Transformational Leadership in Nursing: A Concept Analysis

This concept analysis explores the meaning and usage of transformational leadership in the nursing context, proposing a new operational definition and identifying model cases and defining attributes specific to nursing. The influence of transformational leadership on organizational culture and patient outcomes is discussed, along with the need for further research.

CONCEPT ANALYSIS
Transformational leadership in nursing: a concept analysis
Shelly A. Fischer
Accepted for publication 5 May 2016
Correspondence to S.A. Fischer:
e-mail: [e-mail]
Shelly A. Fischer PhD RN NEA-BC FACHE
Assistant Professor
Fay W. Whitney School of Nursing,
University of Wyoming, Laramie, Wyoming,
USA
F I S C H E R S . A .( 2 0 1 6 )Transformationalleadership in nursing:a concept analysis.
Journal of Advanced Nursing 72(11), 2644–2653. doi: 10.1111/jan.13049
Abstract
Aim. To analyse the concept of transformational leadership in the nursing context.
Background.Tasked with improving patientoutcomes while decreasing the costof
care provision,nurses need strategies for implementing reform in health care and one
promising strategy is transformational leadership. Exploration and greater
understanding oftransformationalleadership and the potentialit holds is integralto
performance improvement and patient safety.
Design.Concept analysis using Walker and Avant’s (2005) concept analysis method.
Data sources.PubMed, CINAHL and PsychINFO.
Methods.This report draws on extant literatureon transformationalleadership,
management,and nursing to effectively analyze the conceptof transformational
leadership in the nursing context.
Implicationsfor nursing.This report proposesa new operationaldefinition for
transformationalleadership and identifies modelcases and defining attributes that are
specificto the nursing context. The influenceof transformationalleadership on
organizationalculture and patientoutcomesis evident.Of particularinterestis the
finding that transformationalleadershipcan be defined as a set of teachable
competencies.However, the mechanism by which transformationalleadership
influences patient outcomes remains unclear.
Conclusion.Transformationalleadership in nursing hasbeen associated with high-
performing teams and improved patient care, but rarely has it been considered as a set
of competencies that can be taught.Also, further research is warranted to strengthen
empiricalreferents;this can be done by improving the operationaldefinition,reducing
ambiguity in key constructsand exploring the specific mechanismsby which
transformationalleadershipinfluenceshealthcareoutcomesto validate subscale
measures.
Keywords:concept analysis,healthcare reform,leadership,management,nursing,pa-
tient safety, performance improvement, practice environment, transformational
Introduction
Awarenessof undesirable patientsafety outcomesbecame
widespread in theUSA when the Instituteof Medicine
(Kohn et al.2000) reported that preventable medicalerror
led to nearly 100,000 deathsin the USA every year;
recently,James’(2013) analysis of the same data increased
the estimateto nearly 400,000 preventableUSA deaths
annually. While patient safety data from other countries are
2644 © 2016 John Wiley & Sons Ltd

less available, researchers indicate that this concern is a glo-
bal one (Arulmaniet al.2007,Redwood et al.2011,Bates
2009).Public and government pressure is high for transfor-
mationalchange in health care to improve patientsafety
outcomes internationally. A prominent potentialsolution to
the patientsafety conundrum thathas emerged in recent
yearsis transformationalleadership (TFL),which encom-
passesthe leadership behavioursand characteristicsthat
positively influence organizationalperformance and patient
safety outcomes (Mullen & Kelloway 2009).While TFL is
not a universalremedy,TFL competencies can have a sali-
ent role in developing cultures of safety in the patient care
environment (Kohn et al.2000) and have been linked with
improved performance and outcomes in many measures of
healthcare performance (Howell& Avolio 1993, Wong &
Cummings 2007,Mullen & Kelloway 2009).Yet, the liter-
ature has not been clear as to how and when TFL positively
affects patientsafety outcomes in healthcare settings.This
article presentsa conceptanalysisof TFL in the nursing
context, including a discussionand applicationof the
results specific to nursing education,research and practice.
The application of TFL as a style and competencies in the
business arena is beyond the scope of this concept analysis.
Background
A concept analysisof TFL for nursing fillsan important
gap in knowledge on the theory and practice ofnursing.
