Developing leadership in nursing: exploring core factors
The purpose of this article is three-fold: firstly, to reaffirm issues concerning definitions and theories underpinning leadership; secondly, to examine the factors that enhance leadership in nursing; and thirdly to convey information about the nature of leadership content taught in undergraduate programmes.
What is leadership?
leadership involves influencing the attitudes, beliefs, behaviours and feelings of other people.
Leadership theory
- The trait approach, which is concerned with personal
traits that contribute to effective leadership. - The behaviour approach, which, like trait theory,
explores leadership from the perspective of the leader and
focuses on leader behaviours. - The contingency approach (Fielder’s contingency theory
and path-goal theory) suggests that leadership is about the
interaction between a person (leader), his/her behaviour
and the situation. - The leader–member exchange approach (charismatic
or transformational leadership) is concerned with the
relationships between subordinate and supervisor.
In a study to examine the characteristics of excellent nursing leadership, Dunham and Fisher (1990) put forward the following as a description:
‘…administrative competence, adequate education, business skills, clinical expertise and an understanding of leadership principles.’
What was interesting about the findings from this study is that nursing leadership, as perceived by nurse executives, differed from general leadership because of its emphasis on nurses assuming responsibility for influencing and improving the practice environment.
Factors that contribute to nursing leadership
A systematic review of research on factors contributing to nursing leadership by Cummings et al (2008) divides the research into studies of behaviours and practices of nursing leaders, their traits and characteristics, the impacts of the healthcare context and practice settings, and educational participation of nursing leaders.
- In terms of behaviours and practices, they conclude that relationship skills are more important than financial and technical abilities, and that demonstrated leadership tends to foster leadership behaviours in others.
- Particular traits and characteristics that have been shown to promote leadership are openness, extroversion and motivation to manage.
- Furthermore, age and experience facilitates leadership, while gender seems unimportant.
- Leader effectiveness was seen to decrease in healthcare settings in which leaders had less contact with care-givers.
- Opportunities to practice, observe and model leadership skills led to greater self-efficacy in nurses’ leadership behaviours.
- Finally, leadership training programmes were mostly found to be effective, not just in bringing about short-term change, but also in the long term.
Leadership vs Management
Hughes et al (2006) make the following distinctions between managers and leaders:
- Managers administer, leaders innovate
- Managers maintain, leaders develop
- Managers control, leaders inspire
- Managers have a short-term view, leaders have a long-term view
- Managers ask how and when, leaders ask what and why
- Managers initiate, leaders originate
- Managers accept the status quo, leaders challenge it.
What needs emphasizing, however, is that a job title on its own does not make a leader. What determines a leader is his/her behaviour. A leader innovates, inspires, guides, and challengers as is evidenced in the distinctions cited above.
Leadership preparation of nurses in undergraduate programmes
- It appears that there are both similarities and differences across undergraduate nursing education in top schools.
- With the limited amount of information available from some of the online sources, however, it was unclear what the actual components of clinical nurse leadership education are.
- The American Association of Colleges of Nursing (AACN) (2007) has provided some detail in this regard, albeit for postgraduate programmes, in their White Paper on the Education and Role of the Clinical Nurse Leader.
- While there is evidence that leadership is being taught within undergraduate nursing programmes, the evidence is that is it largely consigned to the content of the transition from student to nurse.
Conclusion
The importance of leadership to the effective provision of health care is unquestionable, as is the centrality of leadership to nursing, not only at formal management level but at all grades, from student nurse to director of nursing/matron. Therefore, it is now apparent that leadership is not only a function of management but is something that should pervade professional nursing practice. It seems logical to conclude that the development of excellence in nursing leadership should, therefore, begin at the earliest stages of basic nursing education and training.
References
Akerjordet K, Severinsson E (2010) The state of the science of emotional intelligence related to nursing leadership: an integrative review. J Nurs Manag 18(4): 363–82 Crossref. PubMed.
