1. Running head: PERSONAL ESSAY 1
My Personal Leadership Journey
Lynn M. Alexanders-Klima
American Sentinel University

2. PERSONAL ESSAY 2
Abstract
This essay will provide a reflection of this student’s journey in the profession of nursing. The
student provides a comparison of career experiences in relation to transformational leadership
principles over a thirty year period in healthcare. Every nurse is an example of the profession.
Each individual’s contributions and commitment represent interest in the patients that are served.
The student shares goals that will provide developmental milestones to successfully lead the way
to the achievement of a professional doctorate in nursing.

3. PERSONAL ESSAY 3
My Personal Leadership Journey
Oxford dictionaries describe the origin of the word journey as derived from the old
English description of “all in a day’s work”. One definition states it is a “long and often arduous
process of personal change and development” (Journey, 2016). The purpose of this essay is to
describe this student’s leadership journey and how it will culminate in the pursuit of a clinical
doctorate in educational leadership at American Sentinel University.
Personal Journey
Why nursing? This journey started at the age of seven. The attraction of the “identity” of
professional nursing was appealing. Nursing in the 1960’s was a generation of knowledge
workers that were employed in organizations that espoused the classic theories customary of
20th-century management. Formal process and hierarchal structure were reflective in work
environments as described by Marshall (2011, p. 12). The visual images of starched white
uniforms, crisp caps, and authoritative style created a desire to venture into healthcare as a nurse.
Interestingly, the draw was to the perceived position of authority, not what is known as the
essence of nursing: knowledge and caring.
What has shaped this student over the span of a thirty-two-year nursing career is that
efficient and authoritative boundaries of last century can be useful for resource management;
however, they don't build and create environments that support and empower dedicated
employees. Leaders of modern day health care need to creatively share a vision and support a
clear path for diverse team members to move organizations toward transformation in all settings
of care (Crowell, 2016, p.4). This is a personal journey of experiences, highlighting the
components of transformational leadership as described by Crowell. (2016, p. 83).

4. PERSONAL ESSAY 4
Shared Governance
“Leaders are the product of personal and professional development” (Crowell, 2016, p.
97). All nurses are challenged to lead- despite their position of employment. Today’s leaders
are expected to be transformational- to be prepared to lead teams to meet the demands of the
future (Finkelman & Kenner, 2012, p. 482). When one enjoys decades of experience in acute,
primary and educational settings, there is exposure to many types of “leaders”. The majority of
experiences of this student originated in the mid- 1980’s and were obtained within one large
Catholic health system: Trinity Health. This national organization originated in southeastern
Michigan and took a progressive approach to nursing recruitment and retention well before
Magnet designation was a known entity. The chief nursing officer (CNO), nursing directors,
and managers during this time were empowered to invest in staff development. They were
instrumental in initiating shared governance models based on the early work of Tim Porter
O’Grady. Shared governance is a professional practice model that creates accountabilities for
staff and encourages involvement in decision making regarding work that employees are directly
responsible for (Finkelman & Kenner, 2013, p. 486). Marshall reports that shared governance is
an effective way for leaders to willingly empower others within a work environment (2011, p.
28). Through unit committees and shared accountabilities staff were active participants in
decision-making to support fiscal and clinical outcomes. These experiences were valuable for
this student and created an expectation for future career opportunities based on the style of the
leader. Work was difficult, but rewarding and instilled a work ethic that demonstrated personal
investment and commitment to the delivery of quality patient care.

