Comparison of Transformative and Autocratic Leadership Styles in Nursing

This paper discusses the transformative and autocratic leadership styles in nursing and compares their outcomes in terms of patient care delivery and safety.

Running head: NURSING
NURSING
Name of the Student:
Name of the University:
Author Note:

1NURSING
Introduction:
The healthcare sector in recent times has emerged to be one of most dynamic sectors
that is continuously encountering challenges with respect to provision of effective and safe
patient care delivery. It should be noted in this context that the recent times has enhanced the
trend of patient’s disease acuity, fostered technological innovation as well as increased the
associated cost of health care facilities (Knaak et al., 2016). Aligned to the current trend, it is
increasingly important to adapt measures so as to improve the quality of healthcare services
provided so as to improve the quality of cumulative patient outcome (Negandhi et al., 2015).
The concept of nursing leadership is integral within the context of nursing profession as it is
on the basis of the clinical leadership that premium quality of care services can be provided
which can help acquire positive patient outcome and at the same time also ensure increased
patient safety (Sanford, 2016). Having discussed the importance of clinical leadership in the
context of healthcare and patient care delivery, this paper intends to discuss two distinct style
of leadership and compare their outcome with regard to the quality of patient care delivery.
Defining the terms ‘leadership’ and ‘patient safety’:
Clinical leadership is extremely important in the field of nursing profession as it helps
in the process of monitoring and managing the team of care professionals that are associated
with the process of patient care. In addition to this, efficient clinical leadership ensures
improved communication and coordination between the team of multidisciplinary care
professionals (Orchard & Rykhoff, 2015). According to Forman et al. (2015), leadership in
nursing has been considered equivalent to the process of mentoring the subordinates, rather
than ordering the subordinates. Nursing leadership is more about instilling belief in the
followers and treating them with respect and dignity. An efficient nurse leader is one who
actively listens to the followers, is attentive, inspires the followers and is at the same time

2NURSING
adapts a rewarding work environment (MacMillan, 2016). In addition to this, a capable nurse
leader is able to integrate within the followers a common vision of promoting effective care
delivery and prioritizing patient safety (Sanford, 2016). Research studies mention in this
regard that nursing leadership must be patient- oriented such that it covers the holistic needs
of the patients (Ozer et al., 2017, Knaak et al., 2016). In other words, caring holistically for
the patient refers to adapting a patient-centred approach so as to focus on the care needs of
the patient across multiple life domains, rather than only focusing on the symptoms of illness
(Prosser, 2016). An efficient nurse leader is one that is able to mentor the followers and at the
same time contribute positively towards the professional development of the followers
(Prosser, 2016).
According to Bahadori et al. (2016), it has been mentioned that effective leadership
within healthcare organizations help to improve overall healthcare quality and at the same
time enhance the level of patient satisfaction. Research studies further mention that nurse
leaders can efficiently act as drivers of change within a healthcare environment so as to
render safe patient care delivery (Sarabi, 2015). A nurse leader typically assists the
subordinates with the process of critical decision making and integrates the use of evidence
based interventions in order to promote positive patient outcome and ensure increased patient
safety (Bayley et al., 2018).
Description of two types of leadership styles:
Transformative leadership can be defined as the leadership style where in leaders
encourage, inspire as well as motivate employees to induce innovation and integrate a change
within the organization so as to ensure quality improvement and overall development of the
organization. This style of leadership can be exhibited by inducing a sense of organizational
culture, ownership of responsibility as well as inculcating independence within the

3NURSING
organization. As stated by McSherry and Pearce (2016), transformational leaders typically
inspire and motivate the employee base without implementing the principles of
micromanaging (Grindel, 2016). This refers to the fact that the leaders rely upon the trained
or experienced employees to take charge of the fresh and inexperienced employees and
mentor them such that the professional development of the entire employee base irrespective
of years of experience is continuous (Sarabi, 2015). In addition to this, the evidence base
further reveals that the transformative style of leadership involves improved participation of
the followers which offers improved ability to undertake critical decisions (Sarabi, 2015).
Historical accounts suggest that the concept of transformational leadership was propounded
by James V. Downtown in the year 1973 and was expanded by James Burns in the year 1978
(Bayley et al., 2018). Further, M.Bass is said to have expanded on the concept in ways such
that it assists with the process of evaluating the level of success of the transformational
leadership (Bayley et al., 2018). Leaders adapting the transformative leadership style make
use of a strong leadership that expects followers to be inspired to comply with devised
lawsuit (MacMillan, 2016). Research studies mention that the transformative leadership style
is associated with a total of six characteristics that include inducing motivation and ensuring
positive development of the subordinates along with setting moral standards within the
organization (Sarabi, 2015). Further, the leader fosters an ethical work environment that is
built on the elements of priorities and standards. In addition to this, the leader emphasises on
open communication, team work and encouraged independent decision making ability such
that followers take ownership of their actions (Forman et al., 2015).
Autocratic leadership or the authoritarian leadership is another leadership style that is
influenced by dominance over all decisions and disregarding any valuable contribution of the
group members (Ozer et al., 2017). The Autocratic leadership style is also common within
the nursing profession and is associated with poor performance outcome (Prosser, 2016). This

