16 February 2017

Blog entries by Daniel Pesut posted after 2016 now appear solely in Reflections on Nursing Leadership (RNL), an online magazine published by the Honor Society of Nursing, Sigma Theta Tau International.

18 October 2016

Diversity dynamics, defensive routines, and the quest for positive organizations

For the last several years, I have had the privilege and honor of serving on the National Advisory Committee of the Robert Wood Johnson Foundation Nurse Faculty Scholars program. In that capacity, I especially enjoyed serving on the Executive Diversity Committee. Over the years, I had the opportunity to work with male and other minority scholars in the program. We often had discussions about issues of diversity and inclusion related to being a member of a minority and under-represented group in academic nursing.

For example, minority women scholars noted that, because of their minority status, they are frequently invited to participate on numerous committees and task forces and that such inclusion added to their workload. Male scholars discussed negative stereotypes and microaggressions they experienced. These stereotypes were reflected in questions about intelligence, sexual orientation, communication styles, preferential treatment, privilege, compensation, and inattention to issues of power and feminine politics. Knowledge gained and lessons learned sensitized the Executive Diversity Committee and the scholars to stereotype threat, microaggressions, defensive routines, and the challenges of creating and sustaining positive cultures.

Rawpixel Ltd./iStock

Through dialogue and interaction with the RWJF scholars, we defined a number of diversity issues as complementary pairs (Kelso & Engstrom, 2006) and coined the term “diversity dynamics” to define these issues. (Refer to my post, “The squiggle sense and the complementary nature of nursing” for additional information.) Diversity dynamics are intrapersonal factors (culture, gender, sexual orientation, race, ethnicity, and religion) and interpersonal factors (organizational tensions, differing perspectives, and conflict) that influence organizational culture. Through discussions with the scholars, we came to conceptualize diversity issues and essential organizational tensions associated with these issues as polarities to manage.

For example, discussions about diversity and inclusion ought to concurrently consider issues of exclusion and sameness. Reflect on other tensions involved in framing and reframing diversity discussions. The tilde or “squiggle” in the following pairs is used to indicate their complementary relationship: Sameness ~ difference; homogeneous ~ heterogeneous; individual ~ collective; fairness ~ discrimination; visible ~ invisible; ignore ~ recognize; majority ~ minority; express ~ repress; deny ~ acknowledge, surface ~ deep; separate ~ attach; variety ~ likeness; disparity ~ parity; competitive ~ ambitious; privileged ~ advantaged; dominating ~ threatening; defensive ~ offensive; outsiders ~ insiders; aggressive ~ insensitive; analytical ~ emotional; and action ~ process oriented.

What other essential tensions or diversity dynamics have you witnessed, observed, or experienced in your organization? What would you add to the list? Realization of the dynamics associated with the social-justice challenges of diversity will not be resolved until their complementary natures are consciously acknowledged and evaluated.

Diversity dynamics contribute to stereotype threats and defensive routines. Defensive routines are patterns of interpersonal interactions people create to protect themselves from embarrassment and threat. These routines reveal disconnects between espoused theories and theories actually in use.

In positive organizations, people are valued regardless of status. They work toward the greater good, contribute talents, feel confidence, seek growth, express their authentic voices, expand roles to seek new opportunities, build social networks, nurture high-quality connections, embrace feedback, and exceed expectations as members of the organization learn and flourish.

To help organizations reflect and manage essential tensions, Quinn describes what positive organizations look like (Quinn, 2015). Becoming a positive organization requires paying attention to the essential tensions that are part of organizational life. To create positive organizational cultures, people need to become conscious of diversity dynamics, minimize stereotype threat, avoid microaggressions, practice overcoming defensive routines (Noonan, 2007), and support development of high-quality connections.

How will you use your leadership influence to explore diversity dynamics in your organization and, in so doing, contribute to the creation of a positive organizational culture where you work?

Kelso, S., & Engstrom, D. (2006). The complementary   nature. Cambridge, MA: MIT Press.

Noonan, W. R. (2007). Discussing the undiscussable: A guide to overcoming defensive routines in the workplace. John Wiley & Sons.

