Aesthetic Leadership in Mental Health Nursing: Theories and Practice

This report delves into aesthetic leadership as a relevant leadership style within the clinical nursing world, particularly in mental health settings. It begins by acknowledging the critical role of clinical leadership in healthcare, referencing various reports that highlight the need for effective leadership. The report then examines transformational and congruent leadership models, discussing their strengths and limitations. It introduces aesthetic leadership as an alternative that aligns with nursing's recognition of art and aesthetics, emphasizing the importance of followers' perceptions of a leader's qualities. The discussion covers the shortcomings of transformational and congruent leadership, and the potential for aesthetic leadership to overcome these issues. The report highlights aesthetic leadership's focus on sensory awareness, values, and the importance of the leader-follower relationship in determining effective leadership. It suggests that aesthetic leadership could be a valuable approach for clinical leaders across diverse nursing specialties, providing a fresh perspective on leadership dynamics.

Issues in Mental Health Nursing, 36:357–361, 2015
Copyright © 2015 Informa Healthcare USA, Inc.
ISSN: 0161-2840 print / 1096-4673 online
DOI: 10.3109/01612840.2015.1011361
Aesthetic Leadership: Its Place in the Clinical Nursing World
Judy Mannix, MN (Hons), RN and Lesley Wilkes, PhD, RN
University of Western Sydney, School of Nursing and Midwifery, Penrith, New South Wales, Australia
John Daly, PhD, RN, FACN, FAAN
University of Technology Sydney, Faculty of Health, Ultimo, Sydney, New South Wales, Australia
Clinical leadership has been identified as crucial to positive
patient/client outcomes, across all clinical settings. In the new mil-
lennium, transformational leadership has been the dominant lead-
ership style and in more recent times, congruent leadership theory
has emerged to explain clinical leadership in nursing. This article
discusses these two leadership models and identifies some of the
shortcomings of them as models for clinical leadership in nursing.
As a way of overcoming some of these limitations, aesthetic lead-
ership is proposed as a style of leadership that is not antithetical
to either model and reflects nursing’s recognition of the validity
of art and aesthetics to nursing generally. Aesthetic leadership is
also proposed as a way to identify an expert clinical leader from
a less experienced clinical leader, taking a similar approach to the
way Benner (1984) has theorised in her staging of novice to expert
clinical nurse.
INTRODUCTION
There is little doubt about the importance of clinical lead-
ership, given the complexities of the clinical nursing world,
regardless of the setting. The significance of leadership in clin-
ical settings has been reiterated in recent reports into the fail-
ings or otherwise of various health systems around the world
(Committee on Quality of Healthcare in America 2001; Francis,
2013; Garling, 2008), resulting in calls for more effective clin-
ical leadership. Professional nursing organisations have recog-
nised this with global organisations, such as the International
Council of Nurses (2014) and Sigma Theta Tau International
(2014), positioning nursing leadership development at the fore-
front of their activities. At a national level, nursing organisa-
tions (e.g. Australian College of Nursing, 2014; Royal College
of Nursing, 2014) recognise the importance of leadership, as
do discipline-specific nursing organisations. For example, the
Australian College of Mental Health Nurses (2010) empha-
sises leadership in one of their nine standards of practice. Simi-
larly, healthcare organisations have supported clinical leadership
Address correspondence to Judy Mannix, University of Western
Sydney, School of Nursing and Midwifery, Locked Bag 1797, Penrith,
NSW 2751, Australia. E-mail: [e-mail]
programmes (e.g. American Association of Colleges of Nurs-
ing, 2007; Clinical Excellence Commission, 2007), particularly
for health professionals in designated clinical and non-clinical
leadership positions.
Given the widespread calls for more effective clinical lead-
ership, it is prudent to review what leadership theories and
frameworks are influencing contemporary clinical leadership
in nursing and what alternative leadership styles may be avail-
able for consideration. Because nurses have long recognised the
epistemological and ontological validity of art and aesthetics to
nursing and its practice (Finfgeld-Connett, 2008), it is worth
considering if aesthetic leadership could help address some of
the reported failings of leadership in the clinical practice world.