According to Chinn and Kramer (2008), clarifying the
meaning ofa conceptis integralto theory development
and, subsequently,to practice and research thatis guided
and informed by it.In measuring healthcare performance,
factors associatedwith leadership styles have been
strongly linked to patientoutcomes.Among the mostuse-
ful measuresof healthcare performance are nursing satis-
faction, retention (Kleinman 2004,Casida & Pinto-Zipp
2008), patientsatisfaction (Raup 2008)and workgroup
effectiveness(Dunham-Taylor2000).Of particularimpor-
tance for healthcareperformanceand subsequentlyfor
patientoutcomes,are the wayshealthcare teamsare led.
A strong relationship has been establishedbetween
patientsafety processesand outcomeson one hand and
leadership on the other(Thompson et al.2005, Wong &
Cummings 2007). For example, the use of patient
restraintsand the occurrence ofimmobility complications
—two patientoutcomes thatare generally considered neg-
ative—areinverselyrelated to the level of relationship-
oriented leadership and nurse managers’yearsof experi-
ence (Anderson et al.2003).Much research suggeststhat
to improve patientoutcomes,we would do well to con-
sider how leadership is understoodand practiced in
healthcare contexts,particularly on nursing units.Further
research iswarranted to testtheoriesrelated to TFL and
patientcare outcomes.Conceptanalysis ofTFL is a logi-
cal first step to designing research thatmore fully assesses
the impactof TFL on patientoutcomes.
One example ofhow TFL can be tested as a conceptis
offered by Kanste et al.(2009),whose research explicates
Full-Range Leadership Theory in the contextof nursing.
Their findingsemphasize the value ofTFL in nursing in
relation to staff willingness to exert extra effort,perception
of leader effectiveness and leader job satisfaction.The Full-
Range Leadership Theorymodel, with TFL in bold, is
found in Figure 1.
Data sources
Databasessearchedfor the concept analysis of TFL
included PubMed,CINAHL and PsychINFO, with limits
Why is this research or review needed?
• Unprecedented reform isessentialto the survival of the
healthcare system and global economy.
• Healthcare reform isdependenton leaderswho think in
innovative ways and have the skills, attributes and courage
that enable them to implement rapid change.
• A full understanding ofthe conceptof transformational
leadership,including its meaning,usageand operational
definition,is essentialfor preparingcurrent and future
leaders to significantly improve the healthcare system.
What are the key findings?
• The term ‘transformational leadership’ has consistent usage
in the literature, yet it will benefit from an improved opera-
tional definition, as proposed in this report.
• Transformationalleadership is a leadership style as wellas
a set of competencies that can be taught.
• Transformational leadership is not a panacea for improving
patientoutcomes;it should be used in conjunction with
other leadership skillsto optimize the performance ofa
workgroup.
How should the findings be used to influence policy/
practice/research/education?
• This analysis creates a foundation for teaching these com-
petencies in practice and academic settings.
• The new operationaldefinition of transformationalleader-
ship should be tested and validated by expert opinion and
empirical research.
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JAN: CONCEPT ANALYSIS Transformational leadership

set for 5 years and English language.In addition,seminal
articleson conceptanalysis and theory developmentwere
included withoutdate limits as they provided the founda-
tion for the method.Keywords included conceptanalysis,
leadership, transformational leadership, performance
improvement,managementand nursing.An initial search
of PubMed for ‘transformational leadership’ resulted in 198
publications,but when combined with ‘conceptanalysis,’
the result was zero.A search of the combined terms trans-
formational leadership, management and nursing resulted in
80 articles.These articles formed the basis ofthis concept
analysis.Additionalarticles were gleaned from the articles’
reference lists.All the articles reviewed were evaluated for
relevance to analysing the concept of transformational lead-
ership in the context of nursing.
Results
This section presents the results of the analysis of the steps
identified in Walker and Avant’s (2005) method:(a) deter-
mining the aims or purposes of the analysis;(b) identifying
all uses of the concept that can be discovered; (c) determin-
ing the defining attributes;(d) identifying a modelcase;(e)
identifying borderline,related,contrary,invented and ille-
gitimate cases;(f) identifying antecedents and consequences
associated with theconcept;and (g) definingempirical
referents associated with the concept.
