522662

research-article2014

NSQXXX10.1177/0894318414522662Nursing Science QuarterlyClarke and Fawcett / Scholarly Dialogue

Scholarly Dialogue

Transformative Leadership Based on

Nursing Science

Nursing Science Quarterly

2014, Vol. 27(2) 126131
The Author(s) 2014
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DOI: 10.1177/0894318414522662
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Pamela N. Clarke, RN; PhD, FAAN,1 William Cody, RN; PhD; FAAN,2
and Richard Cowling, RN; PhD; FAAN3

Abstract
The dialogue for this column is a summary of a dialogue among two preeminent nursing scholars and myself that took place
live at the 40th Meeting of the American Academy of Nursing, focused on transforming healthcare. The dialogue was
recorded and transcribed verbatim. In editing the dialogue I tried to leave it conversational which was the nature of the
interaction. The paper that follows reflects the thinking of two executive nurse leaders who use different nursing frameworks
as the basis for their practice. Translation of their practice models to leadership is presented as a natural transition to
transformation.
Keywords
humanbecoming framework, leadership, nursing, nursing theories transformative leadership, unitary framework
The dialogue that follows documents a conversation with two
executive leaders about their approach to leadership as driven
by nursing models. Dr. William Cody is the director of the
school of nursing at DePaul University and Dr. Richard
Cowling is Vice President of Academic Affairs at Chamberlain
College of Nursing. Both are well-published scholars and
long-standing members of the American Academy of
Nursing. I was delighted that they accepted my invitation to
meet and deliberate about the role of nursing science in the
leadership arena.
Pamela Clarke (PC):We are meeting together to talk
about the synergy between nursing theory and leadership. The overall goal is to talk about how nursing
knowledge informs your leadership. Would you begin
to describe the connection between leadership and
nursing theory?
Richard Cowing (RC):The prevailing theoretical perspective that guides my work is the unitary nursing
framework (Rogers, 1992). The central idea in unitary
nursing science is the notion of wholeness. Working in a
very complex and large organization I have to remind
myself of the wholeness of the organization. I think of
my own work as an evolution of unitary nursing in the
form of unitary appreciative inquiry and praxis or appreciative nursing (Cowling & Repede, 2010; Cowling &
Swartout, 2011). In the academic setting, one of the
things I did early on was to talk about what it would
mean to apply those principles of appreciative nursing
and nursing practice to education, appreciating students
in their wholeness. I brought that idea into the

organization with my philosophy from unitary science

to attempt to attract people to the idea rather than promote it as the only way of approaching academics. I
believe that I have used the lens of unitary nursing science to inform what I do in my academic leadership
role; in some ways a form of unitary appreciative praxis.
There are other ways too that theory guides what I do
and it is probably around the concept of mutual process.
Relationships are extremely important and developing
relationships and paying attention to patterns, in terms
of what is happening is crucial. While metrics are important indicators of how an academic organization is
doing, the quality and nature of the patterning of relationships is another important gauge of contributions. I
highly value the notion that student and faculty mutual
process is a central force in facilitating positive and
enduring change in learning and teaching. Metrics are
important too, but I believe that we use them to give us
clues to the patterning of the organization rather than
using them as the sole indicator which is reductionistic.
It is important to remember that there is always
something underneath the metrics; they are a clue into
the wholeness of what is happening.
1

Professor and Director of Community Health, University of Wyoming

Director, School of Nursing, DePaul University
3
Vice President of Academic Affairs, Chamberlain College of Nursing
2

Contributing Editor:
Pamela N. Clarke, RN, PhD, FAAN, Professor, University of Wyoming,
School of Nursing, Dept. 3065, 1000 E. University Ave., Laramie,
Wyoming 82079.
Email: pclarke@uwyo.edu

