Teaching The Core Values Of Caring Leadership

Teaching the Core Values of Caring LeadershipTable 2Implementation ofKouzes and Posner's Five Practices at WFUBMC1.2.3.4.5.Model the way. Nurse leaders at WFUBMC share their positive experiences and discuss ideas of how to make them occur morefrequently. They also identify barriers and brainstorm for strategies to help with those opportunities.Inspire a shared vision\ We explore together what it means to be a caring leader in our eyes and our peers. We also explore the impactthat our core values have on our day-to-day leadership.Challenge the process. There is an increased emphasis on decisions and their impact on a caring-healing environment for all. Weacknowledge that caring as a leader is necessary if a culture of caring is desired in the organization.Enable others to act. The model has wide appeal among the leaders to assist in developing a caring consciousness and leadershipskills to bridge the gap between the old way of management to a purposeful acknowledgement of the importance of caring at alllevels and in all actions.I;ncourage the heart. Leaders at multiple levels appreciate the purposeful exploration of what it means to be a caring leader and thetime taken to make this way of being not just an expectation, but an imperative.voice in decisions that affect their practice.Leaders who practice sb.ared decisionmaking have extraordinary responsibilityto ensure that the proper level of authorityis given in the right situation such thataccountability for the decision beingmay rest with the appropriate party. Asa result, they also must have educationalopportunities and mentoring to developand enhance their leadership skills. Theleadership theory of Kouzes and Posner(2012) guided this process.The teaching/learning strategies thatwe use in our classes to illustrate the corevalues and engage the nurse leaders inintegrating them into their practice includeone-page summaries of core value conceptswith reflection and discussion, which wehave included in this article. In order tostimulate reflection, we share exemplarsfrom previous classes to demonstratemeaning of each core value, and thenparticipants then write their own livedexamples for each of the core values.Participants are divided into groups andcomplete worksheets with discussionquestions to make sure the concepts are realand applicable in their day-to-day work.Groups present their conclusions in classfor general discussion and reflection upontopics presented. At the end of the course,participants in small groups complete acapstone project that demonstrates how theyare incorporating the core values into theirown specific practice environment. Theirprojects have been amazing! They all have acore power point which is complemented bytheir presentation of skits, games, music, art,and/or videos. Their presentations arehighlighted in a day of celebration withtheir leaders and peers.When teaching participants, we havefound that the use of one-page sununariesof each of the core values help staff andmanagers to see how the core values arereflected in their work and encourage themto address all issues from these core values,rather than moving from one fire to the next.The content we use in each of thesesummaries is briefly summarized in thefollowing paragraphs. we purposely citewell-known authors ofleadership books toshow that these core values are universal andwell received as values that are important tosuccess. In addition, in the training classes,participants write exemplars to illustrate thecore values, and we have included one ofthese exemplars to illustrate each of the corevalues. Each one-page summary speaks ingeneralities about leadership so thatparticipants can internalize this core valueand show bow they can apply the value intheir own work setting. The goal of each Ofthese one-page summaries is to have servantleadership come a)ive for, ese aspiringleaders. The classes, work sessions, and onepage summaries have been very effectivemethods of teaching with our leaders. SeeBox 1, illustrating how Suzanne Pert, RN,BSN, the Assistant Nurse Manager of ourPalliative Care Unit implemented the corevalues on her unit on Januafy 15, 2013.Always Lead with Kindness,Compassion, and EquanimityWhen teaching the core value of AlwaysLead with Kindness, Compassion, andEquanimity, we provide the participantswith the following surnmary on aone-page handout:Is there really room for kindness andequanimity in the workplace?Healthcare today is a big business withever-changing demands and constantdrives to increase efficiency. In thisenvironment, is it really going to makeany difference if we practice lovingkindness? Who has time for this? Isequanimity really possible? Kindnesscan be a very simple act of pausing tolisten to another's story, genuinelyappreciating persons as they enter yourspace, and practicing empathy.Research in neuroscience and socialsciences has revealed the physiological andcultural basis of emotional resonance insocial networks and its effects on bothindividual and group performance (Watson,2008). If we agree that healthcare is thebusiness of caring for the human condition,and if we make the assumption that humansare more than machines, then we must2013, Vol. 17, No. 4