American Association of Colleges of Nursing (2007) White Paper on the Education and Role of the Clinical Nurse Leader. http://tinyurl.com/45ay6fb (accessed 28 February 2011)
Antrobus S, Kitson A (1999) Nursing leadership: influencing and shaping health policy and nursing practice. J Adv Nurs 29(3): 746–53 Crossref. PubMed.
Bellack JP Morjikian R, Barger Set al. (2001) Developing BSN leaders for the future: the Fuld Leadership Initiative for Nursing Education (LINE). J Prof Nurs 17(1): 23–32 Crossref. PubMed.
Bennis WG (1959) Leadership Theory and Administrative Behaviour: The Problem of Authority. Admin Sci Q 4(2): 259–301 Crossref.
Bowles A, Bowles NB (2000) A comparative study of transformational leadership in nursing development units and conventional clinical settings. J Nurs Manag 8(2): 69–76 Crossref. PubMed.
Carney M (2006) Health Service Management: Consensus, Culture and the Middle Manager. Oak Tree Press, Cork
Chang LC, Liu CH, Yen E (2008) Effects of an empowerment based education program for public health nurses in Taiwan. J Clin Nurs 17(20): 2782–90 Crossref. PubMed.
Cummings G, Lee H, Macgregor Tet al. (2008) Factors contributing to nursing leadership: a systematic review. J Health Serv Res Policy 13(4): 240–8 Crossref. PubMed.
Cummings G, Hayduk L, Estabrooks CA (2005) Mitigating the impact of hospital restructuring on nurses: the responsibility of emotionally intelligent leadership. Nurs Res 54(4): 1–11 PubMed.
Daft RL (2000) Management. 5th edn. The Dryden Press, Philadelphia
Daft RL (2004) Management. 6th edn. Thomson/South-Western, Ohio
Dunham J, Fisher E (1990) Nurse executive profile of excellent nursing leadership. Nurs Adm Q 15(1): 1–8 Crossref. PubMed.
Gelinas L, Bohen C (2000) Tomorrow's Work Force: A Strategic Approach. Voluntary Hospitals of America Research. Voluntary Hospitals of America, Chicago
Greenfield D (2007) The enactment of dynamic leadership. Leadersh Health Serv 20(3): 159–68 Crossref.
Halligan P (2010) Leadership and Management Principles. In: Brady AM. ed, Leadership and Management in the Irish Health Service. Gill and Macmillan, Dublin
Heller BR, Drenkard K, Esposito-Herr MB, Romano C, Tom S, Valentine N (2004) Educating nurses for leadership roles. J Contin Educ Nurs 35(5): 203–10 PubMed.
Hewison A (2004) Management for Nurses and Health Professionals: Theory into Practice. Blackwell Science, Oxford
Hewison A, Griffiths M (2004) Leadership development in health care: a word of caution. J Health Organ Manag 18(6): 464–73 Crossref. PubMed.
Hughes RL, Ginnett RC, Curphy GJ (2006) Leadership: Enhancing the Lessons of Experience. 5th edn. McGraw Hill, Boston
Jewell LN (1998) Contemporary Industrial/Organisational Psychology. 3rd edn. Brooks/Cole Publishing Company, California
Jooste K (2004) Leadership: a new perspective. J Nurs Manag 12(3): 217–23 Crossref. PubMed.
Kleinman CS (2003) Leadership roles, competencies, and education: how prepared are our nurse managers? J Nurs Adm 33(9): 451–5 Crossref. PubMed.
La Monica EL (1994) Management in Health Care: A Theoretical and Experiential Approach. MacMillan Press Ltd, Hampshire Crossref.
Marriner Tomey A. (2009) Guide to Nursing Management and Leadership 8th edn. Mosby Elsevier, St Louis
Marquis BL, Huston CJ (2009) Leadership Roles and Management Functions in Nursing: Theory and Application. 6th edn.
