leadership and management essay nursing

June 1, 2024 . By Kepher

Nursing Leadership Essay: Engaging Examples and Tips for Powerful Essays

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The world of nursing is a complex and demanding one. Beyond the technical skills required to care for patients, successful nurses possess a unique blend of compassion, resilience, and leadership qualities. These qualities become even more crucial as nurses ascend the ranks and take on leadership roles. Writing a nursing leadership essay is a valuable exercise that allows you to reflect on your own leadership journey and articulate your vision for the future.

This essay delves into the intricacies of crafting a compelling nursing leadership essay by providing insightful examples and practical tips. From understanding the core elements to crafting an engaging narrative, this guide will give you the tools to showcase your leadership potential and stand out in the competitive field of nursing.

Understanding the Essence: Core Elements of a Nursing Leadership Essay

A successful nursing leadership essay goes beyond merely outlining leadership skills. It dives deep into your personal experiences, showcasing how you embody specific leadership qualities and how these qualities translate into tangible impact. The foundation of a compelling essay rests on the following core elements:

1. Defining Your Leadership Style:

Every leader possesses a unique approach. Identifying your leadership style is crucial for a compelling nursing leadership essay. Are you a transformational leader who inspires change and fosters a vision? Or perhaps a servant leader who prioritizes the needs of others and empowers team members?

• “My leadership style is rooted in collaboration and empathy. I believe in fostering a sense of shared purpose among my team members, empowering them to take ownership of their roles and contribute to a positive patient experience.”

2. Illustrating Your Leadership Journey:

This section is where you bring your leadership experiences to life. Choose impactful scenarios that demonstrate your abilities. Use the STAR method (Situation, Task, Action, Result) to narrate these experiences effectively.

• Situation: “During a challenging shift with a surge in patient admissions, I noticed a sense of overwhelm among the staff.”
• Task: “I took the initiative to assess the situation and prioritize urgent tasks.”
• Action: “I delegated tasks strategically, ensuring efficient use of resources and maintaining patient safety.”
• Result: “Through effective communication and delegation, we were able to manage the influx of patients effectively, minimizing stress on the team and ensuring high-quality care.”

3. Demonstrating Impact:

Leadership is not just about skills; it’s about making a difference. Connect your leadership experiences to tangible outcomes.

• “By implementing a new protocol for patient education, I witnessed a significant increase in patient satisfaction scores and improved adherence to treatment plans.”

4. Reflecting on Your Growth:

Highlight your commitment to continuous learning and professional development. Mention specific courses, certifications, or mentorship experiences that have honed your leadership skills.

• “I am currently pursuing a Master’s degree in Nursing Administration to expand my knowledge base and develop advanced leadership skills.”

Crafting a Winning Narrative: Tips for a Standout Nursing Leadership Essay

Now that you understand the key elements, it’s time to craft a captivating narrative that showcases your leadership potential. Here are some valuable tips:

1. Start Strong with a Hook:

Grab the reader’s attention right from the start. Use a compelling anecdote, a thought-provoking question, or a powerful statement that sets the stage for your essay.

• “The call to nursing is not just about dispensing medication or monitoring vital signs; it’s about providing unwavering support and compassion to those in their most vulnerable moments.”

2. Weave a Consistent Theme:

Ensure your chosen examples and reflections all tie back to the central theme of your nursing leadership essay. A cohesive narrative will leave a lasting impression on the reader.

3. Stay Concise and Focused:

Avoid unnecessary details or tangents. Every sentence should contribute to your overall message.

4. Use Vivid Language:

Engage the reader with descriptive language that brings your experiences to life. Show, don’t tell, by using evocative imagery and specific examples.

5. Edit and Proofread Rigorously:

A well-written essay free from grammatical errors and typos demonstrates professionalism and attention to detail.

6. Seek Feedback from Mentors:

Before submitting your essay, ask trusted mentors or professors to review your work and offer constructive feedback.

Nursing Leadership Essay Examples: Inspiration from Leaders

To further inspire your own writing, here are some examples of how different leadership styles and experiences can be effectively conveyed in a nursing leadership essay:

Example 1: The Transformational Leader

• Theme: Empowering a team to achieve a shared vision.
• Experience: Implementing a new patient care model that prioritized patient-centered care and increased staff satisfaction.
• Impact: Improved patient outcomes and reduced staff burnout.

Example 2: The Servant Leader

• Theme: Prioritizing the needs of others and fostering a collaborative environment.
• Experience: Mentoring a new nurse during a challenging patient care situation.
• Impact: Enhanced the new nurse’s confidence and contributed to positive patient outcomes.

Example 3: The Visionary Leader

• Theme: Identifying future trends and implementing innovative solutions.
• Experience: Researching and implementing a new technology that streamlined patient care and improved efficiency.
• Impact: Enhanced patient safety and improved staff workflow.

Reputable academic writing websites like Nursing Papers provide well-articulated scholarly article samples that you can also refer to for more inspiration. The platform offers nursing essays, research papers and case studies that can be quite resourceful in writing your own papers.

Common Mistakes in Writing Nursing Leadership Essays

Writing a compelling nursing leadership essay can be challenging. It requires a strong understanding of leadership principles, clear communication, and a focused narrative. Here are some common mistakes to avoid:

• Lack of a Clear Thesis Statement: A strong nursing leadership essay needs a clear and concise thesis statement that outlines the main argument. Avoid vague or generic statements and be specific about your leadership philosophy and its implications.
• Focusing Solely on Personal Experiences: While personal experiences can be valuable, relying solely on anecdotes without theoretical backing weakens the essay. Your nursing leadership essay should demonstrate your understanding of leadership theories and principles, using your experiences as illustrative examples.
• Ignoring the Audience: Remember your nursing leadership essay is for a specific audience, often an admissions committee. Tailor your language and content to address their expectations and the specific requirements of the essay prompt.
• Failing to Proofread Carefully: Typos, grammatical errors, and unclear writing can undermine the credibility of your nursing leadership essay. Take the time to proofread carefully and consider having a trusted friend or colleague review your work.
• Not Demonstrating Impact: A strong nursing leadership essay goes beyond simply describing leadership skills; it demonstrates how these skills have positively impacted others and contributed to the nursing profession.

By avoiding these common mistakes, you can craft a compelling nursing leadership essay that highlights your leadership potential and showcases your passion for the nursing profession. Remember, clarity, focus, and impactful storytelling are key to making your nursing leadership essay stand out.

Types of Nursing Leadership Essays

Nursing is a profession that demands strong leadership skills. From guiding patients and their families through challenging health journeys to leading teams of healthcare professionals, nurses are constantly demonstrating leadership in various ways. This diverse nature of nursing leadership lends itself to many types of essays, allowing students and professionals to explore different aspects of the field. Here are some common types of nursing leadership essays:

1. Personal Leadership Philosophy: These essays delve into an individual’s personal values, beliefs, and approaches to leadership. They often discuss the core principles that guide their actions and decision-making as a nurse leader.

2. Case Study Analysis: These essays involve analyzing a specific situation or case study related to nursing leadership. They can focus on a particular leadership challenge, a successful leadership initiative, or an ethical dilemma encountered by a nurse leader.

3. Leadership Theory Application: These essays explore how different leadership theories and models can be applied in real-world nursing practice. Students might analyze the strengths and weaknesses of various approaches and discuss their preferred leadership style based on specific contexts.

4. Transformational Leadership in Nursing: This type of essay focuses on the importance of transformational leadership in fostering positive change within the healthcare system. It might delve into strategies for motivating staff, promoting innovation, and improving patient care.

5. Ethical Dilemmas and Leadership: These essays examine ethical challenges faced by nurse leaders and explore how they can be addressed. They might discuss navigating conflict of interest, advocating for patient rights, or promoting ethical decision-making within a healthcare team.

6. Future of Nursing Leadership: This type of essay explores the evolving landscape of nursing leadership. It might discuss emerging trends, challenges, and opportunities for nurse leaders in the future. It can also consider the impact of technological advancements and changing healthcare systems on leadership practices.

7. The Role of Nurses in Advocacy: This essay explores how nurses can advocate for their patients, their profession, and the healthcare system as a whole. It highlights the importance of nurse leaders in advocating for policy changes, resource allocation, and improved patient outcomes.

These are just a few examples of the many types of nursing leadership essays that can be explored. Each type offers a unique opportunity to engage in critical thinking, reflection, and analysis of leadership principles in the context of nursing practice.

