Caring and Transformation in Oncology Nursing Administration: Paradigms of Leadership

Abstract

Caring has a history of being central to nursing and has long been held to be an essential component of the clinical practice of nurses involved in direct patient care activities. While nurse administrators have been recognized for their transformational leadership capabilities, less attention has been given to caring in the practice of nursing administration leadership or the effects of this leadership as experienced by their subordinates. The parallels found between transformational leadership behaviors and human caring factors provided the foundation for this study. The purpose of this study was to generate an understanding of the structure and experience of caring as a component of the leadership practice of nurse administrators. Multiple triangulation was used to investigate the phenomenon of caring as it is experienced by nurse administrators and in turn experienced by their subordinates. Nurse administrators of oncology services in large, acute care facilities were interviewed to describe their leadership and the place of caring in that leadership practice. Subordinates from each facility were asked to rate their perceptions of nurse manager caring behavior. Nurse administrator interviews underwent dual content analysis using Watson's Theory of Human Care and Burns' Transformational Leadership Theory.

Three themes emerged from the data: (1) A person centered value system rooted in the reality of clinical practice; (2) Courage and sensitivity in decision making; and (3) The intentional cascading effect of caring leadership. These themes were found present in each interview and were the result of recurring patterns of transformational leadership behaviors and human caring factors. In each administrator-subordinate group pair the ratings of manager caring behaviors supported the cascading effect of caring leadership; that is staff reported feeling cared for by the manager but to a lesser degree than the administrator self report of her own caring behaviors.

Results suggest the initial identification of nurse administrator transformational leadership behaviors and caring attributes which are linked with subordinate perceptions of administrator caring. These behaviors and attributes extend the body of knowledge related to transformational leadership and caring theory. This new knowledge can support nurse administrators in devoting deliberative efforts toward caring leadership and the outcomes of that caring.