Clinical Leadership and Management in Nursing

This assignment critically evaluates four research articles on clinical leadership and management in nursing. It discusses the importance of clinical leadership in healthcare organizations and explores different leadership styles. The articles highlight the impact of leadership on job satisfaction among staff nurses and the quality of patient care. The findings suggest the need for democratic, transformational, transactional, servant, and distributive leadership styles in healthcare settings. However, healthcare managers should adapt their leadership style based on the situation.

Running head: HEALTHCARE
Clinical Leadership and Management in Nursing
Name of the Student
Name of the University
Author Note

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Introduction
Clinical leadership is an umbrella term that comprises of the notion of medical
healthcare staff who are entitled with the responsibility of leadership implementation that
requires them to participate in inspiring, setting, and promoting vision and values (Swanwick
& McKimm, 2017). Furthermore, the clinical experience and expertise of the leaders also
helps them ensuring that the needs and requirements of all patients form the major focus of
care delivery. There is mounting evidence for the fact that clinical leadership covers a
plethora of roles that exist across multidisciplinary team members and primary care nurses,
and forms the forefront of policy execution and healthcare innovation (Stegen, Leveson,
Llewelyn & De Giorgi, 2018). Furthermore, clinical leaders are also entitled with the
responsibility of developing and formulating quality improvement strategies, encouraging
subordinates, bringing about change management, and facilitating team communication. This
assignment will critically evaluate four research articles that are based on clinical leadership,
and will further outline their limitations.
Article 1
This article accurately identifies the fact that under most circumstances, the health
care workers are stressed by a plethora of governmentally determined, top-down change
administration enterprises, which are generally disseminated to grass-roots physicians and
nursing professionals (McKeown & Carey, 2015). Hence, the healthcare workers are not
provided with adequate opportunity for influencing the origin or implementation of the
change management policies. This is in accordance to the fact that the comparative absence
of democracy and contribution/involvement in major decision making processes in workplace
has been identified as a major reason behind weakened staff morale (Timming & Summers,
2018). Therefore, the article highlighted a stereotypically ignored facet of discourse, in
relation to clinical leadership, namely, the prominence of power relations.

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The researchers elaborated on the fact that although transformational leadership has
proved effective in enhancing the quality of care and addressing cost-effectiveness of
healthcare, it is not effective in meeting the challenging professional difficulties, resource
limitations and decision making capacity, thus severely limiting the potential of actualisation
of change management processes. The findings of the research article elaborated on the need
for implementing democratic leadership in healthcare organisations based on the fact that this
form of leadership will observe the service users and health care teams in the form of a
community. Furthermore, the authors also suggested that democratic leadership has the
potential of making the leaders work in collaboration, with the aim of implementing novel
ways that would help them relate to each other (McKeown & Carey, 2015). The findings
further suggested that numerous government policies have been formulated and enforced in
recent years that have accelerated the interest amid service users, and have also enhanced
involvement of the carers in the procedure of development and delivery of public health
services. In addition, nursing professionals have also been identified to play a crucial role in
such endeavours.
It was stated that demonstration of democratic clinical leadership expertise and
characteristics must typically comprise of the characteristics of patience, listening, and
humility. Furthermore, such democratic leaders are also expected to demonstrate flexibility
and resilience while being involved in decision making and change management processes
(McKeown & Carey, 2015). Relevance of the research findings can be accredited to the fact
that it will encourage all members of multidisciplinary care team to share their opinions and
ideas, even under circumstances when the clinical leader retains the concluding say.
Furthermore, application of democratic leadership will also ensure that fairness, creativity,
competence, and honesty is maintained the time of care delivery (Iqbal, Anwar & Haider,
2015). Thus, it is a good leadership style for clinical settings since abilities and skills of all

