NURSING LEADERSHIP

BY-SANDEEP KAUR
 DEFINITION OF
LEADERSHIP
Leadership can be defined as a multifaceted
process of identifying a goal or target, motivating
other people to act, and providing support and
motivation to achieve mutually negotiated goals
(Porter-O’Grady, 2003).

Hersey and colleagues (2013) defined leadership

as a process of influencing the behaviour of either
an individual or a group, regardless of the reason,
in an effort to achieve a goals in a given situation.
 LEADERSHIP IN
NURSING
Leadership has been illustrated in the nursing literature as a difficult
and multifaceted process. It includes providing direction and
support, motivating, coordinating, collaboration, effective
communication, and advocating for patients to achieve optimal
patient outcomes. In nursing, leadership is showing the followers
how things are done, guiding their way, and the course of actions. (
Cook M,2001)

According to O’Connor , “effective communication is central to

leadership in clinical settings”. Nursing leadership has been defined
as influencing others to improve the quality of care along with the
direct participation in clinical care.
 NURSING CLINICAL
LEADERSHIP
Nursing clinical leadership skills focus on clients and healthcare teams
such as those advocating for patients, communicating with the healthcare
team, patients, and their families; compared to individuals reporting to and
working with a nurse in a formal leadership position. In fact, the nursing
profession is very autonomous where it requires nurses to make decisions
and take responsibility for their actions

According to Patrick et al., five characteristics define clinical leadership

skill as follows: clinical expertise, effective communication,
collaboration, coordination, and interpersonal understanding. Clinical
leaders are experts in their field, effective communicators, empowered
decision makers, clinically knowledgeable and competent, provide a
vision, support others, provide guidance to patients and their families, and
drive change by providing high‐quality care .
CHARACTERISTICS OF EFFECTIVE NURSE
A successful nurse clinical leader
LEADER
is one who is a critical thinker,
lifelong learner, and open to new
ideas.
The nurse clinical leader must be
knowledgeable, maintain
professional growth, and stay
current in the profession. In fact,
they should be clinically
competent and clinically
knowledgeable.
In addition, leaders must have a
vision, the art of knowing how to
elect the best from others. In
short, thriving leaders make
others do their best to accomplish
the intended outcome.
leadership skill. Knowing what needs to be done, being
proactive and approaching every patient with a confident
and competent attitude to improve patient outcomes.
Motivating people toward goal‐directed behaviour, which in
turn contributes to the interest of the organization is of
crucial importance.
The leader should be able to communicate clearly and
effectively.
Being a good listener is a valuable attribute as patients and
colleagues may talk to the nurse and ask for guidance.
Effective leaders use problem‐solving processes by being
solution‐focused to improve a situation.
The nurse clinical leaders should be empowered decision
makers utilizing evidence‐based research to make clinical
decisions.
SKILLS TO INTEGRATE
LEADERSHIP
An effective nurse clinical leader possesses self‐awareness, which means knowing
how to read one’s own feelings and how they can affect others. For example, if a
nurse is taking care of a patient in a paediatric unit and the mother expresses her
concerns that her child did not receive a standard treatment when the nurse had
already provided the treatment. The nurse may have mixed emotions such as
irritation or anger. In this situation, it is crucial that the nurse identifies these
emotions and considers how expressing them would influence the situation.
Successful nurse clinical leaders are highly motivated, committed to organizational
vision, mission, and goals, and thus deliver patient care with greater effectiveness .
A clinical nurse leader must be highly committed and focused on teamwork in order
to accomplish a common goal.
An effective nurse clinical leader must develop skills of collaboration, delegation,
and conflict resolution that will facilitate her/his work within teams.
Successful nurse clinical leaders are honest, trust worthy, and respectful.
 CONTD….
Time management is also an important skill that the nurse clinical leader should
posses in order to organize, plan, and prioritize daily tasks and responsibilities
that need to be accomplished for patients.
They are also dynamic, empathic, caring, and passionate about their patients’
needs and values.
Effective nurse clinical leaders have the ability to nurture, inspire others, seek
maximum standards, and maintain high‐quality benchmarks.
Nurse clinical leaders are an advocate for patients by providing and promoting the
best possible available care.
The effective nurse clinical leader will act as a liaison between patients and
healthcare teams in advocating for the rights and welfare of patients and by
emphasizing the importance of a safe health setting for providing care.
 LEADERSHIP
THEORIES
The great man theory states that leaders
are born not made.(syque,2006)