Aims or purposes of the concept analysis
The purpose ofthis analysiswas to clarify and explicate
the conceptualmeaning and common usageof the term
‘transformationalleadership,’to lay a foundation for the
testing of TFL in nursing and patient-safety outcomes.This
analysisproposesa new operationaldefinition ofTFL in
support of future research endeavours.
Uses of the concept
The term ‘transformationalleadership’was first defined by
Burns in the late 1970s (Bass 1990). Bass and Avolio
(1994) are credited with having advanced the concept since
that time by describing its defining features and characteris-
tics,theory and measurement instruments (Dunham-Taylor
2000, Murphy 2005,Thompson et al.2005, McGuire &
Kennerly 2006, Wong & Cummings 2007, Raup 2008). An
extensive review ofthe literature suggested thatthe term
TFL generally referredto certain attributesthat were
applied as a leadership style that incorporated specific com-
petencies.
Transformational leadership as a style
TFL falls on a continuum,with ‘highly transformational’
(TFL) on one end, ‘highly avoidant’(laissez-faire)at the
other end and ‘transactional’in the middle.TFL is derived
EFFECTIVE
PASSIVE
FREQUENCY
Transactional
Transformational
ACTIVE
INEFFECTIVE
Individualized Consideration
Intellectual Stimulation
Inspirational Motivation
Idealized Influence
Contingent Reward
Management by Exception (Active)
Management by Exception (Passive)
Laissez Faire
Figure 1The Full Range Leadership Model, adapted from "Developing Potential Across a Full Range of Leadership (TM)," by B.J. Avolio
and B.M. Bass, Psychology Press: New York, p. 4.Copyright 1991 by Bruce J. Avolio & Bernard M. Bass. Leaders with more frequent use
of TransformationalLeadership behaviors(individualized consideration,intellectualstimulation,inspirationalmotivation,and idealized
influence) and less use of transactional leadership behaviors (contingent reward and management by exception - active) are generally
ered to be more effective than those more frequently employing transactionalor highly avoidant (management by exception - passive and
Laissez Faire) behaviors.
2646 © 2016 John Wiley & Sons Ltd
S.A. Fischer

from the Full Range Leadership Theory (Bass& Avolio
1994)and in it, followerstend to characterize leadersas
being ‘charismatic,visionary and loyal’(van Oyen Force
2005, p.338). TFL is a ‘high impact’(Shirey 2006, p. 282)
style that typically empowerssubordinates,resultingin
greater job satisfaction and sense ofautonomy (Kleinman
2004). Another term commonly associated with TFL is
‘participative’leadership(Casida & Pinto-Zipp 2008).
Other descriptors for transformationalleaders include ‘au-
thentic, genuine, trustworthy, reliable and believable’
(Shirey 2006, p. 280).
Transformational leadership as a set of competencies
Substantialevidence suggests thattransformationalleaders
are not born, but developed.Key competenciescan be
achievedthrough training, education and professional
development(Welford 2002,Murphy 2005, McGuire &
Kennerly 2006).Thompson (2012)identified specific skills
as essentialfor the transformationalleader to master,such
as learning to work with othersin an empowering way,
facilitating growth and learning ofstaff, translating evi-
dence into practiceand practiceinto evidence,critical
reflection and communication,problem-solving and deci-
sion-making.
Defining attributes
The defining attributes and behaviours associated with TFL
were identified by Bass and Avolio (1994)as the ‘five I’s’:
idealized influence (attributed), idealized influence
(behavioural),inspirationalmotivation,intellectualstimula-
tion and individualconsideration.In anothersynthesisof
TFL’s defining attributes,Kouzes and Posner (2008) identi-
fied the transformationalleader’sfive habitualpractices:
modelling the way,inspiring a shared vision,challenging
the process,enabling othersto act and encouraging the
heart.These authors were frequently cited for their work
towards describing and measuring traits, characteristics and
behaviourstypical of the transformationalleader. Still,
additionalwork on the measurementof transformational
leadership may need to be done,given the criticism levelled
towards the currentdefinition and constructsrelated to
transformational leadership.
