Complete Issue Analysis: Leadership in Nursing

Complete Issue Analysis: Leadership in Nursing

Laura Ellis, RN
Frostburg State University

Complete Issue Analysis: Leadership in Nursing

As with any professional field, leadership is of the utmost importance in nursing. Nurses
assume leadership roles regardless of their specific job. Whether they are leading through
education of their patients or leading as a nurse manager or charge nurse, nurses often find
themselves in a position of leadership. With that being said it is vital to the progression and
growth of the nursing profession that nurses be educated on leadership styles, approaches and
applications in order to effectively fulfill their duties.
The aim of this paper is to analyze the issue of leadership in nursing in a hospital setting.
The understanding and approach of leadership has the power to affect many aspects of nursing.
From chief nursing officers to bedside nurses, leadership is a responsibility required of nurses
across the spectrum. The bedside nurse may utilize her leadership skills to coordinate the care of
a single patient where as the chief nursing officer of a hospital would use her leadership skills to
empower and inspire a hospital full of nurses. There are some challenges to this subject as these
two examples show; each nurse requires a varying degree of leadership skills as required by their
job.
Because nurses can serve as a leader at the bedside, among their colleagues and in the
community, there are many different style of leadership that can be effective. One common style
frequently adopted by bedside nurses is the charismatic style. A charismatic leader garners
relationships through emotional connections and inspiring others through loyalty and
enthusiasm. This is an important skill for the bedside nurse who is trying to elicit changes in their
patient. Perhaps the nurse is working to help the patient change their diet or quit smoking; a
charismatic leader is effective when they can communicate a plan for change and the follower
adheres to the plan based on their faith in the leader from their emotional connection (Blais,

Complete Issue Analysis: Leadership in Nursing

2011). This style of leadership helps nurses to develop positive relationships with their patients
and set goals for change in health and lifestyle.
It is a valuable skill for a nurse to recognize when another style of leadership would be
more useful. For example when a patient is being unruly and a threat to themselves or others, it
would be more effective to use an authoritative style of leadership. The authoritative style is
similar to a dictatorship where the leader makes the decisions without allowing the followers or
patients to participate in the process. This style can be effective when decisions are needed
immediately or the individual is not willing or able to make decisions on their own. Authoritative
leaderships can occasionally have a negative connotation but with the proper application, they
can be very effective for the bedside nurse (Blais, 2011).
Another form of leadership that a bedside nurse can employ is the situational style. This
style allows for differing levels of direction and support from the leader. The four levels include
directive, coaching, supporting and delegating. This can be particularly effective for nurses who
are leaders among their colleagues. A good nurse-leader using this style can recognize when it is
necessary to be direct and give specific instructions such as when there is a fire on the unit. That
same nurse can also recognize when is it appropriate to coach a coworker through a skill or task
such as an IV start as opposed to completing the task herself. This style is flexible and places a
lot of power in the leader to determine which style will be most effective for a given situation
(Blais, 2011).
One complication surrounding this issue in nursing leadership is that nurses are rarely
educated on leadership. Every nurse goes through schooling to learn the skills necessary to care
for patients but leadership education is not provided to the bedside nurse. It may be that nurses
are unaware of the resources available to them in terms of leadership. The American Nurses

Complete Issue Analysis: Leadership in Nursing

Association offers members access to several online, self-paced courses ranging from
Becoming a Transformational Leader to Moral Courage. These courses that can be taken by
the average bedside nurse, give nurses the opportunity to educate themselves about leadership
styles and opens their eyes to leadership opportunities. The American Nurses Association also
offers a 2-day leadership immersion program that serves as a crash-course in leading other
nurses. This program is designed for charge nurses and nurse managers to improve
communication and working relationships on hospital units (ana-leadership.org).
Education for leaders is extremely important and can serve to improve efficiency and
performance of hospital units. According to Mannix, effective clinical leadership is the key to
healthy, functional and supportive work environments (2014). The best way to facilitate
effective clinical leadership is to provide education for those who are either formal or informal
leaders.
Once nurses are educated about leadership, they can be held to certain leadership
competencies. Contino groups these leadership competencies into four main categories:
organizational management, communication, analysis and strategy and vision. Within each
category there are specific skills and abilities that leaders must do in order to be effective. Some
of these skills include time and information management, managing change, communication of
skills and vision and relationship development (2004). While many nurses will never have a
formal managerial position, every nurse can benefit from leadership training programs. Using
competencies to gauge how effective leaders are can provide valuable feedback and can lead to
evidence based modifications to any formal leadership program.
Proper education for nurse leaders can promote more effective intercommunication
among staff members and intra-communication with patients and patients family members.

Complete Issue Analysis: Leadership in Nursing

Improved communication across the board will also likely improve patient satisfaction scores,
which in turn increases the hospitals reimbursements. Hospitals would essentially be making an
investment towards their future by creating leadership programs. Unfortunately the number of
hospitals making this type of commitment to their nursing staff is limited.
In summary, every hospital could benefit from educating their nursing staff on proper
leadership. Leadership education programs would not only serve to improve patient outcomes
but would also facilitate professional growth of individual nurses and the nursing profession as a
whole. No harm can come from furthering the education of a nursing staff. As a profession,
nursings focus has been on a commitment to excellence. Excellence simply cannot happen
without dedication to continuing education and leadership education should not be overlook for
nurses. Leadership education and training should be one of many initiatives related to process
improvement that incorporate research, best practices, and methods that inspire our current and
future leaders (Contino, 2004).

Complete Issue Analysis: Leadership in Nursing

References
ANA Leadership Institute. (n.d.). Retrieved April 27, 2015, from http://www.analeadershipinstitute.org
Blais, K., & Hayes, J. (2011). The Nurse as Leader and Manager. In Professional nursing
practice: Concepts and perspectives (6th ed.). Upper Saddle River, New Jersey:
Pearson/Prentice Hall.
Contino, D. (2004). Leadership Competencies: Knowledge, Skills, and Aptitudes Nurses Need to
Lead Organizations Effectively. Critical Care Nurse, 24(3), 52-64. Retrieved April 26,
2015, from http://ccn.aacnjournals.org/content/24/3/52.fullDiana
Mannix, J., Wilkes, L., & Daly, J. (2014). Attributes of clinical leadership in contemporary
nursing: An integrative review. Contemporary Nurse, 3505-3521. Retrieved April 27,
2015, from http://www.tandfonline.com/doi/abs/10.5172/conu.2013.45.1.10#