Clarke and Fawcett / Scholarly Dialogue

PC:In unitary science normally one wouldnt view metrics as that important, yet you value the metrics as one
indicator out of many?
RC:Yes, in some of my own writing I talked about the
conceptualization of practice where you dont dismiss,
because you are unitary, the information that comes to
you that is physiological, spiritual, or emotional. You
dont dismiss it, what you do is understand it in the
context of the whole, not as reducing the whole to that
experience or particular phenomenon, but all those
phenomena are clues, in a sense, to the overarching
pattern (Cowling, 1993). If you carry that idea to an
academic organization, where youre a leader, you
understand the importance of factors like persistence,
retention, graduation rates, student performance,
and NCLEX (National Council Licensure Examination)
pass rates as indicators of academic patterning and
mutual process infused in the organization. There is
more to the story that helps you appreciate the relevance of that to the wholeness. For instance, in our
organization we started a movement called Chamberlain
Care. Its not caring in the way we think about caring
in nursing science, its more the noun, like we all
deserve the best care. In Chamberlain Care, I believe
we are looking at academic success for the standpoint
of wholeness. We give attention to our own well-being,
the well-being of our colleagues, and the well-being of
the students with a focus on them realizing their dreams
and desires. We are designing Chamberlain Care to be
a force for creating an environment that supports all of
this. We believe that doing this means that we are
developing our students potentials to be extraordinary
and transform healthcare worldwide, even if it is one
person, family, or community at time. Our employees
are colleagues and thus we think of them differently
with the idea of mutual process than we would if we
thought of them as our employees. We are essentially
evoking a new form of mutual process by re-thinking
our relationships.
William Cody (WC):I appreciate what youre saying
about a framework within your organization that resonates with your nursing theoretical framework. Ive
experienced something similar at DePaul, in that
DePaul is a Vincentian organization and the framework of values is concerned preeminently with service
to humankind and upholding human dignity. This perspective resonates well with nursing, but also my theoretical grounding in the humanbecoming school of
thought. Human dignity is central to both frameworks
(Parse, 2010). As leaders we know that we need to be
in an organization in which we can embrace the mission, and help to build the mission and vision. This
commitment is central to the leadership challenge that
we all face. Ones theoretical framework informs this
process of aligning mission, vision, values, and

127
strategic planning. Part of living my beliefs in my role
as the director of the school of nursing, emanates from
the humanbecoming school of thought, is the reverence for the people that I work with and work for. This
reverence moves me to be fully and truly present, and
really listen to what they are saying, and to try to use
my personal presence to pull together our common
vision. I feel like the relational aspect of nursing that
comes to me from my particular theoretical framework
really helps me to be able to be with my team in that
way.
PC:You have talked about the Parse concept, leadingfollowing. Would you describe the fit with leadingfollowing in your leadership model?
WC:Parse (2008) has written about the concept, and the
central essences are vision, risking, and reverence for
others. I was pondering these concepts, and they speak
to me in terms of the vision. Having been through leadership training and having been in a middle executive
position for a good many years, we always talk about
the mission and vision. Theres the sense of it that is
more directed toward achieving some end, but if one
comes from a place where ones assumption is that
were co-creating something together and that theres a
seamlessness to it, then my job is to facilitate co-creating a vision we can all share in and that we can all
embrace, and that comes from the values that underpin
our organization. When we grow the vision, if we want
to bring to realization and participate in transforming a
new vision of the way nursing might be, or the way
that our organization might be, or the way people
might be served in healthcare, then there is going to be
a certain risk. The leaders job is to get everyone to
embrace the risk and take the challenge and move forward, and it can be very difficult to get people to
embrace that risk. Parses (2008) view is that if youre
leading youre also following.
RC:They are not extracted from one another. That makes
sense. I like the leading and following concept; I translate it in a unitary way to attraction and appreciation.
For instance, the more I appreciate my colleagues the
more attraction there is to bettering our relationships;
there is less push and pull and more cooperativeness
and collaboration.
WC:The concepts are not oppositional. They are intrinsically in a rhythmical pattern. I certainly follow in terms
of being a so-called leader. In trying to facilitate others
doing something, they are doing it, so in some sense I
am following them.
PC:You both make your theory-driven leadership styles
sound so easy. Are there difficult areas?
RC:One of the most difficult concepts for me to integrate
into an academic organization as a leader is the unitary

