Transforming nursing: A series on nursing leadership

Recognising the evolving landscape of nursing, effective leadership emerges as a critical factor in driving positive outcomes for both patients and nursing professionals. The series ‘Transforming Nursing: A Series on Nursing Leadership’ provides a concise analysis of some leadership principles and practices within nursing.

Nursing leadership is characterised not solely by formal roles but by demonstrable qualities inherent in individuals across all levels. Essential leadership traits include empathy, compassion, integrity, and clear communication. The significance of strong leadership is underscored by past healthcare crises where deficiencies in leadership have demonstrably compromised care. Effective nursing leaders excel at establishing shared visions, fostering team motivation, and cultivating trust and inspiration among colleagues.

This series will delve into a range of leadership styles observed in nursing, emphasising the necessity of adaptable approaches to address the diverse challenges inherent to healthcare settings. By examining the influence of different leadership styles through real-life case study examples, the series intends to demonstrate their impact on nursing practice. The adoption of effective leadership strategies empowers nurses to advance professionally, improve the quality of patient care, and contribute to the strengthening of the overall healthcare infrastructure.

What is leadership?

There are several definitions of leadership (Elwell and Elikofer, 2015; Cope and Murray, 2017; Thusini and Mingay, 2019), all with similar definitions, even when considering leadership from many different sectors. Sources from the industry and professions within healthcare talk about leaders' key skill sets, such as empathy, compassion, integrity, communication, understanding, and inspiration (Cope and Murray, 2017; Thusini and Mingay, 2019). These skills may seem inherent to the healthcare professions, such as nursing, but unfortunately this is not always the case when considering the damming reports and scandals seen over the years, not least the Mid Staffordshire NHS Foundation Trust scandal (The Francis Report, 2013). 
 
The important aspect of leadership is that anyone can do it. According to Cope and Murray (2017), a title or a role specific to leading is not necessary. Leaders are different from managers (Elwell and Elikofer, 2015; Cope and Murray, 2017; Thusini and Mingay, 2019), with leaders focusing on the importance of a shared vision which they encourage others, usually followers, to achieve. Conversely, managers are focused on monitoring and mapping if said goals are achieved and acting based on whether goals and targets are met, such as performance, conduct and standards (Elwell and Elikofer, 2015). 
 
Thusini and Mingay (2019) have argued that leadership is essential in organisations related to healthcare, such as the NHS. They go on to suggest that strong positive leadership is paramount for the NHS to succeed, which is apparent when considering the likes of the Mid Staffordshire NHS Foundation Trust scandal (The Francis Report, 2013). This is because leadership is everyone's responsibility, from leaders to followers (Thusini and Mingay, 2019). Leaders should encompass empowerment of followers alongside motivation, trust and inspiration to allow followers to thrive, with the ultimate end goal being a shared positive outcome for patients and staff alike (Elwell and Elikofer, 2015; Cope and Murray, 2017; Thusini and Mingay, 2019). The nursing regulator and professional body, in its standards and code (Nursing and Midwifery Council 2018), expects nurses, including those who are newly graduated and practising, to show leadership qualities and attributes. This highlights the importance of nurses knowing what leadership is but also how to be strong and positive leaders. 

Leadership styles

There are many leadership styles in the literature, but there are too many to encompass in this series. What is clear, however, is that leadership styles should be fluid and interchangeable (Elwell and Elikofer, 2015). Elwell and Elikofer (2015) suggested that there should not be one set leadership style that someone follows all the time but that based on the situation and the setting, a strong, confident leader can alter their style to meet the needs of said situations and settings.
 
Conversely, in their systematic review, Niinihuhta and Häggman‐Laitila (2022) divided leadership styles into three themes: destructive, supportive and relational-focused. Destructive leadership (e.g. laissez-faire leadership) is associated with nurse burnout, psychological stress and work-related stress, an approach naturally Niinihuhta and Häggman‐Laitila (2022) suggest should be avoided. Supportive and relational-focused approaches (e.g. authentic leadership) are much more appropriate (Niinihuhta and Häggman‐Laitila, 2022), as these styles emphasise equitable relationships, employee engagement, and value-driven conduct, which have been demonstrated to positively impact work-related wellbeing, mitigate burnout, and enhance job satisfaction among nurses. 
 
In an alternative systematic review, Specchia et al (2021) listed leadership styles, including the two styles mentioned previously, authentic and laissez-faire, alongside transformational, transactional, servant, resonant and passive-avoidant, but again, this is not an exhaustive list, and there are many more styles in the literature. What Specchia et al (2021) do highlight, however, is that any style will have an outcome, either negative or positive, on vital aspects within healthcare and nursing, such as professional growth and development, staff retention and commitment, healthcare and patient outcomes and the job satisfaction of staff (followers) working with leaders. This article series aims to select and explore some leadership styles and explain these in detail, giving real-life examples of how each style can contribute positively or negatively to nurses and nursing.

In this series

Table 1 sets out the leadership styles that will be explored in this series.

Each article in the installment will explore the theory and literature of the suggested leadership style and then explore a case study approach of each style in a real-life example of when and how said style could and would be implemented.

Conclusions

Effective leadership is essential for keeping a positive and productive nursing workforce. This article highlights how important leadership is for reaching common goals, improving patient care, and supporting the wellbeing of health professionals. Strong leadership is not just for those in formal roles; it can be found in nurses at all levels. Key qualities like empathy, compassion, integrity, and good communication help inspire and empower nursing teams. 
 
Past healthcare scandals remind us how important positive leadership is for preventing problems and creating a culture of trust and excellence. Looking ahead, nurses and healthcare leaders must keep developing their leadership skills, be flexible, and build environments where staff and patients can succeed. This will create a strong, caring, and effective healthcare system that meets everyone’s needs.