Critics of TFL measuresdisagree with the notion that
attributes of TFL were well-defined or described.One such
author, Yukl (1999), stated thatconceptualweaknesses
keep instrumentsfrom effectively measuring ordescribing
leadership.The most fundamentalweaknessidentified is
that of ‘ambiguous constructs’(Yukl 1999).This criticism
is supported by the facts thatno conceptanalysis ofTFL
has yet been published and thattheredoes seem to be
ambiguity in the defining attributes ofTFL. For example,
previouswork has not clearly established how attributes
were identified,nor is there theoreticalrationale for differ-
entiating among them.
Additional criticismsby Yukl (1999) includethe con-
tention thatthe processesinherentto TFL have not been
sufficientlydescribed,limiting conditionshave not been
adequately specified and behaviours known to be essential
to certain stylesof leadership have been omitted.Similar
concerns regarding TFL are voiced by Hutchinson
(Hutchinson & Jackson 2013) and by Eisenbeisset al.
(2008),who identify and substantiate four fatalflaws with
TFL, going so far as to recommend abandonment of prior
definitions ofthe conceptand ‘starting over’with concep-
tual clarification, operational definition, theory development
and empiricalreferentdesign and testing.The fatal flaws
inherentto the TFL concept and measures,according to
Eisenbeiss (2008), include conceptual ambiguity, inadequate
causalmodelling to support justifiable and credible antece-
dents, lacking operationaldefinition (distinctfrom out-
comes and consequencesof the leadershipstyle) and
empirical referents that are invalid due to lacking specificity
and distinction from otheraspectsor typesof leadership.
According to the above-referenced critics,lack of concep-
tual clarity weakensthe foundation fordefinition,theory
development and operational measure design and testing.
Model case
An exemplar ofTFL is a leader who demonstrates caring
about his or her followers and passion about the mission of
the group.The leader’s followers feelwarmth and security
in their relationships with their leader (attributed idealized
influence),as wellas trust.The leader models ethicalbeha-
viours and is known for honesty and integrity (behavioural
idealized influence).He or she prioritizes personaland pro-
fessionaldevelopmentfor him- or herselfand followers.
Decisions are value-based, which motivates and inspires fol-
lowers to excel (inspirational motivation).
Considerthe hypotheticalcaseof Kathy, a model for
TFL. Kathy was a Master’s prepared nurseleaderwho
had benefitted greatly from innate attributesof charisma
and visionary thinking,as well as from a mentor who
taughther the foundationalcompetenciesof TFL. Kathy
began as the new Director of Nursing for a recently
opened skilled nursingfacility. At the time she started
work at the facility,members ofthe nursing staff,having
suffered a very difficultagency start-up underthe direc-
tion of an autocratic leader,were confused,yet fearfulto
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JAN: CONCEPT ANALYSIS Transformational leadership

speak of problemsor requestclarification.As a result,
the care they delivered wasdisorganized and proneto
error. Growth in occupancy wasslow and businesssuf-
fered.Kathy gathered the staffand quickly sized up the
problem (emotionalintelligence).She knew that,without
intervention,this nursing facility would continue to pro-
vide marginalcare,if it even keptits doors open.Kathy
already knew what she hoped for (visionary):a place
where people who needed supportin everyday tasksfelt
cared for. She began to meetregularly with staffas a
group to lay the foundation for team building (collabora-
tion) and with individuals to getto know them and their
personalinterestsand to develop trust(communication).
Kathy used humour,passion and her warm smile and
sparkling eyes to help even the mostfearfuland hurtsee
possibilities(enthusiasm).Soon, hallwayswere filled with
laughteramong staffand residentsas daily tasksbecame
organized and routine.In meetings,Kathy would align
requests for projectsupportwith the personalinterests of
the staff,create goalsto be achieved and assure thatthe
staff had what they needed to complete the project(em-
powerment).Staff membersnew to project management
were gently guided and coachedto achieve goals and
learn skills in the process (mentoring).Staff became confi-
dent, competent,happy providerswho promoted ‘their’
facility at every turn. The reputation of the facility
became justwhat Kathy had hoped forand in no time,
was filled to capacity with a waiting list and became
financially sound with ready reserves.Through the use of
TFL, Kathy successfullytransformedthe organization,
resulting in greatbenefitto the agency,staff and most
importantly its stakeholders,the patients and families.
Borderline, related, contrary, invented and illegitimate
cases
A concept analysis can be further developed by contrasting
the conceptbeing analysed with cases thatare borderline,
related,contrary,invented and/or illegitimate (Walker and
Avant (2005). The literature search yielded examples for all
case types, except for the invented case.
