Casey is recognized in her organization as one of its most innovative and progressive leaders. The directors who report to her also seem to be more progressive than many of the other department directors, and they are frequently the leaders or chairs of various hospital councils. Casey's department is always on the leading edge of change, and they have the highest nurse, patient, and physician satisfaction scores when compared to other hospital departments. The entire department seems to run like a well-oiled machine.

Sandra is in her second year of a PhD program in executive leadership for nursing, and she has been assigned to Casey for her practicum experience. She is required to spend 100 hours with Casey for a semester as a participant-observer to all that Casey does in her role as chief nursing officer (CNO) and vice president (VP) of Patient Services. Sandra's professor has told her about Casey's reputation for being a transformational leader not only in her hospital but also in the entire community. The professor suggests that Sandra interview Casey to gain insight into how Casey has developed her own leadership skills, as well as the leadership skills of those who report to her. Sandra develops a list of questions that she wishes to discuss with Casey and her learning objectives for the practicum experience. Sandra will work with Casey and her directors over the semester and will accompany them to the group/council meetings and individual meetings with their direct reports. She plans to observe how the directors interact with one another as well as how they interact with Casey and other executives in the hospital.

It does not take Sandra long to recognize the differences between Casey and her colleagues at the VP level. In the nurse executive meetings, Casey is engaged and involved in the discussions and constantly looks for opportunities to expand her scope of responsibility and to demonstrate the accomplishments of her department. She frequently shares some of the innovations that have been developed by her directors to improve patient care outcomes, develop the clinical nurses, improve relationships with physicians, or ensure the best experience for patients and families. The other VPs do not seem nearly as engaged in the discussion and rarely come to the meetings as prepared as Casey is.

In a meeting with Casey, Sandra asks Casey, "What attributes do you desire in your directors as leaders of their units?" and "How have you developed the directors to be successful in their roles?" Casey explains that she looks for individuals who could develop their staff to reach their fullest potential. She looks for individuals who are risk takers and who are open to new ideas for innovation.

When observing Casey with the directors who report to her, Sandra observes a very dynamic and active team who obviously enjoy working together and who support each other as they present their challenges and successes.

During Casey's individual meetings with her directors, Sandra observes Casey constantly teaching and coaching each director and giving support and advice as needed. Casey often shares articles with the directors to expand their knowledge on leadership topics. She encourages the directors to assess the strengths of their direct reports and to seek out individuals who could be groomed for future leadership positions. They discuss specific clinical nurses who could champion various changes and innovations on the clinical units. Casey also encourages each director to develop a succession plan with developmental goals for individuals who demonstrate leadership potential.

When possible, Casey invites one or more of her directors to accompany her to meetings. She is transparent about issues that she deals with in her role, and she explains to Sandra that it is her philosophy to ensure that each of her directors is prepared to step into her role at a moment's notice if needed. Sandra marvels at Casey's personal commitment to mentoring her directors because some VPs might be threatened by strong direct reports, fearing that they might usurp authority or try to position themselves for the VP role. In contrast, Casey states, "If I stepped out of this role, I hope to be missed personally, but any one of my direct reports should be able to step into the role without even a ripple felt by the organization."

While accompanying Casey to her hospital-wide meetings, Sandra notices Casey is also very encouraging to her colleagues and frequently observes Casey "managing them up" to the chief operating officer. Casey spends time building her relationships with the VPs of other departments, which, she explains, is critically important as a foundation for times when challenges or problems might arise. She states, "Building positive relationships with others makes problem resolution much easier, and potential problems can be avoided with early discussions rather than waiting for the problems to escalate." Casey not only lives these principles, she also holds her own direct reports accountable for developing relationships with their peers as well.

Questions

1. What attributes of a transformational leader do you think that Casey exhibits in her role as CNO and VP of the nursing department?
2. How does Casey hold herself and her direct reports accountable for the department's outcomes and outputs?
3. How does Casey demonstrate the coaching aspect of her role as a leader?
4. If you were Casey, what might you do to develop your own team of directors?
5. In the Institute of Medicine's Future of Nursing Report (2011), there is a recommendation that every nurse be groomed to become a leader. With this in mind, what might you do, if you were Casey, to ensure that every clinical nurse is developed to become a leader?