Leadership in Nursing

This article explores the impact of leadership on healthcare culture and patient care in nursing. It discusses different leadership theories, including transactional, situational, and transformational theories, and their application in the healthcare setting. The article also highlights the qualities of a good leader in nursing and the importance of leadership at individual and team levels. Additionally, it emphasizes the role of leadership in improving nursing skills and patient outcomes.

Running head: Leadership in Nursing 1
“It is a truism that organizational culture is informed by the nature of its leadership” (Francis,
2013)
(Author’s name)
(Institutional Affiliation)

Leadership in Nursing 2
Introduction
Health care culture can be highly influenced by its leadership. Most of the healthcare
cultures that can be affected by its leadership include failure to put patients first, acceptance of
poor standards and willingness of change, misplaced assumptions of trust, and lack of
consideration of patient’s risks(Giltinane, 2013). Leadership is complex and various individuals
understand it differently. One of the definitions of leadership is that it is a process that involves
goals identification, the motivation of other people to act, and support provision either manually
or influential in order to achieve mutually benefiting objectives(Williams, McDowell, & Kautz,
2018). Clinically, leadership has been defined as involvement in clinical care as you constantly
influence others to provide quality and safety care. Most people often confuse leadership and
management. Leadership is different from management in various aspects (Williams, et al.,
2018). First, leadership is involved in setting a direction as compared to management which
involves planning. Furthermore, leadership involves aligning individuals comparing to
management which includes staffing and organizing(Fleming & Kayser-Jones, 2013). Other than
that, leadership provides inspiration and motivation while management involves control and
solving problems.
In nursing, there are various qualities of a good leader. These include emotional
intelligence, integrity, critical thinking, respect, communication skills, and dedication to
excellence, professional socialization, mentorship, and professionalism(Wong & Giallonardo,
2013). Such characteristics have been guided using various literature and theories(Fleming &
Kayser-Jones, 2013). Such theories include trait theory, behavioral theories, and contingency
theories, situational, transactional and transformational theories. The most current leadership
theories are transactional, situational and transformational theories. This study seeks to

Leadership in Nursing 3
demonstrate various types of current nursing leadership theories, their application in the
healthcare setting and analysis of how they have influenced healthcare culture.
Understanding Leadership Theories Nursing
Transactional Leadership Theory
This theory suggests that, by offering rewards to workers, a leader can produce positive
impacts. However, most of the transactional leaders often focus on management tasks and
usually do not identify the shared values of a team(Tyssen, Wald, & Heidenreich, 2014). The
transactional approach is usually task oriented thus it effective in emergency care like dealing
with urgent issues. This approach, however, may make nurses fail to treat patient as a whole as
they focus of single tasks that need to be done thus leading to poor healthcare culture
(Amanchukwu et al., 2015). One example of transactional leadership is autocratic leadership.
Autocratic leaders are usually power oriented, controlling and closed minded(Tyssen et al.,
2014). Their main objectives are strict adherence to the rules and obedient. Although most of the
nurses and health care providers dislike aristocratic leaders, they well worked under them. Such
leaders have been found to be effective since they determine what need to be done by creating a
good structural and cultural healthcare organization(Tyssen et al., 2014).
There are three types of transactional leaders which include contingent rewards,
exception active management and exception passive management leaders(Giltinane, 2013).
Contingent rewards offer reword where certain task are met to promote motivation, active
exceptions management involves leadership scenarios where leaders intervene into staff
behaviors before they become problematic and passive exceptions is when leaders do not
intervene into workers activities until they become problematic(Giltinane, 2013). When the

Leadership in Nursing 4
leadership is weak, there is poor performance leading to poor quality of care and poor
organizational culture.
Situational Leadership Theory
Situational leadership involves using different leadership styles to manage various
scenarios. Healthcare organizations are constantly changing and therefore leaders are encouraged
to use different styles while dealing with different situations(West et al., 2015). Other than that,
health care organization should recognize individuals who are effective in leading particular
situations. Situational leaders in nursing have abilities to identify competencies, performances
and can commit to others(Amanchukwu et al., 2015). Situational leaders are built through the
development of good relationships and behaviors between leaders and staff. A leader usually
uses supportive behaviors to involve staff through communication and the provision of emotional
support. In order to make staff cooperate, situational leaders apply directive behaviors to create
roles for the workers(Sfantou et al., 2017). This is usually done by leaders explaining the
activities of each task and how the tasks are done. The development of skills on workers depends
on their hand working, wiliness, experience, and responsibilities.
Clinically, the nurse leader’s uses situational approach while supervising nursing students
or newly qualified nurses. This is due to the fact that situational leadership depends on workers
confidence and level of experience (Giltinane, 2013). A newly employed worker has enough
knowledge but lack personal confidence and experience. In that case, the leader will apply for a
more directive role until that nurse gains enough confidence and experience. Situational
leadership encourages leaders to recognize the complexity of the work and consider a number of
situational factors before deciding what to do(Giltinane, 2013).

