Nursing Leadership: A Review of Theories, Challenges, and Approaches

This report delves into the multifaceted realm of nursing leadership, examining the challenges faced in providing adequate patient care and the evolving role of registered nurses. It explores various leadership theories, including transformational, transactional, and connective leadership, and their application in clinical settings. The report highlights the importance of clinical leadership in improving healthcare system performance and the need for practitioners to develop leadership competencies through training and education. It analyzes several research articles, discussing their findings on leadership approaches, challenges such as poor communication, and the implementation of evidence-based practices. The report also identifies limitations in the existing literature, such as reliance on secondary sources and small sample sizes, and recommends improvements to nursing education and training to enhance leadership skills and address curriculum deficiencies. Ultimately, the report emphasizes the significance of adapting leadership theories to specific clinical situations to achieve better outcomes.

Running head: NURSING LEADERSHIP 1
Nursing Leadership
Student’s Name
University

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Nursing Leadership
The nursing field has faced numerous challenges in the quest to provide adequate care for
patients. The rise of registered nurses has changed the clinical environment for nurses since it
calls for more involvement of nurses in clinical leadership. the need to address poor nursing
outcomes, changing consumer expectations, increasing demand for access to care and the need
for increased quality of health care calls for the need to apply nursing leadership approaches in
making practitioners more responsible for their field and the role that they play. Different
scholars have argued about the concept of nursing leadership, its importance in clinical settings
and the gaps that need to be addressed.
Daly, Jackson, Mannix, Davidson, & Hutchinson (2014) article views clinical leadership
as an important element in the management of care. As global care systems struggle with the
challenges of demand for services and increasing costs effective clinical leadership plays the role
increasing system performance, integrity, efficiency and timely delivery of services. This means
that healthcare professionals need to be prepared for clinical leadership by acquiring adequate
content (Al-Sawai, 2013). To address these deficiencies, models like the Medical Leadership
Competency Framework have been developed to include competencies into professional
education. On the other hand, the Global Nursing Leadership Institute views clinical leadership
as both situational and skills driven where the leader applies advocacy skills and change process
into the followers which leads to new processes. The main role of the leader is to maintain a
happier workplace through effective support and communication with multidisciplinary teams.
Therefore, practitioners need to be prepared for leadership roles through adequate academic
training to empower them with skills for handling clinical situations.

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Scully (2013) article focusses on the evolution of leadership theory to analyze how the
theories have evolved in the field of nursing. Here transformational leadership is seen as a
popular theory where leaders are supposed to master nursing situations and develop ways of
dealing with work challenges. Here, the leader takes the lead role to meet the needs of the
organization. On the other hand, transactional leadership theory involves the leader working with
others in clinical settings to meet the needs of the organization. The leader has to develop
approaches that inspire employees to work better. However, the leadership approaches in the
organization are evolving leading to the development of connective leadership where leadership
is an activity distributed to other members of the organization (Hauck, Winsett, & Kuric, 2013).
This is seen as a paradigm shift since healthcare settings are moved to the interdependence of
actions thus requiring leadership to be treated as both an individual goal and a group goal. This
article is limited because it fails to offer the best theory can be applied in nursing settings. The
fact that the article proposes different theories means that there is no exact theory that can be
applied in nursing.
Xu (2017) article presents leadership theories and their importance in addressing
healthcare challenges. The role of clinical leadership is to guide the way practitioners conduct
themselves at work. The transformational leadership theory is based on the relationship between
the leader and the follower where the leader motivates followers to adjust their opinions,
expectations, and inspirations to the common goals of the organization. this means that the
transformative leader focusses on nurses needs and concerns within clinical settings. The
participative leader uses decision-making process by consulting with team members to make
decisions that meet the needs of the organization (Titler, 2011). Further, the transactional
leadership model focusses setting clear objectives and goals for the practitioner within clinical