Teaching the Core Values of Caring LeadershipBox 1 .··Suzanne Pert's email and narrative "Stop and Listen" illustrating her core values ofcaring leadershipHi Judy!I was a part of the Caring leadership back this summer and enjoyed it so much. This morning, I thought about the poems, letters andinspirational sayings that you would share. i wrote this, this morning after seeing one of my nurses at the bedside. I felt so moved bywhat I saw that I placed this on stationery, laminated it, and read it aloud for her at the nurses' station. I wanted to share with you andthought that maybe somewhere along the way; you may want to share as well. Thanks again!!! Suzanne Pert, RN, BSN, Assistant NurseManager, Palliative Care Unit, Wake Forest Baptist HealthStop and ListenThis morning I chose to come into work earlier than I usually do so that I could spend some time with staff members that I do notget to see as often. It was still dark outside and misting rain. I entered the unit that was quiet and peaceful. Our six patients that arehere were tucked away comfortably in their beds. Some had family present to hold their tired hands and some did not.I smiled at the unit secretary and said "good morning." She pleasantly returned with the same. I sat at the nurses' station to pull upthe census list as I do each day, and a soft voice caught my attention. I heard someone singing. I looked around but saw no one. Icontinued doing what I had sat down to do and heard the voice again. This time I looked at the secretary in mystery who pointed to bed06 which was near the nurses' station. I quietly got up and walked towards the door. I leaned against the frame only to see a silhouetteof a nurse whose reflection was gleaming off of the window overlooking the city. Behind her, I could also partially see three steeplesfrom nearby churches. The raindrops from outside were slowly rolling down the glass. The lighting in the room was dim, and thewarmth was easily embraced. I could ee the nurse gently rubbing the patients arm as she sang beautiful hynms that touched my spirit.Her love and compassion were so apparent even though I could only see the outline of her in the dark window.At that very moment, I became tearful as I was quickly reminded why we do what we do. This particular patient did not havesomeone to hold their hand, or stroke their arm. This particular patient did not have someone to tell them that everything was going tobe ok. Instead her nurse stepped in and took on this responsibility through love and compassion. At this very moment, I witnessednursing at its finest. I was able to see how caring for a dying patient can be beautiful. What a gift - to be able to embrace and providecomfort when it is needed most.There are times that our responsibilities keep us from truly stopping and spending quality time with others like we would like to do.We all become busy, and one task is replaced by another. It is often forgotten during such hectic times to stop, but today she did . .Suzanne Pert RN, BSN, January 15, 2013recognize the relationships of their emotionsto optimal wellness, and the ways in whichemotional resonance affects performance.Baker and O'Malley (2008) in The PowerofKindness suggest that leaders have alwaysrelied on emotions to motivate others: Greatmanagers inspire employees to collaboratewhen problem solving, coaches rally playersto win, and politicians persuade others tovote for them by appealing to theiremotions. Baker and O'Malley interviewedmany leaders and found that thecombination of leadership and kindnessare complementary and gives leadersan edge. So how does a leader functionwith equanimity or balance? How do wepromote and accept positive and negativefeelings? How do we authentically listen toanother's story?Leaders must first strive for balance inthemselves and then in how they work withtheir employees. This can be accomplishedthrough reflecting on what you findmeaningful in your work, determininghow you define success for yourself, andtaking the time to consider your personaldefinition of success in relation to yourorganization. This time of reflection andpersonal mission building helps to defmewhat success means for you and will helpyou to find balance and the motivation tofunction optimally in the workplace.Helping employees find that balancerequires openness to their thoughts andMN International Journal for Human Caring feelings which may differ dramaticallyfrom yours.Rita Louise, PhD, an alternative healthand healing practitioner, and author of ThePower Within and other books states, "Whenwe give ourselves permission to express allour feelings (both positive and negativeones), and when we allow them to run theircourse, we always feel lighter, fresher, andmore centered. When our emotions arebalanced, we can experience all of themto their fullest. is easier for us to ownthem and then process them quickly andeffortlessly. They are allowed to flowthrough us. We breathe them in, weexperience them, and we let them go. It isthe beauty of our existence" (Louise, 20 12).

