NURSING: Exploring Leadership and Management in Healthcare Context

This essay delves into the critical concepts of leadership and management within the healthcare sector, emphasizing their vital role in achieving organizational goals. It explores the evolution of various leadership and management theories, acknowledging the complexities of modern healthcare settings. The essay examines the interplay between leadership and management, highlighting the need for a combined approach in clinical practice to promote optimal patient care. It discusses key management theories such as scientific management, Theory X and Y, and strategic management, alongside common nursing leadership styles including authoritarian, democratic, laissez-faire, interactional, transformational, and transactional leadership. The analysis further extends to the application of situational and aesthetic leadership, recognizing the importance of adapting leadership styles to specific clinical situations and fostering innovation and a positive work environment. The essay concludes by emphasizing the necessity of both leadership and management in the healthcare setting and advocating for the cultivation of effective leadership and management styles to address the multifaceted challenges in this complex environment. The author supports the Y management style and the situational leadership model as they are more likely to greater benefits for the nurses.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author note

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In any organisation the leadership and management are important concepts that play a
vital role in accomplishment of the set targets and goals. It is necessary to fulfil the
organisation’s mission and vision. Similar, health care industry may not work without leadership
and management owing to the complexity of the sector. The essay explores and discusses the
ideas and theories of the leadership and management in the health care. The evolution of the
various leadership and management theories are the complexities of the modern organisations.
According to Mannix et al. (2015) one leadership style cannot be used within the complexities of
the modern organisations, regardless of the situation. It will be critically examined to relate with
the debate about the leadership and management and in reference to clinical situation. The
arguments and the debate are supported with the examples from the clinical practice.
To start with the basics of management, it encompasses the planning, directing,
controlling, staffing, and organising in health care setting (Marquis & Huston, 2015). Clinical
Leadership on the other hand is being visionary while leading a group of people, motivating
them, implementing plans, and direction. It means the leadership role is associated with the
coaches, role models, mentors, and advocates for high quality patient care (Howieson &
Thiagarajah, 2011).). Unlike the manager the leader always focus on development of the
interpersonal communication for result oriented workplace. According to Kieser, Nicolai & Seidl
(2015) leadership is one of the several functions performed by manager. On the other hand it is
also argued that leadership requires strong managerial skills. The role of leadership and the
management both goes hand in hand as per the literature review. It makes it difficult to analyse
the concepts in isolation. For instance, nurses need leadership to manage the effective nurse is to
patient ratio. On the other hand the nurses may lack direction and focus without effective
management. Consequently it leads to the leadership vacuum. In this regards the decisions to be

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made in a manner that it promotes optimal care to the patients. It means there is the need of
amalgam of the leadership and management in clinical practice for growth and development of
the health care sector.
There are several management theories but all are focused on supervising, group
performance and organising. To start with the scientific management theory, it focuses on
increased productivity by working through agreed standards with group members. Therefore, it
may be called ahumanistic approach from the perspective of the closed system (Marquis &
Huston, 2015). For instance, the nurses could be taught to accomplish the risk management in
one best way. The theory X and theory Y are contradictory management theories. The former
focuses on supervision and direction without considering the organizational needs. On the other
hand the Theory Y believes that people are self motivated and should be self-directed. The
theory Y can be well used in nursing as they need great amount of self awareness and self
motivation to deal with job burnout and stress due to long working hours as well as social and
ethical dilemmas (Marquis & Huston, 2015). Nurse leaders should be able to use their acumen
and make strong decisions to develop work environment that is dedicated to high quality care to
the patients (Mannix, Wilkes & Daly, 2013). This may be the underlying principle for nursing
leadership and management. Therefore, the debate on leadership and management still continues.
On contradictory to the above mentioned management theories that belong to the close
system, the strategic management theory are based on open system perspective. It focuses on
following the logical process on meeting the organizational goals while adapting to the external
and internal environment (Courtney et al., 2015). The nurse manger can apply this theory to
address any change required in the organisation. For instance, to address the hospital acquired
infections in the hospital, a survey or audit can be conducted to deduce factors causing the

