NCM119: NURSING LEADERSHIP AND MANAGEMENT

Study Guide 1: Concepts of Leadership and Management in Nursing

Topic Outline
1.1 Leadership Defined
1.2 Leadership Theories—Past and Contemporary
1.3 Primary Styles of Leadership and Management

Learning Objectives
After studying this unit, you will be able to:
• Distinguish between leadership and management.
• Compare characteristics of effective followers with those of leaders.
• Discuss how all nurses can provide leadership in and for the profession

Introduction
Greetings my dear nurse leaders!
Today’s climate demands individuals who are flexible, creative, and able to empower
others to be flexible and creative. With the nursing shortage, managed care, higher patient
acuity, fewer resources, highly diverse demographics, and outside influences, nurses need to be
more effective leaders than ever as they manage patients in various settings.
Nursing’s focus today is on delivering quality and cost-effective patient care rather than
on accomplishing a list of nursing tasks. This focus requires that nurses fulfill both leadership and
follower roles effectively.

LEADERSHIP DEFINED

• A master discipline that illuminates some of the toughest problems of human needs and
social change (Burns, 2003)
• Having a vision and getting people to follow, using the art of persuasion
• Some equate leadership with management and use the words interchangeably
• described the phenomenon of leadership as well studied, with each interpretation
providing a sliver of insight but none providing a holistic and adequate explanation
(Bennis and Nanus, 1985)
• Leadership that matters is the critical factor that makes a difference in people’s lives and
organizations’ success (Sashkin and Sashkin, 2003)

WHAT DO LEADERS DO?

Kotter (2014) notes that management and leadership are different. Specifically, he notes the
following:
• Management involves planning and budgeting. Leadership involves setting a direction.
• Management involves organizing and staffing. Leadership involves aligning people
 • Management provides control and solves problems. Leadership provides motivation and
inspiration.

Effective nurse executives combine leadership and management and work to achieve these
requisite goals. Leadership is a subsystem of a management system. It is included as an element
of management science in management textbooks and other publications. In some sources, the
term leading has replaced the term directing as a major function of management.

A job title does not make a person a leader, nor does it cause a person to exercise leadership
behavior.

This is as true of nurses as it is of personnel in industry or the military. It is a mistake to refer to

the dean of a college, a professor of nursing, a nurse administrator, a supervisor, a nurse manager,
or any nurse as a leader by virtue of position. That person is in a headship position rather than a
leadership position; leadership is more a function of the group or situation than a quality that
adheres to a person who is appointed to a formal position of headship. A person’s behavior
indicates whether that person occupies a functional leadership position.

Most nurses who graduate and enter the workforce are not ready to assume a leadership role.
They require opportunities for self-discovery, self-reflection, and critical thinking to understand
their strengths and build their skills. Skill building occurs through on-the-job training and
coaching, along with support from peers and mentors who are effective leaders. Mentors must
be dynamic, enthusiastic, and passionate about their work to positively influence those they
mentor.

LEADERSHIP THEORIES—PAST AND CONTEMPORARY

GREAT MAN THEORY

This theory assumed that all leaders were men and all were great (i.e., of the noble class). Thus,
those who assumed leadership roles were determined by their genetic and social inheritance. It
was not conceivable that those from the “working class” could be leaders, that leadership could
be learned, or that women could be leaders.

TRAIT THEORIES
During the early part of the 20th century, several researchers studied the behaviors and traits of
individuals thought to be effective leaders. Studies revealed that these leaders possessed multiple
characteristics. Although there were commonalities among them (e.g., they tended to be taller,
be more articulate, or exude self-confidence), there was no standard list that fit everyone or that
could be used to predict or identify who was or could be an effective leader.

SITUATIONAL OR CONTINGENCY THEORIES

These theories embodied the idea that the right thing to do depended on the situation the leader
was facing. The most well-known and used situational theory involves assessing the nature of the
task and the follower’s motivation or readiness to learn and using that to determine the particular
style the leader should use. Despite widespread discussion and use of this theory, however, little
research exists to support its validity.

TRANSFORMATIONAL THEORY
In the mid-1970s, James McGregor Burns asserted that the true nature of leadership is not the
ability to motivate people to work hard for their pay but the ability to transform followers to
become more self-directed in all they do. Transformational leaders, therefore, “look for potential
motives in followers, seek to satisfy higher needs, and engage the full person of the follower. The
result is a relationship of mutual stimulation and elevation that converts followers into leaders
and may convert leaders into moral agents.”

Barker (1990) asserted that transformational leaders need to have a heightened self-awareness
and a plan for self-development. This positive self-regard satisfies the leader’s self-esteem needs
and ends to result in "self-confidence, worth, strength, capability, adequacy, and being useful and
necessary."

NEW SCIENCE LEADERSHIP

Wheatley (1999) described leadership as a method of thinking in a different way, a way that is not
standard, orderly, or goal-oriented. She suggests we think about leadership in a way that reflects
naturally occurring events: free-flowing, dynamic, and accepting of an anything-can-happen
philosophy. Leadership comprises naturally occurring events in which leaders have knowledge
and serve as leaders when needed. Thus, there is no need for others to direct and control what
we do.

RELATIONAL LEADERSHIP THEORIES

Relational leadership theories focus primarily on the relationship that occurs between the leader
and the team member. There is less emphasis on a leader’s traits, the situation or context, or the
end result and more emphasis on the leader’s relations with others.