By exploring different aspects of nursing leadership essays, students and professionals can deepen their understanding of leadership concepts, hone their writing skills, and contribute valuable insights to the field. Regardless of the specific type, nursing leadership essays play a critical role in advancing the profession and fostering a more effective and compassionate healthcare system.

An engaging nursing leadership essay is a powerful tool for showcasing your commitment to professional development and your vision for the future of nursing. By understanding the core elements, crafting a compelling narrative, and seeking feedback, you can create an essay that leaves a lasting impression and helps you advance on your path to nursing leadership.

Remember, the essence of leadership lies in serving others and making a positive impact. Through your essay, let your passion for nursing shine through, demonstrating your ability to inspire, guide, and lead with compassion and integrity.

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Nursing Leadership and Management

Nursing leadership and management essay examples like this one will help you write your own excellent leadership in nursing essay. We recommend it to student nurses and other healthcare workers.

Leadership in Nursing Essay Introduction

• Continuous Quality Improvement & Patient Satisfaction
• Nurse Leaders & Managers: Comparison of Perception

Personal Position and Rationale

In the past, nursing was an amorphous and unrecognized engagement that was often left at the discretion of close family members and relatives of patients. However, after the efforts of Florence Nightingale, it was recognized as a fully-fledged profession and was integrated into the healthcare system. As the profession grew in stature, concepts such as nurse leadership and nurse management emerged. A layperson may use the two concepts are interchangeable. However, within the healthcare context, these two concepts have some key differences that set them apart. This essay explores the similarities and differences between leadership and management in the nursing profession. It specifically focuses on how nurse leaders and managers perceive continuous quality improvement and patient satisfaction.

Continuous Quality Improvement & Patient Satisfaction

The quality of healthcare is a core concern of governments across the world. According to Heyrani et al. (2012), the concept of quality in the healthcare system is multifaceted. It entails resource management, personnel management, patient satisfaction, efficiency enhancement, and safety promotion, among other elements. Until recently, healthcare organizations underscored the importance of some of these elements and ignored others. This trend culminated in poorly performing healthcare systems that prompted the development of a comprehensive framework that incorporates all the tenets of quality in the healthcare system. The framework was named clinical governance. It requires every healthcare organization to commit itself to continuous quality improvement and accountability. Therefore, patient satisfaction is at the heart of this framework.

Nurse Leaders & Managers: Comparison of Perception

Stanley (2006) describes nurse leaders as individuals, who do not necessarily have delegated authority but empower, motivate, inspire, and influence their colleagues. A nurse manager, on the other hand, is an individual who is formally appointed to oversee the operations of a healthcare organization or a section within the organization (Swansburg, 2002). Essentially, the nurse manager plays a conventional managerial role, but in a healthcare context. Both leaders exhibit the following similarities in their perception of continuous quality improvement and patient satisfaction.

Firstly, both of them think on a long-term basis (Swansburg, 2002). In their leadership positions, both nurse leaders and managers think beyond the horizon because the nurses in their teams look unto them for direction and motivation. Their ability to think beyond the present makes them indispensable to the healthcare system, especially considering the fact that continuous improvement of quality in the healthcare system requires people who can envisage future trends and steer nurses towards the right direction. Without this kind of leadership, the nursing profession would not cope with the fast-changing quality standards in the healthcare system.

Secondly, both nurse leaders and managers look beyond their units to understand the relationships that exist between their units and the immediate external environment (Swansburg, 2002). For instance, within a healthcare organization, both nurse leaders and managers have a clear understanding of how their units affect or are affected by other departments. This knowledge helps them to provide leadership that enables their units to contribute positively to the objectives of the organization. This type of thinking is pertinent to the continuous improvement of quality and patient satisfaction because it is not possible to improve quality by simply focusing on one unit within a system (Heyrani et al., 2012). Rather, the head of each unit should clearly understand the role their unit plays in the quality improvement process and then lead it to discharge that role effectively.

Thirdly, nurse leaders, and managers both have the political skill to contain the conflicting requirements of the multiple constituencies that exist within the healthcare system (Swansburg, 2002). While every well-meaning nurse might want to make the health care system better, balancing the conflicts that occur between the different elements that constitute it often prove impossible. However, nurse leaders and managers demonstrate courage without necessarily being reckless as well as caution without being considered cowards (Coonan, 2007). This skill is closely tied to their ability to think beyond the present and to know what to do in any given circumstance. It helps them to show courage and determination when necessary and takes well-timed precautionary steps when certain measures prove to be counterproductive. This ability is invaluable to the continuous quality improvement process and patient satisfaction because they do require not only bold people but also diligent individuals who can detect and alter counterproductive measures (Kerridge, 2012).

Having examined some of the key similarities between nurse leaders and managers, it is important to note that they also exhibit some notable differences as discussed below. The first key difference between nurse leaders and managers is that while the leaders are concerned with affirming the values that are consistent with the nursing profession and challenging those that are not, nurse managers focus on upholding established organizational values (Coonan, 2007). Consequently, in circumstances where organizational values are inconsistent with the situation on the ground, the nurse leader can make the necessary adjustment as opposed to the nurse manager. Therefore, a nurse leader is in a better position to move with changing trends. This attribute places them in a position of advantage insofar as continuous quality improvement and patient satisfaction are concerned.

The second major difference is that the nurse leader is in a better position to achieve workable unity among nurses as opposed to the nurse manager (Coonan, 2007). The nurse leader banks on earned trust to build cohesion and mutual tolerance while simultaneously controlling emergent conflicts. The nurse manager, on the other hand, strictly focuses on ensuring that the assigned duties are discharged as required. Unity, cohesion, and trust may not be of much importance to a nurse manager as long as there is obedience. Consequently, the nurse leader is in a better position to facilitate continuous quality improvement and patient satisfaction than a nurse manager due to a better understanding of what goes on among unit members.

Several other instances of differences between the two categories of nurse leadership exist, but the two discussed examples will suffice for this essay. A point worth noting, however, is that after examining these similarities and differences, it becomes apparent that each of the leadership approaches has its merits and demerits insofar as continuous quality improvement and patient satisfaction are concerned. However, although nurse leaders lack delegated authority, their style of leadership is preferable. They are in a position to achieve their agenda without formal authority. This ability is advantageous because Stanley (2006) asserts that people prefer to be led rather than to be managed. Consequently, they may resist and resent the nurse manager, especially when the manager is high-handed. Therefore, as a nurse leader, it is possible to bring positive change to the nursing profession in a shorter time compared to a nurse manager as long as bureaucracy does not stand in the way.

In conclusion, leadership is necessary for every setting that calls for the combined effort of many people. It is even more important for the nursing profession because nurses have become indispensable to the healthcare system, and leadership ensures that they remain committed to providing quality, safe, and reliable care. As such, the best leadership approach should be adopted when leading nurses.

Coonan, P. R. (2007). A Practical Guide to Leadership Development: Skills for Nurse Managers . Danvers, MA: HCPro Incorporated.

Heyrani, A., Maleki, M., Marnani, A. B., Ravaghi, H., Sedaghat, M., Jabbari, M., & Abdi, Z. (2012). Clinical governance implementation in a selected teaching emergency department: A systems approach. Implementation Science , 7 (1), 84.

Kerridge, J. (2012). Why management skills are a priority for nurses. Nursing Times , 109 (9), 16-17.

Stanley, D. (2006). Role conflict: leaders and managers. Nursing Management, 13 (5), 31-37.

Swansburg, R. J. (2002). Introduction to management and leadership for nurse managers (1st ed.). Sudbury, MA: Jones and Bartlett Publishers.

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Leadership in Nursing: Qualities & Why It Matters

4 min read • May, 19 2023

Strong leaders in nursing are vital to help navigate the constant evolution of health care. Nurse leaders do more than balance costs, monitor productivity, and maintain patient and staff satisfaction. They serve as role models and influence health care organizations at all levels. A strong nurse leader motivates their colleagues, setting the tone for a safe, civil workplace with a culture of high morale and job retention.

What Is a Nurse Leader?

A nurse leader is defined by their actions, and not always by a position of authority. Leaders in nursing inspire and influence others to achieve their maximum potential. They use applied leadership in nursing by drawing upon critical thinking skills to manage a team.

Nurse leaders take a broad view of how daily tasks impact the overall goals of the health care organization. They communicate expectations to their team and motivate them to achieve predetermined goals. Nurses can lead from various organizational areas if they project the necessary leadership qualities to influence others.

