Clinical Leadership in Nursing

This paper analyzes the impact of clinical leadership in nursing on patient outcomes and work environment. It explores different leadership styles such as transformational, transactional, and autocratic leadership. The study highlights the importance of transformational leadership in improving patient safety and overall outcome of care.

Running head: NURSING
Clinical Leadership in Nursing
Name of the Student
Name of the University
Author Note

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Introduction
A leader is defined as a leader of a team who provides guidance and motivation to the
team members. Nurses play an important role in delivering the care for the patients. Any
errors in the nursing care plan result in the generation of medication error or other adverse
health-related outcome and thereby helping to overall outcome of care (Wong, Cummings &
Ducharme, 2013). There have been considerable evidences that have highlighted how the
working environment of the nursing professionals like staffing of the nurses help to improve
the overall outcome of the patients like improvement in the patients’ mortality and decrease
in the adverse health-related outcomes like medication errors, hospital acquired infections,
accidental falls and pressure ulcers. However, less research has been undertaken for the
examination of the effect of nursing leadership in improving in the work environment and
how it helps to promote overall patients’ health-related outcome (Wong, Cummings &
Ducharme, 2013). The following paper aims to analyze the four research articles published
over clinical leadership on nursing. The assignment will identify the leadership theory and
other issues or problems highlighted in the literary articles. At the end, prevalence of the
research findings of each of the articles will be discussed along with subsequent
recommendation stated in the articles. The four research articles selected for this paper
include:
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.
Boamah, S. A., Laschinger, H. K. S., Wong, C., & Clarke, S. (2018). Effect of
transformational leadership on job satisfaction and patient safety outcomes. Nursing
outlook, 66(2), 180-189.

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Clarke, S. (2013). Safety leadership: A meta‐analytic review of transformational and
transactional leadership styles as antecedents of safety behaviours. Journal of
Occupational and Organizational Psychology, 86(1), 22-49.
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.
Discussion
Transformational leadership and nursing education
Transformation leadership style in nursing promotes inspirational behavior of the
nurse leaders in order to motivate the subordinates such that they can perform their
professional duties by outnumbering the expectations (Hutchinson & Jackson, 2013). Here
the nurse manager makes use of the leadership style for promoting intellectual stimulations
among the team members and thus helping in the generation of emotional intelligence,
motivation, dedication towards work and increase in the level of team bonding. In other
words, it can be stated that transformational leadership style in nursing is the most studied
leadership in nursing profession and can be easily applicable under broad clinical settings
(Hutchinson & Jackson, 2013). Ross et al. (2014) conducted an e-mail survey over 448
nurse leaders registered under the professional nurse association (PNAs) in order to elucidate
that the degree of execution of transformational leadership among them. They selected
nurses under PNAs because they are the main medium to provide the proper educational
opportunities for the nurse students along with educating the nursing students about the
importance of leadership qualities for improving the overall patients’ care. The analysis of
the survey highlighted that transformational leadership practices is the most practiced
leadership style among the nurse educators. The PNAs members who are participants of the

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study state that use of the transformational leadership helps in increase the direct association
of the nurse educators with the students. It also helps in improving the provision of sharing
shared values, objectives and outcomes. Ross et al. (2014) recommended that apart from
execution of the nurse leaderships during teaching process, it is also important for the
educators to teach the students about the concept underlying the transformational leaderships.
This will help them in executing this leadership styles during their professional practice.
Transformational leadership and improvement in the patients’ safety
Nurses play an important role in delivering care to the patients. The study conducted
by Boamah, Laschinger, Wong and Clarke (2018) is based on the background of improving
the safety of the patient within the healthcare organization by execution of the effective
leadership styles. The authors focused on transformational leadership and how it helps in
improving level of job satisfaction of the nursing professionals and patients’ safety. Boamah,
Laschinger, Wong and Clarke (2018) used random sampling techniques in order recruit acute
care nurses of Ontario (n = 378) and conducted a cross-sectional survey. The hypothesized
model was tested by the use of structural equation modeling. The analysis of the data
highlighted that transformational leadership style is helpful in influencing a significant
positive influence over the work empowerment of the nurses and this in turn help to improve
the level of job satisfaction. The study also revealed that proper use of the transformation
leadership is effective in increasing the overall patients’ health-related outcome by lowering
the adverse medication events or other medical errors. The authors finally recommended that
it will be wise for the nurse leader to abide by the transformational leadership styles as it
helps to improve the job satisfaction of the nurses. The similar results were highlighted in the
study conducted by Ross et al (2014). Ross et al. (2014) study showed that use of
transformation leadership by the nurse educators help to improve the level of students’
satisfaction and student engagement. Boamah, Laschinger, Wong and Clarke (2018) also

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recommended that transformational must implemented across diverse clinical settings as it is
helpful in improving the patients’ safety quotient and health related outcome. However,
study can sudden limitations like the entire survey was conducted over the healthcare settings
of Ontario. Such that the results that is applicable under the health care settings of Ontario,
might not be applicable under other states of American thus a global prospect must be
undertaken in order to understand the importance of the transformational leadership in
nursing and patients’ outcome.
Transactional and transformational leadership
Clarke (2013) used a comparative study in order to compare and contrast the
theoretical model of transformational and transactional leadership styles in nursing as
antecedents of patients’ safety. Author mainly generated a theoretical model of nursing
leadership that incorporated both transformational and active transactional nursing leadership
styles and then the comparison was done by the use of meta-analytic pathway. The final
model showed that the transformational leadership in nursing had positive association with
both the improvement in the level of patients’ safety and at the same time helping to improve
the overall work culture. On the other hand, the study highlighted that transactional
leadership style also had a positive association with a perceived safety climate, safety
participation and compliance of overall safety. The authors reported that transactional
leadership style, make use of rewards as well as punishments in order to increase the level of
compliance norms by the team members. Under transactional leadership style, the work done
by the registered nursing professional is stringently monitored for elucidating deviation from
the professional code of conduct of practice and thus helping to highlight gaps in practice.
This stringent leadership styles make it suitable under critical clinical condition (Clarke
2013). Like Scully (2015) are of the opinion that the transactional leadership style is suitable
under the clinical settings of intensive care unit (ICU). In ICUs, the pathological conditions