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the authorities would equally contribute to the accomplishment of the healthcare
organization. However, one major limitation of this leadership style can be accredited to the
fact that obtaining responses and feedback from all team members is a time consuming
procedure (McKeown, Carey, Rhodes & Jones, 2015). Furthermore, under most
circumstances, the confident team members continually come ahead and provide suggestions,
whereas hesitant workers might never get the chance to participate in decision making.
Article 2
The aim of the second article was to explore the perception and opinion of staff
nurses, in relation to the leadership styles that were embraced and implemented by their nurse
managers. The researchers aimed to identify the style of leadership that ensured work
gratification amid staff nurses, followed by recognition of the behaviours that required
change in a healthcare organisation (Morsiani, Bagnasco & Sasso, 2017). The researchers
were accurate in identifying the fact that presence of particular conducts among nurse
managers, which the staff nurses recognise as helpful and compassionate, might vary from
behaviours that are considered supportive by the nurse managers. This was in accordance
with the fact that there are a plethora of evidences that discuss the behaviour of nurse
managers to play an important role in influencing satisfaction levels among the staff nurse
(Van Dyk, Siedlecki & Fitzpatrick, 2016). However, the researchers also elaborated on the
fact that there is lack of evidence regarding the manner by which staff nurses identify the
styles of leadership in their managers, and the impacts that are created on the level of job
satisfaction of the nurses.
The researchers conducted a mixed method study that was based on administration of
a Multi‐factor Leadership Questionnaire to the study subjects, and also involved the
conduction of three focus groups. The findings of the study suggested that under most
circumstances, ward nurse managers were found to show adherence to a transactional

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leadership style, commonly referred to as management by exception active (Morsiani,
Bagnasco & Sasso, 2017). Furthermore, it has been found that implementation of
transactional leadership in healthcare organisation has proven effective in monitoring
medication errors at healthcare organisations. In contrast, the findings also suggested that
ward managers also manifested the style of transformational clinical leadership, which in turn
was mostly associated with satisfaction among the staff nurses. It was found that this style of
leadership is commonly influence attributed, and is generally perceived in the form of respect
and a caring approach towards others.
Relevance of the research findings can be accredited to the fact that implementation
of transformational leadership style in health and social care is principally based on providing
reassurance and encouragement to the employees for delivering their best effort. In addition,
implementation of transactional leadership also promotes health and social care by preventing
placing an emphasis on the performance of the healthcare organization. Rather it explores the
best possible strategies that can be implemented for delivering healthcare services in a perfect
manner (Saravo, Netzel & Kiesewetter, 2017). However, some major limitations of the
aforementioned leadership style can be accredited to the fact that while transactional
leadership does not encourage creativity and is often associated with insensitivity towards the
staff, transformational leadership can exert a negative effect if the manager is dissolute or is
self-serving, and can also result in abrupt decision making.
Article 3
The primary objective of the third article was to explore and gain a sound
understanding of the leadership involvements and familiarities of modern matrons. The
researchers were accurate in identifying the fact that in recent years, modern matrons got re‐
introduced to the National Health Service. Furthermore, operative leadership has been
recognised as being vital and indispensable for their work role to be efficacious (Lawrence &

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Richardson, 2014). This was in accordance to the fact that strong leadership in nursing helps
in encouraging other nursing professionals for adorning the role of effective team members.
Time and again it has been proved that clinical leaders must demonstrate the presence of
strong interpersonal skills (Sims, Hewitt & Harris, 2015). However, the researchers were
accurate in illustrating the fact that there remains minimal confirmation of the ways by which
effective leadership are experienced by modern matrons. Thus, the researchers based their
exploration on an expressive generic qualitative methodology.
They adopted the method of one‐to‐one in-depth semi‐structured interviews for data
collection among nine matrons. Following collection of response, the researchers conducted
an inductive thematic analysis that made them identify three themes namely, negative
influences, leadership behaviours, and leadership investment. It was found that while
recounting their leadership understandings, the participants emphasised instances of using the
characteristics allied with transformational leadership such as, generating a vision, teamwork,
accessibility and empowerment (Lawrence & Richardson, 2014). Nonetheless, at the time of
mentioning the leadership approaches that they seemed to support, it was suggested by all
matrons that they would acclimatise their leadership style based on the condition they were
in. Furthermore, the findings also illustrated that under most circumstances, the modern
matrons seemed to place larger worth on the doing character as divergent to the imaginative
element of leadership, and unswervingly mentioned about the prominence of being accepted
as an optimistic role model.
It was also identified by the researchers that some of the major negative influences
that were considered to act as an impediment to the pathway of adorning the role of an
effective leader were namely, workload, time constraint, professional separation, and absence
of preparation for the role of a leader (Lawrence & Richardson, 2014). Furthermore, majority
of the matrons talked about the presence of an ostensible conflict, with the challenging

