Leadership in Nursing; Definitions, Theories, and Styles of Leadership in Nursing, Knowledge, attitudes, and skills of an effective nurse leader, Applications to practice settings, and Education for leadership.

Leadership in Nursing

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Definitions, Theories, and Styles of Leadership in Nursing

What are the various styles of leadership?

One of the most difficult difficulties facing the nursing profession is the development of future nurse leaders (Mahoney, 2001). All nurses, particularly those giving direct care to individuals in high management roles, need strong leadership abilities. A leader is someone who is seen as an authoritative figure (for example, a nurse treating a sick) or who is in charge of providing aid to others (Curtis, DeVries, and Sheerin, 2011). A clinical nursing leader is a person who is active in direct patient care and who works to enhance the quality of care provided to patients by influencing the treatment provided by others (Cook, 2001).

Leadership is more than a set of abilities or a set of duties; it is an attitude that guides behavior (Cook, 2001). Furthermore, strong leadership may be defined as continuously performing better, as well as delivering long-term advantages to all those engaged in the delivery or reception of care. Leaders are more than just commanding officers; they are visionaries who assist workers in planning, leading, controlling, and organizing their actions (Jooste, 2004).

Within the existing academic literature, leadership has been defined in a variety of ways. Most definitions of leadership, however, share a few characteristics. For example, leadership is a process, that includes influence, generally happens in a group environment, involves the accomplishment of a goal, and exists at all levels (Faugier and Woolnough, 2002).

In addition, there are various identified leadership styles. For instance, autocratic leaders define an end objective without enabling others to participate in the decision-making process (Curtis, DeVries, and Sheering, 2011), while bureaucratic leadership happens in settings where a leader firmly conforms to rules, laws, and policies. In contrast, participative leaders encourage personnel to engage in decision-making and aggressively seek out the involvement of stakeholders inside the decision. This sort of leadership encourages team members to feel more dedicated to the objectives they were part of defining (Fradd, 2004).

Laissez-faire leadership leaves people to their own devices in reaching objectives and is a very dangerous kind of leadership as Faugier and Woolnough (2002) further suggest. Finally, a more successful kind of leadership than those already stated may be situational leadership. This is when the leader varies between the various approaches based upon the circumstances at hand and upon the competency of the followers (Faugier and Woolnough, 2002).

There is a distinction between theory and styles of leadership. According to Moiden (2002), theory reflects reality, while style of leadership relates to the different ways one might execute a theory of leadership – the method in which something is spoken or done. Organizations should, it follows, strive for a leadership style that allows for high levels of job performance, with minimal interruptions, and that is applicable in a broad range of situational scenarios, in an efficient way (Moiden, 2002).

Similarly, there is a distinction between management and leadership. Managers plan, arrange and control, whereas leaders communicate vision, motivate, inspire and empower in order to generate organizational transformation (Faugier and Woolnough, 2002). (Faugier and Woolnough, 2002).

Transactional versus transformational leadership

According to Outhwaite (2003), transactional leadership includes the talents needed to operate a team effectively on a daily basis. However, transformational leadership also entails ensuring that a cohesive team works together, and it may also benefit from incorporating creativity into the workplace (Outhwaite, 2003). Allowing people to lead particular portions of a project based on their areas of expertise, for example, may empower team members. This, in turn, will stimulate the development of individual leadership qualities, which will benefit both the person’s talents and future career opportunities.

In addition, when obstacles and problems develop, leaders should investigate them and work together with their team members to overcome them (Outhwaite, 2003). Furthermore, rather than being a leader who is removed from the actual work of the team for which he or she is accountable, the leader should stay a member of the team, partaking in the job and therefore being near to operations and able to grasp the employee’s viewpoint (Outhwaite, 2003).

Transactional leadership is concerned with day-to-day operations, but transformational leadership is more concerned with the processes that encourage followers to achieve their maximum potential. As a result, the latter influences change and provides a feeling of direction (Cook, 2001). According to Faugier and Woolnough (2002), a leader’s capacity to convey a shared vision is a key part of transformational leadership. Furthermore, according to Faugier and Woolnough (2002), transactional leadership is most concerned with maintaining predictability and order, whereas transformational leadership recognizes the importance of challenging the status quo in order to enhance positive possibilities within the project they are delivering.

