Clinical Leadership in Nursing: Theories, Issues, and Recommendations

This report provides an in-depth analysis of clinical leadership in nursing, examining various leadership theories such as aesthetic, person-centered, transformational, and participative leadership. The report evaluates the application of these theories, identifying clinical issues, and assessing their relevance to the current nursing leadership landscape. It explores the limitations of each leadership style and offers recommendations for future clinical leadership practices, emphasizing the importance of combining different leadership approaches to create a harmonious and effective healthcare working environment. The report highlights the need for nurse leaders to consider the emotional aspects of nurse-follower relationships, patient needs, and staff empowerment to improve patient outcomes and ensure staff satisfaction. The report also reviews scholarly articles to support the findings and recommendations. The report aims to provide insights on the ways in which clinical nurse leaders can practice and improve upon usage of clinical nursing leadership.

Running head: CLINICAL LEADERSHIP IN NURSING
CLINICAL LEADERSHIP IN NURSING
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Introduction
The following paper will focus upon exploring and reviewing the concepts of clinical
leadership in nursing, explored by four scholarly, peer-reviewed articles by evaluating the
applied clinical leadership theories, identified clinical issues, relevance of findings to existing
nursing leader scenario along with recommendations for future clinical leadership practice. This
paper will thus, choose to evaluate the concepts of aesthetic leadership by Mannix, Wilkes and
Daly (2015), person-centered leadership by Cardiff, McComack and McCance (2018),
comparison of transformational and participative leadership by Xu (2017) and transformational
leadership by Boahmah and Clarke (2017).
Leadership Theory
The leadership theory explored by authors Mannix, Wilkes and Daly (2015), includes the
concepts of aesthetic leadership, which is characterized by leaders presenting themselves and
undertaking clinical leadership decisions based on the perceptions prevalent among followers
considering how they view their leader. Nurses who seek to specialized in concepts of aesthetic
leadership should enlighten themselves on concepts of servant leadership and emphasize
extensively on ethical and moral values and maintenance of cordial nurse-staff relationships.
Aesthetic nursing leaders are required to experts in relational leadership and formulation of
meaning from experience gathered during interaction with followers using aligned concepts of
sensory, emotional, somatic and tacit awareness (Dangmei & Singh, 2017). Cardiff, McComack
and McCance (2018), alternatively focus on the theoretical concepts of patient centered
leadership in clinical nursing. Person centered nursing clinical leadership is characterized by
nursing leaders delegating, allocating and leading the clinical workforce with the collective aim

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to establish and maintain healthy relationships with patients as well as staff based on humanistic
ethical values like respect, understanding and individual self-determination (Jacobsen et al.,
2017). Author Xu (2017) likewise explored the effects of collective administration of theories of
transformational and participative leadership in the clinical nursing leadership process in
particular and healthcare staff management in general. Transformational nursing leadership is
characterized by nurses imbibing motivational skills upon the clinical workforce based upon
their existing competencies and inspiring them to achieve greater clinical functional outcomes
(Fischer, 2016). Participative leadership on the other hand is a form of democratic nursing
leadership where nurse leaders will provide staff to directly engage or participate in the clinical
decision-making process (Asamani, Naab & Ofei, 2016). Authors Boamah and Clarke (2018),
further expounded the theory of transformational nursing leadership by exploring related
theoretical concepts of idealized influenced, inspirational motivation, intellectual stimulation and
individualized consideration in the achievement of occupational satisfaction, clinical quality and
patient safety among healthcare staff.
Issues/Problems
The clinical issues and problems explored by Mannix, Wilkes and Daly (2015), focused
extensively on the disadvantages associated with transformational and congruent leadership –
nursing leadership theories which have widespread usage in clinical organizational usage. It has
been postulated that transformational leadership fails to allows nurse leaders to administer their
clinical leadership integrity, provides negligible scope to consider the cultural values of staff and
fails to respect the importance of emotional and ethical aspects of nurse-staff relationship
(Giddens, 2018). Congruent leadership, due to its need for alignment between leader actions and
leader principles, has been criticized to restrict leadership creativity and organizational change

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behaviors. Hence, considering the same, aesthetic leadership has been proven to be an
advantageous alternative which prioritizes emotional aspects of clinical workforce delegation
(Stanley & Carvalho, 2016). Cardiff, McComack and McCance (2018), discuss extensively on
the issues of hierarchical nursing leadership which does to explore the importance of
relationships between staff and nurse leaders, which is why, person centered leadership theories
have been implicated to be beneficial and respectful of staff’s needs. Xu (2017) explored the
issues of healthcare organizational challenges such as clinical emergencies, diverse demands and
expectations from patients, medical expenditure issues and occupational goals to fulfill
organizational objectives and quality standards for which, administration of appropriate clinical
governance procedures is of utmost importance. Likewise, Boamah and Clarke (2018), in their
exploration of transformational leadership, identified the major issues of patient safety in the
clinical scenario. Lack of adequate nursing leadership and standards of clinical governance result
in the emergence of adverse healthcare errors and events which are otherwise preventable, and
hence, lead to medical errors, negative health outcomes, fatal incidents like patient death and
injuries and loss of consumer satisfaction (Merrill, 2015).
Relevance
For the achievement of positive health outcomes in the patient along with the
organizational fulfillment of quality standards, there is a need for healthcare organizations to
ensure usage of relevant theories of nursing clinical leadership by nurses (Moorley & Chinn,.
2016). Upon extensive reviewing of all the four identified articles examining nursing leadership
theories in the clinical context, findings obtained were found to be of relevance in terms of
guidelines for future usage by potential nursing leaders. Aesthetic leadership, as explored by
Mannix, Wilkes and Daly (2015), is of particular relevance to the development of leadership

