Leadership Styles in Nursing

This essay discusses the different leadership styles in nursing and their suitability in various clinical settings. It explores autocratic, laissez-faire, transactional, and transformational leadership and their impact on patient care and nurse satisfaction. The essay concludes that leadership styles should vary based on the clinical situation to improve the quality of care.

Running head: CLINICAL LEADERSHIP
Clinical Leadership
Name of the Student
Name of University
Author’s note

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Introduction
A leadership style can is a special style used and implemented any a leader of a team in
order to provide a particular direction, guidance and to motivate the team members. No specific
leadership styles are applicable for the nursing professionals (Sfantou et al., 2017). However,
Smolowitzet al. (2015)are of the opinion that the nurses has a vital role in improving the level of
patients’ health-related outcomes. For improving patients’ therapeutic outcomes, the rate of
errors encountered by the nursing professionals must be reduce and this can be done under the
usage of proper nursing leadership and guidance. The nurse managers are the leaders of
healthcare organisation. Thus capability of the nurse leader to manage the nurses effectively is
mainly determined by the leadership styles they use under any particular clinical settings. Thus
solution of the problems for improving the patients’ care lie in proper understanding of the
leadership stiles and use of these leadership styles under proper clinical situations by a
registered nurse manager (Alharbi, 2017). The following essay aims to highlight five basic forms
of nursing leadership styles and is compatibility under different clinical settings towards
improving the overall outcome of patients’ care. The five leadership styles that will be focused in
this paper include Authoritarian/Autocratic Leadership, Laissez Faire Leadership, Transactional
Leadership and Transformational Leadership.
Authoritarian/Autocratic Leadership
Autocratic leadership is a style of leadership management where the leader controls all
the decisions and takes minimal inputs from the other group members. The choices and the
decisions taken by an autocratic leader is mainly guided by their won critical thinking skills and
do not involve the decisions and opinions for others (Nanjundeswaraswamy & Swamy, 2014).

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An autocratic leadership style is nursing is effective under clinical situation of the emergency
department as under this situation the nursing leader or the nursing manager takes all the
decisions without considering of the opinions of other staffs. Moreover, the mistakes are not
encouraged within the blame put on individuals (Sfantou et al., 2017). Emergency department is
always over-crowed with poor nurse : patients’ ratio. It is also regarded as a demanding clinical
unit of hospital that always seeks prompt actions executed the healthcare professionals. Since the
nurses are the direct point of contact of the patients and their family members in the emergency
department, the role of the nurses becomes crucial for improving the overall quality of care and
improve patients’ outcome (Carter, Pouch & Larson, 2014). Thus it can be said that for the
critically ill patients and accident victim patients brought in the over-crowed or in the rush hours
of the emergency department, ensuring patients’ safety become one of the prime factors. Under
this scenario, the autocratic leadership styles play an important role. Here an autocratic leader
only take the decision regarding how the operations will be operator, deciding the roster of the
nurses, role of the nurse and how the entire operation will be operated in the emergency
department. With a single point of contact under the chaotic environment of the emergency
department, where several patients are admitted from an accident site or from an endemic
situation, the style becomes indispensible to avoid further confusion as there is no time for
discussion (Alharbi, 2017). However, Alharbi(2017) are of the opinion that autocratic leadership
style offer less autonomy and psychological empowerment of the nursing professionals and thus
leading to decrease in the level of nurse satisfaction and increasing the nurse turnover number.
Moreover, in daily nursing profession, this leadership style does not facilitate team work,
trustworthy relationships or effective communication with other nurses and this again increase
high turnover of nurses and poor job satisfaction.