De Geest et al. are one set of writers who have written on Magnet hospitals’ use of transformational leadership (2003). They discuss how the leadership style used in hospitals allows for the installation of faith and respect, the treatment of employees as individuals, and problem-solving innovation, as well as the transmission of values and ethical principles, and the setting of challenging goals while communicating a future vision (De Geest et al., 2003).

As they go on to say, transformational leadership is particularly well-suited to today’s fast-changing healthcare environment, where adaptability is critical, particularly in light of evolving technology and patients’ seemingly ever-increasing demands. The authors go on to say that this leadership style is linked to improved employee happiness and better performance, citing a number of studies. These, in turn, are linked to better levels of patient satisfaction (De Geest et al., 2003).

Action learning is one method for facilitating change via transformational leadership (De Geest et al., 2003). Leaders utilize directive, supporting, democratic, and enabling techniques to execute and maintain change in this approach, and the consequences of such leadership allow for improved results for both nurses and patients.

Empowerment encourages transformational leadership, which focuses on interpersonal dynamics between leaders and followers (Hyett, 2003). Nurses who are empowered may not only believe in themselves but also generate and adapt to change. Setting limits, objectives, and responsibility, as well as putting in place structural support for team members, are all critical when employing a team approach to leadership (Hyett, 2003).

As a result, transformational leadership is perceived as empowering, but the nurse manager must balance the use of authority in a democratic manner to prevent seeming to abuse the power they have been granted (Welford, 2002). Finally, as Hyett (2003) points out, transformative leadership requires the leader’s esteem and trust of his or her employees.

Clinical or shared governance

What is clinical and shared governance?

Clinical governance is a new way of working in which National Health Service (NHS) organizations are held accountable for continuous quality improvement, upholding care standards, and fostering a culture of clinical excellence (Moiden, 2002). Several recent UK government policies require the development of new forms of leadership that better reflect the diversity of the workforce and community.

Since Scott and Caress (2005) made this observation, leadership needs have been reinforced, and the need to involve all staff in clinical leadership has grown. As Hyett (2003) points out, one method for achieving this goal has been shared governance. It has been proven to be an effective form of leadership because it empowers all employees and includes them in decision-making processes, allowing them to collaborate and develop multi-professional care (Rycroft et al., 2004).

Such shared governance has resulted in greater use of a decentralized style of management, in which all team members have responsibility and managers are facilitators, rather than a hierarchical style, which, according to Scott and Caress (2005), has resulted in increased morale and job satisfaction, increased motivation and staff contribution, the encouragement of creativity, and an increased sense of worth among NHS employees at all levels.

Knowledge, attitudes, and skills of an effective nurse leader

What are the knowledge, attitudes, and skills of an effective nurse leader?

Nurse leaders should have knowledge of management, communication, and teamwork skills, as well as a solid understanding of health economics, finance, and evidence-based outcomes, in addition to the skills listed in the previous sections of this assignment (Mahoney, 2001). The possession of a variety of key personal qualities should ideally complement these core skills.

Competence, confidence, courage, collaboration, and creativity, according to Mahoney (2001), are desirable qualities in all nurse leaders. Nurse leaders should also be aware of changing healthcare best practices and make changes ahead of time. As Moiden (2003) points out, leaders who show concern for staff members’ needs and objectives, as well as awareness of the conditions affecting the workplace, encourage productivity, which is important because it allows a productivity philosophy to be established.

The three pillars of a strong leadership foundation, according to Jooste (2004), are authority, power, and influence. As a result, in today’s competitive environment, leaders should use influence more and authority and powerless to be effective leaders. As Jooste (2004) goes on to say, being able to motivate, persuade, appreciate, and negotiate is more important than simply wielding power, and the author goes on to list three types of influence that nurse leaders can use to create a supportive care environment. Modeling by example, cultivating caring relationships, and mentoring by instruction are just a few of them (Jooste, 2004).