128
idea of unpredictability. In the organization I work for
it seems to be were trying to get a handle on predicting what is going to happen in the future in order to
manage it, or take advantage of it, or leverage it. It is
not meant in a negative way, but to grow the organization, to grow what were about, to promote our mission, our vision, our philosophy. What I carry into
those situations, is trying to envision the future and
doing the best we can to envision what is going to happen and to be there to build on what we believe, which
is to prepare extraordinary nurses to transform healthcare worldwide, thats our vision. I prefer an understanding of the unpredictability of the future as
meaning many possibilities can unfold that we cannot
imagine. It is allowing the organization to dream big
and that allows us to consider all kinds of approaches
to educating our students and paying attention to how
this works for them and for us. As a member of a leadership team, I work to build on building relationships
and how we might contribute to a shared vision that
leads to something greater than anyone of us can imagine individually. I carry my theoretical framework into
our leadership discussions. Often Im not using the
words of theory, but using the ideas of the theory, or
the conceptualizations to talk about issues, the problem, the challenge we face, or the opportunity were
trying to build for ourselves. Unitary science is an optimistic framework with infinite possibilities. In terms
of humanbecoming, it carries not only a way of thinking, but an attitude, a feeling state, and all of those
things that are aspects of the whole, into it, that changes
the way you do your work, the way other people see
you. Its kind of a mutual process that is more beneficial in many ways than is typically seen in the problem-oriented approach.
WC:Certainly one of the aspects of being a leader in
nursing in a new paradigm framework is dealing with
the need for measurement, the need for predictability,
and in our discipline, the evidence-based practice
movement. The reality is that there are a lot of instances
that we encounter when we are caring for human
beings where there is no objective, cause-effect evidence out there. In human care, the amount or percentage of the care that can be predicted through randomized
clinical trial research is very minimal. Thus, one thing
that Ive taken into my last three jobs, coming from a
different paradigm, has been to keep hammering on
how much of our care is actually values-based. We
value human dignity. I dont practice my profession
this way because of the evidence from the research, but
because I value human dignity and I value relating to
human beings and being truly present with human
beings, while honoring their human dignity. This perspective has actually resulted in changes in the curriculum framework the last two jobs, and Im working on
a revision right now in which we will be sure to get the

Nursing Science Quarterly 27(2)

values-base in there. Unfortunately, there are places in
our profession where it can be eclipsed to just get on
the evidence-based band wagon.
PC:What was the process you used to accomplish the
change in thinking, at the last two places?
WC:By engaging with the faculty toward realizing a
common vision that our curriculum would not be
solely objectivistic science, but would include values
like human dignity. One curriculum, for example, portrayed values and evidence as twin pillars of the
curriculum.
RC:Along those lines when you are trying to promote
change like that, where you have theoretical concepts
that you want to integrate into your work, I believe that
it is actually about creating a mutual process that
allows for diversity of thinking, but finds common
ground. The process seems to be about synergy; things
changing positively, and perhaps accelerated, when
you connect to a bigger goal. As a leader, I focus on the
goal and share different ways of realizing that goal that
evokes more creative approaches to teaching. The faculty teaching from a biomedical perspective teach
from that perspective because they truly believe it; I
have to remember that for them, just as it is for me
when I am teaching from my perspective, it resonates
with their heart, their soul, and their cognition; everything. They are doing it as passionately as I would
probably be teaching something from my frame of reference, and if you create a mutual process where you
say the possibility of having people recover in a healthy
way from cardiac challenges by using an understanding of the wholeness of their experience and relate it to
what they are trying to accomplish, you can find this
common ground where there is at least a potential to
consider the possibility that there is another way of
viewing the person rather than an illness-centered
view. Most of the time I find that the people who are
very bio-medical want the human condition to
improve and they see it happening in a very different
way. I am very empathetic about faculty because of
what they face in terms of trying to prepare graduates
for a healthcare system that is metrically driven, and
evidence-based. They are trying to prepare students to
live in that world and most understand that human
experience and the nature of life are more than the biomedical phenomena.
PC:In terms of faculty, how are your faculty informed
about your theoretical approach?
RC:Their knowledge of my theoretical framework may
come from either knowing about my writings or my
role as the editor of the Journal of Holistic Nursing.
Often they will reach out to me and ask me about it
which leads to some interesting conversations. Many
of them have the same appreciation for a unitary perspective. I was also invited to give the opening address