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Transformational Leadership Theory
Transformational leaders inspire workers and acts as mentors. Such leaders recognize
workers needs using Maslow’s hierarchy of needs and thus they will want to address them.
Transformational leaders empower nurses to become leaders by acting as a role model(Meyer,
VanDeVelde-Coke, & Velji, 2013). Other than that, they usually compel vision for the future,
identify people differences, inspire workers and help them to develop strengths. Therefore, they
instill motivation to the team members and help them pursue their dreams. When staff has input
in teams vision, they feel valued and thus strengthens their relationship with the leader(Kumar &
Khiljee, 2016). Additionally, workers are able to develop ownership, responsibility, morale and
increases commitments to workers. This leads to workers becoming more motivated thus
developing their own leadership skills.
Inspirational motivation is a type of transformational leadership where leaders influence
workers through charismatic communication, therefore, setting objectives and motivating them
to achieve them(Meyer et al., 2013). In nursing, there are two types of idealistic influencer which
include idealized influencer attributed and idealized influencer behavior(Giltinane, 2013).
Idealized influencer attributed leaders uses charisma to instill strong motivational bonds whereas
idealized influencer behavior leaders use their own behaviors to form collective values and
motivation throughout the healthcare organization. Through this clinical leaders can create a
collective team that has a common goal(Giltinane, 2013).
Transformational leaders are important in improving nursing skills and patient outcomes.
This style of leadership can improve clinical and healthcare environment and culture as leaders
usually give quality objectives and ensure other staff are involved (Sfantou et al., 2017).In

Leadership in Nursing 6
addition, transformational leaders tend to create a healthcare culture that ensures patients to the
nursing association are increased thus increasing therapeutic relationships.
Application of Leadership Theory in Nursing
Individually
Leaders in healthcare use theoretical knowledge and leadership skills to motivate and
influence others in order to achieve common goals and objectives. Leaders often have visions
and usually equipped with strategies, plans, and desires to direct teams for the purpose of
creating positive organizational cultures that can help in achieving common goals(Frankel,
2012). Effective leaders are required to use problem-solving processes, motivate and maintain
group effectiveness and develop group team identification. Nurses leaders usually apply these
characteristics in their work in order to influence the team trust and respect thus leading to
change in clinical practice(Frankel, 2012). By demonstrating effective leadership style, nurse’s
leaders become powerful thus they can easily lead to the development of other nurses ensuring
professionalism and making other nurses to grow clinically. Individual leaders who develop a
driving force in an organization is usually admired and thus most of other health care workers
usually try to copy his behaviors and attitudes(García García & Santa-Bárbara, 2009). Nurse’s
leadership often surrounds certain issues which include resolving conflicts, delegating
appropriately, making decisions and acting with integrity and respect. In addition, nurse’s leaders
nurture others and make themselves aware of what other people are feeling in the team. For
instance, a nurse leader can in a hospital create a suggestion forum that allows other nurses to air
views about what they think about a certain issue. The key characteristics that are described as
effective in nurturing other nurses include making oneself as a role model, mentoring and

Leadership in Nursing 7
clinical supervision, creating careers pathways for other nurses and valuing other nurse’s
competencies.
Healthcare Teams and healthcare services
Healthcare teams are governed by different leaders who form a larger team of leader that
governs the whole organization(Nash & Govier, 2013). The type of organizational leaders
determines the types of health care services that will be given thus affecting patient care.
Different health care teams will have different roles in the hospital and thus may require different
leadership strategies. A group of leaders in a hospital organization is usually put into place
consisting leaders from all health care team in order to come up with collaborative decisions that
allow team working among workers(Nash & Govier, 2013). Such leaders usually form a board of
governors, creating visions and goals for the whole organization in order to make sure patients’
needs are met.
Healthcare teams leadership determines if the leadership systems are failing by checking
areas that require attention. Such failures in healthcare services usually occur where the leaders
fail to actively corroborate and influence the healthcare workers to change the organizational
culture towards positive(Williamson, 2009). For the organization to transform towards proper
patient care and positive outcomes a good organizational structure and leadership is needed. The
quality of healthcare services provided by an organization is determined by the commitment and
responsibility of the boards(Mallon, 2017). Therefore, leadership boards must demonstrate they
give priority to patients needs by providing quality and safe care. For instance, boards can try to
seek client’s feedback, reflecting and learning from patient complaints, taking time to listen to
patient’s stories and learning from the staff(Williamson, 2009). By doing so, an organization will
definitely deliver quality healthcare services. Team leaders have proven to be most effective

