Open Journal of Leadership
2013. Vol.2, No.4, 85-86
Published Online December 2013 in SciRes (http://www.scirp.org/journal/ojl) http://dx.doi.org/10.4236/ojl.2013.24013
Open Access 85
Embracing Empowerment in the Healthcare
of the United States
Bozena Padykula1*, Karen Wexell2,3,4
1Department of Nursing, Western Connecticut State Universit y, Danbury, USA
2Poison Control, Farmington, USA
3UConn School of Nursi n g, Storrs, USA
4Sacred Heart University, Fairfield, USA
Received August 2nd, 2013; revised September 5th, 2013; accepted September 18th, 2013
Copyright © 2013 Bozena Padykula, Karen Wexell. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the origina l w o rk is properly cited.
The United States experiences an economic and healthcare crisis that calls for change. Transformational
leadership model by Kouzes and Posner (2003) defines traits that are important to embrace by today’s
healthcare leaders in promoting organizational change. To promote growth, engaging and empowering all
members in the organization opens the door for collaborative work intentionally establishing sustainable
healthcare outcomes. Since nurses play a significant role in US and global healthcare systems, healthcare
organizations demand empowered nursing leaders that have an equal voice. The significance of this re-
view to the future is to awaken nursing leaders to step away from a dependent mode and to step forward
to an empowered mode.
Keywords: Nursing Leadership; Empowering Nursing Leaders; Kouzes and Posner Transformational
Leadership; Collaborative Healthcare
The United States experiences an economic and healthcare
crisis that calls for change. The healthcare system in the United
States needs leaders that influence an organization’s capacity to
change dedicated to “get involved in something that you care so
much about that you want to make it the greatest it can possibly
be, not because of what you will get, but just because it can be
done” (Collins, 2001: p. 209). Transformational leadership
model by Kouzes and Posner (2003) defines traits that are im-
portant to embrace by today’s healthcare leaders in promoting
Kouzes and Posner-Transformational
Kouzes and Posner’s (2003) transformational leadership
model focuses on establishing a caring relationship between the
leader with his followers. This form of professional relationship
promotes leadership that “will be wholly dependent upon the
capacity to build and sustain those human relationships that
enable people to get extraordinary things done on a regular
basis” (Kouzes & Posner, 2003: p. 3). In their model, Kouzes
and Posner (2003) introduced 5 fundamental practices of ex-
emplary leadership that motivate extraordinary performance.
These 5 practices require leaders to: “1) challenge the process;
2) inspire a shared vision; 3) model the way; 4) enable others
to act; [and] 5) encourage the heart” (p. 3).
To challenge the process, leaders seek and explore “opportu-
nities to innovate, grow, and improve” (Kouzes & Posner, 2003:
p. 6). Based on their knowledge and expertise, they investigate
new ideas and consider applying the initiative in practice. To
inspire a shared vision, leaders envision clearly what they plan
to accomplish and reach acceptance of this vision with follow-
ers. To model the way, leaders develop their own individual
voice after clarifying personal and professional values. This
independent voice represents their distinct beliefs that they need
to stand for and express. To enable others to act, leaders estab-
lish trust that promotes collaboration and engagement. These
essential components further create an enabling environment
that embraces choice, accountability, and interest to share and
eliminate “hoarding the power ... by giving it away” (p. 8).
Lastly, to encourage the heart, all constituents need to feel that
their contributions are appreciated and valued; and they are mo-
tivated to dedicate time and energy to work on common goals.
The leaders are like captains on a ship accountable to sail
with the wind and anchor the future of the organization on the
paradise island. Everything starts with the leader, who he is and
where his heart is. The leader according to Kouzes and Posner,
needs to model the way, challenge the process, and inspire
shared vision. To model the way, the leader needs to start with
individual self-awareness; who he is representing professionally
and personally. To challenge the process, the leader’s knowl-
edge contributes to how much he will be able to invest in
transforming opportunities. Once the leader is confident in
selected opportunities, the ideas and possibilities need to be
inspired in followers.
B. PADYKULA, K. WEXELL
Kouzes and Posner, in the practice of enabling others to act,
focus on creating an environment where trust, collaboration and
accountability are valued and acknowledge the significance of
encouraging the heart. When followers gain a sense of appre-
ciation, they establish full dedication to common goals of the
organization. Kouzes and Posner reinforce the value of rela-
tionships with followers as the primary source of creating
prosperous future for the organization.
Value of Empowerment
According to Kouzes and Posner (2003), one of the charac-
teristics of exemplary leaders is to empower others to act. Many
organizations support this vision but the healthcare system,
nationally and globally requires significant improvement in
empowerment of others to act (Coonan, 2008; Dossey &
Keegan, 2013; Hurley & Linsley, 2007; Neera, Anjanee, &
Shoma, 2010; Patrick, Spence, Wong, & Finegan, 2011; Tho-
mas, 2005; Thompson, 2012).