Clarke and Fawcett / Scholarly Dialogue

at our national faculty meeting and I spoke on appreciative nursing education. I also look for examples of
innovative theoretically-driven pilots or demonstration
projects going on and encourage and support faculty.
Often these projects attract other faculty because they
see the positive changes happening in students. Thats
an attractive force, and you look for those little opportunities for change.
PC:Chamberlain is a large multi-state organization. How
will the small changes you are talking influence the
whole?
RC:In our organization, all of the faculty members who
are teaching the same course are part of what we call
collaboratives. These instructors are talking about
what works and what doesnt and sharing best practices. Sometimes best practices are really the most
innovative things that have yet to be tested. This is how
faculty members across such a large organization are
able to connect. We use technology so the collaborative is happening virtually and through other outlets.
I like the concept of being values-driven, and I trust
that is true of my organization. We share a common
framework of values that we operate from, but it might
express itself in different ways depending on what you
do and where you are located. If you are in Phoenix
you might be dealing with a population that has different needs than in Florida. You have to allow for the
differences but embrace those universal values in
whatever kind of educational experience you are creating for students. The frameworks that Bill and I come
from allow for that kind of diversity.
WC:In talking with coworkers and colleagues, when we
are having dialogue and envisioning projects, I find
that I talk to them in ways that are similar to the way I
talk to persons practicing as humanbecoming nurses.
Its an extraordinary witnessing, and I use phrases similar to what I would ask in practice, Well, what does
that mean to you? and Whats most important about
that to you? and What would be the pros and cons of
that? If a direction emerges, then Who could help?
What kinds of things would help to move that along?
Ultimately What do you picture this being in the
end? Going through a similar process as I would with
the person I am having the dialogue with in practice as
to What does it mean to you? I regard it as an ethical
commitment to bear witness to the truths of the faculty
whom I serve as leader. I seek to understand their living experiences, their values, their commitments; then
we go from there (Cody, 2001).
PC:As you talk, Im picturing this discussion with a
much larger group using your practice methodology.
WC:Using a form of it. As the director, the supervisor,
Im hesitant to call it true presence, because Im not
giving myself over entirely to it as I would with a person, because I was hired by the organization, I do have

129
an agenda. The centerpiece of my agenda is to help
people to develop and so its really about them. That
meshes very nicely with my practice perspective.
RC:I was thinking as Bill was talking, in Rogerian unitary science we dont use the terms of being and
becoming. However, I do think that unitary science
offers a parallel view of understanding oneself as
always unfolding and gaining greater and greater
awareness through knowing participation in change
(Barrett, 1998). Also, cognition, inspiration, and sensations are intertwined phenomena that cannot be understood when divided as mind, body, and spirit. One of
these phenomena has no precedence over the others. In
an academic environment, for me I have to pay attention to all of them in order to be best at leading our
educational work. I pay attention to experiences or
cases when I am being inconsistent; for instance,
reducing academic success to NCLEX scores. I have to
remind myself that there is more there. I want our students to be stellar in their NCLEX scores, but more
than that I want them to be stellar in terms of their
practice as nurses. When you embrace a frame of reference in a theoretical framework, it makes you more
aware of what youre doing and how it relates to what
you believe. It makes you more conscious of what
youre doing. To me it doesnt matter whether youre a
leader, a teacher, or a practitioner, your consciousness
changes when you get deeply engaged with a framework, whether it is one of the frameworks Bill and I are
talking about, or another. One is different in the world.
WC:The process of reflecting in preparation for this dialogue brought me to realize I hadnt actually fully integrated my own philosophical assumptions about what
informs my leadership. One would think after going
through leadership training programs that I might have
done that. I was thinking about some ways that being
in a new paradigm informed a process that might be
different or advantageous in ways that I had never
really thought about. I considered the assumption that
change and transformation are continuous, these are
always happening and its indivisible. Thats an important part of who I am and how I experience the world,
as a nurse, as a leader. It seems as though the challenge
is to work to co-create a chosen pattern or set of values,
to make reality come to be in a chosen way, or to participate knowingly (Barrett, 1998, p. 138) in change
from Rogerian science. Thats a fundamental assumption of who I am and what Im about. I just had not
really questioned it or thought about what it might
mean that it might be different from other people in
leadership positions.
RC:The concept of participating knowingly in change, as
articulated by Barrett (1998), is a key idea. I would add
the notion of appreciation, so I believe that participating knowingly and appreciatively in change broadens
possibilities for organizational and academic innovation. To participate knowingly in change means seizing