Quinn, R. (2015). The positive organization: Breaking free from conventional cultures, constraints, and beliefs. Oakland, CA: Berrett-Koehler Publishers

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

16 June 2016

Governance as leadership: What organizations want from board members

For the past several years, I have had the opportunity to be a faculty member of the Board Leadership Institute (BLI), sponsored by the Honor Society of Nursing, Sigma Theta Tau International. During my presentation at the institute, I share principles I’ve learned over time from my experience on boards and with organizations. Successful leadership of an organization depends on board members being knowledgeable about their core values and potential contributions to the organization. Mastery of fundamental knowledge and characteristics expected of a board is central, therefore, to effective board membership.

Below are some of the concepts and principles I share and discuss at the Board Leadership Institute together with resources and references you can use to develop your own knowledge base about what organizations want from board members. During the course of my BLI presentation, I advise attendees to:
  • Be intentional about their board leadership aspirations. Understand governance as leadership.
  • Know the wisdom of contributions based on talents, strengths, and values.
  • Master skills associated with change and transformation, futures literacy, levels of perspective, polarities, and competing values.
  • Understand the power of alignment and logical levels of learning and leadership.
  • Know the basic responsibilities of board work and how to be an effective and ethical board member.
  • Be clear about the importance of expectations related to fundraising, philanthropy, fiduciary responsibility, and return on investments.
  • Commit to being a team player by developing resilience and through personal and professional renewal.
A place at the table? BLI is
an excellent place to prepare.

Basically, the 10 responsibilities of nonprofit boards are to: 1) determine the organization’s mission and purpose, 2) select the chief executive officer, 3) provide proper financial oversight, 4) ensure adequate resources, 5) ensure legal and ethical integrity, and maintain accountability, 6) ensure effective organizational planning, 7) recruit and orient new board members, and assess board performance, 8) enhance the organization’s public standing, 9) determine, monitor, and strengthen the organization’s programs and services, and 10) support the chief executive and assess his or her performance.

Richard Chait and his colleagues, William Ryan and Barbara Taylor, observe that effective boards attend to the following variables. They pay attention to the context and culture of the organization, while discerning needs of members and stakeholders. They build a sense of community and inclusiveness among members, and they value education and development among themselves and members of the organization. Effective boards cultivate future leadership and build community. They possess analytic skills that help discern relationships among the complexities of competing issues. They value differences of opinion and seek out information that helps them in their deliberations. Effective boards are politically sensitive, and they communicate and attend to needs of all stakeholders. Effective boards are strategic rather than bound up in the day-to-day operations of the organization.

If you are eager to learn more about board leadership, consider attending the Board Leadership Institute scheduled for 18-19 August in Indianapolis, Indiana, USA. If you are unable to attend, check out the variety of learning resources available that provide information and guidance regarding organizational governance of for-profit and nonprofit boards. Resources I especially like are available through an organization called BoardSource. Also, read Nurse on Board: Planning Your Path to the Board Room. Authored by the late Connie Curran, EdD, RN, FAAN, the book was recently published by Sigma Theta Tau International.
Join the Honor Society of Nursing, Sigma Theta Tau International for the Board Leadership Institute! The program will be held all day on Thursday, 18 August, and end midday on Friday, 19 August. Register by 8 July to receive the Early Bird rate of US $599!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

08 March 2016

Nursing informatics, data science, and health analytics

What are your beliefs and values about the significance and meaning of nursing informatics as it relates to data science and health analytics? To what degree do you value the role of nursing informatics and technology as they relate to the future of nursing knowledge work and transformation of our current health care systems?

For several years, I have been fascinated by work in the area of nursing informatics. I am especially interested in the evolution and development of standardized terminologies related to nursing interventions and outcomes, as they support effective clinical reasoning and contribute to development of nursing research and knowledge work.

Peter Howell/iStock
A number of pioneering thought leaders in both practice and academic settings have advanced the vision and mission of developing nursing knowledge through the creation, application, development, and evaluation of nursing informatics. In spite of the scholarship, research, and developments in this area, I believe many nurses have yet to fully appreciate the value, impact, and consequences that nursing informatics and technology play in regard to advances in data science and health analytics. I believe all nurses ought to develop a philosophy and take a stance on the value of nursing informatics for professional nursing practice and the care of people.

As we evolve toward the fourth paradigm of data-intensive scientific discovery, it is evident that advances in nursing informatics and data science will influence the way nurses provide care, conduct research, and create nursing-sensitive health analytics that support strategic planning, analysis, and transformation of the current health care enterprise.

Last June I had the opportunity to facilitate a national conference—Nursing Knowledge: 2015 Big Data Science—where many nursing informatics leaders shared works, gained insights, and created visions for the future to advance a national agenda regarding nursing knowledge and data science. As you explore the proceedings of this conference, which of the work groups and future agendas do you find of interest?