Quantum Leadership
Traditionally, leaders have looked at work activities from the basic perspective of identifying tasks,
jobs to be completed, and roles to be performed. The quantum leader looks at the system, the
processes, and the relationships between workers and tasks to determine efficiency and job
performance. The unpredictability of a world dominated by chaos mandates models of leadership
that incorporate flexibility and adaptability. Quantum leadership involves the premise of an
increasingly complex, dynamically changing health-care environment. Nurses as leaders today are
faced with ever-increasing complexity in both job duties and technological advances. Quantum
leadership offers nursing a framework within which to develop leadership skills to assist in
advancing the goals of their organizations.

Transactional Leadership
The transactional leader focuses on the goals of the organization, with a directive style
establishing expectations for team members and motivating with rewards. With this type of
leadership, both the leader and the team member gain something from the interactions, although
theirs is not necessarily a shared vision. The leader is focused on getting the job done, and the
team member is motivated by the reward earned. This approach limits innovation and the ability
for team members to truly engage in the outcomes of their work. Given the focus of task
completion, the concrete rewards that followers receive are more generally limited to a sense of
a job well done.

Transformational Leadership
Transformational leadership involves an active involvement of both the leader and team
members. It is a process in which leaders and team members motivate each other to attain and
achieve levels of success. There is a unified investment in achieving the goals of the organization
with shared values. A transformational leader guides staff in creating an environment in which all
members contribute to meeting the mission of the organization. The leader provides a vision that
has included the input of all members, thus encouraging members to reach their highest potential
and often exceed expectations.

Transformational leaders transform organizations. In the process, all nurses at all levels of the
organization are involved in decision making. Transformational leaders are able to help followers
grow by responding to needs, empowering individuals, and aligning goals and objectives across
all levels in an organization.

Transformational leaders are comfortable with challenging themselves, learn from their failures,
and consistently demonstrate effectiveness in organizational change and innovation.
Transformational leadership is viewed as an effective type of leadership for nurses to lead the
change necessary to meet the demands of the current health-care system.

Connective Leadership
Connective leadership incorporates the needs of diverse stakeholders within the health-care
environment through acknowledgment and use of the strengths of members and by including
them in the leadership process. Nurse leaders and managers must consider not only whom they
are guiding but where they may be leading them.

Today’s healthcare environment demands a seamless continuity of care across multiple settings.
Connective leaders identify and foster strengths of team members by including them in the
processes of change within the organization. A successful connective leader can develop future
leaders who begin contributing early in their career, well before undertaking a formal nursing
leadership position.

Attribution Leadership Theories

Attribution leadership theories share the historical perspective of trait theories, by considering
the characteristics or attributes of the leader as the cornerstone within leadership relationships.
In contrast to trait theories, attribution theories also take into consideration either the context or
the interrelational aspects. Nurse leaders are neither born nor practicing within a vacuum.

An attribution leadership theory used in nursing is authentic leadership. Leaders engaged in

authentic leadership hold firmly to their values, beliefs, and principles and inspire their followers.
The determination and courage of the authentic leader in difficult and challenging times create
an environment that is predictable, efficient, and steadfast. In addition, the integrity of the leader
is evidenced by a strong commitment to truth telling, thereby decreasing ambiguity in the system
and increasing efficiency and productivity. When leader’s integrity is at a high point, a healthier
work environment is achievable. The health-care environment can present challenges from
multiple conflicting stakeholders with competing agendas, and these challenges require fortitude
and steadfastness from leaders.

For example, financial pressures may be placed on nurse leaders and managers to adjust nursing
care to fit within specific parameters that are not in keeping with their own value system (e.g.,
being asked to change nurse-patient ratios to unacceptable levels). An authentic leader will be
challenged to hold steady to his or her beliefs and values. The authentic leader must embrace
self-awareness and self-regulation to enhance moral leadership. In moral leadership, the core
ethical principles of nursing are held in highest regard. An authentic leader, while holding these
principles in mind, “develop(s) heart and compassion by getting to know the life stories of those
with whom they work and by engaging co-workers in shared meaning.” The five distinguishing
characteristics of authentic leaders are purpose, heart, self-discipline, relationships, and values.

The newest and latest developments in nursing leadership and management involve aspects such
as "strategic agility" and "system leadership." While the health-care industry is constantly
undergoing change and being required to adapt, it is the nurse leader and manager’s
responsibility to ensure safety and quality. Nurse leaders and managers must “incorporate
strategic agility to be bold and mindful.” There is the case for system leaders to "develop in order
to foster collective leadership," to provide a broader perspective to solve larger problems. The
current development of leadership theories is moving toward a more comprehensive view,
incorporating flexibility and adding broader perspectives.

PRIMARY STYLES OF LEADERSHIP AND MANAGEMENT

Autocratic
• Makes decisions without input from the team
• Does not consider valuable suggestions from team members’ input
• Potentially demoralizes team members
Democratic
• Expects team members to contribute to the decision-making process
• Encourages team input
• Analyzes and makes final decisions
• Increases participation in projects and creative solutions
• Brings about higher production and satisfaction
Laissez-faire
• Provides advice, support, and timelines with low-level involvement
• Lacks focus or time management, resulting in high job satisfaction with risk of low
productivity
• Risks the potential of team members not having the knowledge to execute the tasks
• May find intrateam disagreements common, which may produce disharmony

REFERENCES
Patronis Jones, Rebecca A. Nursing Leadership and Management Theories, Processes and
Practice. 2007.
Marquis, Bessie L., and Carol J. Huston. “Leadership Roles and Management Functions in
Nursing.” Theory and Application, 2017.