Aesthetic leadership is an established theory of leadership that
increasingly has gained traction in the leadership studies litera-
ture (Bathurst, Jackson, & Statler, 2010; Guillet de Monthoux,
Gustafsson, & Sjostrand, 2007; Hansen, Ropo, & Sauer, 2007)
but as yet, has not been considered in relation to clinical leader-
ship in nursing.
In the new millennium, transformational leadership has dom-
inated the nursing discourse as the preferred leadership model
offered in professional development programmes (Martin, Mc-
Cormack, Fitzsimons, & Spirig, 2014), a reality also reflected
somewhat in the nursing leadership research (Cummings et al.,
2010). Other leadership theories and frameworks less promi-
nent, include servant leadership, authentic leadership, transac-
tional leadership, leadership practices and situational leadership
(Cummings et al., 2010; Stanley, 2008). While these theories
and frameworks can all have some application to the clinical
setting, none are specific to clinical leadership. One leadership
theory to emerge in relatively recent times is congruent leader-
ship theory, proposed by Stanley (2008). This particular theory
is somewhat unique in that it is specific to nursing and clinical
leadership. With the domination of transformational leadership
and the uniqueness of congruent leadership to clinical leader-
ship it is reasonable to initially critique these two theories to
determine why calls for effective clinical leadership continue in
various reports (Francis, 2013; Garling, 2008). This article dis-
cusses aesthetic leadership as a theory for application by clinical
357
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358 J. MANNIX ET AL.
leaders from community-based settings to inpatient practice ar-
eas and across the range of nursing specialties, including mental
health.
TRANSFORMATIONAL AND CONGRUENT
LEADERSHIP THEORIES
It is clear from the leadership studies’ literature that the dom-
inance of neo-charismatic leadership theories, including trans-
formational leadership and charismatic leadership, go beyond
nursing and healthcare areas (Dinh et al., 2014). According to
Kuepers (2011), the intent of this style of leadership is for lead-
ers to transform followers so they are aware and accepting of the
organisational missions and goals. Therefore, it is not difficult to
see its appeal to organisations wishing to achieve their goals. In
healthcare facilities with Magnet status and those aspiring to it,
transformational leadership is a fundamental component of the
organisational framework (Kramer, Schmalenberg, & Macguire,
2010). As a leadership model, transformational leadership is
one of a number of relational styles of leadership that focus
on individuals and relationships (Cummings, 2012), and not
out of place in a nursing world that involves human interac-
tions and experiences. Transformational leadership encourages
leaders to be visionary, be able to inspire others to share that
vision through effective communication, and empower others to
lead, while leading to meet organisational priorities (Clavelle,
Drenkard, Tullai-McGuiness, & Fitzpatrick, 2012). To ensure
effective transformational leadership, it is important for leaders
to possess an extensive range of personal and social emotional
intelligence capabilities, including behaving ethically and being
able to challenge the status quo to facilitate change (Hutchinson
& Hurley, 2013). As a leadership style, it has been shown to
be compatible with how nurses function in their various clini-
cal settings. For example, in the area of mental health nursing,
transformational leadership processes support the collaborative
involvement of consumers in care delivery (Cleary, Horsfall,
Deacon, & Jackson, 2011) and the development of essential in-
terpersonal skills of nurses working in mental health settings
(Blegen & Severinsson, 2011). Studies in nursing have shown
transformational leadership to be a style of leadership to support
high job satisfaction among nurses, increased organisational
commitment, enhanced role clarity, reduced workplace conflict,
and lower levels of stress, anxiety and emotional exhaustion
among staff (Cummings et al., 2010).
First proposed by Nicholls (1986) for business organisations,
congruent leadership was adapted from the situational leader-
ship model, and identified to occur when an appropriate lead-
ership style is used, once an understanding is gained of aspects
specifically related to the leader, the followers and the setting.