Leadership Qualities in Nursing

A  nurse leader role combines essential nursing, business, and leadership skills developed through ongoing learning . They must be flexible enough to adapt to technological changes, fluctuating payment methods, new treatment modalities, and regulatory and legislative environments. Critical skills for effective nursing leadership include:

• Communication and Collaboration : These skills can reduce miscommunication, encourage shared decision making, and provide a sense of working together toward common goals.
• Education and Quality of Practice :  Continued professional development  allows leaders in nursing to keep pace with the ever-changing health care environment while striving for excellence by supporting quality, evidence-based practice.
• Environmental Health and Resource Utilization : Leadership in nursing ensures that patient care can be provided effectively in a  safe and healthy environment  while promoting wellness among all health care staff.
• Ethics and Professional Practice Evaluation : Influential nurse leaders model ethical practices to guide decisions, display honesty by being accountable for their actions, and evaluate their adherence to professional practice standards.  Learn more about the Code of Ethics for Nurses .
• Professionalism and Leadership : Leaders in nursing build vital relationships and collaborate with various health care teams on sensitive topics. Using critical thinking skills allows those in nursing leadership roles to analyze decisions impacting the organization. They then clearly explain the rationale in a manner that encourages staff support.

Other nursing leadership skills, such as displaying compassion and empathy, can assist the nurse leader in developing interpersonal relationships and gaining respect in their role.

7 Leadership Styles in Nursing

Nursing  leadership styles can impact job satisfaction ,  nurse retention rates , quality of care, and  patient outcomes . The nurse’s educational background, personality, and work environment may influence their nursing leadership style. Each type of nurse leader role can be valuable when utilized in the right setting.

• The Transformational  nurse leader works to inspire nurses to achieve a greater vision by helping with strength development. This nursing leadership style works well with mentoring.
• The Autocratic  nurse leader makes quick decisions with little input from employees and excels at task delegation. This nursing leadership style may be most effective in an emergency.
• A Laissez-faire  leadership style puts faith in every facet of a well-oiled machine. This method may work well with experienced teams or self-directed nurses.
• The Democratic  nurse leader is collaborative and focuses on team success. This nurse leader might excel in quality improvement roles but may not be effective in situations requiring independent decisions.
• The Servant  nurse leadership style focuses on employee development and individual needs. This method works well with goal-driven environments or as a nurse educator.
• The Situational  leadership style is the most adaptable since it analyzes the situation and determines the appropriate approach. This nurse leader is flexible enough to modify their approach based on the organization or individual’s needs. This style works well with nursing students but may divert from the organization’s long-term goals.
• The Transactional  nurse leader does well with short-term goals by focusing on efficiency and performance. This task-oriented style reduces errors and works well with tight deadlines.

Examples of Leadership in Nursing

Projecting leadership skills in nursing that influences others can allow a nurse to lead without being assigned a specific leadership position. The aspiring nurse leader might:

• Seek out a mentor or become one
• Volunteer for committee roles
• Become involved in the community
• Take educational courses
• Stay current on the latest health care trends
• Get involved with public policy

A nurse aspiring for a nursing leadership role can get a certification or obtain additional degrees specific to nursing leadership to increase their knowledge base and expand upon professional development. But a title and the education aren’t enough to create an effective leader. Nurses and other health care staff need to believe their contributions make a difference in the organization.

Why Is Nurse Leadership Important?

Nurse leaders make a difference in workplace culture and drive positive changes in health care legislation. When a team admires the qualities of their leader, it boosts morale and promotes a psychologically safe workplace, which leads to higher job satisfaction and retention rates. Influential leaders in nursing ensure that the organization's vision is communicated to the nursing staff while  mentoring the nursing leadership of tomorrow .

Explore courses, webinars, and  other nursing leadership and excellence resources offered by ANA .

Images sourced from Getty Images

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How leadership matters

Clinical nurses' perceptions of leader behaviors affecting their work environment.

Raso, Rosanne DNP, RN, NEA-BC, FAAN, FAONL; Fitzpatrick, Joyce PhD, MBA, RN, FAAN, FNAP

Rosanne Raso is the editor-in-chief of Nursing Management and the vice president and CNO at NewYork-Presbyterian/Weill Cornell in New York, N.Y. Joyce Fitzpatrick is the director of the Marian K. Shaughnessy Nurse Leadership Academy and Elizabeth Brooks Ford professor of nursing at Case Western Reserve University Frances Payne Bolton School of Nursing in Cleveland, Ohio.

The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

For 131 additional nursing continuing professional development articles related to management topics, go to NursingCenter.com/CE .

What should nurse leaders do to ensure a healthy work environment? This article presents positive and negative leader attributes in the words of clinical nurses and actions you can take to boost your relational leadership competencies.

What should nurse managers and leaders do to ensure a healthy work environment for clinical nurses? What we know is that relational styles of leadership have been studied in nursing for years and are consistently associated with positive workforce outcomes. 1,2 Relational leadership is built on solid relationships with direct reports and individuals from other disciplines, as its name implies. This type of leadership is positive, particularly in nurturing employee engagement and healthy work environments. Mastering the skills of interpersonal engagement and creating trust and influence through connections are hallmarks of great nurse leaders. 3 Yet, even though there's considerable support for relational leadership, there are still gaps in the implementation of programs to develop nurse leaders. Developmental programs for nurse managers often focus on the management skills needed, such as finances, budgeting, and resource allocation and procurement, creating a significant gap in preparation related to the development of relational leadership competencies.

From a qualitative perspective, we were interested in determining what clinical nurses describe as positive and negative leadership behaviors that affect their work environment. In this article, we present our findings in the words of clinical nurses, along with implications for nurse leaders seeking to understand the impact of clinical nurses' perceptions of their supervisors' actions, especially their relational leadership competencies.

Relational leadership is based on positive psychology, which focuses on helping people find meaning and purpose, live meaningful lives, and search for personal strength and value. 4 Therefore, relational leadership is grounded in optimism, integrity, positive emotions, and employee growth and development. The link to nursing leadership is obvious—ethics, positive change, purpose, growth, and social connection are all part of who we are as nurses and nurse leaders.

The most common relational leadership styles are transformational, authentic, and servant. All three leadership styles have connections to healthy work environments and staff engagement, which, in turn, provide the foundation for positive workforce and patient outcomes. 5,6 (See Figure 1 .) To add empirical support to these connections, we previously conducted two research studies on authentic nurse leadership and its relationship with a healthy work environment, expecting a positive relationship. In both studies, we found a significant positive relationship, providing empirical evidence that authentic nurse leadership is a standard for a healthy work environment. 7,8

We used Giordano-Mulligan and Eckhart's authentic nurse leadership model in our studies. This model has three main domains with five subcomponents or attributes: personal integrity to include moral-ethical courage and self-awareness, transparency to include relationship integrality and shared decision-making, and altruism to include caring. 9 These attributes were found to be important for nurse engagement. Caring was identified as an integral attribute that nurses seek in their leaders, which makes this one of the first nursing leadership models with caring science embedded in the practice. 10 (See Table 1 .)

We also used the American Association of Critical-Care Nurses' (AACN) healthy work environment model, which is evidence-based and relationship-centered and includes six standards: skilled communication, true collaboration, effective decision-making, authentic leadership, meaningful recognition, and appropriate staffing. All six elements are considered essential, meaning that missing any one of them won't result in a sustainable healthy work environment. 11 (See Figure 2 .)

This study received Institutional Review Board approval. Participants were recruited at the 2019 American Nurses Credentialing Center National Magnet ® Conference. Two open-ended questions were asked after quantitative and demographic questions in an anonymous survey:

• How does your manager positively affect your work environment?
• How does your manager negatively affect your environment?

What did clinical nurses say?

Four-hundred and fifty-six open-ended comments were collected, split between positive (n = 245) and negative (n = 211) from a final sample of 254 clinical nurses. Eighty of the “negative” comments were either blank or positive rather than negative. Most respondents practiced in critical/progressive care (27%) and adult medical-surgical (26%) areas on the day shift (77%). The responses revealed behaviors that clinical nurses valued and criticized in their managers, which trended into several categories.

For positive comments, the top trends were related to relational skills, such as communication, positivity, and approachability (n = 87); caring and professional growth (n = 68); visibility (n = 57); and advocacy (n = 10), aligning with both authentic nurse leadership attributes and healthy work environment standards. There were 10 comments about flexible scheduling. (See Table 2 .)

