Relational or Task-Focused? Choosing a Leadership Approach for a Discharge Change on Two Units With Different Levels of Trust, Using Three Systematic Reviews
[Student Name]
University of Phoenix
DNP/730: Organizational and Systems Leadership
Week 3 Assignment
[Instructor Name]
[Date]
The units and leaders are composites written for a model paper.
Leading a change to morning discharges on two medical units requires more than a good plan. How I lead will shape whether staff engage. Last week's culture assessment showed that 5 East has stronger teamwork and trust in management than 5 West. This paper examines evidence on leadership styles and chooses an approach for each unit.
Leadership Styles and the Nursing Workforce
Cummings et al. (2018) screened more than 50,000 records and kept 129 studies linking how nurse leaders lead with what happens to nurses and their workplaces. They grouped outcomes into staff satisfaction, relationships with work, health and well-being, relations among staff, organizational environment and productivity. In 52 studies, relational approaches, among them transformational, resonant and authentic styles, went along with more satisfied nurses, whereas a smaller body of studies tied task-centered styles to less satisfied staff. Relational leadership was associated with better outcomes across most categories.
Leadership and Patient Outcomes
Wong et al. (2013), updating a systematic review of nursing leadership and patient outcomes, included 20 studies and found that units led in a relational way tended to have more satisfied patients and fewer deaths, drug errors, restraint episodes and hospital-acquired infections. They called for research on the mechanisms of influence.
Leadership and Quality Measures
Sfantou et al. (2017) reviewed 18 studies on leadership style and quality of care across health care settings and found that leadership styles were strongly correlated with quality measures, and that leadership was a core element for coordinated, integrated care.
On 5 East I could ask; on 5 West I would first have to earn the right to ask.
What the Reviews Do Not Show
The studies in these reviews are mostly cross-sectional, so they show associations rather than proof that leadership style causes outcomes. Leaders who are relational may also work in better-resourced organizations. Still, the consistency across reviews and outcome types makes relational leadership a reasonable choice.
Transformational Leadership
Transformational leaders articulate a compelling vision, inspire motivation, stimulate staff to think creatively and attend to individual needs. For a discharge change, this means connecting morning discharges to patient safety in the emergency department, inviting staff to design solutions and supporting individual nurses who worry about rushing teaching.
Task-Focused Elements Still Matter
A change also needs clear expectations, measures and follow-up. Relational leadership does not mean avoiding accountability. The evidence suggests leading primarily through relationships while providing clear structure.
Servant Leadership
Servant leadership emphasizes serving staff by removing barriers. For discharge, this means fixing practical obstacles, such as transport scheduling or delayed pharmacy prescriptions, that make morning discharge hard for nurses.
Applying the Evidence to 5 East
With stronger teamwork and trust, 5 East is ready for a transformational approach. I will present the problem and evidence at a staff meeting, invite the unit's shared governance council to lead design and support the charge nurses who already hold morning huddles. My role is to inspire and remove barriers.
Applying the Evidence to 5 West
Low perceptions of management on 5 West mean staff may view a vision from the director with suspicion. I will begin with listening sessions, asking what makes their work harder, and act on one or two concerns quickly, such as a broken medication room scanner. Only after demonstrating responsiveness will I introduce the discharge change, with the unit manager as the visible leader.
What This Looks Like in Practice
On 5 East, I will attend the morning huddle twice a week during the pilot, thank specific staff for specific actions, ask what is getting in the way and report back on what I have fixed. On 5 West, I will round weekly with the manager, asking each nurse one question about their work and following up in writing. These small, repeated behaviors are how relational leadership shows up day to day.
Handling Pushback
Some nurses will say morning discharges rush teaching. A relational response acknowledges the concern, asks what would make morning teaching possible and adjusts the process, for example by beginning teaching the evening before. A task-focused response would restate the target. The first builds commitment; the second produces compliance at best.
Developing Unit Managers
Much of the evidence concerns frontline managers. I will coach both managers in relational leadership, including rounding with staff, giving specific recognition and involving staff in decisions, and meet with them weekly during the change.
Shared Governance
On 5 East, the shared governance council already reviews practice issues. Asking the council to own the discharge redesign gives staff real authority, which is a feature of transformational leadership: leaders set direction and staff shape the path. On 5 West, the council has lapsed; reviving it is part of rebuilding trust.
Recognition
Recognition is a simple relational behavior with outsized effect. When a charge nurse on 5 East organized the first afternoon discharge conversation, I thanked her publicly at the staff meeting and in the hospital newsletter. Specific, timely recognition tells staff that the change is valued and that their effort is seen.
Leading Across Professions
Discharge involves physicians, case managers, therapists and pharmacists who do not report to me. Here, leadership relies on influence rather than authority: building shared goals with the hospitalist medical director and the case management director and presenting joint messages.
Partnering With the Hospitalist Director
The hospitalist medical director and I will co-sponsor the change and present it together at both units' staff meetings and at the hospitalists' group meeting. A shared message from nursing and medical leaders signals that morning discharge is a joint goal, not a nursing demand on physicians or the reverse.
Measuring Leadership Effects
I will track Safety Attitudes Questionnaire perceptions of management and teamwork climate, turnover and the discharge measures, looking for improvement on both units.
Consistency Between Units
Using different approaches on two units risks appearing inconsistent or unfair. I will be transparent: both units will make the same change, with the same goals and measures, but the sequence differs because each unit starts from a different place. Explaining this openly prevents the perception that one unit is favored.
My Own Development
I tend toward task-focused behaviors under pressure. I will ask a peer director to give me feedback on my listening and recognition during the change.
Signs the Approach Is Working
On 5 West, early signs of rebuilt trust would include staff raising problems at rounds without prompting and volunteering for the working group. On 5 East, signs of engagement would include staff proposing their own tests of change. These behaviors will guide when to move from listening to leading the change.
Conclusion
Systematic reviews associate relational leadership, including transformational styles, with better nurse satisfaction, patient outcomes and quality measures. Applying this evidence, I will lead the discharge change with a transformational approach on 5 East, build trust through responsive, servant-oriented action on 5 West before introducing change and provide clear structure and accountability on both.
References
Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19-60. https://doi.org/10.1016/j.ijnurstu.2018.04.016
Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare, 5(4), Article 73. https://doi.org/10.3390/healthcare5040073
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709-724. https://doi.org/10.1111/jonm.12116
How this DNP 730 Week 3 example is structured
The DNP/730 Week 3 work usually examines transformational and other leadership models. This paper summarizes what the evidence says about leadership styles and outcomes, applies it to two specific units and explains how the leader will act differently on each. Students search this week as DNP 730 Week 3, DNP730 Wk 3 or DNP/730 Wk 3; all three are the same assignment.
DNP/730 Week 3 questions, answered
What does DNP/730 Week 3 usually ask for?
Many sections ask students to compare leadership models, such as transformational, transactional and servant leadership, and apply them to a leadership challenge.
Does nursing leadership style affect patient outcomes?
An updated systematic review linked relational leadership with more satisfied patients and with fewer deaths, medication errors, restraints and hospital infections.
Is task-focused leadership always worse?
Evidence associates relational styles with better nurse and patient outcomes, but task-focused behaviors such as clear expectations and monitoring are still needed; effective leaders combine them.
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