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problem. Formulation of hand hygiene policy is based on such logical process to address the
organizational goal to reducing noscomial infections. Similarly patient assessment for diabetes
and schizophrenia may not be same. It needs to follow logical structure for assessment of each
illness. This calls for strategic management leadership in nursing (Marquis & Huston, 2015).
Thus, it again makes it difficult to prioritise the importance of leadership and management.
Common nursing leadership styles in nursing in 1951 were “authoritarian, democratic,
and laissez-faire” (Marquis & Huston, 2015). The first one focuses on the strong control,
punitive criticism, and does not involve others in decision making. Democratic leaders give
constructive criticism, exhibit less control, and involve others in decision. Laissez-faire leader
only motivates people without direction and criticism.
Interactional leadership is the style for nurses to diagnose a situation such as medication
error, increase in noscomial infection or fall rates among elderly. This leadership style calls for
effective group interaction. It is determined by the situation and the leader’s personality (Marquis
& Huston, 2015). Nursing leadership is dominated by the transformational leadership style and is
considered the popular style for professional growth of the nurses. It is argued by Grossman &
Valiga (2016) that this leadership style allows the leaders to transform the followers so that can
accept change for organisational mission and goals. As this leadership is focused on the
individuals and relationships, it is appropriate for nurses who are into the world of the human
interactions and experiences. Nurse manage can use this theory to encourage and inspire fellow
nurses to share ideas thorough effective communication. They may empower the nurses to meet
the patient and the organisational priority. For instance, the implementation of the patient
centered care model involves great role by transformational leadership style in mental health
setting (Cleary et al., 2011). Transactional leaders are also in alignment with above style of

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leadership as both focus on morals. Unlike the transformational leadership style, the transactional
leaders identifies the common values, acts as a caretaker, has long term vision, look at affects
and empower others (Grossman & Valiga, 2016).
Other leadership theory that is congruent with the transformational theory is the
compatibility of this style with the nurses’ day to day function in their clinical setting. It is in
alignment with the situational leadership model and congruent leadership style. However, it is
argued that that the later is adapted from the former (Courtney et al., 2015). Congruent
leadership style is the reflection of the leader’s values and beliefs in the actions and demonstrates
the interpersonal and communication skills well enacted with integrity (Scully, 2015). Like
transformational leadership it considers the patient-focussed care as first priority (Courtney et al.,
2015). Based on this literature, it can be interpreted that the congruent leadership is more
appropriate than transformational leadership for development of nurse leaders. However, it is
questionable due to lack of sufficient evidence for efficacy of congruent leadership for its
newness and bulk of literature favouring transformational leadership. Both can be well applied
for mental health and geriatric setting that requires patient focused care (Sayers et al. 2015).
Health care sector is the complex sector and dynamic in nature. The nurses in clinical
setting face varied challenges related to medication error, risk of fall among elderly, falls
prevention, interpersonal conflict with fellow nurses. Each of the problems may demand
different leadership style. Medication safety can be taught through transformational leadership
style (Mannix, Wilkes & Daly, 2013). However, fall prevention is multifaceted problem.
Innovative fall prevention problem requires evidence based practice. Fall can be prevented
through need assessment, support from stakeholders, and implementation of strategy, project
outcomes and evaluation (Breimaier et al., 2015). These processes promote the complexity of the