Leadership in Nursing 8
when they work in groups that promote collective leadership leading to the development of well-
established teams(Kumar & Khiljee, 2016). Such teams should develop similar objectives that
align in meeting patient’s needs. Healthcare teams can help in resources utilization, maximizing
the use of time and thus improving the overall organizational quality and safe care.
Analysis
The phrase “It is a truism that organizational culture is informed by the nature of its
leadership” (Francis, 2018) is definitely true. The nature of leadership determines how an
organization will run and thus affecting the overall patients’ quality and safe care. Leaders
usually create roles and responsibilities of workers through motivation and inspiration to increase
individuals responsibilities and commitments(The Kings Fund, 2013). An organization that lack
effective leadership usually lack implementations of goals and objectives thus patients’ needs are
not met. Positive organizational culture has common goals that prevent risky behaviors and
practices among staff that can lead to poor patient care(Dyess, Sherman, Pratt, & Chiang-
Hanisko, 2016). Ineffective leadership usually leads to a culture that has low staff morale,
denials, lack of team working, disagreements among team leaders, acceptance of poor behaviors,
lack of goals, isolation, discouragement of patients feedback and increases reliance from external
assessments. Failing of the staff in an organization is primarily to challenges they encounter in
their day to day work(Dyess et al., 2016). Leaders need to understand what is going around the
workers in order to solve and prevent certain issues from happening. Reluctant leadership will
definitely lead to failure and negative cultures(Dyess et al., 2016).
In order for an organizational culture to change for the betterment of patients and
healthcare delivery, leaders must be alert and ready to learn from the mistakes they have already
made(Remus, 2016). By owning their mistakes, an increase in transparency and trust among

Leadership in Nursing 9
workers can be demonstrated thus, in turn, improving patient care. In that way, positive values
can be put into place to change an organization culture(The Kings Fund, 2013). Such a culture is
usually patient-centered and put the patient first beyond other things. In addition, a positive
organizational culture has leaders that observe fundamental standards, discourages non-
compliance and motivate all workers to be highly committed.
In a healthcare organization, leadership is important and it should be practiced at all
levels from ward up to the board. It is the responsibility of the leaders to practice strong patients
–centered leaderships which are ethically in all healthcare organizations(West et al., 2015). In
order for leaders to develop strong leadership skills they must listen to patients and staff, be a
good example to others, understand organization as a whole, think literally across boundaries,
share and engage leadership with all staff in order to ensure they are well valued and respected,
challenge others effectively, encourage clinical engagement , and be able to exercise collective
leadership at board level(West et al., 2015). Other than that, leaders should be ready to engage
and collaborate with each other’s to form team leadership in order to facilitate organizational
objectives implementation. Healthcare organizations where team leaders are arrogant, selfish,
burry workers more frequently, do not listen and assume most of the organizational complaints
end up adopting negative cultures that do not help the patient(West et al., 2015). It is good for
organization leaders to usually keep in their minds that, the patient is always the center of all
plans and implementation of healthcare services.
Conclusion
In conclusion, Francis 2018 was right about his concerns regarding leadership influences
on organizational culture. Positive organizational culture needs good leadership who applies
correct leadership styles and theories to govern an organization. A good leader in healthcare

Leadership in Nursing 10
understands his or her organization well and highly utilizes leadership skill and knowledge to
influence and motivate workers to work on common objectives. Some of the characteristics of a
good manager include one who challenges others effectively, encourage clinical engagement,
integrity, critical thinking, respect, good communication skills, and can be able to work with
other leaders to enhance patient safety and quality care. A good healthcare system should not
only have a board of leaders but also it should incorporate all leaders down from the word. The
ability to know what is happening in patient care can only be enhanced if all health care teams
come together to accomplish organizational common goals and objectives.

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