5. PERSONAL ESSAY 5
Components of Transformational Leadership
Individualized Consideration
Marshall tells us that organizations and managers who demonstrate a transformational
leadership style are more likely to have staff who are interested in improvement and change.
(2011, p.28). The Institute of Medicine (IOM) report on the future of nursing, challenges the
need to increase the educational preparation of nurses not only at the BSN level but also to
prepare nurses with advanced degrees so that they can be partners in developing the healthcare
services needed today (2010, p. 1).
The Trinity Health Organization/ St. Joseph Mercy Hospital was an early adopter of a
clinical ladder program that encouraged educational pursuits through advanced education or
certification. It invested in clinical leadership development. Interestingly, nurses who desired
career advancement had two distinct options- either work on achieving the levels in the ladder, or
become a manager. The management route was considered the “leadership” route. They were
mutually exclusive career paths. What is currently known is that all nurses share a responsibility
to be leaders – whatever their position. This student was inspired to achieve movement on the
clinical ladder and pursued a Master's degree and certification as an adult nurse practitioner.
This provided the opportunity to continue working in acute care at a broader level as a clinical
nurse specialist and developing clinical protocols and evidence-based practices to support
patients with chronic conditions. This is described as a microsystem- working with a discrete
group of high-risk patient populations and linking processes to improve clinical outcomes based
on the development of clinical pathways. (Crowell, 2016, p. 59). This work paved the way to
understand gaps in care post-hospitalization and how care could be coordinated efficiently to
reduce rehospitalizatons and improve the patient experience of care.

6. PERSONAL ESSAY 6
Inspirational Motivation
The early nineties demonstrated that there was a need to consider where care could be
provided and how to consider shifting work to alternative settings. Working in an acute care with
chronically ill patients generated the desire to practice at 1) a preventive level and 2) improve
overall health care outcomes. Porter O’Grady shared his predictions of this as he challenged
the profession to prepare for providing care in various contexts. He identified that organizations
would have to be innovative in creating new environments of care to maintain viability of
resources and generate revenue (2003, p. 106).
Obtaining an MSN as a nurse practitioner provided the chance to transition into primary
care for approximately fifteen years in various settings. Patients in primary care experience
issues with access related to a range of determinants that impact their ability to receive care.
The microsystem model developed by Nelson that Crowell describes has five leadership actions
that are effective in smaller work groups that are subsets of large organizations. One of them,
interdependence of the care team is vital for clinical success (Crowell, 2016, p.60). Practice
administrators, physicians, and care team members collaborate on supporting patients with
shared respect and vision. Working in a variety of outpatient settings provided the chance for
this student to envision how teams could work together creatively with a distinct patient focus.
The administrative staff demonstrated support by allowing this student to evaluate the best
resources to bring into the settings by increasing accessibility of care such as certified diabetes
educators, financial services, and pharmacists. The development of transdisciplinary
partnerships during this time was creating a new model of care that could render effective
services. This was a precursor to “accountable care and the focus on the patient’s position within
the healthcare continuum” (O’Grady & Malloch, 2016, p. 72).

7. PERSONAL ESSAY 7
Idealized Influence
In the mid 2000’s the student transitioned into an executive leadership role for a large
multi-specialty ambulatory physician network. The student was directly responsible for the
medical management and quality measures for thirty independent practices. Understanding the
complex health care industry and reimbursement models for physician payment was required.
This work was valuable in understanding the business aspects of healthcare as the transition into
the Affordable Care Act was in full force. The implications for payment, direct clinical services
and the challenge of creating new care delivery models was front and center. The organization
sought out collaborative partners at the State level and pursued alternative payment structures
with payers to financially support piloting various types of care teams. Nationally- this is the
direction that everyone is waiting for- to see what will work to balance efficient payment models
and deliver excellent clinical outcomes. While this was a very valuable work experience this
was a hierarchal leadership organization with a focus on growth and revenue. Nursing presence
as a partner in planning and even directly in the patient care area’s was minimal to non-existant.
It was obvious for this student to understand that it was imperative to empower nursing to be a
part of the planning for the new models of care that were being discussed . The nursing role
could be instrumental in supporting the providers on achieving financial benchmarks on
readmission and emergency room indicators- transition management. Unfortunately nursing
personnel are considered an expensive resource, and their voices were limited in the planning.
This organization provided a good example of traditional autocratic leadership, consistent with
management styles of the 1960’s.