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of the patients are mainly critical and thus any errors like medication error or lack of
compliance of proper hand hygiene might endanger patients’ safety by increasing the cost of
care and length of stay at the hospital. In such critical condition, transactional leadership
style is found to be effective. This is because, since each and every step of the nursing
professional is being monitored, the nurses work stringently and thus increasing the level of
compliance of the evidence-based nursing practice and improving the level of care and
patients’ safety. However, Clarke (2013) highlighted that this constant monitoring to the
work and punishments or penalties imposed over the nursing professionals when defaulter
claim is proved, place the nursing professionals under the burden of stress and anxiety and a
constant pressure to perform. The fear of performing every day and penalties impose upon
fault create a tendency of hiding of the faults or less reporting of the faults and this
detrimental for overall nursing work culture and patients’ safety. Thus Clarke (2013)
concluded that active transactional leadership is important in ensuring the compliance of the
all the rules and the regulations associated with nursing and use of the transformational
leadership styles help to create a positive yet encouraging working environment that helps the
nursing professional to feel motivate to work through collaborative participation. In other
words it can be said that Clarke (2013) stated that for optimal nursing environment and for
improvement in the work practice a combination of both transformational and transactional
leadership style is important. Clarke (2013) recommended that further research is required to
be undertaken in order to elucidate the research and practical implications of leadership
training and development under nursing practice.
Authoritarian or autocratic leadership
Autocratic leadership or authoritarian leadership is a special style of nursing
leadership management where the nurse leader plays the principal role in controlling the
decisions of the overall work execution while taking minimal opinions from the subordinates

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or the group members. The choices and the decisions taken by the autocratic leaders are
mainly guided by their own level of understanding or the critical thinking skills
(Nanjundeswaraswamy & Swamy, 2014). The study conducted by Alharbi (2017) stated that
the autocratic leadership style in nursing is effective under the clinical situation like the
emergency department. Emergency department is under constant pressure of handling critical
patients like patients from the accidental site with fatal injury, burnt cases or patients with
chronic condition like asthma or congestive heart failure. There is no direct estimation of the
flow of the patients in the emergency department and in the majority of the case; the ratio of
patients is high in comparison to the nurses leading to increase in the level of job pressure
and stress. Alharbi (2017) stated that under this environment it is important to have a leader
who is strict and takes prompt decision over which other professionals are required to abide
by. Allowing each and every subordinates or the registered nurses to take the decision on
their own will lead to the generation of confusion, increase in the chance of error and
unwanted delay of over-all execution of the process. An autocratic leader take the decision on
his or her upon, which other subordinates are required to abide by and this decrease the
chance of delay (Alharbi, 2017). Taking decision on time will help to avoid unnecessary
delays in procurement of the care process. Moreover, having a strict leader, who will take all
the decisions helps to maintain an ordered structure in the workplace. Alharbi (2017) also
highlighted in their study autocratic leadership style offers less degree of autonomy and
psychological empowerment of nursing professionals. Hamper in the autonomy hampers the
level of nurse satisfaction and thus increasing the overall turnover of the nurses. Moreover,
autocratic leadership styles do not provide provision for extensive teamwork as it does not
lead in the generation of trustworthy relationships. Lack of trustworthy relationship hampers
the overall performance of the nursing professional. Alharbi (2017) recommended that in
order to improve the teamwork and the level of trust among the nursing professional, it is the

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duty of the leader to indulge in effective communication. Bringing modification in the
autocratic leadership style lithe use of effective communication skills help to improve the
overall outcome in the emergency department.
Conclusion
The analysis of the four papers highlighted three main leadership styles namely
transformational leadership, transactional leadership and autocratic leadership. Autocratic
leaders are defined as leaders who make their own decisions and do not consider the opinion
of the other subordinates like their team members. It is best suited in the emergency
department where there is a constant work pressure and safety of the patients is critical.
Transactional leadership styles provide both rewards and punishments. However, both the
leadership styles do not offer the provision for team work and the provision of developing
trustworthy relationships. Moreover, both transactional leadership and autocratic leadership
are not suitable for the development of the motivational environment where the nurse feel
comfortable to work. Transformational leadership style is one of the important leadership
styles that can be effectively used in diverse clinical settings. It helps in the empowerment of
the nursing professionals and creates a positive environment for the nursing professionals.
The increase in the job satisfaction of the nursing professional helps to improve the overall
patients’ safety and thereby helping to improve the overall outcome of care. Overall analysis
of the articles helped to highlight that transformational leadership helps in improving
patients’ safety care and overall outcome of patients’ care.

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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.
Boamah, S. A., Laschinger, H. K. S., Wong, C., & Clarke, S. (2018). Effect of
transformational leadership on job satisfaction and patient safety outcomes. Nursing
outlook, 66(2), 180-189.
Clarke, S. (2013). Safety leadership: A meta‐analytic review of transformational and
transactional leadership styles as antecedents of safety behaviours. Journal of
Occupational and Organizational Psychology, 86(1), 22-49.
Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a
more critical interpretation. Nursing inquiry, 20(1), 11-22.
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.
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.
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing
leadership and patient outcomes: a systematic review update. Journal of nursing
management, 21(5), 709-724.