All nurses are leaders every day (Anderson, 2016; Fahlberg & Toomey, 2016). The immediate need for complex skills, including leadership skills, challenges entry-level nursing professionals who have limited leadership experience (Tropello & DeFazio, 2014). Despite the many challenges they face, entry-level practitioners must master leadership skills to succeed (Anderson, 2016; Fahlberg & Toomey, 2016). Nurses enjoy benefits of leadership including: increased care coordination, quality, safety, and outcomes (Anderson, 2016; Fahlberg & Toomey, 2016; Tropello & DeFazio, 2014). Thus, leadership development is an important and essential element in entry-level, specifically baccalaureate, nursing programs. The principles of Greenleaf’s Servant Leadership Theory (1977), such as service to others, mirror the vital leadership skills needed by nurses; thus, it is an ideal framework to study leadership development in baccalaureate nursing programs (American Association of Critical-Care Nurses [AACN], 2016; Anderson, 2016; Fahlberg & Toomey, 2016; Fields, Thompson, & Hawkins, 2015; Robert K. Greenleaf Center for Servant Leadership [RGCSL], 2016). Greenleaf (1977) based his Servant Leadership Theory on the premise that leaders first serve, then decide to lead. Greenleaf asserted the focus on others’ needs and sharing of power by the leader increases performance and personal development of the people being led (RGCSL, 2016; Spears, 2010). Principles and characteristics important to servant leadership include, for example: service to others, holistic approach to work, listening, empathy, caring, trust, altruism, and empowerment. Despite formal recognition of Greenleaf’s Servant Leadership Theory over 40 years ago, incorporating servant leadership principles into baccalaureate nursing education is not well studied (Anderson, 2016; RGCSL, 2016, Tropello & DeFazio, 2014). Available literature focuses on defining theory ideals, with a few studies examining how servant leadership is measured, demonstrated in practice, or used in education (Anderson, 2016; Neill & Saunders, 2008; O’Brien, 2011; Tropello & DeFazio, 2014; van Dierendonck, 2011). Most empirical evidence focuses on individual and organizational outcomes of servant leadership; for example, servant leaders tend to have followers with increased satisfaction, commitment, and performance (Hanse, Harlin, Jarebrant, Ulin, & Winkel, 2016; Sturm, 2009; van Dierendonck, 2011; Yancer, 2012). Research is limited on how to develop servant leadership skills. Anderson (2016) and Tropello and DeFazio (2014) note the limited study on servant leadership in baccalaureate nursing education, despite the urgent need for these skills. Examining a case of a baccalaureate nursing program, through the lens of Greenleaf’s Servant Leadership Theory, can provide understanding of leadership development into entry-level programs.
Methods
Thus, the purpose of this case study was to describe how a baccalaureate nursing program (unit of analysis) incorporates the principles of Greenleaf’s Servant Leadership Theory. The study was constructed around two propositions (1) the baccalaureate nursing program intentionally promotes service to others, holistic approach to work, sense of community, and sharing of power in decision making when teaching nursing, including leadership, skills and (2) the baccalaureate nursing program encourages character attributes, such as listening, empathy, and healing, that are consistent with Greenleaf’s Servant Leadership Theory. Case study methodology was selected to understand the theory in a contemporary, real-world context (Yin, 2014). This study was appropriate as case study research since experimental control was not possible or needed (Yin, 2014). Multiple sources of data were sought to increase study rigor and allow a comprehensive understanding of the case (Yin, 2014). Additional strategies to ensure study quality and rigor included: triangulation, peer-debriefing, documented audit-trail, detailed study protocol, thick descriptions, pattern matching, and use of theory to structure the study (Houghton, Casey, Shaw, & Murphy, 2013; Yin, 2014). The study was conducted in a private, Christian college in the eastern United States. In this baccalaureate nursing program, there are approximately 200 enrolled students and 10 full-time faculty employed. The study’s site clearly prioritizes servant leadership principles; thus, it was determined an ideal case to examine (Yin, 2014). Data sources included (1) review of the nursing program website, student handbook, course catalog, program description, and relevant course syllabi, (2) alumni survey data, and (3) faculty semi-structured interviews. Institutional Review Board approval was obtained before data collection commenced. Fifteen nursing program recent alumni (i.e., 2015 and 2016 graduates) surveys were completed and three faculty completed the semi-structured interviews. Systematic data analysis followed an inductive approach. Data were analyzed and evaluated for empirically-found patterns (themes) and compared to study propositions.
Results
Empirically-found themes included: service to others, holistic approach, building community, compassionate care, humility, empowerment, professionalism, and lifelong learning. Pattern matching revealed discovered themes were consistent with study propositions, thus with key principles and characteristics outlined in Greenleaf’s Servant Leadership Theory.
Discussion
Both study propositions were supported. To avoid bias and present a high-quality study, alternate explanations for the empirically-found themes were also considered (Yin, 2014). Both the Christian paradigm and the Transformational Leadership Theory can be considered rivals in this case study. First, since the nursing program is part of a Christian college, the possibility exists that the emphasis on service, humility, and building community results from the religious affiliation (i.e., the Christian paradigm). Many of the principles encouraged by servant leadership are also promoted by Christian theology (Robinson, 2009). However, as Robinson (2009) asserts, many other religious and nonreligious traditions promote service and other principles of service leadership. Therefore, although the program may attribute its emphasis on servant leadership to faith, the two are not necessarily dependent on one another. Next, as Transformational Leadership Theory premises, such as: leaders inspiring followers, role-modeling expectations, and encouraging intellectual pursuits, match some of the case’s empirically-found themes, this theory must also be considered as a rival (van Dierendonck, Stam, Boersma, de Windt, & Alkema, 2014). However, servant leadership differs in its prioritization of meeting others’ needs and, thus, best fits with the nursing program. Available literature focus on individual and organizational outcomes of servant leadership; however, studies are limited in providing insight on how to develop these essential skills (Anderson, 2016; Hanse et al., 2016; Sturm, 2009; Tropello & DeFazio, 2014; van Dierendonck, 2011; Yancer, 2012). This study serves as a foundation and provides insight into the important, complex process of leadership development in entry-level nursing programs (Yin, 2014). As all nurses lead every day, it is vital that leadership skills are introduced early in such programs. Greenleaf’s Servant Leadership Theory could be considered a framework in designing curricula to promote leadership skill and in meeting baccalaureate essentials outlined by the American Association of Colleges of Nursing (2008).
Servant nurse leaders “speak up, volunteer, advocate,” and listen “not because [they] want power or prestige, but because [they] care” (Fahlberg & Toomey, 2016, p. 50). Nurse servant leaders get involved in (1) “initiatives around safety, quality, staffing,” (2) “mentoring new nurses or nursing students,” and (3) “helping others get their work done” (Fahlberg & Toomey, 2016, p. 50; Savel & Munro, 2017). They not only listen and advocate for patients, families, and coworkers, but also empower those they serve (Fahlberg & Toomey, 2016). In these sentiments, one can see the connection to the study’s empirically-found themes. Nurse servant leaders can help realize the servant leadership individual and organizational outcomes (i.e., benefits) emphasized in current literature. Deliberate and comprehensive integration of leadership development, ingrained in the culture of nursing programs, could support successes. Benefits of skilled leadership include improved care coordination, quality, safety, and outcomes. Training entry-level practitioners, in baccalaureate nursing programs, to be skilled leaders can help realization of these benefits.