Nurses who invest time learning more about nursing informatics, data science, and health analytics will play a key role in discovering knowledge in data we have collected over and through time. Nurses are well positioned to take the lead in creating and using big data to discover the nursing care patterns and trends that have had the most impact.

If you are not familiar with contemporary trends and issues in nursing informatics, take some time to discover the Alliance for Nursing Informatics home page or explore resources from the TIGER Initiative. Consider learning more from nursing informatics pioneers, and reflect on your professional stance in regard to the impact and influence that nursing informatics can have on the care of individuals, groups, and communities. The evolution and development of professional nursing knowledge into the future will be accelerated through mastery of nursing informatics knowledge, skills, and abilities.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

20 October 2015

From vision to action: Discover the Nexus

To what degree are you contributing to the vision and reality of interprofessional practice and education? To become a part of this national and international movement, explore the resources and activities of the National Center for Interprofessional Practice and Education (the Nexus). If you are already involved in interprofessional practice and education, you should definitely consider registering and becoming a part of the growing Nexus network. The story of Amina best represents the vision of the national center in advancing a desired future for practice and education in the health professions.

People Images/iStock
Recently, I had the opportunity to facilitate a national conference hosted by the Nexus. More than 100 people from around the United States who are part of the national center’s Innovation Network came to Minneapolis to share stories, insights, and results of ongoing initiatives related to the movement. Drawing upon a variety of liberating structures, participants engaged in dialogue and shared learning about their individual projects, challenges, and issues. The social networking and cross-pollination of ideas, experiences, and lessons learned fostered additional innovations and insights among conference participants.

The center is supported by Health Resources and Services Administration Cooperative Agreement Award No. UE5HP25067 with major funding from the Josiah Macy Jr Foundation, the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, and the University of Minnesota. If you are looking for resources and ideas to advance research, teaching, or partnerships in interprofessional education and practice, explore the center’s website and go to the Nexus Learning System or Resource Center links to learn more and connect with others.

One of the most exciting aspects of the center’s work is the creation of a National Center Data Repository (NCDR) that will support comparative effectiveness research about the value and promise of interprofessional practice and education efforts to meet the triple aims of high-quality patient experiences, improved population health, and lower costs. As the center continues its work and learns over time, it will be an example of an organization turning vision into action.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

08 June 2015

Values in conflict? View your organization through a CVF lens

Robert E. Quinn, PhD, is one of my favorite leadership scholars. One of his significant contributions to the field of organizational studies and leadership development is the competing values framework (CVF). The CVF helps one make sense of the tensions people often experience in organizational life.

As noted in this video introduction to the CVF, individuals and organizations are continuously challenged to manage polarities that relate to external positioning and internal maintenance, as well as flexibility and control. The juxtaposition of these competing tensions creates different types of organizational cultures, which are animated by values associated with framing and focus. Simply put, these frames and focuses involve collaborating, creating, competing, and controlling. Which of these four values resonates personally and professionally with you?

— Dolgachov/iStock/Thinkstock
Gaining insight into these tensions helps one appreciate and value differences between and among people and processes in an organization. Such appreciation leads to development of compassion and respect for individual contributions to the organization. Using the lens of CVF, how would you describe the culture in your organization?

Three levels of analysis
Given the competing values framework, there are three levels of analysis that help one gain insight. At one level, organizations are analyzed relative to external outcomes and expectations. At another level, competing values in terms of an organization’s internal workings are analyzed. Finally, at the third level, how the framework relates to individuals in the organization is contemplated. Knowledge and understanding of CVF provides leadership insights and guidance about how to navigate tensions and issues and support alignment of people with organizational processes, purposes, and effectiveness (Cameron, Quinn, DeGraff, Thakor, 2014).

For example, if an organization is focused on internal maintenance and stability, the culture is probably hierarchical and its orientation one of control. Leaders in this type of organization focus on coordinating, monitoring, and organizing. Value drivers are efficiency, timeliness, consistency, and uniformity. By contrast, if a culture is focused on external positioning and is flexible, it is an adhocracy, and creativity is valued. Leaders in this type of organization are innovative, entrepreneurial, and visionary, and value drivers are innovative outputs, transformation, and agility.