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settings. The goals focus on encourage compliance with established standards to meet clinical
requirements. However, there are clinical challenges like poor communication and poor
preparation for leadership which makes it difficult for the nursing practitioner. This means that
leadership is an aspect that needs to be practiced and perfected.
As the call for evidence-based approaches takes the twenty-first-century nursing trend,
leadership has been seen as the best approach for achieving the objective. In their article Kvist,
Tahka, Ruotsalainen, & Tervo-Heikkinen (2014) argue that leadership is a critical element in
implementing evidence-based approaches since it works on ensuring that practitioners develop
key skills like thinking, planning, and implementation of change. Different leadership
approaches can be used in nursing but all the approaches must ensure that the leader understands
the responsibility that they need to carry out and how the approach needs to be done. This means
that having knowledge of key leadership competencies is crucial in achieving the intended
results. Good leaders understand their role and have knowledge of different leadership
approaches that they can use. With these, they are able to meet the requirements of the
organization and achieve better results for the organization (Webb, 2016). However, these article
is limited because it used a small sample size of participants which makes it difficult to
generalize the findings of the study. further, the results are based on two different surveys that
were carried out rather than using a sign survey questionnaire for the study.
One limitation that all these articles have is they relied more on secondary literature
rather than primary literature. This means that they did not apply research to determine the
leadership theories that most practitioners use. This means that sometimes the nursing may not
be aware of the leadership approach being applied but rather only following a set of procedures
(Mianda & Voce, 2017). Another limitation is the fact that the articles failed to integrate

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leadership theories with other nursing theories in the application. Despite the leadership
approach that the practitioner makes, decisions are bound by other nursing theories and models
within the clinical environment.
One recommendation that the articles offer is the need to adequately train nursing
practitioners and empower them with the right skills for the job. This means that the curriculum
needs to be assessed and changed to ensure that leadership content is included in what the
practitioners learn. According to Gifford et al (2014) leadership theory needs to be implemented
in clinical settings through preparing students adequately for leadership theories. By addressing
curriculum deficiencies in health professional courses, leadership theories can be effective in
meeting the needs of the nursing practitioner and ensure that leaders develop the right
competencies.
Another recommendation for improving nursing leadership skills is identifying and
developing ways of ensuring that they develop the right skills. These nursing deficiencies include
communication and team leadership which affects the way the nurse leader makes decisions.
Communication is an important nursing skill that practitioners need to relate with their fellow
colleagues and clients. In clinical settings, communication entails how clinical decisions are
shared between practitioners before the right decision is made. On the other hand, teamwork
entails making collective decisions as a team within the clinical environment. In most cases,
clinical situations call for the efforts of different types of practitioners like doctors and nurses,
which means that practitioners require teamwork skills within clinical settings.
Therefore, these research findings indicate that nursing leadership theories work better
when they are applied according to the situation that the practitioner is in. This means that the
practitioner has to make decisions on the leadership theory that they apply. For example, some

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situations require transformation abilities while others require transactional abilities or both.
Therefore, these articles suggest the need to develop leadership competencies through changing
nursing education and ensuring that it has ways of developing leadership abilities to improve the
leadership abilities of practitioners.

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References
Al-Sawai, A. (2013). Leadership of Healthcare Professionals: Where Do We Stand? Omani
Medical Journal, 28(4), 285-287.
Daly, J., Jackson, D., Mannix, J., Davidson, P. M., & Hutchinson, M. (2014). The importance of
clinical leadership in the hospital setting. Journal of Healthcare Leadership, 6, 75-83.
Gifford, W. A., Holyoke, P., Squires, J. E., Angus, D., Brosseau, L., Egan, M., . . . Wallin, L.
(2014). Managerial leadership for research use in nursing and allied health care
professions: a narrative synthesis protocol. Systematic Reviews, 3(57).
Hauck, S., Winsett, R., & Kuric, J. (2013). Leadership facilitation strategies to establish
evidence-based practice in an acute care hospital. Journal of Advanced Nursing, 69, 664-
674.
Kvist, T., Tahka, K., Ruotsalainen, M., & Tervo-Heikkinen, T. (2014). The Impact of Nursing
Leadership Training on Evidence-Based Leadership and Practice. Journal of Nursing
Care, 3(181).
Mianda, S., & Voce, A. S. (2017). Conceptualizations of clinical leadership: a review of the
literature. Journal of Health Leadership, 9, 79-87.
Scully, N. J. (2013). Leadership in nursing: The importance of recognising inherent values and
attributes to secure a positive future for the proffesion. Collegian, 22, 439-444.
Titler, M. (2011). Nursing science and evidence-based practice. Western Journal of Nursing
Research, 33, 291-295.
Webb, S. S. (2016). Applying Leadership Theory to Practice Using a Structured Clinical Journal.
Journal of Nursing Education, 55(10).

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Xu, J.-H. (2017). Leadership theory in clinical practice. Chinese Nursing Research, 4(4), 155-
157.