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Nursing Science Quarterly 27(2)

the opportunity to promote change based on awareness
of the patterning and wholeness of your organization.
Barrett suggested that power, choice, and freedom
emerge or evolve with knowing participation in
change. To participate appreciatively adds to this a
willingness to suspend judgment and value and
embrace all aspects of an organization when considering change even those aspects that seem antithetical
to what is desired. The more you appreciate multiple
ways of viewing things the more you experience
consciousness-raising associated with seeing more
possibilities that inform your decisions. The organization Im in now is also a business and they are always
reflecting on who they are and what theyre about,
which is like getting in touch with appreciating what
theyre about and want to be. For me, what Im finding
is that many organizations are welcoming the way of
thinking that I bring, because they are also asking
themselves, whats happening in our organization,
what works, where are we struggling, and what are the
patterns that can guide us to consider new ways of
meeting our goals? Organizations are learning about
themselves, they are becoming more conscious, at
least thats my optimistic view; they are working
toward, embracing, different paradigms. There are still
a lot of old ways of thinking, but the way we think
about leadership now is more in the vein of wholeness
and patterning and mutual process.

PC:Certainly we see new paradigm thinking in the literature in terms of the evolution from management to
leadership.
RC:I wonder too, if there is something that goes beyond
leadership?
WC:Mainstream organizations are shifting more and more
toward new paradigm thinking. By the time they get
there they wont be new paradigms anymore. Maybe
thats true already, but, for example, appreciative inquiry
is in the mainstream textbooks. And values-based has
become a buzz-word in schools of business. The business school leaders go beyond business itself to valuesbased concepts and vision, which means you have a
vision rooted in values; you want to co-create, and thats
actually mainstream now. Richard is right, the new
thinking is more valued now than it has been in the past
and its welcomed even beyond nursing.
RC:We started a service excellence project at
Chamberlain. We wanted to get out of the mindset of
reducing it to the customer. My president was asked to
take the lead on this project for our parent organization
and she engaged her colleagues in creating a model
within our College. The concept that she worked from
was the idea of that customer service in academia is
really about providing the best conditions possible for
student success. It does not mean that students do not
have accountability for their own learning, but rather

excellent service means assuring that we do everything

that is possible to facilitate students reaching their
optimal possibilities. That was the birthing of what we
call Chamberlain Care. A part of this initiative is for all
of us, no matter what we do in the organization, to
remember that the student is the center of the concern
of our organization. A mortarboard that is placed in
every meeting room of our home office symbolizes
their success. This serves to remind us why we exist. I
think of it is as an expression of the unitary concept of
pan-dimensionality we bring the student into our
meetings without their physical presence. By doing
this a kind of energy is created through symbolism and
metaphor that says, Were here doing this work for
our students.
PC:Coming into the Robert Wood Johnson (RWJ)
Executive Nurse Leaders experience as a Parse scholar
Bill, how would you describe the impact of the leadership experience on your perspective?
WC:The thing that jumped out at me was the notion, we
were talking about earlier about the Robert Wood
Johnson Executive Nurse Leaders experience; Two
things I took away from that was leading as who you
are and knowing self in order to be a strong leader. For
me, that is very much analogous to knowing oneself
within the context of ones theoretical perspective, and
Ive written about that (Cody, 2000). If my theoretical
perspective informs my understanding of my own reality then leading as who I am is also leading from that
theoretical perspective. The RWJ experience also gave
me the chance to appreciate the huge diversity of leadership styles. We have introverts and extroverts (in
traditional terms), and when we would practice presentations in our groups some people would turn cartwheels and others would want to stand at the podium
and some would sing. Others would be very good at
creating diagrams or models. Some would be forcefully persuasive with public speaking and others would
be subtly persuasive in soft tones. New paradigm theories lead us to appreciate human individuality and the
uniqueness of each human being. When you express
yourself as a leader in the way that is best for you, as a
person, to express yourself, then that helps to develop
all the members of your work group or team or colleagues to be who they are and to fully realize who
they are. That, to me, is the essence of leadership.
RC:Thats a central core idea, you mention Bill, which
I too seek in my experience as a vice president
because we employ executive coaches. One of the
executive coaches that we use with individuals and
our team always starts with the principle: you have to
be who you are. This is not about changing centrally
who you are, as a matter of fact its embracing who
you are and paying attention to how authentic and
genuine you are in the organization and when you