Teaching the Core Values of Caring Leadership1As Glen Hubbard, Dean of ColumbiaBusiness School, points out in the prefaceto Baker and O'Malley's (2008) book,Leading with Kindness, "The ability toleverage one's kindness is not a soft skill.On the contrary, it is a no-nonse seapproach to business that can return harddividends in organizational effectivenessand business performance. For the beginner,leading with kindness is a good first lesson.For the seasoned leader, it is a gentle andoften entertaining reminder that there isno time lik-l:: the present for masteringkindness" (p. xi).After reading this summary, andparticipating in the class session, one ofthe nurses wrote the following exemplar toillustrate how she sees this core value in herpractice. Note how clearly she is able topicture what kindness, compassion, andequanimity all look like in her practice:Exemplar of Always Lead with Kindness,Compassion, and EquanimityI admitted a patient to our medical unitlast week who had been transferredfrom another hospital. He and his wifewere very upset about how he had beentreated. They had a lot of anger over thecare he had received and the lack ofreal caring they had both felt. I knewthat it was important to allow them toexpress those feelings and help them toget past them. After a while, I was ableto get them to express the positives ofhow they wished his care would be.We talked about goals that we could sittogether to make this happen. Both thepatient and his wife felt much better . . .less frightened and more comfortablethat we cared about him as a personand would try to meet his needs withkindness and he would be treated withdignity and respect.Generate Hope and Faiththrough Co-creationThe second core value of our leadershipmodel is Generate Hope and Faith throughCo-creation. In teaching nurses about thiscore value, we chose to focus on Goertz's(2011) work on healing presence as theessence of nursing. Our goal in choosingthis wonderful source was to expose ournurses to Goertz's work in hopes that theywill get her book and share it with staffon their units. We believe that this is oneway that we can teach our leaders totransform nursing. We include the followinginformation on a one-page handout for· ;,the nurses:Do we really take the time to be surethat we are generating faith and hopein our work with our patients andfamilies? Do we even recognize whenfaith and hope are needed? Do weidentify these as needs for ourselves aswell as our colleagues?Do we inspire our patients and familiesas we care for them in their times ofdeepest need? Do they feel our faithand hope as we struggle to address theirproblems and concerns? Are we able toco-create an environment to keep hopeand faith alive? Do we share this visionwith our colleagues?We must respect the authenticity thatis required of us for presence insituations calling for faith and hope.We must also recognize and honorthe meaning and substance of the livesof those for whom we care.Research has shown that when people arefacing crises of illness, pain, loss, stress,despair, grief, trauma, and death . they "gohome" to their culture and their inner deepbelief systems. That is when they need usmost . to accept them where they are . . andto address the concerns of their hearts andsupport them in "what matters most" at thetime (Watson, 2008).Watson's Caritas Process One, lovingkindness and equanimity, is the foundationfor co-creating an environment of love,faith, and hope in which our patients andfamilies can thrive, even in the mostdifficult of times. Also, it iS' only throughour own authentic presence that we are ableto connect to others and open ourselves tothe possibilities of outcomes we may nothave considered. This authenticity is key tohow we are seen and experienced by others.We must touch their experience in amanner that is helpful and hopeful, andthat is healing rather than diminishing.(Goetz, 2011).To encourage and support our patientsand families through their crises, we mustuse all our ways of knowing to help themfind methods to sustain their faith and hope.Genuine teaching and learning experiencesare interpersonal and interactive processesin which both the nurse-teacher and patientlearner are engaged in co-creation of acaring, healing environment. This core valueis also essential to the development of atrusting relationship (Caritas Process Four)between the nurse and patient.How do caring leaders use Iheirknowledge, skills, and feelings to bringabout transforrnative relationships andhealing for self and others? Goertz (20 11)says that, "Within each of us lies a deeperway of knowing and being in the world"(p. 206). Presence is our way of being thatis felt by others. We must open ourselvesup to create a safe and compassionate spacethat allows others to sort through theirsituation honestly, clearly, and with candorand courage.As we work to deepen our own faith andhope, we make a powerful connection toothers. The privilege ofbeing a staff nurseor manager gives us innumerableopportunities for expansive and creativerelationships that enlarge our capacitiesand sensibilities and inform our caritasconsciousness. A caring leader lives andinspires this level of work.This one-page handout has been a veryeffective teaching strategy, as is illustratedin the following exemplar written by one ofthe leaders of the Pediatric Intensive CareUnit (PICU):Exemplar of Gener ate Hope· and Faiththrough Co-creationWe had a 3-year-old patient in thePediatric Intensive Care Unit (PICU)2013, Vol. 17, No. 4MM