In the words of clinical nurses, positive leadership attributes included:

• “By inspiring me to be my best.”
• “When I see her, she's supportive and responsive to my concerns. She has asked me to be a part of various committees to further my career development.”
• “She's very approachable and is an active listener.”
• “She's concerned for my well-being as a person.”
• “She's very involved in encouraging advancement and uplifting her staff.”
• “Listens and takes suggestions/concerns seriously.”
• “She uses open communication at all times in all situations.”
• “Sends out a bulletin every Friday that's helpful for keeping up with nursing news and hospital updates.”
• “She fights for us on a daily basis.”

For negative comments, the top trends were lack of presence and caring (n = 28), lack of follow-through and open-mindedness (n = 18), lack of visibility/unapproachable (n = 16), and inadequate communication (n = 11). There were seven negative comments about staffing and scheduling. (See Table 3 .)

In the words of clinical nurses, negative leadership attributes included:

• “The overall feeling on our unit is that our managers need to communicate more effectively.”
• “She isn't always approachable and cares about budget more than staff wellness.”
• “She doesn't always notice work I've done.”
• “The manager focuses only on problems.”
• “Night shift workers are unfortunately neglected.”
• “She's judgmental. Has a hard time taking our opinion into consideration. She makes decisions without consulting us.”
• “Doesn't have confidence in self and, therefore, doesn't instill confidence in staff.”
• “Is too scattered, starts many things without finishing. Lacks follow-through and accountability.”

These qualitative results with a vast majority of positive comments aren't surprising considering our previous empirical findings that both authentic nurse leadership and healthy work environments were present in the national prepandemic sample of clinical nurses. In the second, midpandemic study in the summer of 2020, we also found that authentic nurse leadership was present in a much larger sample, signaling that nurse leaders throughout the country demonstrate authentic attributes as noted by their direct reports, even in a crisis. 8 Finding many more positive comments than negative points to the same conclusion about the overarching presence of sound nursing leadership.

Because the top positive trends were related to communication skills, caring, professional growth, and visibility, we understand what aspects of leadership are important to clinical nurses. It isn't their leaders' nursing acumen or clinical skills, although being able to help was mentioned several times. It isn't a perfect schedule or staffing, although flexible scheduling was brought up, albeit infrequently. Rather, it's about the alignment of relational competencies, authentic nurse leadership attributes, and healthy work environment standards. Clinical nurses want to be heard, receive honest information, be supported by a visible leader, grow, and be recognized. Values-driven leadership, shown in the comments on advocacy and “fighting” for staff, is integral for the authentic nurse leadership attribute of moral-ethical courage. We believe that nurse managers aspire to be this type of leader.

The negative behavior trends were consistently the opposite of the positive ones. Lack of presence, communication, recognition, follow-through, and collaborative decision-making are noticed and can contribute to disengagement. Staffing and scheduling were only occasionally mentioned, which was surprising considering there wasn't agreement that appropriate staffing was present in the rating of healthy work environment standards. Perhaps clinical nurses consider staffing to be out of the scope of the frontline manager and more of an organizational issue.

The attribute of caring in the authentic nurse leadership model, with its concomitant depiction as nurturing, compassionate, kind, and personally interested, was frequently mentioned and important to clinical nurses, further supporting this relatively new framework for nursing leadership. This attribute isn't specifically included in the healthy work environment standards, although the standard of meaningful recognition certainly includes professional growth and feeling valued for your contributions.

Implications for nurse managers

The link between relational leadership and nursing values, such as ethical practice, positive change, purpose, growth, and interpersonal connections, was evident in our findings, as was the association with healthy work environments and staff engagement—the foundation for positive patient outcomes. Nurse leaders must remove the barriers to relational, authentic, and visible leadership. Covering two geographically separate units, being inundated with meetings and tasks, or not having a frontline leader at all impacts clinical nurses' perceptions of leadership support. Making this case to senior leaders is imperative when decisions are being made about frontline leaders' scope and responsibilities.

Effective communication and meaningful recognition are practices we can all do, and structures are needed to support them. Regarding communication, you must get information first, which may be challenging, and share it in as many formal and informal ways as you can (verbal, written, posted, emailed, cascaded), with night supervisors on the same page. Shared governance structures can be effective not only for decision-making, but also communication. 12 If you think you've communicated enough, do it again. As a human resource colleague often implores, get the message out seven times in seven different ways.

Recognition is the same—there's never enough. Do you get tired of being recognized for your value? Of course not. Structured mechanisms include daily shout-outs, bulletin boards, “random acts of kindness” programs, DAISY awards, employee of the week/month, Nurses Week activities, thank-you cards, leader rounds, and numerous other ideas. Leaders must make recognition as important as any other responsibility in the job description. 13

Our obligation to teach and learn relational behaviors, authentic nurse leadership attributes, and healthy work environment standards and how to build and demonstrate them is another implication. Effective leadership development occurs through experiential learning, as well as didactic mechanisms. 14 This applies to aspiring leaders, clinical leaders, and formal leaders.

Leadership matters

Our clinical nurses have spoken. The importance of relational competencies, caring behaviors, and visibility is evident. Relational leadership is even more critical as we continue to be challenged through our second year of the pandemic. This type of leadership alone isn't enough to create a healthy work environment for clinical nurses; nevertheless, it's required. We're all obligated to be present and lead with integrity, caring, and transparency. Leadership matters.

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Home — Essay Samples — Life — Nurse — Importance of Leadership in Nursing: Styles and Impact

Importance of Leadership in Nursing: Styles and Impact

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Published: Sep 12, 2023

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Leadership styles in nursing, adapting leadership styles, impact of effective nurse leadership, elevating nursing values.

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Impact of Nurse Leaders Behaviors on Nursing Staff Performance: A Systematic Review of Literature

Nourah alsadaan.

1 Jouf University, Sakaka, Saudi Arabia

Basma Salameh

2 Arab American University, Jenin, Palestine

Fadia Ahmed Abdelkader Elsaid Reshia

3 Mansoura University, Mansoura, Egypt

Reem F. Alruwaili

Majed alruwaili, shaimaa ahmed awad ali, abeer nuwayfi alruwaili, gehan refat hefnawy, maha suwailem s. alshammari, afrah ghazi rumayh alrumayh, alya olayan alruwaili, linda katherine jones.

4 Charles Sturt University, Wagga Wagga, NSW, Australia

Nursing leadership is critical in facilitating and improving nurse performance, which is essential for providing quality care and ensuring patient safety. The aim of this study is to explore the relationship between nursing leadership and nurse performance by understanding the leadership behaviors and factors that motivate nurses to perform well. To study the factors that nurses believe motivate them to perform better, a systematic review was undertaken, correlating these factors to leadership behaviors/styles. The PRISMA guidelines were followed to identify relevant articles. After applying the selection criteria, 11 articles were included in the final analysis. Overall, 51 elements that influence nurses’ motivation to perform better were found and categorized into 6 categories, including autonomy, competencies, relatedness, individual nursing characteristics, relationships and support, and leadership styles/practices. It has been discovered that both direct and indirect nursing leadership behaviors affect nurses’ performance. A better understanding of the factors that motivate nurses to perform well and facilitating them in the work environment through leadership behaviors/styles can improve nurses’ performance. There is a need to increase research on nurse leadership and nurses’ performance in the current innovative and technologically integrated work environment to identify new factors of influence.

• What do we already know about this topic?
• Effective leadership in nursing can have a positive impact on nurse performance, job satisfaction, and patient outcomes.
• How does your research contribute to the field?
• It can provide new insights and understanding of how different leadership styles and practices impact nurse performance and patient outcomes
• What are your research’s implications toward theory, practice, or policy?
• To identify effective leadership practices that promote positive work environments, better nurse performance, and ultimately better patient outcomes, thus leading to improved patient contentment, safety, and care quality.

Introduction

Nurses are essential resources in hospitals as they spend more time with patients than any other healthcare personnel. Therefore, they play a significant role in ensuring quality care and patients’ safety by improving their performance. Despite accounting for 50% of the global healthcare workforce, 1 there is a severe shortage of nursing personnel in almost all countries. Developed countries such as the USA need an additional 275 000 nurses from 2020 to 2030. 2 According to the International Council of Nurses, there is a need for 13 million nurses globally to fill the shortage gap in the future. 3

The shortage of nurses has resulted in an increasing workload for existing nurses, significantly affecting their work life and performance, which can have a direct impact on the quality of care delivered. 4 Nursing performance is influenced by cognitive, physical, and organizational factors. 5 Various factors such as high workloads, lack of technological support, 6 skills and competencies (eg, problem-solving ability, nursing informatics competencies), 7 communication skills and confidence, 8 commitment, 9 quality of work life, 10 job stress, 11 and motivation 12 can significantly influence nursing performance. It is interesting to observe that most of these factors are a part of leadership management, focusing on providing training and support and addressing the issues affecting nurses.