Trait theory assumes that leaders are born

with traits particularly suited to leadership.

Behavioural theory proponents assume

that leaders are made, not
born.(syque,2006).This leadership theory
focuses on the actions of leaders not on
intellectual qualities or internal states.
According to the behavioural theory, people
can learn to become leaders through training
and observation.

Situational theory proposes that leaders

choose the best course of action based upon
situational conditions or circumstances.
Different styles of leadership may be more
appropriate for different types of decision-
making.
Transactional theories, also known as management theories, focus
on the role of supervision, organization and group performance and the
exchanges that take place between leaders and followers. These
theories base leadership on a system of rewards and punishments
(Charry, 2012).

Relationship theories, also known as transformational theories, focus

on the connections formed between leaders and followers. In these
theories, leadership is the process by which a person engages with
others and is able to “create a connection” that results in increased
motivation and morality in both followers and leaders. (Charry, 2012).

Skills theory-This theory states that learned knowledge and acquired

skills/abilities are significant factors in the practice of effective
leadership.A strong belief in skills theory often demands that
considerable effort and resources be devoted to leadership training and
development (Wolinski, 2010).
 STYLES OF
LEADERSHIP
Lewin’s leadership styles-A group of psychologists
led by Lewin(1939) focused their theory on leadership
styles. They identified three leadership styles
autocratic, democratic, laissez-faire.

Autocratic leaders make decisions without consulting

anyone.Autocratic leadership sometimes happens in
health care situations when the administration decides
on a change without consulting nursing. Revolution
may not result, but low morale, bad feelings, and
undercover retaliation can occur.

Democratic leaders involve people in their decisions,

although they make the final decision. Participants in
settings that have a democratic leader may participate
being consulted, but they may be confused when
confronted by a wide range of opinions with no clear
way to reach a decision.

Laissez-faire leaders are minimally involved in

decision making. This type of leadership works best
when people are capable and motivated to decide and
are not hindered by a central coordinator .
Charismatic Leadership Style-Charismatic leadership
describes what to expect from both leaders and followers.
Charismatic leadership is a leadership style that is
identifiable but may be perceived with less tangibility than
other leadership styles (Bell, 2013).

Bureaucratic leaders follow rules rigorously, and ensure

that their staff also follow procedures precisely. This is an
appropriate leadership style for work involving serious
safety risks (such as working with machinery, with toxic
substances, or at dangerous heights) or where large
sums of money are involved. Bureaucratic leadership is
also useful in organizations where employees do routine
tasks (Shaefer, 2005).
 LEADERSHIP
SCENARIO
The setting of the current scenario is a long term care in the local area. At this long term centre, which
holds more than 175 beds, community centre administrators have devised a series of work policies
and protocols, one of the most important policies in the long term care, states that no member of the
staff is allowed to use their cell phones while on duty.