Borderline and related cases
An example of a borderline or related case is aesthetic lead-
ership (Mannix et al.2015).Like TFL, this is a ‘follower-
oriented’leadership modelthat is characterized by vision-
ary, action-orientedleadershipcharacteristicsand beha-
viours.However,whereas TFL emerges from the attributes
and behaviours ofthe leader,aesthetic leadership emerges
exclusively from the perceptionsof the follower.Another
related leadership modelis that of congruentleadership
(Mannix et al. 2015),which is associated with the Situa-
tionalLeadership theory.Congruent leadership is like TFL
in that both involve modifyingleadership behaviourto
accommodate and inspire the group at hand; however, con-
gruentleadership does notdrive change in followers,nor
does it encourage innovation and creativity,both of which
are key characteristics of TFL.
Contrary cases
In addition to noting borderline and related cases, contrast-
ing the conceptbeing analysed with contrary cases further
explicatesthe concept.TFL can be contrasted with other
typesof leadership,such as transactionalleadership and
laissez-faireleadership,as well as with trait theory and
pseudo-transformational leadership.
Transactionalleadership is characterized by active man-
agementby exception,passive managementby exception
and the use of contingent rewards. Active and passive man-
agementby exception are defined as leadership behaviours
that are reactivewhen mistakesare made or thingsgo
wrong (Kanste et al.2009),in contrastwith TFL’s proac-
tive, preventive approach. Contingent rewards represent the
recognition offered to a follower following the achievement
of a specific goal,a sort of economic exchange.Several
studies (Kleinman 2004, Raup 2008, van Oyen Force 2005)
show a significantrelationship between contingentreward
leadership behavioursand staff RN job satisfaction and
retention,although someresearchers(Murphy 2005) are
critical of transactionalleadership,positing thatthis style
‘lacksvision for the future and endorsesonly changesof
smallmagnitude thatare predicated on policy and proce-
dure rather than organizationalor cultural change’(p.
130). By contrast, TFL is generally promoted in the nursing
contextfor its encouragementof behavioursthat inspire,
engageand motivatefollowers to completelytransform
staid organizationalprocesses and culture (Suliman 2009).
Effectiveleadersmay demonstrateboth transformational
and transactionalleadership characteristics (Lindholm et al.
2000, Bass et al. 2003). Some will say that the group needs
and the situation at hand should dictate the leadership style
used (Kleinman 2004), while others have identified relation-
ship between leader and follower, as well as tasks and goals
established as determinants of the most effective leadership
approach (Murphy2005). TFL does not substitutefor
transactional leadership, but rather complements and poten-
tiates it (Murphy 2005) by assuring that both management
and leadership functions are appropriately tended.
Another contrary leadership style mentioned above,lais-
sez-faire leadership,is characterized by behaviours that are
2648 © 2016 John Wiley & Sons Ltd
S.A. Fischer

true to the English translation ofthe phrase from French:
‘let it be’ (Perkel 2002). This style tends to be ‘hands off’ at
best and at its worst means having a leader who intention-
ally avoids engagement and decision-making.Levels of lais-
sez-faire characteristics and behaviours are inversely related
to willingness of staff to exert greater effort,perception of
leader effectiveness and satisfaction with the leader (Kanste
et al. 2009), contrasting theessentialeffecton followers
attributed to TFL.
On a more theoreticallevel,TFL also stands in contrast
with trait theory.While TFL aligns with Full Range and
SituationalLeadership theories,discussed above,TFL does
not comportwith trait theory’s claim thatleaders possess
inherenttraits enabling them to assume leadership roles;
trait theory further posits that,based on the identification
of certain traits,personalitiesand characteristics,one can
predict whether a person willbe a leader (Cummings et al.
2008).While trait theory holds thatleaders are born,not
made,substantialevidence exists to support TFL as a com-
petency that can be taught (Gowen et al. 2009, Duygulu &
Kublay 2011).