8. PERSONAL ESSAY 8
Intellectual Stimulation
The experience in the provider organization created a paradigm shift for this student. The
current employment situation is in a faculty role at a small liberal arts university. The reality is
that there is a significant opportunity to shape the knowledge and skills of the next generation of
nurses in the profession. The landmark reports the Future of Nursing (IOM, 2010, p. 4)
challenges that nurses need to be at the forefront of care. It will require nursing leaders who not
only incorporate transformational principles in their management style, but also who have
evolved to understand and practice within a complexity science framework. This is where this
student wants to be- shaping the direction of how we stay at the table- participating in creating an
adaptable system of care that values the contributions of the professional nurse as a vital member
of the care team. To establish further credibility with partners in this endeavor, there is a
commitment to working toward achievement of a doctorate in nursing practice with a focus in
educational leadership. A clinical doctorate will enhance the ability to partner across the
industry with health care providers at all levels.
Goals
The development of a system of coordinated care to support patient engagement across
the continuum is the interest level of this student. As the journey continues on the path to the
DNP, there are a few initial goals that will stimulate critical thinking and prepare for the
development of a successful capstone project.
Leadership Theory
Increase understanding of the components of complexity theory as they relate to
healthcare transitions. The student will analyze and select two leadership theories and master
their core principles to prepare for the capstone project. This is relevant to the student’s growth

9. PERSONAL ESSAY 9
professionally as clinical leaders are necessary to facilitate change across all settings in
healthcare. This will be achieved at the completion of the student’s residency in June 2016.
Relationship Building
The student will identify ways to build a community of interest on Interprofessional
practice about care coordination and transition management. To achieve this, the student will
prepare a comprehensive summary of partners that create a “system of care” for care
coordination efforts. This is necessary because clinical leadership is about serving those who
promote health through facilitating communication and consensus building (Marshall, 2011, pp.
18-19). The student will complete this by August 2016.
Personal Growth
The student will share information and demonstrate principles from complexity
leadership theory with the faculty peer group. The student will share journal articles and
facilitate discussions at a team meeting on the concepts of emotional intelligence and
empowerment. This is relevant to the student’s growth in mastering principles that “recognize
and promote the contributions of others" (Marshall, 2011, p.5). This is an important strategy to
employ in preparation for potential changes to the curriculum that is projected with the capstone
project. The student will achieve this by November of 2016.
Evidence Based- Interventions
The student will increase their ability to select relevant literature to compare and contrast
scientific evidence that supports alternative care delivery models. To achieve this, the student
will identify three interventions that need to be included in a nursing curriculum to support
transition management. Five articles or resources for each intervention will be selected to
contribute to the foundational base for the capstone project. This is relevant for teaching care

10. PERSONAL ESSAY 10
coordination/transition management interventions that are based on research. The student will
have achieved this milestone by December of 2016.
Conclusion
Over the last thirty years, healthcare has evolved dramatically. The complexity of current
systems is amplified by a variety of factors that were not problematic even a short time ago. In
this new environment, organizations are required to be adaptive systems. Crowell urges that
complex adaptive systems need diverse agents that interact to create new systems from emerging
relationships (2016, p. 34). “This creates spontaneous emergence of a new order” (Crowell,
2016, p. 35). The profession of nursing is called to develop complexity leaders. The
understanding of complexity leadership influences one’s style. Personal leadership growth from
transformational leader to complexity leadership completes the journey. This student’s transition
to a complexity leader is supported by the challenging work of achieving a doctorate in nursing
practice. It will achieve the ultimate goal of being an advanced practice nurse that will be a
“citizen of the community of leaders who will solve problems of the future” (Marshall, 2011, p.
286).

11. PERSONAL ESSAY 11
References
Crowell, D. (2016). Complexity leadership: Nursing’s role in health-care delivery. (2nd ed.).
Philadelphia: F.A. Davis Company.
Finkelman, A. & Kenner, C. (2013). Professional nursing concepts: Competencies for quality
leadership (2nd ed.). Burlington, MA: Jones and Bartlett Learning.
Institute of Medicine (IOM), (2010). The future of nursing: leading change, advancing health.
Washington, DC: author.
Journey. (2016). In Oxford dictionaries: Language matters. Retrieved from:
http://www.oxforddictionaries.com/us/definition/american_english/journey
Marshall, E. (2011). Transformational leadership in nursing: From expert clinician to
influential leader. New York, NY: Springer Publishing.
Porter- O’Grady, T. (2003). A different age for leadership, part 1: New context, new content.
Journal of Nursing Administration, 33(2), 105-110.