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Laissez-faire Leadership
Laissez-faire leadership style deals with leaders who do not make decisions and the
employees or the subordinates’ acts without any particular direction or supervision. However,
there is a hands-off style causing in rare changes (Sfantou et al., 2017). Alharbi (2017) stated that
laissez-faire leadership style do not provide any particular direction or any particular supervision
and mainly prefers a hands-off style. Under the nursing contexts it can be said that this kind of
leadership mainly specific that it like having no particular nurse manager in order to supervise
the work. Nurses here work on their own. The nurses also take decisions and if the decision went
wrong, they are blamed. Laissez-faire leadership style is mainly adopted by a registered nursing
professional who is newly appointed as a nurse manager as they lack adequate experience in
order to run a team efficiently. At times the registered nurse manager who is about to retire also
make use of this leadership style as he or she seem to avoid any conflict with his or her team
mates during this last few days of work. Saeed, Almas, Anis-ul-Haq and Niazi(2014) are of the
opinion that laissez-faire leadership style is suitable under the circumstance when a nurse
manager is leading a team of experienced and tenured professionals and less critical clinical
settings like post-operative mental health rehabilitation ward. Under this ward, there are less
chances of the medication errors as mainly counselling therapy is applied in order to promote
faster mental health recovery of the patients who are suffering from depression due to chronic
surgical issues. Moreover, working with a team of experienced or tenured nursing professionals,
there are negligible chances of encountering error that might endanger the level of patients’
safety. The study conducted by Morsiani, Bagnasco and Sasso(2017) highlighted that in laissez-
faire leadership style promote supreme nursing empowerment as it provides full liberty to the
nursing professionals to execute and implement their critical thinking skills. This helps to

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improve their level of jobs satisfaction and make use of their critical thinking skills in an
independent manner and thereby helping to improve the overall outcome of the patients.
However, Asiri, Rohrer, Al-Surimi, Da’ar and Ahmed (2016) have reported in their study that
laissez-faire leadership style is associated with certain disadvantages like it is associated with
high likelihood of medical errors. However, since the nurses operate independently, there are
fewer chances that the errors are highlighted and prompt actions are taken. Thus nurse who is at
the defaulter end, may not leave immediately, they might leave later. Presence of nurse who is
making the mistakes in the team cast a negative outcome in patients’ health-related outcome.
Transactional Leadership
In transactional leadership, leader uses rewards as well as punishments. It is a means to
ensure proper compliance by the norms by the team members. Under the context of nursing, it
can be said that in order to ensure that in transactional leadership, the nurse manager provides
special attention over the organization and supervision of nurses who are working under his or
her supervision. The overall group performance is the prime focus. The work done by the
registered nursing professionals are monitored stringently in order to elucidate whether there is
any fault of deviations from the standardized practice protocol (Alharbi, 2017). This leadership
style is suitable only when the condition of the patient is critical like under the intensive care
units. Under the incentive care units (ICU), any provision for the medical errors can invite in
fatal outcomes for the patients(Scully, 2015).Thus for the avoidance of the medication error or
any other error related to nursing practice like the observance of the hand hygiene, transactional
leadership styles is proved to be effective. Decrease in the chances of the medication errors and
proper use of the hand hygiene protocol helps to improve the overall outcome of the patients and
at the same time reduces the cost of care and overall length of stay in the hospital (Carayon et al.,

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2014). Since the activities of the nurses or the actions of the nurses are monitored strictly in
transactional leadership, there are lower instances of medical errors. Moreover, effective
monitoring of the activities of the nurses helps to highlight the errors of the nursing
professionals. This approach further helps in designing of the training of the nurses who are
weak in execution of the professional standards of practice. The rewards given on successful
procurement of the patients’ care, helps to motivate the nursing professionals (Mah’dAlloubani,
Almatari & Almukhtar, 2014). However, Gregersen, Vincent-Höper and Nienhaus(2014) are of
the opinion that the fear of getting punished or penalized or the constant pressure of work
environment where your activities are constantly monitored increase the chance of medical errors
due to increase in the level of stress among the nurses and thus endangering the life of the ICU
patients.
Transformational Leadership
In contrast to the use of the gifts for motivation and punishment for poor perfmance as
per the guidelines in transactional leadership style, transformational leadership promotes
inspirational behavior of the nurses to motivate the subordinates so that they can perform beyond
expectations, transcending self-interest. Under the nursing context of transformational
leadership, a nurse manager makes use of this leadership style for promoting the image of the
organization, which is associated with high quality of care. Intellectual stimulation given under
the transformational leadership create provision for the generation of novel thoughts and at the
same time replaces old ideas, traditions and beliefs that are associated with the profession of
nursing. In transformational leadership, the nurse leader is also concerned about the needs of an
individual and skills of the nurses as any problems in these domains might endanger the patients’
safety(Alharbi, 2017). In order words it can be said that ideal, inspirational, intellectual with

