NUR 5103 Module 1 Leadership Theory Comparison Example

A Protocol Everyone Signed and Nobody Changed For: Adaptive and Authentic Leadership Compared at a Long-Term Acute Care Hospital's Weaning Program

Student Name

American College of Education

NUR5103: Leadership and Management Theory in Nursing

Module 1 Assignment

Instructor Name

March 2, 2027

The Situation

The setting is a composite 40-bed long-term acute care hospital (LTACH) that occupies two floors of a larger acute care hospital and admits adults who remain on mechanical ventilation after a critical illness. Such hospitals care for a demanding population. In a study of 1,419 patients at 23 long-term care hospitals, the median age was almost 72 years, the median stay was 40 days, and 54.1% of patients were weaned from the ventilator by discharge (Scheinhorn et al., 2007). Weaning is the LTACH's core work, and the speed and success of weaning shape both patient outcomes and the hospital's finances.

A year ago the medical executive committee approved a weaning protocol in which nurses and respiratory therapists screen every patient each morning and run a spontaneous breathing trial when the patient meets set criteria, without waiting for a physician's order. The protocol was presented at staff meetings and signed by every nurse and therapist. An audit this spring found that breathing trials were done on only 41% of the days patients met the criteria. Most were done when two particular therapists were on duty. Several nurses said the trials were the therapists' job; several therapists said they waited for the pulmonologist's rounds because two physicians had rebuked them for starting trials without asking. The author, the LTACH's new director of nursing, must decide how to lead from here.

Adaptive Leadership

Heifetz et al. (2009) separate problems that known expertise and formal authority can fix from adaptive challenges, which require the people with the problem to change their values, habits, loyalties or roles. The central error of leadership, in their account, is treating an adaptive challenge as if it were technical. Adaptive leadership asks the leader to step back and observe the system from a distance, which they call getting on the balcony, to identify the adaptive work, to regulate the distress that change produces so it is neither too low to motivate nor too high to bear, to keep attention on the hard issue and to return the problem to the staff whose own habits must change to solve it.

The theory has been applied in health care settings where rules alone failed to change practice. Corazzini et al. (2015) studied nursing homes implementing person-directed care and found that the barriers staff described were largely adaptive challenges, such as delivering person-directed care within existing rules or motivating staff to provide it, which could not be solved by new policies alone. Thygeson et al. (2010) argued that much of chronic illness care involves adaptive rather than technical work, for clinicians as well as patients.

Authentic Leadership

Authentic leadership centers on the leader's character and relationships rather than on the nature of the problem. Avolio and Gardner (2005) describe authentic leaders as highly self-aware, open about their thinking and feelings with followers, willing to weigh evidence and views that contradict their own before deciding, and guided by an internalized moral standard rather than by outside pressure. They argue that such leaders build trust, and that trust in turn draws out positive behavior in followers.

Nursing research supports part of that chain. In a survey of acute care staff nurses, Wong et al. (2010) found that authentic leadership by the manager predicted nurses' trust in the manager and their engagement at work, which in turn predicted voice behavior, meaning nurses speaking up with suggestions and concerns, and nurses' ratings of care quality on their unit. The finding matters here because the weaning protocol depends on nurses and therapists speaking up and acting without waiting to be told.

Comparing the Two

The theories differ first in where they look. Adaptive leadership looks at the problem and asks what kind of work it demands. Authentic leadership looks at the leader and asks what kind of person followers will trust. They differ second in what they predict about this situation. Adaptive leadership predicts that the protocol failed because it was installed as a technical fix, a document and a signature, when the real change was a shift in who holds authority at the bedside: nurses and therapists must act on their own judgment, and physicians must accept that they will learn about a breathing trial after it starts. Authentic leadership predicts that the protocol will move only if staff trust the director enough to take the risk of acting, and that trust will depend on the director's openness and consistency.

They differ third in what they tell a leader to do, and here they fit together more than they compete. Adaptive leadership supplies the strategy; authentic leadership describes the manner in which it can be carried out without losing the staff. Adaptive leadership explains why the protocol stalled; authentic leadership explains why anyone would take the risk of changing it. The weakness of authentic leadership for this problem is that it says little about the structure of the change, and a trusted director could still repeat the error of treating the problem as a matter of better communication.

Applying Adaptive Leadership

The director will lead with adaptive leadership. From the balcony, the pattern is clear: the protocol succeeds when two therapists are on duty because they have already made the adaptive change, and it fails elsewhere because others have not. The technical parts, the screening checklist and the order set, will stay. The adaptive work will be named aloud at a joint meeting of nurses, therapists and the two pulmonologists: the protocol asks each group to give up something, nurses the safety of deferring to therapists, therapists the safety of waiting for orders, and physicians the habit of approving each trial.

To regulate distress, the director will start with one unit of 20 beds for eight weeks, with the two experienced therapists pairing with others on the morning screen. To keep attention on the issue, the daily percentage of eligible days with a breathing trial will be posted each morning and discussed at the unit huddle. To give the work back, a small group of nurses and therapists will decide how the screen is divided and what happens when a patient fails, and the director will ask the medical director to tell the two physicians, privately, that starting trials under the protocol is now expected rather than tolerated. Authentic leadership shapes how this is done: the director will say openly that the problem was misread at first, ask for disagreement at each huddle and act the same way whether the result that day is good or bad.

How the Choice Will Be Judged

The choice of theory will be judged by what happens on the pilot unit. If breathing trials are done on at least 80% of eligible days by the end of eight weeks, and the gain does not depend on which therapists are on duty, the adaptive diagnosis was right and the approach will extend to the second unit. If trials rise only on the days the two experienced therapists work, the adaptive work has not spread, and the director will return to the balcony to find out which group's loss has not yet been faced. Either result will be shared with staff, since a leader who reports only good news cannot claim the openness that authentic leadership requires.

References

Avolio, B. J., & Gardner, W. L. (2005). Authentic leadership development: Getting to the root of positive forms of leadership. The Leadership Quarterly, 16(3), 315-338. https://doi.org/10.1016/j.leaqua.2005.03.001

Corazzini, K., Twersky, J., White, H. K., Buhr, G. T., McConnell, E. S., Weiner, M., & Colón-Emeric, C. S. (2015). Implementing culture change in nursing homes: An adaptive leadership framework. The Gerontologist, 55(4), 616-627. https://doi.org/10.1093/geront/gnt170

Heifetz, R. A., Grashow, A., & Linsky, M. (2009). The practice of adaptive leadership: Tools and tactics for changing your organization and the world. Harvard Business Press.

Scheinhorn, D. J., Hassenpflug, M. S., Votto, J. J., Chao, D. C., Epstein, S. K., Doig, G. S., Knight, E. B., & Petrak, R. A. (2007). Post-ICU mechanical ventilation at 23 long-term care hospitals: A multicenter outcomes study. Chest, 131(1), 85-93. https://doi.org/10.1378/chest.06-1081

Thygeson, M., Morrissey, L., & Ulstad, V. (2010). Adaptive leadership and the practice of medicine: A complexity-based approach to reframing the doctor-patient relationship. Journal of Evaluation in Clinical Practice, 16(5), 1009-1015. https://doi.org/10.1111/j.1365-2753.2010.01533.x

Wong, C. A., Spence Laschinger, H. K., & Cummings, G. G. (2010). Authentic leadership and nurses' voice behaviour and perceptions of care quality. Journal of Nursing Management, 18(8), 889-900. https://doi.org/10.1111/j.1365-2834.2010.01113.x