According to De Geest et al. (2003), these skills should be combined with the application of five specific leadership practices: inspiring a shared vision, enabling others to act, challenging processes, modeling, and encouraging. A leader, for example, can motivate others to take action by recognizing their contributions and encouraging collaboration. These techniques are important because recognizing contributions motivates employees to do their best work, whereas team leadership shifts the focus away from the leader and toward the entire team (Mahoney, 2001).

Applications to practice settings

How can leadership be effectively applied in practice settings?

Hyett (2003) identifies a number of barriers to health visitors taking on leadership roles, including the fact that they typically work in a self-directed environment, which creates issues because there may be no mechanism for self-control or decision-making at the point of service, stifling innovation. Moreover, if nurses who attempt to initiate change are not supported, they will lose confidence and assertiveness, as well as feel disempowered and unable to support one another, resulting in a drop in motivation and a negative impact on patient care (Fradd, 2004).

As Hyett (2003) points out, management often focuses on the volume of services provided, which leads to a loss of self-esteem and an increase in dependence. This, as Hyett (2003) points out, can lead to workers becoming disruptive or leaving the organization, resulting in organizational upheaval. Also, when employees leave because they feel disempowered, replacements must be found and trained, which entails not only additional recruitment costs but also training as new people are introduced to the company’s culture.

In addition to Hyett’s comments, focus group data from a study of implementing change in a nursing home suggests that nurses want a leader who has drive, enthusiasm, and credibility to lead and inspire them, rather than a superior leader (Rycroft-Malone et al., 2004). Members of the focus groups also identified characteristics that are desired in a leader who is attempting to facilitate change. This individual should be familiar with the collaborative project, have team status, be able to manage people, have a favorable attitude toward management, and have excellent management abilities (Rycroft-Malone et al., 2004).

Education for leadership

How can nursing education for leadership be steered?

In order for nursing practice to improve, money must be spent on training nurses to be successful leaders (Cook, 2001). Cook believes that leadership should be included when beginning nursing education curriculum, and that prospective nurse leaders should be mentored not just throughout their official education but also throughout their careers (2001). The use of evidence-based practice, which requires nurses to be able to analyze data and design solutions based on the best available evidence, exemplifies the relevance of this broader approach (Cook, 2001).

In order for these things to happen, nurses must have educational leadership preparation throughout their training in order to educate them to have a better grasp and control of events that may occur during work circumstances (Moiden, 2002). This may be seen as a step toward further professionalization of the nursing profession, a trend that has seen an increase of nurses earning formal academic credentials in the last 10 years.

Indeed, the NHS has accepted the Leading an Empowered Organisation (LEO) programme to foster the adoption of transformational leadership, demonstrating its commitment to professional certification (Moiden, 2002). The NHS believes that by doing so, professionals would be able to empower themselves and others via a sense of duty, authority, and accountability.

Additionally, the curriculum intends to assist professionals in developing autonomy, taking chances, solving challenges, and articulating responsibilities (Moiden, 2002). Future nursing leaders should be aware of the advantages of transformational leadership, according to strategies like the Leading an Empowered Organization (LEO) program and the RCN Clinical Leaders Program (Faugier andWoolnough, 2002). As a result, this is not just a curriculum that is relevant to today’s NHS, but also one that is training tomorrow’s nursing leaders.

Challenges and opportunities to stimulate change

What are the challenges and opportunities to stimulate change in leadership?

The healthcare environment is always evolving, posing new problems for nurse leaders to deal with (Jooste, 2004). Leadership is helping individuals to create outstanding results while still carrying out their everyday responsibilities and adjusting to change and challenge (Jooste, 2004). While management used to take a direct, hierarchical approach to leadership, the time has come for a more inclusive strategy that involves encouragement, listening, and facilitation (Hyett, 2003).

Leadership in Nursing; Definitions
Nurse Evaluating an Opportunity

Yoder-Wise (1999) defines leadership, according to Hyett (2003, p. 231), as “the capacity to build new systems and techniques to realize a desired goal.” Today’s thinking is that anyone can be a leader, and that leadership is a set of skills and practices that can be learned (Hyett, 2003). In the delivery of health care, all nurses must demonstrate leadership qualities such as adaptability, self-confidence, and judgment (Hyett, 2003). Nurses are expected to lead care and to be able to switch between leading and following roles depending on the situation (Hyett, 2003).