The healthcare system, nationally and globally, undergoes
many changes to meet the needs of every community. Nurses
play significant roles as healthcare providers globally (Dossey
& Keegan, 2013). The role of nurses shifted drastically in the
last 10 years however, “historically, nursing culture is grounded
in dependent role delineated attitudes” (Hurley & Linsley, 2007:
p. 751). As reminded by Hurley and Linsley, based on the bu-
reaucratic management structure in healthcare organizations,
nurses still are not taking active participation in organizational
decisions and report being a victims of managerial hierarchy.
Globally, nurses in the twenty first century envision functioning
in the empowered collaborative role with other members of
healthcare organizations. Nurses are self-determined to build
partnership with “equitable power manifested through shared
decision-making, effective senior leadership and interpersonal
constructs of mutual respect, trust and authenticity toward
shared goals and visions” (p. 751). This sense of victimization
is present when nursing leaders are considered irrelevant by
other medical professionals. Inclusion of nursing leaders with
medical professionals creates the initial step forward for nurses
to build an equal voice in the decision making process. As sug-
gested by Hurley and Linsley, nursing leaders are challenged to
“empower staff, fuse enthusiasm, and instill confidence” (p.
The authors Hurley and Linsley (2007) highlight four factors
that contribute to improving the value of nursing leaders in the
hierarchy of healthcare organizations: 1) self-awareness with
courage to know individual strengths & weaknesses; 2) human-
istic principles-autonomy, empathy, creativity, social skills; 3)
open to collaborate with different disciplines; and 4) flexibility.
When nursing leaders embrace these principles in building a
reputation for themselves in healthcare organizations, they cre-
ate an opportunity to advocate and thus empower every nurse to
gain their own voice in the profession.
Hurley and Linsley (2007) remind that “nursing leadership
remains caged in a multiplicity of boundaries, many self-im-
posed” and the above concepts are the cornerstone to align
nurses toward a collaborative role. The authors conclude, that it
is the responsibility of nursing leadership to support “fluidity
and an increasing realization that each nurse is, leader” (p.
To thrive in the 21st century, each organization must con-
tinuously be open to change and growth. To promote growth,
engaging and empowering all members in the organization
opens the door for collaborative work intentionally establishing
sustainable healthcare outcomes. Since nurses play a significant
role in US and global healthcare systems, healthcare organiza-
tions demand empowered nursing leaders that have an equal
The significance of this review to the future is to awaken
nursing leaders to step away from a dependent mode (Hurley &
Linsley, 2007) and to step forward to an empowered mode
(Kouzes & Posner, 2003). Further, this new empowered voice
in nursing leaders invites nurses to collaborative work opportu-
nities with other healthcare members.
In agreement with Kouzes and Posner (2003), transforma-
tional leaders who create a compelling relationship with fol-
lowers capture their interest and motivate them to work toward
a common vision. Hurley and Linsley (2007) describe nursing
leaders with self-awareness model personal humanistic qualities
and attributes such as creativity and flexibility and inspire oth-
ers to the same. When leaders align with leadership attributes
according to Kouzes and Posner, they inspire and empower
followers to engage in collaborative work.
In conclusion, the fundamental purpose of this paper is to in-
troduce the value of the transformational leadership model by
Kouzes and Posner (2003) to healthcare leaders. These leaders
influence an organization’s capacity to change and ability to
thrive amid the demands of our changing world. Therefore in
order to create a sustainable future in every organization, “we
need leaders who can unite us and ignite us” (Kouzes & Posner,
2003: p. xiii).
Collins, J. (2001). Good to great: Why some companies make the
leap… and others don’t. New York: Harper Collins Publishers.
Coonan, P. R. (2008). Educational innovation: Nursing’s leadership
challenge. Nursing E conomics, 26, 117-121.
Dossey, B. M., & Keegan, L. (2013). Holistic nursing: A handbook for
practice (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Hurley, J., & Linsley, P. (2007). Leadership challenges to move nurses
toward collabo rative individua lism within a neo-corpo rate bureaucr atic
environment. Jo ur na l o f Nu r si ng Management, 15, 749-755.
Kouzes, J. M., & Posner, B. Z. (2003). Exemplary leadership. San
Francisco: CA: Jossey-Bass Publi shers.
Neera, J., Anjanee, S., & Shoma, M. (2010). Leadership dimensions
and challenges in the new millennium. Advances in Management, 3,
Patrick, A., Spence, H. K., Wong, C, & Finegan, J. (2011). Developing
and testing a new measure of staff nurse clinical leadership: The
clinical leadership survey. Journal of Nursing Management, 19, 449-
Thomas, H. (2005). Clinical leadership: An oxymoron? Clinician in
Management, 13, 111-114.
Thompson, J. (2012). Transformational leadership can improve work-
force competencies. Nursing Management—UK, 18, 21-24.