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urgencies between the management and leadership constituents of their role. Thus, it was
found that being understood and perceived as an optimistic role model was cited imperative
for maintaining leadership trustworthiness. Hence, it was found that modern matrons
commonly perceived clinical leadership to comprise of behaviour that is characterised by
role-modelling. Hence, they placed due emphasis on manifestation of positive actions that
could be imitated by the team members. Owing to the fact that characteristics, such as,
honesty, problem-solving, courage, consistency, problem-solving, and enhanced interpersonal
abilities were valued by the matrons, nursing managers must demonstrate the attributes of
servant leadership (Hanse, Harlin, Jarebrant, Ulin & Winkel, 2016). The relevance of this
leadership to health and social care can be accredited to the fact that instead of making
decisions in an approach that aids the team, it will make the managers consider the complete
organization. Furthermore, it will also prove effective in creating diversity in workplace, and
will also focus on serving the patients. However, one major limitation of this leadership style
can be associated with the fact that leaders adopting this style take longer in decision making,
and considerable amount of money and time needs to be spent in restraining the personnel to
adopt this style.
Article 4
The researchers of the fourth article highlighted the fact that health and social care has
both social and scientific dimensions, and has also been identified as a domain of enormous
political concern. Massive quantities of gross domestic product are expended on health, the
association of multifaceted systems of well-being provision is problematic, and
administrations are progressively adjudicated on their capability to provide high quality
services (Aggarwal & Swanwick, 2015). This is affirmed by the fact that the purpose of an
effective management is to provide care services to the society in a suitable, reasonable and
sustainable manner (Ginter, Duncan & Swayne, 2018). The researchers recognised the

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presence of an estimated 60,000 junior doctors in the UK and also explained the need of
postgraduate medical training, in relation to addressing the medical needs of the society.
Findings from the article suggested that transformational leaders target human potential
through enablement and expansion of followers. In addition, they also stated that the concept
of distributed leadership moves past the secluded prototype of heroic leadership to an
adaptive, shared, and cooperative method that forces the front-runners to emphasise on
delivery of care, and not merely administrative delivery of consequences.
This was followed by explanation of the Leadership Qualities Framework that was
published in 2002, and recognised 15 cognitive, personal, and social potentials indispensable
for efficacious leadership across care services. Hence, the researchers suggested that
implementation of the Medical Leadership Competency Framework (MLCF) was imperative
in care delivery owing to the presence of three different domains namely, setting direction,
personal qualities, and service delivery (Aggarwal & Swanwick, 2015). In addition, it was
also stated that leaders should be able to demonstrate character that embraces excellence as a
business policy. Hence, relevance of the findings is that distributive leadership would provide
more options for clinical decision making and would also make the leaders take
psychological ownership of their job (Martin, Beech, MacIntosh & Bushfield, 2015).
However, maintaining accountability can be challenging and the leaders might suppose to
have their views heard.
Conclusion
To conclude, it has often been established that clinical leaders are imperative in
enhancing the quality of care services and transforming the services for excellence. In
addition, clinical leadership encompasses setting a directed vision for individuals, while
setting values of the particular organisation in a definite direction. The articles analysed in the
previous sections focused on five leadership approaches that namely, democratic,

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transformational, transactional, servant, and distributive, all of which were considered best
for healthcare organisations under particular circumstances. However, rather than restricting
oneself to one particular approach, healthcare managers must adapt themselves to the
situations, and act accordingly.

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References
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