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Clarke and Fawcett / Scholarly Dialogue

feel you cant be thats informational energy telling
you that something is going on. We are such a
thought-driven culture but paying attention to how
we feel is also important. That kind of coaching is in
line with what you are saying. My executive coach
would always start with me reflecting on who I am
and what I want; thinking of the match between the
job I chose and me as a person. The approach is truly
central and goes along with the newer transformational paradigms of leadership.
PC:Richard, talk about the principle of the Chamberlain
model and the impact on employees and colleagues.
RC:The whole of the DeVry Company decided to have
yearly summits where they bring in organizational
leaders. We had one last year and brought in a guy who
teaches leadership from the paradigm of the symphony.
As a former conductor, he brought an orchestra into a
room of 400 participants and asked everyone to move
about, paying attention to the changes in music; particularly when he told a section to do something different or more creative. Then he asked, What happened
here? He applied it to organizational theories of leadership. The metaphor of the symphony and the relationships among all in creating conditions of change is
another expression of the relevance of patterning,
wholeness, and mutual process in an organization. All
of this is about learning a new consciousness that leads
to new unitary competencies.
PC:Perhaps we could summarize by talking a bit about
the structure of your organizations, As I understand it
yours Richard is a private proprietary, and yours Bill,
yours is a religious institution.
WC:Yes, its Roman Catholic and Vincentian. I was actually thinking about that in relation to pan-dimensionality from unitary science, and Parses concept of
illimitability from humanbecoming theory. The two
people who are with us always at a Vincentian institution are St. Vincent DePaul and St. Louise DeMarillac,
who was his partner, in the chaste sense. She was a religious woman, and co-founder with Vincent of the
Daughters of Charity. They are really with us every day,
the whole notion of what they founded, and their statues are on campus. Its interesting, the difference
between St. Ignatius Loyola, at Loyola theres a statue
and hes sort of imperious and seated alone, and then on
the campus of DePaul the statue of St. Vincent is actually hanging out with other bronze statues of kids with
their backpacks. I was thinking of that when you are
talking about pan-dimensionality. They are definitely
with us. They inspire servant leadership, and I have
found servant leadership to be consistent with my values base in humanbecoming, in terms of being a servant
to the mission and vision of the organization, to my colleagues and co-workers; and the service I provide is to
try and lead them. The measure of success, according to
the founder of the servant leadership movement, Robert

Greenleaf (Greenleaf, Frick, & Spears, 1996), is the

extent of the development of your followers, how well
do they develop as human beings and as servants.
RC:There is an interesting parallel, I may have a misunderstanding of this, but DeVry Educational Group
purchased Deaconess Hospital School of Nursing in
St. Louis, which was how Chamberlain originated.
Part of the contract was that they use a different name,
so they started with a few hundred students. Deaconess
has a history; they would be 125 years old today. We
see ourselves rooted in Deaconess, which was also a
Deaconess Order, and they built a school on the
Nightingale model. When we purchased Deaconess,
we embraced all of that in a sense; we have some of
their statuary that we transported from the old school.
There was a lot of discussion about the new name, and
Chamberlain has a connotation of chief steward. It
conveys that we are the stewards of the students wellbeing and success. We have grown a lot, we have 13
campuses that are brick and mortar for our pre-licensure BSN program, an RN to BSN program and a variety of masters tracks (leadership, informatics, and
education) and a doctor of nursing practice (clinical
and health systems leadership) program that are primarily online.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect
to the authorship and/or publication of this column.

Funding
The authors received no financial support for the authorship and/or
publication of this column.

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