Apart from the name, there are few similarities between the
original congruent leadership model and the newer congruent
leadership theory developed by Stanley (2006), specifically as
a theory of leadership for clinical leaders. This newer theoreti-
cal proposition aligns more with authentic leadership (Huston,
2008), one of the value-based leadership models (Mumford &
Fried, 2014). The foundation of Stanley’s (2006) congruent lead-
ership theory is the way in which values and beliefs about care
and nursing are reflected in and shape the activities and actions
of the clinical leader. Leaders who are experts in their clini-
cal field and who demonstrate this congruence in the clinical
setting are ‘guided by their passion for care’, and seek to em-
power colleagues, rather than elevate their own status (Stanley,
2006, p. 139). In relation to emotional intelligence capabilities,
congruent leaders require effective interpersonal and commu-
nication skills that are enacted with integrity (Hutchinson &
Hurley, 2013). Another feature of the theory, is that it is de-
rived from a study of clinical leaders who mainly were either
not in a designated leadership position or not trying to lead in
the clinical setting (Rolfe, 2006). Because of the relative new-
ness of the congruent leadership theory, a search of the extant
literature found no studies that have directly tested the theory.
Finally, Stanley (2008) argues that congruent leadership pro-
vides a sound foundation for clinical leaders in nursing because
it is reflects the core values of the nursing profession and places
patient-focussed care as the main consideration, ahead of man-
agers and medical officers.
Limitations of Transformational and Congruent
Leadership
As in all leadership theories, some limitations or shortcom-
ings of both transformational leadership and congruent leader-
ship theories have been identified in the literature (see Table
1).
When considering leadership in the clinical nursing context,
it is not difficult to see the potential issues that could arise for
clinical leaders when embracing transformational leadership as
their leadership style. Stanley (2008) has argued that as a theory
of leadership, transformational leadership is not a suitable the-
oretical foundation for developing clinical leaders in nursing.
Instead, he proposes congruent leadership theory. While this
may be the case, because of its relative newness, the lack of em-
pirical evidence needs to be taken into account. Nonetheless, as
a leadership theory for clinical leadership, the identified short-
comings are not particularly relevant to the clinical workplace.
Findings of the research from which the congruent leadership
theory was developed call into question the appropriateness of it
as a leadership model outside acute hospital settings (Cameron,
Harbison, Lambert, & Dickson, 2012).
AESTHETIC LEADERSHIP
Aesthetic leadership is a style of leadership that has been var-
iously positioned in the leadership studies literature. It has been
identified as one of the established leadership theories that focus
on followers and their subjective views of leader qualities in the
leader–follower dyad, views gained through sensory awareness
and knowledge (Dinh et al., 2014). Others similarly argue that
aesthetic leadership is fashioned by ‘sensory knowledge and
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AESTHETIC LEADERSHIP 359
TABLE 1
Shortcomings of Transformational and Congruent Leadership
Models
Transformational leadership Congruent leadership
Lack of a balanced gender
outlook (Hutchinson &
Jackson, 2013)
A new theory—limited
empirical evidence
(Stanley, 2006)
Narrow representation of
cultural values and beliefs
(Hutchinson & Jackson,
2013)
Similarities with authentic
leadership (Stanley, 2006)
Lack of explicit emphasis on
leader integrity (Hutchinson
& Jackson, 2013)
Does not encourage change
(Stanley, 2006)
More suited to nurse leaders
distant from clinical areas
(Hutchinson & Jackson,
2013)
Of little use to distant leaders
and managers (Stanley,
2006)
Fail to adequately address
altruistic leader behaviours
(Dinh et al., 2014)
Creativity not considered a
valued attribute (Rolfe,
2006)
Lack of consideration for
emotional, embodied, and
aesthetic dimensions of
leadership (Kuepers, 2011)
May be more suited to
clinical settings where
nurses work in close
proximity (Cameron et al.,
2012)
felt meaning associated with leadership phenomena’ (Hansen
et al., 2007, p. 552). Hansen and colleagues also contend that
a significant feature of aesthetic leadership is the way in which
followers’ views about the leadership qualities of leaders are
as important as the leaders’ qualities. In other words, aesthetic
leaders are not self-appointed but emerge from the perceptions
of colleagues (Guillet de Monthoux et al., 2007). Mumford and
Fried (2014) position aesthetic leadership as one of a number of
ideological models of leadership that are, together with servant
leadership and ethical leadership, values-oriented and focus on
moral behaviours. In the organisational studies literature, aes-
thetic leadership has been offered as a way of enabling flow
between the fields of management, administration and aesthet-
ics in organisations, where all three fields are regarded as being
of equal importance (Guillet de Monthoux et al., 2007). In this
interpretation of aesthetic leadership, the management field is
where visionary, action-oriented managers and economists op-
erate and seek profits, while the administration field is occupied
by those who value tradition, regulation, equality and a place
for controlling costs. They go on to describe the aesthetic field
as that part of the organisation where one seeks to determine
what it means to provide or produce quality through ‘creative
philosophizing’ (Guillet de Monthoux et al., 2007, p. 267). In
some ways, the aesthetic field provides a buffer between the
other two fields.