Illegitimate cases
Having identified borderline,related and contrarycases
associated with the concept of TFL,it is important to rec-
ognize illegitimate exemplars ofTFL. All transformational
leaders have in common the power to influence people,but
they do not universally possess good intentions (Hutchinson
& Jackson 2013,Tourish 2013).Cult leaders like Charles
Manson or Jim Jones are illegitimate cases of TFL.Differ-
entiating illegitimate cases of TFL is important for guarding
against inadvertent development of leaders who do not pri-
oritize ethicalintention and good faith efforts in their lead-
ership practice.
Another example of an illegitimate case of TFL is that of
Pseudo-TransformationalLeadership.First identified by
Bass and Steidlmeier (1999),this leadership style is charac-
terized by many of the same traits as TFL,but the leader’s
intentions emerge from self-interestand unethicalmotives.
The capacityto influence others, when undergirded by
malevolence,becomesmanipulativerather than inspira-
tional. The magnitude ofunethicalintentand severity of
impact on followers serveto define Pseudo-Transforma-
tional Leadership as an illegitimate example of TFL.
While substantialevidencedemonstratesthe strengths
and positive influencesof TFL on the work environment,
culture, performanceand outcomes,many authors are
quick to caution that one should not conclude that TFL is
a panacea.Welford (2002) emphasizesthat despitethe
value of TFL as a style,no one leadership style is effective
in all situations.This is consistentwith the view of Fie-
dler,who for this reason developed the SituationalLeader-
ship theory (Murphy 2005), described above.Lindholm
et al. (2000)also notesthat the mosteffective leadership
profile is one thatcan be adapted to differentsituations,
as does Jones (2006).
Antecedents and consequences
Despite the extensive research related to TFL,few antece-
dents have yet been proposed:leader identity (Johnson
et al. 2012),emotionalintelligence and socialskills (Tycz-
kowskiet al.2015).However,the competencies considered
essentialto TFL could be construed as antecedents,includ-
ing communication, collaboration, coaching skills and men-
toring skills(O’Brien et al.2008, Clavelle 2012,Buckner
et al. 2014).Most research related to antecedents suggests
that further study is warranted.Much more attention has
been paid to the consequences or outcomes of TFL.
In terms of consequences,TFL is known to have signifi-
cant effects on followers,organizations and leaders them-
selves.Most notably for followers,TFL has the effectof
inspiring and motivating, leading them to grow and develop
personallyand professionally(Bamford-Wade& Moss
2010).These followers tend to feelmore valued (McGuire
& Kennerly 2006) and their performance is enhanced as a
resultof increased self-efficacy and engagement(Salanova
et al.2011).This effect likely results from a greater invest-
ment in coaching and mentoring on the part of the transfor-
mational leader (Koerner & Bunkers 1992).
TFL followers and the leaders themselves enjoy multiple
benefits while the organization reaps tremendous outcomes
in loyalty and commitment from these followers.Increased
loyalty and commitmentto the organization,along with
improved job satisfaction and morale,all resultin signifi-
cant reductionsin turnover and greaterjob performance
(Leach 2005),giving the organization an overallcompeti-
tive advantage.TFL predicts performance even when per-
sonality characteristic variablesare controlled (Basset al.
2003).
Empirical referents
Severalempiricalreferents have been proposed for measur-
ing TFL. The most common instrument for measuring TFL
is the Multifactor Leadership Questionnaire (MLQ),devel-
oped by Bass and Avolio (2004).This 45-item,self-report
questionnaire measuresa range of leadership behaviours.
The 12 subscales of the MLQ measure each of the defining
attributes of leadership,as wellas attributes categorized as
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JAN: CONCEPT ANALYSIS Transformational leadership

transactionaland laissez-faire,in addition to generalattri-
butesof extra effort, effectivenessand satisfaction.The
MLQ has been used extensively in health care and other
industries, despite ongoing challenges to its factor structure;
studies have repeatedly failed to replicate the original factor
structure (Edwards et al.2012).Less frequently used mea-
suresfor TFL include the Leadership PracticesInventory
(Kouzes & Posner 2008) and the GlobalTransformational
Leadership Scale (Carless et al.2000).All of the scales in
use have been criticized forthe ambiguity oftheir con-
structs and the high correlations among subscales (Hutchin-
son & Jackson 2013). In nursing leadership studies, the use
of the MLQ and LPI scales is allegedly suspect due to fre-
quent methodologicaldesign weaknesses(Hutchinson &
Jackson 2013).