Quality leadership was identified to be one of the major factors for promoting behaviors among the nurses for exhibiting greater responsibility and physical activity. 13 Similarly, workplace incivility from supervisors was identified to be negatively related to nursing performance. 14 Nursing leadership behaviors play a crucial role in shaping nursing performance, thereby achieving the organizational goals of ensuring the delivery of quality care and achieving better patient outcomes. 15 - 17 Considering the nursing leadership theories, transformational and transactional leadership styles 18 , 19 and their impact on nurses’ satisfaction, burnout, and resilience have received lot of attention. 17 , 18 , 20 However, most of the studies investigated the leadership styles influence on the factors affecting the nursing performance, but very few studies have focused on the leadership factors influencing the nurses’ motivation to perform well. An attempt in this aspect was made in a study 21 through the systematic review, but it only included studies till 2006. However, major changes have been observed in the factors influencing nursing performance in the past decade. The use of the internet and telecommunication technologies have significantly changed the quality of work of nurses, and led to the new forms of remote practices such as telenursing. 22 Furthermore, advanced innovative technologies such as artificial intelligence, intelligent systems such as IoTs 23 , 24 have significantly contributed to the nursing practice. 25 , 26 Additionally, due to the sudden surge of patients caused by the recent Covid-19 pandemic, nurses have experienced heightened levels of burnout, 27 which has significantly affected nurses work-life balance and their performance. 28 , 29 Furthermore, the COVID-19 pandemic has rendered the nursing shortage a critical issue on a global scale, according to the ICN study report 2023. 30 There are issues including understaffing and low job satisfaction, as well as an aging nursing workforce and a lack of young individuals entering the profession. The report highlighted that nurses’ shortage has grown significantly from 30.6 million in 2019 after the pandemic began. Furthermore, it identified that key research from surveys and reviews in the past 3 years, after the emergence of Covid-19 pandemic, there is a significant increase in nurses burn-out. This has resulted in burn-out nurses either leaving their employment or reducing their work hours, which has led to additional burden of work, increasing levels of stress among the resilient working nurses. 30 Therefore, significant changes in the factors that influence nurses’ motivation to perform well might have occurred. Considering these developments, it is necessary to extend the review conducted in Brady Germain and Cummings, 21 to identify the new developments in the research arena. For that, the purpose of this study is to conduct a systematic review for examining the factors related to nurses’ leadership and nurses’ performance. To achieve this objective, the following research questions are formulated.

• RQ1: What factors do nurses think affect their drive to excel in their work? The ambition and aptitude of the nurses to achieve their companies’ objectives of high-quality care and patient safety serve as the benchmarks for performance in this context.
• RQ2: Which leadership traits are associated with strong nurse performance? In this context, behaviors are described as the traits or tactics used by leaders to control nurses’ performance in order to accomplish organizational objectives, such as patient safety and high-quality care.

Materials and Methods

The protocol for this study is registered with PROSPERO (registration number: CRD42023387324), the registration date 15/01/2023.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 33 was used for conducting the systematic review of recent literature and reporting the findings relating to nursing leadership attributes and nursing performance.

Search Methods

Various databases, including CINAHL, Cochrane, EMBASE, HealthSTAR, Medline, and PsychINFO, were utilized to search for relevant studies. The search terms “nursing performance,” “nurse motivation,” “nursing leadership,” and “nursing leadership behaviors” were combined using Boolean operators “AND” and “OR.” To improve search sensitivity, keywords from the identified studies were also used in the search process. Only studies published in English were considered. Additionally, studies published within the last 20 years were included to ensure the search was current and covered new literature since the previous study by 23. Therefore, those studies before 2003 are excluded. Inclusion and exclusion criteria, as presented in Table 1 , were applied for selecting studies. Figure 1 provides a detailed overview of the search strategy used to select studies.

Inclusion and Exclusion Criteria.

PRISMA flow diagram.

Quality Appraisal

Two methods were used to rate the methodological quality of the chosen studies. The PRISMA 31 methodological quality criterion, which contains 27 elements, was used to systematic reviews. TREND 32 was used to evaluate quasi-experimental studies. TREND 32 comprises 22 criteria. The last criterion received a “yes,” a “no,” or a “unclear” rating. The “yes” items were added up to create a total score for each study, which ranged from zero to the total number of items that were examined. Studies with low methodological quality were deemed to be omitted from the review if they received a score of less than or equal to 50% on the evaluated items. Studies were deemed to be of medium or high quality and included in the review if they scored more than 50% on the analyzed items.

Data Extraction

Quantitative studies were the source of data, which encompassed details such as the author, publication year, research aim, sample size, methodology employed, independent and dependent variables, measurement criteria, reliability and validity of the measures, analytical techniques, and findings. The number of studies examined and the key conclusions were retrieved for systematic reviews.

Search Outcomes

Initially, 1632 articles were identified from different electronic databases, and 16 articles were identified through manual searching of journals, resulting in a total of 1648 articles. After removing 587 duplicates, 1061 articles were screened for titles and abstracts. Out of these, 984 articles were excluded based on title and abstract assessment, and 77 articles were selected for full-text reviews. After reviewing the full-text articles, 64 articles did not meet the inclusion criteria and were excluded. Finally, 13 articles were deemed eligible for quality assessment. Two articles did not meet quality criteria and were excluded resulting in 11 articles that are included in this review (See Figure 1 ).

Study Characteristics

Table 2 exhibits the attributes of the studies that were incorporated in this review. It can be observed that 6 studies were published recently (1 study in 2020, 3 studies in 2021, and 2 studies in 2022). Majority of the participants in most of the studies were females and were aged above 30 years with high work experience.

Summary of Study Characteristics Included in This Review.

Focusing on the leadership styles, 3 studies considered the effect of different leadership styles on nursing performance, 2 studies exclusively focused on transformational leadership, one each on sustainable leadership, entrepreneurial leadership, and servant leadership. There were 10 studies that have adopted quantitative approach of survey in data collection, and different analysis techniques were utilized in these studies. Only one systematic review was included that focused on the leadership attributes and nursing performance.

Theoretical Framework

Theories in research provides a rationale for developing hypothesis and testing the relationship between the variables, 44 and therefore it is important that the research studies should be guided by theoretical framework or a model that either confirmation of existing theory or generating new theories. Ten out of the 11 studies in this review were guided by a theoretical framework or a model. Six studies 33 - 37 ,45 in this review adopted leadership theories or developed a model for testing the leadership attributes on nursing performance. Social exchange theory and self-determination theories were used in Kül and Sönmez, 38 supporting the role of servant leadership in developing the innovative behavior of nurses (guided by social exchange) and motivating them in improving their performance by developing autonomy, competence and relatedness (self-determination theory: extrinsic motivation from leaders leading to intrinsic motivation among nurses). 39 Another study conducted by Salanova et al 40 emphasized the significance of social interactions in the work environment in improving self-efficacy by adopting social cognitive theory, where self-efficacy is considered as the primary personal resource, and transformational leadership as contextual resource for motivating nurses. In extending the leadership theories, another study 41 linked it with Innovative work behavior theory.

This theory contends that while functional competences give entrepreneurial nursing leaders the ability to inspire nurses to take innovative action while providing care, personal competencies enable them to establish an innovative vision. This builds confidence and commitment to adopting new ideas. 42 , 43 Wang et al 37 argued that leadership is a position that can be achieved by gaining skills, which contradicts leadership theories that suggest some people are born leaders. This also contradicts psychological theory that women have low aggressiveness and avoid leadership positions 46 , 47 However, recent studies focus on theories relevant to changes in the nursing industry, including the introduction of innovative technologies and new business models such as gig economy and eHealth. Many frameworks continue to focus on leadership styles such as transformational and transactional styles and relevant attributes that have been extensively researched over the past few decades. 21 However, new leadership attributes such as nursing informatics leadership, in light of growing influence of technology and industry policies in the quality care sector, have been neglected.