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skills among future nurses, due to its adoption of a follower centered approach. It is worthwhile
to mention that healthcare organizations like hospitals are extensively prone to occurrence of
medical emergencies and adverse situations whose success in terms of mitigation is heavily
dependent on the teamwork and clinical workforce cohesiveness. Respective the emotional needs
and expectations of followers, characteristic in aesthetic leadership, is crucial for the
maintenance of workforce cohesiveness and results in quality healthcare deliverance and
achievement of positive patient outcomes. Hence, skills of aesthetic leadership is of relevance
since administration of the same, will allow nurse leaders to compensate for the emotional
deficits in transformational and congruent leadership styles and positively reinforce aspects of
nurse-follower relationships in solving challenging healthcare problems (Barkhordari-
Sharifabad, Ashktorab & Atashzadeh-Shoorideh, 2018). The usage of person centered
leadership, as extensively discussed by Cardiff, McComack and McCance (2018), is of relevance
to the nursing leadership scenario, since, similar to aesthetic leadership, it dictates nurse leaders
to not only respect followers’ opinions but also compels incorporation of direct patient
involvement and personalized patient needs in the overall deliverance of quality patient care and
provision of respect to the humanitarian needs of staff and patients. The relevance of the findings
uncovered in the study by Xu (2017), lies in their ability to enlighten nurse leaders on the need to
incorporate multiple leadership theories such as transformational and participative leadership
which will not only empower staff to outdo their capabilities but also allow nurses to arrive at
comprehensive clinical decisions, by considering the clinical decisions of the subordinate staff.
Boamah and Clarke (2018), enlightens upon foundational principles of transformational
leadership which are relevant to future nurse leaders since they guide nurses on the maintenance
of patient safety by setting quality standards of performance by clinical staff (idealized

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influence), motivating staff to achieve organizational objectives through inspiring speech and
imagery (inspirational motivation), consideration of the diverse opinions of staff (intellectual
stimulation) and consideration of individual competencies and differential needs of each staff
member (individualized consideration).
Limitations
While each article extensively explored varied leadership theories and styles, each theory
explored by the authors pose several limitations. It is worthwhile to note that aesthetic
leadership, as discussed by Mannix, Wilkes and Daly (2015), adopts a follower centric approach.
A major limitation of an aesthetic leadership style, similar to servant leadership style, is that it
administers extensive emphasis on the needs and opinions of followers, as a result of which,
nurse leaders may have little scope to be in possession of leadership integrity (Pishgooie et al.,
2019). Similar limitations can be found in the leadership style of person centered leadership
explored by Cardiff, McComack and McCance (2018). Along with consideration of nurse and
follower relationships, person centered leadership also takes into account the direct participation
of patients in the clinical decision making process. Despite ensuring high patient satisfaction, this
leadership style often raises ethical dilemmas when there is lack of congruency between the
nurse’s and patient’s decisions further hindering traditional nursing autonomy (Young & Siegel,
2016). Participatory leadership style, as researched by Xu (2017), relies extensively on the
inclusion of views and opinions of every nursing staff member in the clinical decision making
process. A major limitation of this style of leaderships lies in its susceptibility to administer staff
discord considering that the nurse leader may be to unable and pressurized to prioritize every
demand of each staff member further disrupting the clinical workflow (Zhang et al,. 2016). The
transformational leadership concepts explored extensively by Boamah and Clarke (2018), pose

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several limitations in terms of lack of consideration of the diverse complexities prevalent in
healthcare organization and perceptions of staff. While the four core aspects of transformational
leadership proves to be advantageous in clinical improvement, the same may be difficult to
administer in situations of clinical emergencies or high patient flow due to time constraints
(Vaismoradi et al., 2016). Further, the effects of transformational leadership on work satisfaction
explored by Boamah and Clarke (2018), does not take into account additional factors such as
stress, burnout, patient flow, personal motivation and organizational environment. Such
additional factors are also influential in determining occupational satisfaction across staff which
may not be possible for mitigation by transformational leadership alone (Lu, Zhao & While,
2019).
Recommendations
According to Mannix, Wilkes and Daly (2015), the nurse leaders can overcome the
limitations of relational consideration in transformational and congruent leadership styles by
collectively administering these principles with aesthetic leadership. Hence, it is recommended
that, nurse leaders improve their existing clinical leadership skills by emphasizing on the
emotional aspects and being aware of the emotional subtleties across nurse-follower
relationships resulting in a harmonious clinical working environment (Oshvandi et al., 2016).
Further, as researched by Cardiff, McComack and McCance (2018), it is recommended that
nurses adhere to aspects of person centered leadership to ensure positive patient outcomes. This
involves consideration of patient needs in the clinical decision making process resulting in high
levels of patient satisfaction and hastened recovery (Clarke & Fawcett, 2016). According to Xu
(2018), it is recommended that nurses adhere to a variety of leadership styles such as
transformational and participative leadership in accordance to the clinical situation since it is not

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possible for one leadership theory to address every clinical objective and patient needs. Lastly, as
recommended by Boamah and Clarke (2018), clinical nurse leaders can ensure healthcare quality
and staff satisfaction, by actively using principles of transformational leadership, which involves
evaluation of patient outcomes as a guide to direct staff achievement of organizational goals as
per their competency levels and scope for improvement.
Conclusion
Hence, it can be concluded that an exploration of diverse leadership theories in the
identified four articles, provided a key insights on the ways in which clinical nurse leaders can
practice and improve upon usage of clinical nursing leadership. Despite the potential for each
theory to improve clinical outcomes, the limitations associated with each must also be
consideration. Hence, it is recommended that nurse leaders use a combination of leadership
theories to compensate for the deficits in each and administer quality healthcare working
environment.

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