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individualized dimensions of the nursing mangers are the few preliminary characteristics of the
transformational leadership style and is one of the researched and popular leadership styles in
nursing profession(Weng, Huang, Chen &Chang, 2015). Transformational leadership though
applicable under diverse clinical care settings, it is best applicable under the palliative care unit
or the clinical units handling trauma patients. In both palliative and the trauma care units there is
a high level of compassion fatigue experienced by the nursing professionals leading to increase
in the level of burnout. Moreover, any consequences of the medication errors under the palliative
or the trauma care unit can prove to be fatal(Sansó, Galiana, Oliver, Pascual, Sinclair & Benito,
2015).Thus transformational leadership style offers less chances of the medication error and the
motivation leadership approach taken by the transformational leaders help to reduce the work-
related stress, compassion fatigue and burnout. The e-mail surveys conducted by Ross,
Fitzpatrick, Click, Krouse and Clavelle(2014) highlighted that the transformational leadership
style create provision for the increased association with the leaders and the employees and this
attachment between the professionals help to promote the exchange of the shared values,
objectives and beliefs towards the nursing practice and thereby helping to improve the outcome
of patients’ care. The cross-sectional qualitative study conducted by Lin, MacLennan, Hunt and
Cox (2015) revealed that transformational leadership contributes to increase level of supervisors’
support. This increase level of support coming from managers, helps to increase the level of job
satisfaction and thus decreasing turn-over of nurses. Decrease nurse turn-over help to increase
the pool of experienced and tenured nurses in the team and thereby helping to improve the
outcome of patients’ care. Experienced yet satisfied nurses are less likely to encounter medical
errors and thus improving health-related quality of life of the patients in palliative care unit.

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Conclusion
Thus from the above discussion, it can be concluded that leadership styles of the nurse
managers must vary based on the clinical situations in order to improve the overall quality of
care of the patients. The leadership style that is suitable in the emergency department is
autocratic leadership as it helps to handle the chaotic situations where there in increased work
load. Laissez-faire leadership style provides the liberty to the subordinates to work independently
and is suitable under clinical settings that care less critical like post-operative rehabilitation of
the mental health. However, giving complete flexibility to the employees to work as per their
wish and best understanding can increase the chances of medication errors. Transactional
leadership style is suitable in incentive care unit or the critical care unit as to undergo strict
supervision of the activities of the nurses. Transformational leadership style is widely practice
leadership style in the nursing profession and is applicable under wide clinical settings. Under
palliative care settings application of transformation leadership helps to reduce the level of
compassion fatigue among the nurses.