Summary of results
This concept analysis has reviewed the established definition
of TFL, in addition to the common use of the term in busi-
ness and social/psychologicalscience theory.Severallimita-
tions and criticismsof the common usageof TFL have
emerged,primarily due to conceptualambiguity and theo-
reticalweaknesses.The concept has neither a strong opera-
tional definition, nor clearly identified underlying
constructs.Further definition of TFL and concept clarifica-
tion will benefit theory development and future research.
Discussion
The literature search for this conceptanalysis revealed an
abundance of literature related to TFL in the nursing context;
many research studies document and explore the outcomes
and importance ofthis leadership style.‘Transformational
leadership’is a term that is frequently used in nursing
research and publications and is increasingly used in verbal
communication in the health care and business setting.By
and large, researchers have accepted and put to use the work
of Bass and Avolio (Bass 1990) that specifies,differentiates
and definesthe attributes,characteristicsand behaviours
associated with TFL.Researchers consistently express that
further research is needed to more fully explicate how TFL
influences leaders, followers and outcomes.
Limitations
One of the challengesto a comprehensive conceptanaly-
sis, especially in the healthcare context,is the field’s ever-
changing landscape.The healthcare environmentis facing
such rapid change that there are ongoing shifts in meaning
and usage of existing verbiage,as new constructs and lan-
guageare created to describenew structuresand pro-
cesses.
Theoretical implications
An important theoretical implication that emerges from this
conceptanalysisis the questionable validity ofthe com-
monly used operationaldefinition ofthe term ‘transforma-
tional leadership.’TFL is definedby Bass and Avolio
(2004)as ‘a type ofleadership style thatleads to positive
changes in those who follow.’Leaderswho use this style
‘are generally energetic, enthusiastic and passionate [as well
as] . . .concerned and involved in the process [and] focused
on helping every member of the group succeed as well’(p.
25). A problem with this definition is that it defines Trans-
formationalLeadership on the basis of what it does,rather
than what it is.For a full understanding of the meaning of
the term,it is essentialto develop a definition based on the
traits and characteristics of the leader, rather than based on
the impact on followers.
Future research
Ample opportunitiesexist to develop and testleadership
models.This conceptanalysiscreatesa foundation for
future research by proposing a new definition of TFL,one
that is distinctfrom the antecedentsand consequencesof
the concept. The proposed definition is as follows:
Transformationalleadership isan integrativestyle of
leadership as wellas a setof competencies.The Transfor-
mationalLeadership style isidentified by an enthusiastic,
emotionally mature,visionary and courageous lifelong lear-
ner who inspires and motivates by empowering and devel-
oping followers. Competencies essential to the
transformational leader include emotional intelligence, com-
munication, collaboration, coaching and mentoring.
This definition identifiesthe traits,antecedentsand the
consequences of the two faces of TFL: a set of competencies
and a leadership style.
Implications for nursing practice
This concept analysis bolsters nursing theory, research, edu-
cation and practice at a time when nursing leaders are posi-
tioned to becomemore prominentplayersin healthcare
reform and policy development.A growing responsibility
for expansion of practice requires strong and effective lead-
ership skills and an understanding of transformational lead-
ership will benefit this skill development and practice.
2650 © 2016 John Wiley & Sons Ltd
S.A. Fischer

Conclusion
The process ofconstructing conceptualmeaning is crucial
for theory developmentand testing(Chinn & Kramer
2008).No concept analysis of TFL has yet been published
in the context of nursing, despite the prevalence in usage of
the term TFL, its prominence in conversations about organi-
zational influence and the lack of consensus regarding defini-
tion and group or individual-leveleffects of TFL (Wang &
Howell 2010).The present report addresses this gap in the
literature,contributing to the foundation of nursing knowl-
edge as itrelates to leadership theory,education,research
and practice,by proposing an improved operationaldefini-
tion and delineating essential competencies for TFL.
Funding
This research received no specific grantfrom any funding
agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
No conflict of interest has been declared by the author.
Author contributions
All authors have agreed on the finalversion and meetat
least one of the following criteria [recommended by the
ICMJE (http://www.icmje.org/recommendations/)]:
•substantialcontributionsto conceptionand design,
acquisition of data, or analysis and interpretation of data;
•drafting the article or revising it critically for important
intellectual content.
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