Excellent leadership in nursing is likely to pull from different theories according to the job at hand, the team’s needs and the local state of affairs.
There is no simple answer to the complex question of what makes exceptional leadership in nursing, despite the existence of evidence showing that it can have a positive impact on both patient experience and outcomes, and nurse satisfaction and retention. There is some suggestion that the latter then influences the former. However, establishing what makes good nursing leadership is challenging.
A number of leadership theories describe how they can be applied to nursing and how effective they are. What appears is that different approaches are needed according to the goals of the individual leader. One thing is clear: success hinges on good relationships between leaders and their teams.
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In the face of ambiguity and complexity, it seems that good leadership is an anomaly and requires careful evaluation. Where there are contradictory findings, it is important to delve deeper to uncover what each different approach has in common.
Historically, leadership studies have been focused on the beliefs and actions of leaders, leaving followers with a passive role and at the of the mercy of those they follow. Recent studies have explored the roles of both leaders and followers, and suggest that it is the nature of the relationship between them, rather than any specific behavior of their leaders, that creates effective leadership.
Hersey and Blanchard (1969) observed that the leader’s actions should be determined by the experience of the team remembering that the behaviors of good leaders are circumstantial rather than permanent. In this model, leaders evaluate the needs of the followers and adjust their actions accordingly.
Haslam et al (2011) suggest that leaders must be an essential part of the team and that their primary role is to create a sense of group uniqueness. The leader must convey what the team dynamics are and why people would want to be part of it, and motivate followers to identify with the group, by fostering a true sense of loyalty.
Uhl-Bien et al (2014) go further, suggesting that the guidance of a team is co-produced with followers and that it depends on their actions toward the leader and the leader’s reaction towards them, in an open network. The idea is that you cannot force leadership and that it must be earned from followers. In this model, there is a distinction between people in positions of authority and leaders, and leadership has to be won rather than assumed.
Avolio, who had worked with Bass on transformational leadership, developed his thinking further into authentic leadership, which emphasizes the leader’s ethics and behavioral integrity (Avolio et al, 2004). This is reflected in Haslam’s model, which requires the leader to lead by example, displaying the team’s values and desired behaviors (Haslam et al, 2011). What these theories have in common is a focus on collegiate relationships that leaders form with, and promote between, other members of the team.
The best and most relative example of exceptional leadership that comes to mind is exemplified by my Walden professors. The following key leadership skills are routinely exhibited by all of my professors:
· Monitoring and calibrating the team’s workload
· Upholding the Walden Code of Conduct
· Creating a work environment in which all staff feel they can contribute the maximum in a fulfilling way for them
· Creating relationships that build camaraderie
· Ensuring that the team delivers the best use of available resources (Maxwell, 2017)
· Every week each of my professors provides direction, critical updates and other additional tools provided via announcements, feedback is frequently offered on previously completed assignments and/or discussions, individual support is offered through e-mail or the blackboard. Each of us embarked on this course with virtually the same goal in mind, however, the outcome is dependent partially on personal performance, but also the leadership and expertise of those who educate us.
· Nurse leadership is in truth a pragmatic blend of theory and evidence, adapted to the local circumstances, flexible enough to respond to the reactions of the team, and agile enough to deal with the unexpected.
Maxwell E (2017) Good leadership in nursing: what is the most effective approach? Nursing Times [online]; 113: 8, 18-21.
Avolio BJ et al (2004) Unlocking the mask: a look at the process by which authentic leaders impact follower attitudes and behaviors. The Leadership Quarterly 15: 6, 801-823.
Haslam SA et al (2011) The New Psychology of Leadership – Identity, Influence and Power. Hove: Psychology Press.
Hersey P, Blanchard K (1969) Life cycle theory of leadership. Training & Development Journal 23(5) 26-34
Herzberg F et al (1959) The Motivation to Work. New York: Wiley. Gerontological Nursing; 1: 3, 217-228.
Laureate Education (Producer). (2014). Leadership [Video file]. Baltimore, MD: Author.
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.
Uhl-Bien M et al (2014) Followership theory: a review and research agenda. The Leadership Quarterly; 25: 1, 83-104.
West MA et al (2014) Collective leadership for cultures of high-quality health care. Journal of Organizational Effectiveness: People and Performance; 1: 3, 240-260.