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References
Alharbi, A. Y. (2017). Leadership styles of nurse managers and their effects on nurse and
organisational performance, issues and problems. International Journal of Information
Research and Review, 4(9), 4516-4525. Retrieved from:
https://pdfs.semanticscholar.org/acb0/8ab37e4ea1dd9d4a9b6f6cfc044b6ae967c8.pdf
Asiri, S. A., Rohrer, W. W., Al-Surimi, K., Da’ar, O. O., & Ahmed, A. (2016). The association
of leadership styles and empowerment with nurses’ organizational commitment in an
acute health care setting: a cross-sectional study. BMC nursing, 15(1),
38.https://doi.org/10.1186/s12912-016-0161-7
Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden,
R., &Gurses, A. P. (2014). Human factors systems approach to healthcare quality and
patient safety. Applied ergonomics, 45(1), 14-
25.https://doi.org/10.1016/j.apergo.2013.04.023
Carter, E. J., Pouch, S. M., & Larson, E. L. (2014). The relationship between emergency
department crowding and patient outcomes: a systematic review. Journal of Nursing
Scholarship, 46(2), 106-115. https://doi.org/10.1111/jnu.12055
Gregersen, S., Vincent-Höper, S., &Nienhaus, A. (2014). Health-relevant leadership behaviour:
A comparison of leadership constructs. German Journal of Human Resource
Management, 28(1-2), 117-138. https://doi.org/10.1177/239700221402800107
Lin, P. Y., MacLennan, S., Hunt, N., & Cox, T. (2015). The influences of nursing
transformational leadership style on the quality of nurses’ working lives in Taiwan: a

9
CLINICAL LEADERSHIP
cross-sectional quantitative study. BMC nursing, 14(1),
33.https://doi.org/10.1186/s12912-015-0082-x
Mah’dAlloubani, A., Almatari, M., &Almukhtar, M. M. (2014). Effects of leadership styles on
quality of services in healthcare. European Scientific Journal, ESJ, 10(18). Retrieved
from: http://eujournal.org/index.php/esj/article/view/3586
Morsiani, G., Bagnasco, A., &Sasso, L. (2017). How staff nurses perceive the impact of nurse
managers’ leadership style in terms of job satisfaction: a mixed method study. Journal of
nursing management, 25(2), 119-128.https://doi.org/10.1111/jonm.12448
Nanjundeswaraswamy, T. S., &Swamy, D. R. (2014).Leadership styles. Advances in
management, 7(2), 57.
Ross, E. J., Fitzpatrick, J. J., Click, E. R., Krouse, H. J., &Clavelle, J. T. (2014).
Transformational leadership practices of nurse leaders in professional nursing
associations. Journal of Nursing Administration, 44(4), 201-206. doi:
10.1097/NNA.0000000000000058
Saeed, T., Almas, S., Anis-ul-Haq, M., &Niazi, G. S. K. (2014). Leadership styles: relationship
with conflict management styles. International Journal of Conflict Management, 25(3),
214-225. https://doi.org/10.1108/IJCMA-12-2012-0091
Sansó, N., Galiana, L., Oliver, A., Pascual, A., Sinclair, S., & Benito, E. (2015). Palliative care
professionals' inner life: exploring the relationships among awareness, self-care, and
compassion satisfaction and fatigue, burnout, and coping with death. Journal of Pain and

10
CLINICAL LEADERSHIP
Symptom Management, 50(2), 200-207.
https://doi.org/10.1016/j.jpainsymman.2015.02.013
Scully, N. J. (2015). Leadership in nursing: The importance of recognising inherent values and
attributes to secure a positive future for the profession. Collegian, 22(4), 439-444.
https://doi.org/10.1016/j.colegn.2014.09.004
Sfantou, D., Laliotis, A., Patelarou, A., Sifaki-Pistolla, D., Matalliotakis, M., &Patelarou, E.
(2017, October). Importance of leadership style towards quality of care measures in
healthcare settings: a systematic review. In Healthcare (Vol. 5, No. 4, p.
73).Multidisciplinary Digital Publishing Institute.doi: 10.3390/healthcare5040073
Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C., & Wood, L.
(2015). Role of the registered nurse in primary health care: Meeting health care needs in
the 21st century. Nursing Outlook, 63(2), 130-
136.https://doi.org/10.1016/j.outlook.2014.08.004
Weng, R. H., Huang, C. Y., Chen, L. M., & Chang, L. Y. (2015).Exploring the impact of
transformational leadership on nurse innovation behaviour: A cross‐sectional
study. Journal of Nursing Management, 23(4), 427-439.
https://doi.org/10.1111/jonm.12149