We are all followers at different points and times in our lives. For example, we follow our parents, our spouses, our neighbors, our friends, and others at certain times and under certain circumstances. At other times, they are following us. The questions are: why do we care who is leading and who is following, at which times, and under what circumstances?
Leadership is well-documented in the literature and has numerous theories and views about what constitutes leadership and what it is leaders do. Less well-known is followership and what followers do. And as the old saying goes, if a leader has no followers, that person is just out for a walk.
Why Address Followership?
As Simon Sinek (2009) says, we should begin with why: why do we care about followership in the first place? In general, people want to know why they have to learn something before they care about what the actual content is. The answer to why we should be concerned is this: several positive organizational benefits are the result of a team that includes effective leaders and followers. Those benefits include self-management (in other words, the leader doesn’t have to be present to be certain the members are being effective) and organizational commitment (Everett, 2016). Additionally, fewer errors result, patient outcomes are improved, and patients are better engaged.
What Do Effective Followers Do?
Followers within the nursing profession have an enormous set of roles and responsibilities. The need to develop and cultivate followers into effective followers is undeniable.
According to Kelley (1992, p 92), “the primary traits that produced the most effective followers in an organization were critical thinking and active participation.” New graduates are typically well-prepared in critical thinking and in active participation, although the focus of both of those activities may not have been as a member of a team.
Effective followers have several critical characteristics that distinguish them from a person who is simply a member of a team. These characteristics are displayed in Box 1.
Note that these characteristics are also common of leaders. Thus, it is not a surprise that effective followership is a part of effective leadership. Smart leaders ask questions to motivate a team. Smart followers ask questions to seek clarity and assurance. Smart leaders transition into followership roles when needed, just as smart followers transition into leadership roles as needed.
Box 1: Effective Follower Characteristics
- Asks intelligent, thought-provoking questions
- Speaks up when concerns arise
- Strives for autonomy but knows when to ask for assistance
- Engages in decision-making processes
- Engages in open communication
- Transitions into leadership roles when needed
- Advocates for patients
- Commits to evidence-based, quality care
- Engages in lifelong learning
- Motivates himself or herself (Boothe, 2019, p.95)
How Can We Support this Role Development?
If followership is an important ability, how do we make sure graduates of nursing education programs are prepared to be effective as such and ready to move along the continuum to being effective leaders? Although several strategies can be used, we offer two suggestions: one, a classroom discussion of “what if,” and the other, hands-on simulations where students can experience the simulation of real-life situations.
In the classroom (or in a patient care setting), the leader (who may be a manager or faculty member or seasoned team member) can pose a situation beginning with the question of, “What if?” For example, what if you were overwhelmed with your assignment? What could you do? Or, the leader could ask, what if you were faced with conflicting views in the family about patient care? What could you do? The discussion that ensues can form the basis for determining which, if any, of the characteristics in Box 1 are exhibited. The leader can then use that information to provide feedback to the learner.
Simulation allows for learners to test how their responses are received. For example, in a simulated situation, a physician has overlooked an important lab result (potassium, digoxin level, platelet count) that would likely change the approach to care. The follower finds that the orders don’t match what is the typical clinical protocol in such a situation (administering digoxin or lanoxin, or enoxaparin). Other than seeking out the charge nurse to ask what to do, what could the nurse do to effect quality care? That response can be role-played. In order to use this situation most effectively, specific lab reports, diagnosis, patient data, medication administration record, and physician orders should be part of what is available to the learner.
Another example could be a simulated team meeting where a new graduate (for example, a second-degree graduate with a marketing background) is involved in a discussion about expanding clinical services. This new graduate is attending this meeting as part of the residency program in the organization to help create organizational commitment. If this new graduate speaks up, that talent is now available to the team. If, however, that new graduate does not speak up, the group could struggle with ideas to consider for some time.
Another example is when a nurse moves from one healthcare organization to another. Often, the first encounter is a general orientation, which often is designed for new graduates without experience. As a result, some special skills, such as having been a trauma nurse for three years, are overlooked until a critical situation presents itself. This simulation could be set up with the expectation that the unit personnel are waiting for the code team to arrive. How will this talent be tapped to provide better care for the patient experiencing the code?
Conclusion
Typically, the nursing profession has focused on developing leadership skills. Often that focus has been on the higher level of skills as opposed to the ones that all of us must be able to exhibit all the time. If we are all in THE leadership role, we don’t have a team. A shift has occurred from thinking of leadership as a linear (vertical) approach to a circular one where any one of us may be called up to assume the leader role as we execute our care throughout the day (Malak, 2016). The roles of charge nurses and nurse managers are to capitalize on the distinctive talents each brings to a setting and to encourage effective followership, both for the development of the person and the enhancement of the organization. This talent-seeking activity is eased when followers know how to be effective in their roles.
Learn more and request your complimentary review copy of Leading and Managing in Nursing, 7th Edition here.
Other title(s) related to followership:
Leadership and Nursing Care Management, 6th Edition by Diane Huber, PhD, RN, FAAN, NEA-BC.
References
Boothe, A. (2019). Being an effective follower. (7th ed.). Leading and Managing in Nursing (pp.89-98). St. Louis, Missouri: Elsevier Mosby.
Kelley, R.E. (1992). The power of followership: How to create leaders people want to follow and followers who lead themselves. New York, NY: Doubleday/Currency.
Malak, R. (2016). A concept analysis of “Follower” within the context of professional nursing. Nursing Forum, 51(4), 289-294. https://doi.org/10.1111/nuf.12158.
Sinek, S. (2009). Start with why. How great leaders inspire everyone to take action. New York, NY: The Penguin Group