Aesthetic leaders are those leaders who count on tacit knowl-
edge, a type of knowledge that resembles sensory/aesthetic
knowing, and is gained from deep indefinable know-how that
defies a logical explanation (Hansen et al., 2007). Proponents of
aesthetic leadership also argue that knowledge is formed, trans-
formed and transferred through interactions and connections
with others. This aesthetic knowledge and awareness is a way to
make meaning and realities on the basis of embodied experience
(Woodward & Funk, 2010) and gives leaders a variety of intel-
lectual and emotional tools that complement conventional ways
of knowing (Bathurst et al., 2010). It is also argued that aesthetic
leaders need to be effective relational leaders, especially when
negotiating between and with managers and administrators in
an organisation (Guillet de Monthoux et al., 2007). In a review
of the literature, aesthetic leadership was determined to be a
style of leadership underscored by sensory, somatic and emo-
tional awareness, and a strong moral purpose around the values
of being just, fair and truthful (Katz-Buonincontro, 2011).
What Aesthetic Leadership Could Offer Clinical
Leadership
It is evident from the leadership studies’ literature that lead-
ership can be variously described, influenced by a number of
factors including culture and context (Casey, McNamara, Fealy,
& Geraghty, 2011). It is also evident that with the complexities
of modern organisations, one particular leadership style cannot
be the only model followed, regardless of the situation. Within
the context and culture of the clinical nursing world, aesthetic
leadership is a style of leadership that would not be out of
place in supporting clinical leader effectiveness, especially with
the long held recognition of the relevance and importance of
aesthetics and art to nursing practice. As a leadership model,
aesthetic leadership is not antithetical to either transformational
leadership or congruent leadership, and could go some way to
overcoming some of the identified shortcomings of these partic-
ular leadership models. All three leadership models recognise
the importance of relationships in the leader–follower dyad.
Aesthetic leadership, with its follower-centric position (Dinh
et al., 2014), could provide a more holistic and balanced view
of the leader–follower dyad if used to complement either trans-
formational or congruent leadership models, both of which tend
to focus on leader traits (Hutchinson & Jackson, 2013; Stanley,
2006).
Given calls for more effective clinical leadership, and the
dominance of transformational leadership in nursing, it is evi-
dent that its place in the clinical practice world needs reframing.
The reframing of its place does not necessarily mean discarding
it as a useful leadership model. Instead, by drawing on aes-
thetic leadership and aesthetic processes, some of the identified
shortcomings of transformational leadership as a model for clin-
ical leadership could be overcome. By incorporating aesthetic
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360 J. MANNIX ET AL.
processes that emerge from embodied, symbolic and sensual
elements shaped from one’s cultural perspective and experi-
ences (Woodward & Funk, 2010), the cultural and moral limi-
tations of the transformational leadership model (Hutchinson &
Jackson, 2013) may not prevail. The way in which transforma-
tional leadership encourages leaders to be visionary and creative
(Hansen et al., 2007) sits well with aesthetic leadership because,
as Hansen and colleagues (p. 549) argue, ‘visions are sensory
rich’ and ‘appeal to aesthetic senses’. Kuepers (2011) contends
that aesthetic transformational leadership evokes in both lead-
ers and followers, an enthusiasm and sense of satisfaction when
confronting workplace challenges.
The way in which Guillet de Monthoux et al. (2007) regard
aesthetic leadership as a way of facilitating flow between man-
agement, administration and aesthetic fields could be beneficial
to the clinical practice setting. In the nursing world, one could
equate these different fields as management being where senior
executives, including nurse leaders, operate, answerable to hos-
pital boards/shareholders; administration where nursing admin-
istration, including nurse managers function; and the aesthetic
field being the clinical practice setting, where clinical leaders
provide leadership and where all necessary clinical leader com-
petencies may be difficult to pinpoint (Guillet de Monthoux
et al., 2007).