Measures of Nurse Performance

Twenty-two distinct measurement instruments were employed to evaluate the various factors that influence nursing performance in relationship with nursing leadership attributes. Five studies used questionnaires developed by authors for measuring nurses’ performance in relation to different aspects such as motivation, engagement, self-efficacy, performance, problem solving skills, and job satisfaction. Multifactor leadership questionnaires or its components were used in 3 studies focusing on different leadership styles and their impact on nursing performance as a part of the study model designed by respective authors. 34 , 35 , 40 Other major instruments used for measuring nurses’ performance related attributes include Caring Efficacy Scale, nurses’ activity scale, 45 Nurses performance evaluation checklist, 34 , 38 Innovative work behavior scale, 38 generic job satisfaction scale, 35 and innovative work behavior questionnaire. 41

Factors Influencing Nurses’ Performances

A total of 51 different factors that affected the nurses’ performance were identified from the studies included in the review ( Table 3 ). These factors were grouped into 6 categories including autonomy, competencies, relatedness, individual nurse characteristics, relationships and support, and leadership practices.

Factors Affecting Nurses’ Performance.

Three studies 33 , 38 , 45 examined the influence of autonomy related factors on nurses’ performance. Manojlovich 45 identified that strong nursing leadership behavior can contribute to the empowerment and self-efficacy on practice behaviors of the nurses, indicating that nursing leaders should provide more access to structural empowerment factors for nurses and exhibit unit-level nursing leadership. Kim and Sim 33 suggest that utilizing action-oriented and self-reward strategies, along with constructive thinking, can improve self-efficacy and empower individuals, leading to a significant improvement in their performance.

However, it is also observed that nursing performance can be affected by their communication abilities, indicating that in developing autonomy, communication skills play a significant role. Kül and Sönmez 38 identified that servant leadership attributes, such as being humanistic, empathetic, mutually beneficial, and service-oriented, can empower nurses to develop innovative behavior, which can improve their job performance. Innovative behaviors reflect an autonomy in nurses’ attitudes, where they autonomously take decisions in developing new ideas and new ways of delivering care, thereby improving the performance.

Competencies

Four studies 37 , 36 , 41 , 48 examined the influence of competencies related factors on the nurses’ performance. Few of these studies reflected new approaches in leadership and their impact on new areas of performance. For instance, Bagheri and Akbari 41 found that entrepreneurial leadership has positively influenced nurses’ innovation work behavior such as ideas exploration, generation, implementation, and championing, which can improve the overall performances and can support the achievement of organizational goals such as sustainability. Similarly, by creating a positive work environment and effectively managing resources and transformational leadership practices, nurse managers can significantly improve sustainability of nursing leadership. Moreover, Fing et al 36 found that competencies such as treating employees like family members, guiding them, and letting them make independent decisions have led to improvements in several areas that can impact nurses’ performance. These improvements include decision-making, the ability to accept criticism and suggestions. 36 Wang et al 48 found that leaders’ skills, such as idealized influence and intellectual stimulation, have a significant positive impact on nurses’ self-efficacy and work engagement.

Relatedness

Relatedness reflects how the nurse managers relate them to nurses and vice versa, which is reflected in their behavior toward each other. The study conducted by El-Azim et al 34 was the only study that did not find a significant statistical relationship between nursing leadership styles and nurses’ performance.

Individual Nurse Characteristics

Two studies have identified individual nursing characteristics related to nurses’ performance. The interest of nurses’ in taking up extra roles in addition to the existing roles supported by the nurse managers supported by transformational leadership practices through increased work engagement. 40 The findings of this study indicated that through supportive leadership practices, extra-role performance can be enhanced which in turn increases hospital efficacy. Wang et al 48 identified that psychological safety (a belief that nurses won’t be punished or humiliated for sharing ideas, concerns, and issues) could effectively improve nurses’ performance.

Relationships and Support

Wang et al 37 assessed the impact of nursing performance on nursing leadership along with other variables. They found that a caring and supportive work environment can positively affect nurses’ behavior and performance, and in turn, nursing leadership. This emphasizes the need for support from nursing leaders. 37

Leadership Styes/Practices

Although leadership practices were considered in most of the studies, significant approaches can be analyzed from 3 studies. Firstly, as discussed in the autonomy section, servant leadership approaches, such as humanistic, empathic, mutual benefit, and service-oriented approaches, can improve nurses’ competencies and skills, especially their ability to express themselves, communicate, and apply innovative ideas. Secondly, both transformational and transactional approaches, such as motivation, support, contingent rewards, and intellectual stimulation, can improve nurses’ satisfaction levels and job performance. 35 Thirdly, paternalistic leadership practices, such as treating nurses as family members, and laissez-faire practices, such as enabling nurses to make independent decisions, were identified as improving nurses’ performance. However, paternalistic approaches were found to be more influential than laissez-faire approaches. Fourthly, entrepreneurial leadership practices, such as driving innovation, risk-taking, and passion for work, were identified as promoting innovative behavior among nurses, which can improve their performance.

This study mainly focused on examining the link between nursing leadership and nurses’ performance by assessing the factors that nurses believed had an impact on their motivation to perform well; and the leadership behaviors that correlate with nurses’ performance. There has been a significant rise in the identification of number of factors that nurses perceive to be influencing their performance in the recent literature. This study has identified 51 such factors from research studies published since 2005, compared to a study conducted by Ronquillo et al 23 which included studies from 1995 to 2006, identifying 25 factors. This development indicates that significant progress can be observed in the research related to nurses’ leadership and nurses’ performance. One of the interesting findings in the review is that most of the studies (10 out of 11) were quantitative and adopted survey strategy for data collection; and only one study adopted systematic review approach, indicating the gaps in adoption of different methodological approaches in the research, which can contribute to diverse findings.

Most of the previous studies adopted social theories and the self-determination theory in assessing the relationship between nursing leadership and nurses’ performance. As a result, few studies mainly focused on the nurses’ approaches in providing quality care through social interaction, rather than on their personal attributes such as satisfaction, quality of life, and motivation. However, some studies attempted to develop theoretical models, 34 , 35 , 40 indicating the emergence of various constructs and relations between nursing leadership and nurses’ performance. One of the effective qualities of leaders is promoting autonomy among the team and making them self-reliant by developing skills and competencies to improve overall processes. Accordingly, from the findings ( Table 3 ), it was observed that the majority of the factors identified were in relation to leadership practices that focused on promoting autonomy and competencies among nurses

In the past few years, significant developments can be observed in the adoption of Industry technologies such as the Internet of Things, Artificial Intelligence, Cloud computing, block chain technology etc., 49 - 52 giving rise to new form of leadership such as nursing informatics leadership. 53 , 54 These developments can influence various factors within hospital settings, including organizational culture, workload, motivation, values in hospital settings that can directly or indirectly influence nursing performance. However, no studies were identified in this review which considered these developments in identifying the factors that influence nurses’ performance. Studies reviewed indicated that nursing leadership can influence autonomy, 33 , 38 , 45 relatedness, 34 competencies, 36 , 37 , 41 , 48 individual characteristics, 40 , 48 and relationships and support, 37 as perceived by nurses influencing their motivation to perform well. In addition, leadership practices were identified to be nurses’ abilities to perform well. Furthermore, leadership behaviors that support autonomy, inclusivity, transformation (improving skills, innovation abilities, and competencies), and staff prioritization (caring, paternalistic behavior, empathy) can result in high nursing performance. 33 , 38 , 45 It is important that nurse leaders share organizational goals to encourage staff, offer suggestions, and receive feedback on innovative practices for achieving goals in a cooperative and supportive work culture. The studies reviewed suggest leadership plays a crucial role in influencing nurses’ performance in various areas, such as innovation, decision-making, and work engagement. 36 , 37 , 41 , 48 Furthermore, new approaches to leadership, such as entrepreneurial leadership and transformational leadership practices, can positively impact nurses’ performance and support the achievement of organizational goals such as sustainability. 41 Therefore, it is important for nurse managers to continuously develop their leadership skills and create a positive work environment that supports nurses’ ability to perform well. 36 By doing so, nurse managers can help to create practice environments that promote nurses’ ability to perform their roles effectively, thus enhancing overall nursing performance.

While one study included in the review did not find any significant statistical association between nursing leadership styles and nurses’ performance, it suggested that further research is needed to better analyze the relationship between nursing leadership and nurses’ performance by adopting relatedness factors in the areas of advanced leadership approaches and providing performance appraisal. 34 This highlights the importance of considering relatedness factors in nursing leadership to support nurses’ performance and promote positive relationships between nurse managers and nurses.

The results of Salanova et al 40 study highlight the significance of nurse managers adopting transformational leadership practices to increase nurses’ interest in taking up extra roles, which can lead to improved hospital efficacy. Additionally, promoting psychological safety in the workplace can create a supportive work environment that encourages open communication and enhances nurses’ performance. 48 This indicates the nurses should have enough freedom with nurse managers for sharing their opinions without any hesitation or fear, which may benefit both of them.