The charge nurse of my unit assumes a leadership role in this scenario. she is responsible for the
management of the all the RPNs, PSW and all other staff working at the same time. She told the all
the staff using cell phones means neglecting their duty and violating the shift policy as well. If the
nurses and other staff didn’t follow the rules means they are against the policy, patient safety would be
ignored and quality care would not be provided, that will lead to diminished patient satisfaction and
negative outcomes.
First, the charge nurse in the above scenario schedule an appropriate time and designate a private
room for a meeting with the nurses to reassure the nurses of the leader's respect and trust. At this
stage, she said it is crucial to mention that this is just a talk, similar to the process of story-telling rather
than a process of criticism. Second, when communicating with the nurses, the nurse manager
listened carefully to the nurse's thoughts, as it is imperative to recognize the nurse's needs and
concerns. Third, the nurse manager analyze all the aspects of this policy and she said in case of
emergency staff can use the landline phone for the patient needs.
The charge nurse in my unit has used transformational leadership theory in the above
scenario.The concept of transformational leadership was originally identified by
leadership expert James MacGregor Burns. According to Burns, transformational
leadership is a relationship between the leader and the follower in which they motivate
each other to higher levels, resulting in value system congruence between the leader
and the follower Moreover, they motivate their followers to adjust expectations, opinions,
and inspirations to work toward common goals. Additionally, he mentioned four
components in transformational leadership: ideal impact, strong motivation,
intellectual stimulation, and personal consideration.

Specifically, transformational leadership theory is focused on change. The leaders

who utilize this style are regarded as change agents who use their qualities and
personalities to motivate their followers to achieve their goals, to share their visions,
and to empower them. Transformational leaders influence followers by
encouraging and inspiring them to achieve organizational objectives.
THE IMPACT OF NURSING
CLINICAL LEADERSHIP
Nursing clinical leadership is crucial for various reasons. First, clinical nurse leaders play a
critical role in sustaining the efficient production, and cost effectiveness of nursing services.
Effective clinical leadership skills empower nurses while providing care with the abilities to
direct and support patients and healthcare teams . It also improves the care delivered to
patients, which in turn improves patient outcomes. In addition, clinical nursing leadership
impacts the safety and quality of care provided (Morris F,2012).

In their systematic review, Wong et al. found a relationship between nursing leadership
practices and patient outcomes.Their findings indicated that effective leadership has been
associated to reduced length of stay, lowering rates of medication errors, patient falls, urinary
tract infections, and pneumonia. Additionally, the nursing literature proposes that clinical
leadership improves the quality of care provided, patient outcomes, and lower patient
mortality. Nurses who possess clinical leadership skills influence the clinical setting and
improve patient safety. Thus, it can be said that clinical leadership serves to achieve safe
care and optimal patient outcomes, which emphasizes its importance.
 MY FUTURE
LEADERSHIP GOALS
I have learnt from my charge nurse that first, leaders must build a
connection of trust with their followers. This connection of trust can
be established by being open, fair, and honest with the staff and by
motivating them to be independent in their decision-making.
Second, leaders must use effective communication to lead the staff
to achieve ultimate goals. Furthermore, leaders should possess
great self-confidence, firmly believe in their vision and have the
courage to achieve their goals.
 CONCLUSION
Leadership takes practice. Leadership is not a role that is practiced once
and then mastered.Transformational leaders, for example, inspire others
with their vision and collaborate with their team to identify common values.
Participative leadership is a managerial style that invites input from
employees on all organizational decisions. Transactional leadership is based
on contingent rewards and can have a positive effect on followers'
satisfaction and performance. Two other leadership styles often used in
nursing practice are situational leadership and autocratic leadership.
Different leadership theories should be combined in clinical application in
current complex organizations.
Still, the development of leadership skills is an ongoing journey that begins
with knowing and understanding oneself.Nurse leaders encounter many
different situations every day, and no particular leadership style is suitable
for all situations. Nurse leaders should therefore be flexible in their
leadership styles and tailor them accordingly.Applying different leadership
styles to different situations seems to be most effective, and thus each
leader must know when to exhibit a particular approach to achieve the
organization's goals.
 REFERENCES
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Hersey,P.,& Blanchard, K.H., Johnson, D.E.(2008). Management of organizational behaviour: Leading human
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Syque.(2006). Leadership theories. Retrieved November 3,2018, from

http://changingminds.org/disciplines/leadership/theories/trait_theory.htm

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