Elizabeth L. Paxton, Ph.D. is a 2021 graduate of the PHD Program in Leadership and Change at Antioch University.

Liz Paxton at her Dissertation Defense.

From L-R: Dr. Ronald Riggio, Committee Member, Dr. Lize Booysen, Committee Chair, Dr. Elizabeth Holloway, Committee Member.


courageous followership, leadership, communication, health care, critical incident technique

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Health care is fraught with communication issues, many of which can lead to patient safety errors and toxic behaviors. Communication in a hierarchical environment has been historically challenging, especially for nurses. Courageous followership, a style of leadership first introduced in the early 1990s, is a duality of “powerful leaders supporting powerful followers” (Chaleff, 2009, p. 3). The tenets of this leadership style empower both the leader and the follower to have the courage: to assume responsibility, serve, transform, challenge, take moral action, speak up to the hierarchy, and listen to the follower. All of these actions are needed in the hierarchical health care environment to empower the staff and the leaders to speak up both for themselves and for their patients. I investigated whether nurses currently utilize the concepts of this leadership style in conversations with their colleagues. Through the use of critical incident technique, stories were collected to understand if this type of leadership is naturally occurring in conversations with nurses and their colleagues. Meaningful incidents, either positive or negative, were collected and analyzed for relevance to this topic. The research showed that positive leadership, CF concepts, and communication can influence and be beneficial to the future health care environment for both staff and patients. This dissertation is available in open access at AURA: Antioch University Repository and Archive, and OhioLINK ETD Center,


Liz Paxton

ORCID Scholar ID #: #0000-0001-5264-3102

Elizabeth L. Paxton, Ph.D., MSN, RN, NE-BC, earned her doctorate in Leadership and Change from Antioch University in Ohio (USA) in 2021. She is currently the Regional Chief Nurse Executive for Providence Health and Services in Alaska. Before joining Providence, she enjoyed a 17-year career at Riley Hospital for Children at Indiana University Health and a 10-year career at the Children’s Hospital of Alabama. She has focused on team building and healthcare culture for most of her nursing leadership career. She leveraged this experience in her dissertation which explored the use of courageous followership in healthcare conversations between nurses and their colleagues. Dr. Paxton also consults with nurses on career planning and healthcare environmental culture through her business, Wise Path Leadership.