TkeLast Word

The ”Parental Role Instant Replay” Theory of Nursing Leadership

Leadersh ip theories abound. They tend to postulate a preferred outcome, arguing back to a set of behaviors that will assure or at least offer probabilities of the desired result. Aspiring leaders engage in such behaviors, hopeful for the outcomes proffered. Such theories are inherently flawed, however, since they do not accommodate the unique sources of variance that grace, or plague, selected settings. Healthcare settings are an exemplar.

A good deal of ink has been spilled in the last 20 years on the nature of oppression and its impact, particularly on women. This literature has found afriendly, even optimistic audience in professional nursing. We have collectively hoped to find explanations for our anxieties, frustrations, even our apathy and lethargy. Oppression fits.

Given this fit, systematic long-term oppression would conceivably not only explain these human potential disjunctures, but create additional effects less immediately apparent. Certainly, a group experiencing decades of institutionalized oppression will have developed a few habits of the mind and heart that might shape responses to authority and efforts at leadership. This convergence of realities has led to a recently developed theory of nursing leadership: the parental role instant replay theory.

Even a modest superficial appraisal of nursing history here in the United States reveals the preferred dynamic used in the oppression of nurses: the parental negotiation. The assumption is that nurses are too defective to engage in mature, adult autonomous decision making. The solution is the introduction of a diverse array of purportedly more adult individuals who can guide, direct, even order nurses toward a desirable and desired range of behaviors. Relieved of the threat of error and misdemeanor, nurses can be enabled to achieve some modest degree of productive output through such external assistance.

Nursing has generated a diverse array of responses to this dynamic. Some nurses have found it ofensive and insulting, and rebelled. Some have adapted the notion that there was little hope in altering the established patterns. Some have noticed it a useful dynamic, and recognizing that they surely weren’t as inept as the dynamic implied, have set their sights on becoming part of the superior decision-making group. Some have pondered these diverse attitudes. Many, however, merely drifted along. In the main, the dynamic was initiated by men, and over time nurses, most of whom were women, have learned to describe the process as one of paternalism. While some of the time the dynamic was blatantly offensive and misguided, often it seemed useful. One could manipulate it. There were promising seconda y gains. Further, it was familiar. It was much like dealing with one’s father.

As one or another nurse ”climbed” her way to the superior position, and was identified as a nurse leader, the added dimension of memories of mother emerged. Now the dynamic could be either like dealing with one’s father, or like dealing with one’s mother. Maternalism emerged. The parental role instant replay theory of nursing leadership was born.

Psychological studies have proven useful in ampli@ing this theory. Psychologists postulate that we are driven compulsively to repeat old dynamics learned in our parents’ homes until such time as we evolve to a level of consciousness where we can choose to question, explore, accept, integrate and alter such dynamics. Many people never get through this journey to a point of change and wholeness. Indeed, many people never even start the trip.

This information is useful. It argues for the intrinsic utility of the theory of parental role instant replay. Since most people are out looking for useful arenas wherein they might enact their repetition compulsions of parental relationships, the nurselnurse leader relationship can provide such an arena. Further, the continuing presence of a large number of paternalistic men in healthcare environments enables the nurse to find a useful father alternative. Thus, the stage is set for the repetitious

Nursing Forum Volume 27, No. 3, July-September 1992 35

The Last Word

enactment of hundreds of childhood dramas (and traumas), assuaging needs otherwise left to fester and foment.

The the0 y is also robust, since variance in parental relationships is substantial. Hence, a wide variety of childhood behaviors can be enacted with the same nurse leader. It actually is of limited import whom the leader happens to be; the illusion of a returning mother figure is enough. One can simply find the trait or trigger behavior that reminds one of one's mother, and instantaneously, the dynamic is activated. Nurses who prger intact family systems can usuallyfind a physician father or two to balance the dynamic.

The range of potential responses to such leadership creates a scintillating work environment. One nurse may be in adolescent rebellion, another in toddler dependency, a third in prepubertal industry. Nurses edging toward adulthood can be reflective and concerned, sensing that something pretty primitive seems to be going on. Physicians in search of additional daughters to do their bidding can garner substantial rewards from the submissive compliant daughter, the seductive daughter, the idolizing daughter, the darling daughter. Conversely, they can clearly focus their discomforts with the institution by interacting with the recalcitrant and challenging daughter, the daughter stumbling for confused moments of self-discovery.

Nurse leaders, busily studying more socially acceptable theories of leadership, may be tragically misled by such theories. None of these deliberately deal with the seconda y effects of systematic oppression, that is the repetition compulsion to relive parental relationships when others t y to become parent substitutes. Such nurse leaders would be well advised to take the time to study this alternate the0 y of parental role instant replay. They might even want to consider inviting parents of selected troublesome nurses to lunch, to study the parental style to gain a better grasp of the nature of the dynamic presented by these nurses. Certainly, they are well-advised to recognize that the theoy dominates many nursing environments. This knowledge will free them from unnecessa y guilt and discouragement. After all, if the first set of parents created the crazy pattern,

why should nurse leaders take the blame for the repetition. Give credit where credit is due.

Of course, a danger exists in this attifude. Some nurse leaders may be seduced by the dynamic, and indeed attempt to become mothers, and, in the case of growing numbers of men invited to the dynamic, fathers. Hence, rather than adapting their behavior to the diverse array of parental roles they encounter as the expectations they have projected on them by their followers, they may begin to think they really are staff members' parents. Under these conditions, the dynamic becomes disruptive, since the parent a given nurse leader chooses to be may lack a fit with various nurses' prior experiences. Conflict is inevitable. Indeed, the nurse leaders who are acting out a repetition compulsion to "be" their parents are particularly at risk, since their need to be one person may be in direct competition with the persons others want them to be. This inner conflict can degenerate to an endless series of miscommunications. Physicians have an advantage in this regard. Nurses can shop around until they find the appropriate father figure. The nurse leader, often the only available option, is thus disproportionately disadvantaged in these cases.

Recent analyses of this the0 y have revealed an additional dimension that warrants exploration. The illusional character of the entire dynamic, perpetuated, may be a further incursion on self- realization in nurses. This misperception, in turn, could reinforce maladaptive behaviors to oppression, reinforcing seconda y gains at the expense of a more substantive solution. Thus, there are obvious unexplored ethical implications yef to be assessed. It is unclear who would volunteer to investigate these implications, however.

Parental roles, prescriptively and societally reinforced with minimal examination, discourage ethical reflection. Thus, one need not grapple with this modest deterrent when the utility of the the0 y is so clear and persuasive. In the main, the richness and variance emergent from the the0 y argues for concurrence rather than testing, with a grutefLll nod to the comforts of expedience. After all, if they were good enough to be our parents the first time around, why quibble later? A t least we know what to expect!

36 Nursing Forum Volume 27, No. 3, July-September 1992