Teaching the Core Values of Caring Leadershipthat had been very sick for his entireshort lifetime. He had been in and outof our unit several times. At this time,he was definitely terminal and hisfamily wanted very badly to make itpossible for him to die at home. We alsofelt strongly that this was the right thingto do. We had a team meeting anddiscussed ways of making this happen.We worked diligently with the parentsto teach them how to feel safe in caringfor him and to find ways that we couldsupport them in their hopes and beliefs.We taught them how to manage hismedications and his respiratorytreatments. I felt that we learned asmuch as they did as we went throughall of this. We also sent one of ournurses and respiratory therapists withthem to get them settled at home.Everything went much more smoothlythan you would believe! He died threedays later surrounded by his familyand favorite things.Actively Innovate with Insight,Reflection, and WisdomOur third core value is Actively Innovatewith Insight, Reflection, and Wisdom. Ourexperience has Mught us that nurse leadersrarely thought about their role as innovators.In our one-page summary, we focusedprimarily on teaching our nurses whatinnovation is, and we included a briefreference to Peter F. Drucker's (2006) modelof servant leadership. Once again, we hopedthat including the Drucker reference wouldspark our leaders' interest in seeing hownurses can use management innovators whohave changed the world. We included thefollowing general description of innovationon our one-page summary:Innovation - who has time for that?Well, today it is not a question ofhaving the time for innovation- itis a must if we are to survive. Thisis especially true in a healthcareenvironment as all the things around usare changing at a faster pace than everbefore. Healthcare reform is no longer aquestion of if or when, it is happeningnow, and where there are still manyuncertainties, what we do know is wewill have to do more with less and havebetter outcomes. More than ever, thepublic is asking for healthcare to bepersonalized and for us to meetindividuals where they are- physically,mentally, and emotionally. Nowadays,the only constant in our lives and in ourwork is change. Yet, while this may beour reality, it is not necessarily an idealway to function.Our values, particularly our leadershipvalues, must be defined and refined suchthat when the winds of change come, weare grounded by remembering what mattersmost to us. In the context of the caringleadership model, "Actively innovate withinsight, reflection, and wisdom," is key tosurviving and thriving.Innovation is often born out of necessity,which provides opportunities to bringtogether our collective ways of knowing inorder to make things better for our future,Innovation derives from the Latin wordinnovatus, from the verb innovare "to renewor change." The term innovation refers to thecreation of better or more effective products,processes, technologies, or ideas.Peter F. Drucker, considered by many tobe the most influential management thinkerwho has ever lived, points out (2006) theusual reasons for innovations are changes inindustry structure, market structure, localand global demographics, humanperceptions, and mood and meaning. In thecurrent society ofhealthcare, innovation iscritical. This requires insight, wisdom, andreflection in order to ensure that innovationsare meaningful, practical, and valuable.This core value of caring leadershiprequires that we use our knowledge andcollective wisdom. We must combineintuitive knowledge from experience withthe purposeful use of reflection to designinnovative processes, ideas, and practicesthat produce more valuable outcomes.Does this occur in isolation? In the realworld, rarely does one individual have allMf.w International journal for Human Caringthe knowledge required for an innovativeprocess to arise in a way that is prac

leadership model, servant leadership, Watson . s . caring theory, Kouzes and Posner . s . leadership theory, five practices of exemplary leadership, teaching leadership, front-line managers Introduction Developing and nurturing our leaders is something that we do not always do very well in nursing, or healthcare, or in many