Therefore, nursing leadership has a significant impact on nurses’ perceptions of the factors that influence their motivation to perform. This impact can be both direct and indirect. Therefore, it is essential to have competent nursing leaders to create practice settings that can foster nurses’ capacity to succeed. In other words, the link between nursing leadership and nurses’ success is critical, and it is necessary to prioritize leadership development in the nursing profession to achieve optimal patient outcomes.

As observed from the recent report by ICN, 30 the lack of strategic and systematic approach by the employers and policymakers is one of the key challenges associated with rising nursing problems. In this context, it may be implied that effective leadership approaches coupled with systematic management of nursing resources could be one of the effective ways to improve nursing performance, retention, and reduced burn-out rates. Accordingly, apart from the patient-related aspects, personal, co-worker, organizational, and societal related factors were identified to be the significantly contributing factors of nurses’ burn-out during the pandemic, 55 highlighting the issues with nurses’ leadership and organizational/employer approaches. In this context, a systematic review on interventions to reduce occupational stress and burn-out, 56 observed that the interventions were effective when they focus at individual level and organization directed, implying the strategic and systematic approach adopted by the employers and led by nursing leaders, with an individualized focus, signifying the relevance of transformational, motivational, and supportive leadership styles. For instance, spiritual intelligence among nursing leaders was identified to be influencing nursing managers’ competencies in managing stress and burn-out, 57 and similar strategies could be directed by employers to effectively manage nursing resources. Such streamlined approaches may be effective in not only improving nurses’ performance, but also in addressing the challenges such as nurses’ burn-out, retention, and increasing stress in the post-pandemic era.

Implications for Nurse Researchers

The findings from this review supports a theoretical model ( Figure 2 ) on factors that influences nurses’ motivation to perform well, which may be tested and evaluated in future research. Analyzing published research till date in this review has suggested that leadership practices that support autonomy, competencies, and relatedness through inclusive approaches reflect that nurses’ contributions are valued and this process resulted in increased motivation of nurses to perform well. In addition, leadership practices that support innovation (entrepreneurial), and cooperative culture (transformational) were identified to be more influencing in improving nurses’ motivation to perform better. Although, different leadership practices and their relationship with nurses’ performance were investigated, significant changes have been observed in the nursing work environment in the past few years. The introduction of innovative technologies and business models, such as the gig economy and online health services, is among the many changes. These changes can lead to new leadership practices and new factors that influences nurses’ performance, such as informatics competencies and skills, remote work culture. These are some areas that future researchers can investigate to identify new leadership practices and the factors that influence nurses’ performance. Furthermore, sustainability has become a core component of all organizations, including healthcare. Therefore, it is important to examine leadership behaviors that can have an impact on nurses’ abilities to help achieve sustainable organizational goals. Furthermore, unexpected disasters such as the recent Covid-19 pandemic has significantly increased the burden on nursing care. Leadership practices in such a highly demanding workload environment and their impact on nurses’ abilities to provide quality care and achieve better patient outcomes could be examined. Finally, it is evident from the review that most of the studies have adopted quantitative methods. Diverse methodological framework adoption can contribute to the quality of research. Therefore, future researchers should focus on adopting other frameworks such as qualitative, and mixed methods in conducting the research.

Proposed theoretical model.

Implications for Nurse Leaders

Nursing performance is a key factor influencing the sustainability of nursing leadership. 37 Therefore, nurse leaders must adopt various leadership practices and behaviors that improve nursing performance, especially those that increase nurses’ motivation to perform better. Leadership practices that encourage employees’ motivation can influence organizational practices and goals. 58 As nurse leaders carry huge workloads, their work effectiveness can be affected, 59 which create barriers and challenges in achieving optimal nursing performance and ultimately providing high-quality care. Addressing nurse leaders’ workload is therefore necessary to enhance their ability to influence nurses and improve overall nursing performance.

Limitations

This review has a few potential limitations. It can be observed that 10 out of the 11 studies reviewed adopted quantitative methods, reflecting the limitation of including diverse methodological studies. Furthermore, reporting bias may exist as published studies tend to over-report positive findings. Many studies used self-designed scales to measure nurses’ performance, and others used different tools, limiting the validity and generalizability of findings. Most of the studies in this review are cross-sectional correlation studies and may be prone to bias 44, but they are helpful in examining the relationship between nursing leadership practices, behaviors, and nurses’ performance, which is the main purpose of this study.

Conclusions

Providing quality care and ensuring patients’ safety are fundamental goals for all healthcare organizations. Since nurses are the primary healthcare providers who spend a significant amount of time with patients delivering care and services, they have a crucial role in achieving these objectives. Nurse leaders who manage the nursing resources are the key personnel who are responsible for overseeing the quality of care and patients’ safety, and therefore they need to encourage nurses’ in better understanding the patients’ needs and values. Strong nurse leaders are effective in implementing evidence-based practices to ensure that these objectives are achieved, as research showed that nursing leadership can both directly and indirectly influence nurses’ performance. The present review has identified 51 factors that nurses categorize under 6 domains, which they believe motivate them to perform effectively. These included autonomy, relatedness, competencies, individual nurse characteristics, relationships and support, and leadership practices/styles. Comprehending these actors is essential and necessary for nurse leaders to promote quality of care and to achieve organizational goals such as sustainability, growth and innovativeness. Therefore, nurse leaders should strive to understand and identify the factors that motivate nurses to perform well and accordingly should address/facilitate these factors through their behavior or leadership styles.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval: Our study did not require an ethical board approval because systematic reviews generally do not need ethics committee or institutional review board approval,

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The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership

Affiliations.

• 1 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada. Electronic address: [email protected].
• 2 Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Level 1, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia.
• 3 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada.
• 4 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada; Technical High School of Campinas, State University of Campinas (UNICAMP), Barão Geraldo, Campinas - São Paulo 13083-970, Brazil.
• PMID: 33383271
• DOI: 10.1016/j.ijnurstu.2020.103842

Background: Nursing leadership plays a vital role in shaping outcomes for healthcare organizations, personnel and patients. With much of the leadership workforce set to retire in the near future, identifying factors that positively contribute to the development of leadership in nurses is of utmost importance.

Objectives: To identify determining factors of nursing leadership, and the effectiveness of interventions to enhance leadership in nurses.

Design: We conducted a systematic review, including a total of nine electronic databases.

Data sources: Databases included: Medline, Academic Search Premier, Embase, PsychInfo, Sociological Abstracts, ABI, CINAHL, ERIC, and Cochrane.

Review methods: Studies were included if they quantitatively examined factors contributing to nursing leadership or educational interventions implemented with the intention of developing leadership practices in nurses. Two research team members independently reviewed each article to determine inclusion. All included studies underwent quality assessment, data extraction and content analysis.

Results: 49,502 titles/abstracts were screened resulting in 100 included manuscripts reporting on 93 studies (n=44 correlational studies and n=49 intervention studies). One hundred and five factors examined in correlational studies were categorized into 5 groups experience and education, individuals' traits and characteristics, relationship with work, role in the practice setting, and organizational context. Correlational studies revealed mixed results with some studies finding positive correlations and other non-significant relationships with leadership. Participation in leadership interventions had a positive impact on the development of a variety of leadership styles in 44 of 49 intervention studies, with relational leadership styles being the most common target of interventions.

Conclusions: The findings of this review make it clear that targeted educational interventions are an effective method of leadership development in nurses. However, due to equivocal results reported in many included studies and heterogeneity of leadership measurement tools, few conclusions can be drawn regarding which specific nurse characteristics and organizational factors most effectively contribute to the development of nursing leadership. Contextual and confounding factors that may mediate the relationships between nursing characteristics, development of leadership and enhancement of leadership development programs also require further examination. Targeted development of nursing leadership will help ensure that nurses of the future are well equipped to tackle the challenges of a burdened health-care system.

Keywords: Interventions; Leadership; Nursing workforce; Systematic Review.

Copyright © 2020. Published by Elsevier Ltd.

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• Targeting personalised leadership factors based on the organisational needs of nurses may cultivate and improve their nursing leadership. Singh S, Kapoor S. Singh S, et al. Evid Based Nurs. 2022 Apr;25(2):68. doi: 10.1136/ebnurs-2020-103385. Epub 2021 Aug 18. Evid Based Nurs. 2022. PMID: 34407986 No abstract available.