4NURSING
leadership style typically involves the absolute and authoritative control over a group. The
leaders impose their decisions on the subordinates barely caring to pay attention to the say of
the other team members (Grindel, 2016). Researchers have conducted comprehensive
analysis on the leadership style and have identified a number of strengths and weaknesses
(Ozer et al., 2017). The strengths associated with the leadership style can be explained as
increased convenience with respect to the decision making ability and the easier feasibility to
direct a chain of command (Prosser, 2016). The weaknesses on the other hand can be
explained as ignorance of group input, impairment of group morale and non-consideration of
valuable input from the team members (Prosser, 2016). The leadership style has typically
been considered effective for managing miniature groups of professionals where a structured
leadership does not exist. However, a number of research studies have stated that the
autocratic leadership is bound to deteriorate the quality of performance output and yield
poorer outcome (Ozer et al., 2017; Prosser, 2016).
Discussion on leadership styles and patient safety outcome:
Upon evaluation of the evidence base, it can be stated that the transformative style of
leadership is associated with positive performance outcome. This style of leadership is
broadly based upon the fostering of motivation such that the team of care professionals can
make use of their skills and expertise to quality care services to the patient (Forman et al.,
2015). In addition to this, this leadership style is also associated with the continuous skill and
performance development of the care professionals so as to make use of the evidence based
strategies in order to render safe and effective care services to the patient (MacMillan, 2016).
On the other hand, the autocratic leadership style is associated with poor performance
outcome which hampers the overall quality of patient care and at the same time comprises the
safety quotient associated with the patient care delivery (Orchard & Rykhoff, 2015).
Research studies mention that the autocratic or the authoritarian style of leadership evokes

5NURSING
feelings of resentment, distrust and lack of self-confidence which hampers the quality of
patient care and at the same time compromises with the patient safety (Forman et al., 2015;
Sanford, 2016). Authoritarian leadership style is also studied to foster poor work environment
which results in increased burnout and employee turnover. On the other hand, transformative
leadership has been studied to improve employee retention and the same time improve
holistic patient outcome (Orchard & Rykhoff, 2015). As stated by MacMillan (2016),
transformative leadership style has been studied to be the most effective leadership style that
helps to acquire positive patient outcome and increased level of patient satisfaction.
Conclusion:
Therefore, to conclude, it can be mentioned that clinical leadership is one of the
integral aspects that helps to ensure increased patient safety and render quality in terms of
care delivery. Typically an efficient leader is responsible for ensuring improved performance
output of the team of care professionals so as to assure increased efficiency in terms of
patient care delivery. Two most prevalent leadership styles were discussed in the paper that
included the transformative leadership style and the autocratic leadership style. The
transformative leadership style was majorly concerned with the fostering of motivation
among the team of care professionals and encouraging the participation of the team members
to undertake critical decisions so as to acquire improved patient outcome and assure
increased patient safety. On the other hand, the autocratic or the authoritative leadership style
was associated with poor performance output and lack of self-confidence and emergence of
insecurity that led to poor patient outcome and decreased patient safety. Hence, it can be
mentioned that within the healthcare context, the transformative leadership style is one of the
most appropriate leadership styles that not only help to promote quality patient care outcome
but also help to foster a positive work environment.

6NURSING

7NURSING
References:
Bayley, H., Chambers, R., & Donovan, C. (2018). The good mentoring toolkit for healthcare.
CRC Press.
Forman, D., Jones, M., & Thistlethwaite, J. (Eds.). (2015). Leadership and collaboration:
Further developments for interprofessional education. Springer.
Grindel, C. G. (2016). Clinical leadership: a call to action. Medsurg Nursing, 25(1), 9.
Knaak, S., Karpa, J., Robinson, R., & Bradley, L. (2016, May). “They are Us—We are
Them” Transformative learning through nursing education leadership. In Healthcare
management forum (Vol. 29, No. 3, pp. 116-120). Sage CA: Los Angeles, CA: SAGE
Publications.
MacMillan, K. (2016). Sustaining a focus on transformative change. Nursing
Leadership, 29(2), 38-41.
McSherry, R., & Pearce, P. (2016). what are the effective ways to translate clinical leadership
into health care quality improvement?. Journal of healthcare leadership, 8, 11.
Negandhi, P., Negandhi, H., Tiwari, R., Sharma, K., Zodpey, S. P., Quazi, Z., & Gaidhane,
A. (2015). Building interdisciplinary leadership skills among health practitioners in
the twenty-first century: an innovative training model. Frontiers in public health, 3.
Orchard, C., & Rykhoff, M. (2015). Collaborative leadership within interprofessional
practice. In Leadership and Collaboration (pp. 71-94). Palgrave Macmillan, London.
Özer, Ö., Ugurluoglu, Ö., Kahraman, G., & Avci, K. (2017). A study on toxic leadership
perceptions of healthcare workers. Global Business and Management Research, 9(1),
12.

8NURSING
Prosser, S. (2016). Effective People: Leadership and organisation development in healthcare.
CRC Press.
Sanford, K. D. (2016). The five questions of physician leadership. Frontiers of health
services management, 32(3), 39-45.
Sarabi, A. (2015). Active leadership can promote leadership effectiveness in healthcare
organizations. International Journal of Hospital Research, 4(1), 21-26.