Empowering patients to participate in the decision-making process

How can patients be empowered to participate in the decision-making process?

Only when healthcare services are well-led can they be well-organized to satisfy patients’ requirements (Fradd, 2004). Nurses have a significant impact on individual patients’ health-care experiences, particularly as most patient engagement in treatment is nurse-led (Fradd, 2004). Patients are more conscious of their own health care requirements and are more knowledgeable about treatments and practice today; it is also critical that patients can articulate their own health care demands and participate in conversations about their treatment alternatives.

Nurses must be better trained with analytical and assertiveness abilities as a result of these increased levels of health-care communication, particularly if they must ‘fight the patients’ corner against the view of a single doctor who may set his own ideas above those of the patient (Outhwaite, 2003).

Transformational leadership is suited for today’s nursing practice since it focuses on satisfying needs and includes both the leader and the follower (Welford, 2002). It is also adaptable, allowing the leader to adjust to a variety of scenarios. As a result, if the leader recognizes that things will change often, followers will appreciate the flexibility.

As a consequence of the avoidance of hierarchical structures and the embrace of innovative methods of working, both nurses and patients profit since organizations are able to pool resources to produce additional value for both staff and customers (Mahoney, 2001). Transformational leadership is critical in this healthcare environment since it empowers team nurses to expand their roles as educators and advocates (Welford, 2002).

Frequently Asked Questions (FAQs)

1. What is good leadership in nursing?

Leadership in Nursing; Definitions
Nurse Leader Communicating

Leadership is more than a set of abilities or a set of duties; it is an attitude that guides behavior (Cook, 2001). Furthermore, strong leadership may be defined as continuously performing better, as well as delivering long-term advantages to all those engaged in the delivery or reception of care.

2. What are the 3 pillars of leadership?

The three pillars of a strong leadership foundation, according to Jooste (2004), are authority, power, and influence.

3. What are good leadership skills in nursing?

Nurse leaders should have knowledge of management, communication, and teamwork skills, as well as a solid understanding of health economics, finance, and evidence-based outcomes


Cook, M. (2001). The renaissance of clinical leadership. International Nursing Review, 48: pp. 38-46.

Curtis, E. A., de Vries, J. and Sheerin, F. K. (2011). Developing leadership in nursing: exploring core factors. British Journal of Nursing,

20(5), pp. 306-309.

De Geest, S., Claessens, P., Longerich, H. and Schubert, M. (2003). Transformational leadership: Worthwhile the investment! European Journal of Cardiovascular Nursing, 2: pp. 3-5.

Faugier, J. and Woolnough, H. (2002). National nursing leadership programme. Mental Health Practice, 6(3): pp. 28-34.

Fradd, L. (2004). Political leadership in action. Journal of Nursing Management, 12: pp. 242-245.

Hyett, E. (2003). What blocks health visitors from taking on a leadership role? Journal of Nursing Management, 11: pp. 229-233.

Jooste, K. (2004). Leadership: A new perspective. Journal of Nursing Management, 12: pp. 217-223.

Mahoney, J. (2001). Leadership skills for the 21st century. Journal of Nursing Management, 9: pp. 269-271.

Moiden, M. (2002). Evolution of leadership in nursing. Nursing Management, 9: pp. 20-25.

Moiden, M. (2003). A framework for leadership. Nursing Management, 13: pp. 19-23.

Outhwaite, S. (2003). The importance of leadership in the development of an integrated team. Journal of Nursing Management, 11: pp.371-376.

Rycroft-Malone, J., Harvey, G., Seers, K., Kitson, A., MCormack, B, and Titchen, A. (2004). An exploration of the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing, 13: pp. 913-924.

Scott, L. and Caress, A-L. (2005). Shared governance and shared leadership: Meeting the challenges of implementation. Journal of Nursing Management, 13: pp. 4-12.

Leadership in Nursing


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