most definitions of leadership need to be turned inside out, moving from viewing leadership only in terms of its external manifestations to seeing it from its internal source.
—Kevin Cashman

Dictionaries define authentic as genuine, unquestionable, reliable, trustworthy. What happens, then, when we link authentic to leadership? “Leadership,” writes Kevin Cashman, “is authentic self-expression that creates value.” Cashman, an author and the CEO of LeaderSource, an international leadership development, executive coaching and team effectiveness consultancy, identifies authenticity as one of three core traits of leaders.

When viewed from the perspective of value, leadership is not defined simply by title, role or hierarchical level. Authentically self-expressing and creating value happens in developing ideas, improving systems and interacting with people, all of which are done by people at every level of an organization. For example, a staff nurse advocating for a patient or posing solutions to problems may show leadership as authentic as that of a manager.

The word “may” is important because, as Cashman suggests, we often try to divorce the act of leading from the person who leads. Leadership development depends on our internal personal development, he says, “our being in action.” Hence the title of his popular book, Leadership From the Inside Out. Leadership demands that we use insight and self-reflection to clarify our values, our purpose for work and our areas for growth. Too often we go to work day after day, ticking off tasks and projects without considering why we do this work and, more to the point, what value we bring.

Optional Authenticity?
There is a world of difference between optional and required authenticity. In the context of healthy work environments, authentic leadership is required from individuals-not just those in designated positions. “Nurses must fully embrace the imperative of a healthy work environment,” the sixth standard states, “authentically live it and engage others in its achievement.”

Some positions lend themselves to demonstrating authentic leadership. Nurse managers and clinical nurse specialists, for example. The impact of these roles permeates every aspect of a clinical unit, even reaching into the larger organization. This means that nurse managers and clinical nurse specialists can choose whether or not to remain in a leadership position, but they cannot choose whether to be an authentic leader.

Organizations also have an obligation to help develop and sustain authentic leadership. The critical elements of standard six are unambiguous. Organizations are required to offer support to education programs, to formal co-mentoring and access to key decision-making forums with the authority to make necessary decisions.

Every Nurse Brings Value
What value do you think you bring to your colleagues, your organization and, above all, to patients and their families? Consider these familiar examples:

As a progressive care staff nurse, you were notified about an ICU transfer patient. You knew the patient well because she had been admitted frequently for chronic heart failure. You also knew she was not ready for transfer, but the ICU needed the bed. You were sure she would quickly deteriorate because her inotropic therapy had been discontinued less than an hour before.

What value did you contribute? Did you marshal evidence from your knowledge of the science and past experience with this patient? Did you put forward the evidence honestly and respectfully, helping to discover if this was indeed the most appropriate patient to transfer? Did you engage your clinical nurse specialist or manager to bring forward solutions to the larger system issues that cause this recurrent problem?

What about your experience as an ICU manager? Your unit was asked to pilot new technology that would eventually be used throughout the hospital. The purchasing contract was already signed, yet nursing was neither involved in nor even aware of the decision. The pilot began, and immediately numerous hardware and software problems developed.

Did you approach each situation with authenticity? Did you discuss with administrators why nurses need to participate in decisions that affect nursing practice and patient care? Did you offer honest, respectful communication to ensure a safe, successful pilot program and address issues collaboratively as they arose? Above all, did you have the courage to say that the pilot needed to halt if safety issues needed to be resolved?

Going Forward
Can I become an authentic leader? Below are some questions guiding me on my journey toward authentic leadership. I don’t just ask them of myself. I also ask trusted colleagues for their insights. Sometimes their responses validate my own insights; sometimes their wisdom causes me to reflect further.
• Where am I on my journey to becoming an authentic leader?
• How skilled am I at self-expression?
• How much value am I creating?
• In what circumstances are my actions guided by my internal values? When are they guided by my need to maintain image or control?
Please share your insights with me as you follow the path to authentic leadership, whether in an official leadership role as a manager or advanced practice nurse or at the bedside where most of our colleagues practice. I am especially interested in hearing about authentic leaders you have known. Please send you stories to me at insights@aacn.org.

Authenticity is the single most important quality of leadership. You cannot “get authentic” by delivering a great speech. It is demonstrated day-to-day through thousands of micro-behaviors.
—Bob Kidder

What do you see?

See something a new way and you’ll never see it the old way again. Each of my columns this year will feature a different graphic so we can share a different dimension of seeking insights. —MFT

Is this a saxophone players or a human face?

Letter to the Editor

New Orleans nurses endured one of the worst nightmares imaginable when Hurricane Katrina devastated their city. These nurses did not leave their posts to check on their homes, families, pets and possessions. Instead, they stayed at their respective hospitals for five days without electricity, food and water. They quickly ran out of oxygen, medications and other necessary supplies.

Although unable to communicate with the outside world, they heroically stayed at their posts, hand-bagging their patients night and day. Titrating life-saving IV drips by hand, using the only nonelectric blood pressure cuff in the unit to rotate turns checking their patient’s responses to medications. Keeping their hands on their patient’s pulses because there were no monitors, and they needed to save the defibrillator batteries for shocking. Starting IVs on each other to remain hydrated so they could continue to care for their patients.

They had no suction for their patients and jury-rigged suction using Foley catheters and bulb syringes. Life-saving surgeries were done at the bedside without the ability to administer anesthesia. When there were rumors of evacuations, the nurses dragged their patients on bath blankets up pitch-black stairwells to the roof four floors above, only to find that the rumors were just that, rumors. Then, while ducking sniper shots, they dragged their patients back down again. Now these heroic nurses are experiencing yet another, far worse nightmare. They are being tried for murder because many of their patients died. These are patients who had a high potential for dying in the best of circumstances.

As fellow nurses, we cannot afford to remain silent. This could be any one of us, and the time to act is now! I urge each nurse to write his or her respective senators and representatives and let them know about the injustice that is occurring in New Orleans. Legislation must be initiated to cover healthcare workers who respond and remain on-post when crisis occurs. If not, there will be no one who will want to take the risk of losing their license and perhaps even their freedom to stay and help the helpless. The only ones who are being sued are the ones who stayed, not those who left.

I urge AACN to assist us in our letter-writing campaign and challenge each local AACN group to take the ball and run with it. Get all of your members and nonmembers involved. We can be a mighty force and we have been silent for too long. It is time we supported each other and let the world know what heroes are all about.

Ann Whitehead, RN, CCRN-CMC-CSC, CEN
Rio Rancho, N.M.
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