Journal of Nursing Management, 2000, 8, 83���87 A nursing theory for nursing leadership C. L. LAURENT rn msn cfnp Captain (select), Nurse Corps, United States Navy, Clinic Director, Family Medicine Department, Naval Hospital, Camp Pendelton, California, USA Correspondence laurent c. l. (2000) Journal of Nursing Management 8, 83���87 C. L. Laurent A nursing theory for nursing leadership Clinic Director Family Medicine Department For many years nursing practice has found its foundations in nursing theory. A review of Naval Hospital theorists such as D. E. Orem, C. Roy, B. Neumen, V. Henderson, M. E. Rogers and Camp Pendelton others reveals a focus on the management of patient care, not leadership. This has California provided most nurses with a solid foundation in ���management���, but little in terms of USA ���leadership.��� In more recent years, theories such as the Deming Management Method, Managers as Developer Model, Shared Governance and Transactional Leadership have been introduced, none of which are nursing theories. This article discusses the conceptualized diCerences between management and leadership theory arguing that there is a diCerence between ���leadership and management���. A leadership theory is proposed utilizing Ida J. Orlando���s model for nursing. This theory provides a nursing foundation for nursing leaders to utilize both in the management of patient care and in leadership. Accepted for publication: 30 September 1999 Introduction plethora of documentation and research within and out- side nursing to support concepts of nursing leadership. For many years nursing has struggled with the concept of This would be true if being a nursing leader and being a leadership. In letters written mainly to nursing students, nursing manager were the same. Nightingale advocated that nurses should be responsible for the internal management of patient care (Lorentzon 1997). Bureaucratic health care organizations have Nursing manager versus nursing leader adhered to this concept, at least in title, by continuing to use such terms as ���Nurse Manager.��� A review of nursing Registered Nurses (RN) are trained to manage patient theorists such as Orem (1980), Roy (1976), Henderson care. Nursing theorists such as Henderson (1966) stressed (1966), Rogers (1976), and Neuman (1982) reveal strong that the ���unique function of the RN is to assist people in theoretical basis for eCective management of patient care. those activities contributing to health, it���s recovery���. Orem In more recent years, theories such as Deming���s (1980) asserted that nursing is related to the patient���s Management Method (Walton 1986), Manager as need for the provision and management of self-care action. Developer Model of Leadership (Aorian et al. 1996), Roy (1976) used the term ���manipulation��� for parts of the Shared Governance (Ireson & McGillis 1998), and system within her adaptation model. Neuman (1982) Transactional Leadership (Prenkert & Ennfors 1997) have called the RN an ���intervenor���. Finally, Rogers (1976) alluded the fact that the RN maintains and promotes peppered the literature. Therefore, there appears to be a 83 �� 2000 Blackwell Science Ltd

C. L. Laurent health, prevents illness and cares for and rehabilitating However, the major diCerence between Orlando and the sick and the disabled. Many other nursing theorists other nursing theorists is that she takes this one step emphasized similar concepts in the management of patient further. Orlando advocates that the RN should explore care and to discuss each one would be repetitive. The their assumptions with the patient to identify the patient���s point of each theorist has been that nursing manages immediate needs. patient care. RNs therefore have a strong background to Orlando���s concepts correlate with the nursing process be managers of patient care. Patient care can be said to in terms of assessment, planning, intervention and evalu- consist of things such as taking blood pressure, changing ation by simply adding the patient to these components a dressing, holding a hand, etc. These are, as stated, in every phase versus just the assessment. In addition, like ���things���. A person manages things. However, people are the nursing process, Orlando���s concepts have strong simi- lead (Covey 1989). To further stress this point, in many larities to the steps of the research process. The RN cases patients are not even human anymore, but ���things��� formulates an hypothesis about the patient���s immediate themselves. Instead of Mr Smith in room 3, a RN may needs based on data. The RN then validates or invalidates say, ���The chest pain in room 3���. that hypothesis based on the results of an experiment, Within most organizations, the RN who is the best at survey or other method. In the case of Orlando, through managing patient care is promoted to a position of interactions with the patient. The RN cannot assume that authority. The basis for the RN���s success has been their any hypothesis regarding the patient is correct unless ability to manage (McNeese-Smith 1995). Most RNs then validated by the patient. Essentially, Orlando transfers attempt to manage people as they have patient care. The ���control��� of the patient���s care to the person who knows management of patient care is frequently outcome driven, the most about the patient, the patient themselves. hopefully successful outcomes. In managing people, suc- The following example is provided to demonstrate cess is again frequently measured in outcomes (Bultema Orlando���s concepts in practice. A 76-year-old male with 1995). Therefore, the RN tends to continue those manage- a history of insulin-dependent diabetes presents to the ment traits that brought success even into the executive Emergency Department with a complaint of ���pain on levels of nursing. This provides for outstanding managers. urination and lightheadedness.��� The RN obtains the fol- These abilities of RNs to manage things brings a repu- lowing vital signs: blood pressure, 128/69 pulse, 116 tation of ���getting the job done.��� Everyone in the organiz- respirations, 24 temperature, 38 ��C oral. In addition, ation generally wants a RN on their team or committee. because of the patient���s history, the RN performs a Are they there for their ability to lead people or their glucometer test, which shows that the patient���s blood ability to manage things and achieve outcomes? sugar is greater than 250 (normal 80���120). Further investi- Frequently the skills attributed to nursing leadership gation by the RN reveals that the patient ���had taken his have been based on research in which the ���leaders��� them- insulin��� and had eaten a normal breakfast. selves were surveyed (Henderson 1995). Would an auto- In this example, the RN formulates an immediate mobile manufacturer ask the designer, or the person who hypothesis based on verbal and non-verbal data and purchased the car about the quality of the product? RNs attempts to validate that hypothesis by collecting in positions of authority sell the product of leadership, additional data (glucometer test, questioning patient employees have a right to demand a quality product. To about insulin, breakfast). Now from the patient data, the evaluate the quality, traits or characteristics of nursing RN formulates several hypotheses about the patient. In leaders, the followers (employees) are the best qualified anecdotal surveys using this example, most RNs have to evaluate the product of leadership (Walton 1986). focused on the patient���s elevated blood sugar and insulin- There is a voluminous supply of successful nursing man- dependent diabetes. Accordingly, their plans of action agers available. There are even professional journals consisted of interventions directed at addressing the dedicated by title to nursing management. However, patient���s elevated blood sugar. If using Orlando���s model nursing also needs leadership (Editorial 1997). for nursing, no nursing action would be taken until each hypothesis is validated to determine the patient���s immedi- Ida J. Orlando���s model for nursing practice ate needs. In this scenario, the RN might validate with the patient their concern regarding the elevated blood Orlando���s (1961, 1972) model for nursing practice pro- sugar. In doing so, the RN may learn that the patient���s vides a conceptual framework for patient care as well as blood sugars normally run ���high���, and the patient is not nursing leadership. In patient care, Orlando requires that concerned. His immediate need was expressed on arrival, RNs identify, using all or part of their perceptions, feelings and thoughts, a basis for nursing actions. ���pain on urination.��� 84 �� 2000 Blackwell Science Ltd, Journal of Nursing Management, 8, 83���87