The emergence of congruent leadership as a theory to explain
the relatively unique and complex world of clinical leadership
has enhanced the understanding of what is required for leader-
ship in this context. Congruent leadership theory’s centrality of
the values and beliefs of the leader (Stanley, 2006) sits well with
aesthetic leadership’s focus on leaders displaying a strong moral
compass (Katz-Buonincontro, 2011; Mumford & Fried, 2014).
However, the idea that clinical leaders with clinical knowledge
and expertise need not be in designated leadership roles (Stan-
ley, 2006) is contentious, especially if, as Rolfe (2006, p. 146)
suggests, congruent leadership is ‘a natural way of being, rather
than a skill to be taught’. This notion does not specifically take
account of designated clinical leadership roles that carry with
them an expectation that these positions be occupied by nurses
with advanced clinical knowledge and skills in a particular clin-
ical field.
It is perhaps useful to consider clinical leadership expertise in
the same way Benner (1984) theorised levels of clinical practice
expertise, from novice to expert. To be an expert clinical leader,
the central ideas of congruent leadership theory around visible
leader values and beliefs would need to be considered. There
would also be an acknowledgement that to be an expert clini-
cal leader, nurses would also demonstrate aesthetic leadership
through a recognition and reliance on tacit knowledge; the aes-
thetic knowledge gained from deep indefinable know-how that
defies a logical explanation (Hansen et al., 2007). It is this aes-
thetic knowledge that can really only be gained and utilised with
the professional maturity that comes with clinical experience
and high level moral maturity, reflecting developmental stages
of maturity, a notion proposed by Habermas (1995). Sumner
(2010) describes moral maturity to be at the post-conventional
level when nurses are at Benner’s expert stage, where nurses,
rather than having to consciously focus on the task at hand,
purposefully and skilfully use their emotions.
One could imagine expert clinical leaders engaging in these
types of behaviours across all clinical nursing contexts, from
community to acute settings and across discipline areas of
nursing. For example, consider contemporary clinical lead-
ership expertise in mental health nursing context. The de-
institutionalisation of care for people with mental health prob-
lems to community-based care leads to changes for nursing lead-
ership in mental health (Holm & Severinsson, 2010), resulting
in part in the development of specialist roles like consultant
nurses and clinical nurse specialists (Bonner & McLaughlin,
2014). Clinicians occupying these specialist positions require
well developed levels of skills to manage challenging clinical
situations (Ennis, Happell, & Reid-Searl, 2015), expertise that
could benefit from aesthetic knowledge and professional matu-
rity. The community-based nature of much mental health care
means that clinical nurses undertake their practice in diverse and
sometimes less predictable and less controlled settings. Clinical
leaders in these settings may also find themselves practicing
across both community and inpatient settings. Consequently,
clinical leaders could benefit from the way in which aesthetic
leadership can facilitate flow between management, administra-
tion and aesthetic fields involved in the delivery of mental health
services.
CONCLUSION
Leadership has been referred to as being extremely complex,
involving actions that are interpreted subjectively, affected by
politics and all forms of communication (Block, 2014). Some
writers contend that leadership is inherently aesthetic (Ackoff,
1998), a performing art (Biehl-Missal, 2010, p. 279) or an em-
bodied practice (Hansen et al., 2007, p. 554). It is evident in the
clinical world of nursing that one leadership style does not fit
all contexts and that the complexities of clinical nursing prac-
tice and leadership require an approach to clinical leadership
that maximises the potential for positive outcomes for both re-
cipients of nursing care and those charged with administering
that care. This article has proposed that by considering aesthetic
leadership in relation to clinical leaders, some of the shortcom-
ings of both transformational leadership and congruent leader-
ship could be overcome. At the same time, embracing aesthetic
leadership as a relevant leadership model in nursing opens up
the possibility of incorporating art and aesthetics into clinical
leadership and recognising how an expert clinical leader might
differ from other clinical leaders in nursing.
Declaration of Interest: The authors report no conflicts of
interest. The authors alone are responsible for the content and
writing of the paper.
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AESTHETIC LEADERSHIP 361
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