In a market-driven culture, the focus is external positioning, stability, and control, with competition the orientation. Leaders in this type of organization are hard driving and competitive. Value drivers in a market culture are market share, goal achievement, and profitability. A fourth culture type is clan. In this culture, the focus is internal maintenance and flexibility. Leaders in this culture are perceived as facilitators, mentors, and team builders. Value drivers are commitment, communication, and development of people and relationships.

In successful organizations, the competing values of collaborating, creating, competing, and controlling are at play concurrently. Consider the conflicts that can erupt if leaders and managers in an organization have a competitive market-driven focus and workers adhere to a clan or collaborative focus. Or how does one manage tensions between a need to be creative and innovative while, at the same time, working in a hierarchical bureaucracy? Or how does one both compete and collaborate?

How about your organization?
As you reflect on your organization, how does competition among the competing values of creating, competing, controlling, and collaborating play out among leaders, managers, and staff? With your personality, traits, and behaviors, what role, from a competing values perspective, do you play in your organization? Are you a pioneer, networker, achiever, strategist, anchor, analyst, team player, or helper? How can you leverage your strengths and role to make a positive difference in the organization’s culture and milieu?

As a result of learning more about the competing values framework, I have developed more compassion for and insight into the dynamics of academic and health care organizations, and this has enabled me to positively influence change and transitions. I invite you to learn more about the framework, and apply leadership insights you gain to the culture in which you find yourself. Developing a competing-values leadership skill set will enable you to maximize, influence, and activate your own success, as well as the success of your organization.

Cameron, K.S., Quinn, R.E., DeGraff, J., & Thakor, A.V. (2014). Competing values leadership. Northampton, MA: Edward Elgar Publishing.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

10 March 2015

Influence, power, and activism

There is focused effort to get more nurses on governing boards. The goal is to have 10,000 nurses serving in that role by the year 2020. There is no doubt that nurses have much to offer in terms of knowledge, skills and experience, but many are apprehensive about issues of influence, power, and activism.

I continue to be perplexed by the paradox that, although nursing is ranked consistently as one of the most respected professions, nurses are not regarded as being very influential. What does it take for nurses to own and master their influence skills? Eleanor Sullivan, PhD, RN, FAAN, a past president of the Honor Society of Nursing, Sigma Theta Tau International (STTI), tackles this issue in her book Becoming Influential: A Guide for Nurses, 2nd edition (2013), Prentice Hall, Boston, MA. In "Taking the Mystery Out of Influence," Sullivan advises reading the subtext of situations and going beyond the non-verbal to gain influence insights. Suggesting that professional presence supports influence consciousness, she notes that power is a foundation for influence. Perhaps nurses need new ways to think about the powers they possess?

Six stages of power
Janet Hagberg’s model of personal power is a useful guide for reflecting on the dynamics of what she identifies as the six stages of power: 1) powerlessness, 2) power by association, 3) power by achievement, 4) power by reflection, 5) power by purpose, and 6) power by wisdom. She believes there is a developmental trajectory to these stages and that people grow and evolve from one stage to another. She describes the characteristics of each stage, where people can get stuck, and how a person can move forward from stage to stage. 

Observing that individuals can be, at any particular moment and relative to other people, at various stages of power, Hagberg links these stages to issues of leadership and motivation. Using her model and reflecting on one’s own developmental progress in regard to stages of power leads to insights and understanding of self and others. I personally believe that, to be effective and successful as a governing board member, power by reflection, power by purpose, and power by wisdom—stages 4, 5, and 6—are required.

Armed with influence, empowered nurses activate leadership skills. As Karen Kelly, EdD, RN, CNAA, BC, notes in “From apathy to political activism,” published in American Nurse Today (2007), there is a developmental trajectory associated with activism. It moves from apathy to buy in to self-interest to acquisition of political sophistication to leading the way. There is an emerging community of people who are becoming health activists and there are great stories about nurse activists. To prepare nurses to serve on boards, we need to do a better job of helping them own their influence, master their power, and be better activists, particularly at the grass-roots level.

What are your current beliefs and values in regard to the triple helix of influence, power, and activism? Where are you developmentally on the journey from powerlessness to wisdom? What are the compelling issues that ignite your reflection, purpose-power, and wisdom? How will you contribute your leadership talents to a nonprofit or for-profit organization that is meaningful to you? How will you move beyond apprehension to confidence? On what governing board will you serve? Will you be one of 10,000 nurses who serve on a board? The year 2020 is not far off.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.