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Models of leadership and their implications for nursing practice

S'thembile Thusini

MSc Student, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London

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Julia Mingay

Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London

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Leadership in today's NHS, either as a leader or follower, is everybody's business. In this article, an MSc student undertaking the Developing Professional Leadership module at King's College London describes two leadership models and considers their application to two dimensions of the NHS Healthcare Leadership Model: ‘Engaging the team’ and ‘Leading with care’. The author demonstrates the value of this knowledge to all those involved in health care with a case scenario from clinical practice and key lessons to help frontline staff in their everyday work.

The Ely inquiry into the systematic brutal treatment of patients in a Cardiff mental institution was the first formal inquiry into NHS failings ( Department of Health and Social Security, 1969 ). Since that time there have been more than 100 inquiries with inadequate leadership persistently identified as a major concern ( Sheard, 2015 ). National responses have included the NHS Healthcare Leadership Model, delivered by the NHS Leadership Academy and its partners (2013) . A range of online and face-to-face programmes aim to increase an organisation's leadership capacity by developing leaders who pay close attention to their frontline staff, understand the contexts in which they work and the situations they face and empower them to lead continuous improvements that enhance patient outcomes and safety ( NHS Leadership Academy, 2013 ).

At King's College London, ‘Developing Professional Leadership’ is a core module of the Advanced Practice (Leadership) pathway. The module critically appraises theoretical and professional perspectives on leadership and supports participants to take up leadership roles with attention to ethical practice. Both national and college leadership activities promote an understanding of vertical transformational leadership (VTL) and shared leadership (SL).

Vertical transformational leadership

VTL is a hierarchical leadership model that describes an individual leader who, through various influences and mechanisms, elevates himself or herself and followers towards self-actualisation ( Pearce and Sims, 2000 ). VTL values collaboration and consensus, integrity and justice, empowerment and optimism, accountability and equality, and honesty and trust ( Braun et al, 2013 ). A vertical transformational leader inspires others by interpreting complex data, creating a vision and formulating a strategy for its attainment ( Avery, 2004 ). They aim to create an organisation that is agile, responsive, open to learning and future ready through innovation and creativity. They do this by appealing to followers' emotions and internal motivations, and by building rewarding relationships and raising morale. They use delegation, consultation and collaboration to engage followers but retain power so that responsibility and accountability for a vision and its strategy rests with the leader ( Avery, 2004 ).

Behaviours associated with this leadership style have been classified by Avolio et al (1991) as the four ‘I's: idealised influence, individualised consideration, inspirational motivation, and intellectual stimulation:

• ‘Idealised influence’ represents the charismatic part of VTL. Leaders model integrity, optimism and confidence, and act with courage and conviction demonstrating their intellectual and technical skills
• ‘Individualised consideration’ requires self-awareness and an appreciation of the values, aspirations, motivations, strengths and weaknesses of others. From this perspective leaders need to be able to listen and communicate effectively, and may be called upon to teach, coach, mentor or counsel
• ‘Inspirational motivation’ necessitates a clearly communicated vision and belief in a team's abilities to achieve a desired goal
• Through ‘intellectual stimulation’ leaders support and facilitate independent thinking, encouraging followers to be more rational, creative and innovative in their decision-making and problem-solving.

Tse and Chiu (2014) have advised that leaders adopt a balanced approach to the use of the four Is that is contingent upon their followers' orientation. For example, if group cohesion is required then idealised influence and inspirational motivation are appropriate leader behaviours. However, if greater creativity is needed from staff, then a leader is advised to exhibit individual consideration and provide intellectual stimulation. Conversely, mismatching leadership behaviour to follower orientation can have detrimental effects. For example, providing intellectual stimulation with high expectations but offering insufficient individualised consideration.

During times of large-scale dramatic organisational change an effective vertical leader is necessary for recalibrating and reviving an organisation ( Binci et al, 2016 ). They can provide clarity, motivation and empowerment. There are several examples of positive VTL outcomes in NHS trusts that have managed to improve their Care Quality Commission ratings. This was achieved through measures to revive cultures and empower staff with open communications and active support ( Health Foundation, 2015 ). Critics argue that VTL dependence on a single figure can be futile for an organisation, especially if the individual is prone to dysfunctional behaviour ( Wang and Howell, 2012 ). In response, an ‘authentic leader’ is proposed ( Jackson and Parry, 2011 ); this is someone with a ‘high socialised power orientation’, who is humble, modest, deflects recognition for achievements, who celebrates the team, and exhibits vertical and shared leadership behaviours. Through self-awareness and reflecting on actions a VTL leader can exhibit authentic leadership behaviour.

VTL overlaps other leadership approaches including authentic, servant, charismatic, inspirational and visionary ( Avery, 2004 ). What often differentiates VTL is its motivation or focus, which is typically on achieving organisational goals. VTL is also associated with pseudo-transformational and transactional leadership. The former is a dysfunctional form of charismatic leadership, characterised by narcissistic behaviours associated with dictators and sensational political and corporate leaders. Transactional leadership is practised by positional managers whose job it is to set expectations and engage in corrective or autocratic measures that aim to maintain efficiency. Transformational leaders do utilise some transactional methods to achieve goals and the two leadership styles can be complementary. However, VTL is two-way leadership with follower influence whereas transactional leadership represents one-directional hierarchical leadership.

Shared leadership

SL is a non-hierarchical leadership model that describes leadership that emerges within a group, depending on the context and skills required at a given time ( D'Innocenzo et al, 2016 ). SL values openness and trust, engagement and inclusiveness, reciprocity and fluidity, democracy and empowerment, and networking and support ( Jameson, 2007 ). Shared leaders are peers who possess no authority over the group outside the context of their shared contribution. Individual leadership is de-emphasised and a vision and its strategy are created and owned by the group. Open discursive engagement is favoured for mutual sense making through the pooling of diverse skills, knowledge and experience. SL is dynamic, multidirectional and collaborative. Power is shared so that responsibility and accountability for a vision and its strategy rests with the group ( Avery, 2004 ).

SL is often associated with, but different conceptually from, co-leadership, distributed leadership, and self-managing teams. Carson et al (2007) suggested that these all lie on a continuum with co-leadership at one end and shared leadership at the other. Participation, consultation and delegation are used in SL as are the four Is of transformational leadership. SL has been described as a type of group transformational leadership as transformational behaviours within a shared leadership model achieve similar results to VTL ( Wang and Howell, 2012 ). SL necessarily exists in organisations such as the NHS where different professional groups with their own leadership structures need to collaborate. Transforming a culture through shared leadership requires patience and investment. It is an iterative process involving cycles of learning and reflection that require trust, personal and professional maturity, and organisational support.

SL leadership behaviours can become widespread within teams, lessening their dependence on one leader and the potential effects of rogue single leaders ( The King's Fund, 2011 ). This is vital in environments where problems are increasingly complex and leaders are required to possess multiple problem-solving skills. Cost efficiencies can result from diminishing hierarchical leaders' workloads and a consequent reduction in their posts among highly skilled cohesive groups ( Tse and Chiu, 2014 ). Critics argue that SL efficiency is influenced by group dynamics, which may be prone to relationship conflicts that lead to decision paralysis ( Pearce and Sims, 2000 ). Additionally, the emergence of a vertical leader who could manipulate the workforce for political or corporate gain may be an unintended consequence of SL.

Both VTL and SL are moderated by internal and external factors. VTL is influenced by levels of trust, follower receptiveness, personality traits, task complexity and urgency. Stress and burnout can lessen leadership benefits while trust can enhance performance outcomes ( Robert and You, 2018 ). SL is moderated by trust, time, group size and cohesion, skill mix, confidence, task complexity and interdependence ( Nicolaides et al, 2014 ). Trust, sufficient time, a balanced skill mix and group cohesion have a positive influence, while task complexity, especially at formative stages, hinders effective SL.

The two approaches are complementary. During the formative stages of shared leadership, a vertical leader is crucial to guide and sustain shared leadership. Some final decisions will need to rest with the hierarchical leader. As the team gains confidence, a vertical transformational leader's role evolves to consultant, mentor, facilitator and, at times, recipient of group leadership. A significant body of evidence associates VTL and SL with positive individual, group and organisational outcomes ( Wang and Howell, 2012 ; Nicolaides et al, 2014 ; D'Innocenzo et al, 2016 ). VTL predominantly influences individual and organisational outcomes while SL is more influential at the group and organisational levels. Table 1 summarises some of the differences between the approaches, although they share much more in common.