The Role of a Transformational Leader in an Emergency Department

As standards and expectations increase emergency department staff stress and decrease staff preparedness, it is crucial to understand the role of transformational leadership to improve staff engagement, staff retention, and patient outcomes while developing staff into emergency department leaders. Specialties Management Article

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The Role of a Transformational Leader in an Emergency Department

Healthcare is a constantly shifting industry, becoming more tedious with new politicians elected to office, added regulations for patient experience, updates to service line policies, etc. With these increasing standards and complex expectations, emergency departments struggle to maintain a sense of belonging for staff, therefore losing staff faster than they can replace them. Decreased retention and decreased time getting to know their coworkers and leaders causes increased personnel stress levels making it crucial to understand the leadership model best suited to role model for staff in such a dynamic and complex environment. Transformational leadership is embraced by leaders who want to make changes to not only individual staff but also social systems to develop staff into future leaders. With a transformational leadership structure, there will be improvements in staff engagement, staff retention, and overall patient outcomes.

Hospital establishments are also dissimilar to other industry establishments in that units are open 24/7, 365 days a year, with staff working around the clock. Therefore, it is essential to have constant, dependable leadership and supervision, day and night. Each shift, for leaders and staff, is full of interruptions, patient volume ebbs and flows, high-intensity decision-making, and unforeseen patient interactions ranging from civil to hostile. Through all these changes, emergency department leaders need their departments and staff ready to provide comprehensive emergency care on non-emergent, emergent, and mass casualty scales at all times. According to the University of Massachusetts Global1, transformational leaders "know how to encourage, inspire and motivate employees to perform in ways that create meaningful change. The result is an engaged workforce that's empowered to innovate and help shape an organization's future success.” Therefore, transformational leaders encourage staff to be a part of the solution to any problem so that they will be motivated to make the changes necessary to keep the department prepared, equipped, organized, and successful.

As mentioned, decreased retention has been a huge problem for emergency departments and the healthcare industry overall. Patient experience numbers are increasing while simultaneously seeing decreasing healthcare worker satisfaction. Burnout rises as staff-to-patient ratios increase, the ability to take breaks decreases, and growing stressful environments intensify physical and mental strain. Emergency department leadership's attempts to keep tenured staff positive and motivated while welcoming more new staff require all leaders to have a transformational approach. "Highly reliable organizations have high scores regarding employee engagement, patient satisfaction and patient outcomes which are correlative to transformational leadership, strong shared governance and eventually great retention"2.  Leadership attempt to stay collaborative and in touch through routine staff meetings and staff rounding, but the focus of a transformational leader should include how to influence direct reports and other followers to find what motivates them on an individual level.

The emergency department I worked in for eight years prided itself in feeling like family, but unfortunately, after a few years, I noticed, whether due to burnout, personal life changes, or other career advancement opportunities, a large turnover of staff hit our emergency department causing the leadership to have a difficult time maintaining the current culture and feeling of work "family.” The role of the Clinical Nurse Coordinators (CNCs), charge nurses with direct reports and service line autonomy, in our emergency department provides a holistic approach to maintaining culture by role modeling overall leadership expectations on shift and taking the time to get to know the new staff personally, caring for each and every one individually to empower and motivate them. The idea of this trusted position role modeling behaviors to staff is explained through idealized influence, a concept encompassed by transformational leadership.

Idealized influence "is defined as having transformational leaders who behave in ways that result in their being role models for their followers. These leaders are admired, respected, and trusted since followers identify with the leaders and want to emulate them. One of the things leaders do to earn this credit is to consider the needs of others over their own personal needs. They can be counted on to do the right thing, demonstrating high standards of ethical and moral conduct, and avoid using power for personal gain"3. Transformational leaders who value idealized influence engender trust, admiration, loyalty, and respect among followers. Trust is at the foundation of these components, building loyalty as trust grows, with staff knowing things will run smoothly through trusting who is in charge. Transformational leaders realize how their actions affect outcomes and how knowing each staff member's personal strengths and needs allow the catering of decisions on shift.

From my years of leadership experience, leaders strive to create a safe haven where honest communication can be shared mutually, show trust in staff knowledge and decisions, create a non-judgmental learning environment, and take the time to recognize staff contributions. Through role modeling, these behaviors to staff, staff, in turn, treat each other with the same respect and extra attention. "Transformational leadership with an emphasis on "idealized influence" is a model of leadership that, when applied, will lead to successful healthcare teams and organizations in local as well as globalized operational environments. This, in turn, will lead to high-quality and responsive healthcare being provided, which benefits patient and organization, as well as other supportive and protective organizations and the community"3. The goal is to bolster an environment of inclusion, influencing and encouraging each other to grow as leaders and create an environment of success.

In conclusion, transformational leaders are passionate about bridging the gap of the "us versus them" mentality between leadership and staff to build a foundation of trust through collaboration, flexibility, and honest feedback, thus creating an environment supported by idealized influence. In healthcare, especially in emergency departments, transformational leadership is particularly important to run an erratic environment smoothly. If leaders decide to utilize a transformational leadership model, they will see improved department trust, staff retention, and team dynamics, thus leading to improved core measures and patient outcomes. Transformational leaders role model for and inspire future leaders, creating a transcended environment staff want to remain a part of and new staff seek out. The result is a team that nothing and nobody can stop.


What is transformational leadership? Understanding the impact of inspirational guidance: UMass Global Administration

Transformational Leadership: One Emergency Department's Journey: Sigma Repository

EMS Leadership Part 5: Idealized Influence Transformational Leadership in EMS: HMP Global

Nancy Fry, MBA, BSN, RN, CEN with 11 years of emergency care experience in both bedside and supervisory positions.

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Specializes in Oceanfront Living.

  Maybe I am wrong. but it does not appear you have actively worked in an ER in a few years. 

  My daughter is an ER doc and says there is a real shortage of ER nurses and nurses in general to move the patients up to the floors for care.

 I am a former ER nurse, many years ago, and we didn't have this problem.