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workplace, and impact the leader’s relationship with the followers. It calls for implementation of
different leadership theories.
To establish any kind of change such as patient centered care model, hand hygiene policy
or a new fall risk prevention policy, it is necessary to consider the views of the followers.
Aesthethetic leadership is one such philosophy that is base on knowledge of felt meaning of
leadership phenomena as well as sensory knowledge. It gives the leader a variety of emotional
tools as it is underpinned by moral, sensory, somatic, and emotional awareness. It acts as a buffer
between the transformational and congruent models (Mannix et al., 2015). It is best style of
complex clinical situations. It overcomes the limitations of all the above mentioned leadership
styles.
According to Marquis, & Huston (2015) contingency and situational theory of leadership,
nurse mangers must adapt to the different leadership style depending on task delegated to each
nurse, relationship with the nurse team, commitment and skill levels of the followers. For
instance, if the nurses are less committed and skilled to prevent fall in geriatric care a strong
supervision is needed on the other hand, if registered nurses are present with high commitment,
nurse leader may switch to low supervision/control (democratic). Thus, it is the mixture of
autocratic, authentic, transformational, transactional leadership style and democratic leadership
style. Authoritarian leadership style can be used to reduce nursing frustration due to interpersonal
conflicts and give feeling of security. When all the nurses are self motivated in fall prevention,
the use of laissez faire leadership can result in much creativity and productivity. If the leader is
congruent in beliefs, values and actions in mitigating the fall risk issue, then it is the
implementation of congruent leadership (Scully, 2015). Interpersonal conflicts among nurses can
also be resolved by keeping values and beliefs central to leadership. Nurses may respect each

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other values and beliefs and of patients to act as role model in establishing the patient centered
care model. It is called as authentic and servant leadership style (Courtney et al., 2015).
Health care environment is all about adapting to change contributed by the technical,
social, professional, political, economic, environmental factors. Thus, the leadership and
management imperatives involve creating and fostering innovation, building shared visions, and
creation of positive work environment for nurses and staff. Therefore, it must involve situational
leadership model to implement appropriate leadership style discussed as above. Coming back to
debate about leadership and management, both are equally necessary in clinical setting. Any
management and leadership style chosen by the nurse must be consistent with her ideals. The Y
management style and the situational leadership model as per my opinion are more likely to
greater benefits. Nurses must cultivate these leadership and management styles to deal with any
situation in complex health care setting as the main focus of aesthetic leadership. Dearth of such
model may become redundant expression.

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References
Breimaier, H. E., Halfens, R. J., & Lohrmann, C. (2015). Effectiveness of multifaceted and
tailored strategies to implement a fall-prevention guideline into acute care nursing
practice: a before-and-after, mixed-method study using a participatory action research
approach. BMC nursing, 14(1), 18.
Cleary, M., Horsfall, J., Deacon, M., & Jackson, D. (2011). Leadership and mental health
nursing. Issues in Mental Health Nursing, 32(10), 632-639.
Courtney, M., Nash, R., Thornton, R., & Potgieter, I. (2015). Leading and managing in nursing
practice: Concepts, processes and challenges. Leadership & Nursing contemporary
perspectives.
Grossman, S., & Valiga, T. M. (2016). The new leadership challenge: Creating the future of
nursing. FA Davis.
Howieson, B., & Thiagarajah, T. (2011). What is clinical leadership? A journal-based meta-
review. International Journal of Clinical Leadership, 17(1).
Kieser, A., Nicolai, A., & Seidl, D. (2015). The practical relevance of management research:
Turning the debate on relevance into a rigorous scientific research program. The
Academy of Management Annals, 9(1), 143-233.
Mannix, J., Wilkes, L., & Daly, J. (2013). Attributes of clinical leadership in contemporary
nursing: an integrative review. Contemporary Nurse, 45(1), 10-21.
Mannix, J., Wilkes, L., & Daly, J. (2015). Aesthetic leadership: its place in the clinical nursing
world. Issues in mental health nursing, 36(5), 357-361.

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Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing:
Theory and application. Lippincott Williams & Wilkins. (8th Ed). PILADELPHIA
Wolters: Kluwer Health | Lippincott Wiliams & Wilkins
Sayers, J., Lopez, V., Howard, P. B., Escott, P., & Cleary, M. (2015). The leadership role of
nurse educators in mental health nursing. Issues in mental health nursing, 36(9), 718-724.
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.