Wolters/Kluwer/Lippincott Williams and Wilkins, Philadelphia
Muchinsky PM (2006) Psychology Applied to Work: An Introduction to Industrial and Organisational Psychology. 8th edn.
Thompson/Wadsworth, Australia
Oliver S (2006) Leadership in health care. Musculoskeletal Care 4(1): 38–47 Crossref. PubMed.
Parkin P (2009) Managing Change in Healthcare: Using Action Research. SAGE Publications, London
Picker-Rotem O, Schneider A, Wasserzug S, Zelker R (2008) Nursing leaders of tomorrow: a peer selection process.J Nurs Manag 16(8): 915–20 Crossref. PubMed.
Roussel L, Swansburg RC, Swansburg RJ (2009) Management and Leadership for Nurse Administrators. 5th edn. Jones and Bartlett Publishers, Massachusetts
Sellgren S, Ekvall G, Tomson G (2007) Nursing staff turnover: does leadership matter? Leadersh Health Serv 20(3): 169–83
Shirey MR (2009) Authentic leadership, organizational culture, and healthy work environments. Crit Care Nurs Q 32(3): 189–98 Crossref. PubMed.
Sofarelli D, Brown D (1998) The need for nursing leadership in uncertain times. J Nurs Manag 6(4): 201–7 Crossref. PubMed.
Spector PE (2006) Industrial and Organisational Psychology: Research and Practice. 4th edn. John Wiley & Sons, New Jersey
Sullivan EJ, Garland G (2010) Practical Leadership and Management in Nursing Pearson Education Limited, Harlow
Sullivan EJ, Decker PJ (2009) Effective Leadership and Management in Nursing. 7th edn. Prentice Hall, London
Sutherland AM, Dodd F (2008) NHS Lanarkshire's leadership development programmes impact on clinical practice. Int J Health Care Qual Assur 21(6): 569–84 Crossref. PubMed.
Thyer GL (2003) Dare to be different: transformational leadership may hold the key to reducing the nursing shortage. J Nurs Manag 11(2): 73–9 Crossref. PubMed.
The Times (2010) The Times Good University Guide. Times Newspapers Ltd, London
Tregunno D, Jeffs L, Hall LM, Baker R, Doran D, Bassett SB (2009) On the ball: leadership for patient safety and learning in critical care. J Nurs Adm 39(7–8): 334–9 Crossref. PubMed.
Trinity College Dublin (2010) Bachelor of Science (Nursing): Curriculum Document. TCD, Dublin
Trofino J (1995) Transformational leadership in health care. Nurs Manage 26(8): 42–7 Crossref. PubMed.
University of Edinburgh (2010) Nursing Studies: Undergraduate Study, http://inyurl.com/64jy64c (accessed 28 February 2011)
University of Washington (2010) BSN Curriculum Grid. http://tinyurl.com/6dhzwm8 (accessed 28 February 2011)
US News and World Report (2010) Best Health Schools: Nursing. http://tinyurl.com/6965lkh (accessed 28 February 2011)
Wagner JI, Cummings G, Smith DL, Olson J, Anderson L, Warren S (2010) The relationship between structural empowerment and psychological empowerment for nurses: a systematic review. J Nurs Manag 18(4): 448–62 Crossref. PubMed.
Wedderburn Tate C (1999) Leadership in Nursing. Churchill Livingstone, Edinburgh
Weihrich H, Koontz H (2005) Management: A Global Perspective. 11th edn. McGraw Hill, Singapore
Wong C, A Cummings GG (2007) The relationship between nursing leadership and patient outcomes: a systematic review. J Nurs Manag 15(5): 508–21 Crossref. PubMed.
Zilembo M, Monterosso L (2008) Nursing students perceptions of desirable leadership qualities in nurse preceptors: a descriptive survey. Contemp Nurse 27(2): 194–206 Crossref. PubMed.
