What is Nursing Leadership?
Nursing leadership is one of the single most important factors in motivating and inspiring nurses (who make up the clear majority of the healthcare workforce) to practice at the top of their licensure. The ANA Leadership Institute describes a nurse leader as “a nurse who is interested in excelling in a career path, a leader within a healthcare organization who represents the interests of the nursing profession, a seasoned nurse or healthcare administrator interested in refining skills to differentiate them from the competition or to advance to the next level of leadership.”
Nursing leadership and management is most successful when the entire team is also successful. While the definition of leadership in nursing often includes qualities such as encouraging, inspirational, and supportive—truly successful nursing leadership must be equipped to evolve as the nursing industry itself experiences ongoing change and shifts. This style of nursing leadership has been linked to improved patient outcomes, reduced medical errors, and improved staff retention, benefiting the healthcare workplace as whole.
The Nurse Leader Role
As nurse leaders become increasingly aware of the correlation between a stronger team and stronger achievements in patient quality and safety, understanding how to incorporate steps for strategic, long-term success into day-to-day practice is key. In any given day, a nurse leader will problem solve for issues related to bedside care, patient safety, budget constraints, and staffing shortages. Being able to perform well under pressure and balance the myriad of daily challenges is no small endeavor for even the most experienced nurse leader.
Aside from analyzing reports and dashboards (quality metrics, data, and finances), a nurse leader must also focus on their people. Without a team that feels supported, motivated, and inspired, the nurse leader and the organization will experience negative consequences. A good nurse leader will incorporate a healthy balance of managing people and processes into their daily routines by ensuring staff is recognized for quality improvements, that feedback is encouraged to promote continued success in improving patient care, and a physical presence is maintained (onsite visits, rounding or huddles) to show support and appreciation.
What is the Most Important Skill for a Nurse Leader?
While many leadership qualities in nursing can naturally benefit a nurse leader throughout their career, the willingness and ability to learn new skills will help them succeed in their nurse leadership role. For example, nurses are not always prepared for managing budgets, utilization goals, quality metrics, yet these are critical components of a nurse leader’s role. Effective leadership and management in nursing requires the will and capacity to quickly adapt in whatever way they can to succeed (mentorship, additional education and training, etc.). If we ask, “what is the most important skill of the nurse leader?” one all-encompassing answer might be agility.
Agility as Nursing Leadership Skill: Of all the leadership skills in nursing, agility allows a nurse leader to implement rapid changes that will benefit the organization without sacrificing momentum or losing sight of the overall vision/goal. Aside from the constant flux in healthcare processes (changing regulatory requirements, new evidence-based standards, updates to reimbursement policies), nurses have more and more options for in their careers rather than traditional bedside nursing. Nursing leaders must be agile in adapting to not only new processes in the nursing industry, but also flexible and forward thinking enough to effectively lead nurses that will be in the field for many years to come. This will bring a new set of unpredictable challenges and opportunities.
Additionally, a truly agile nurse leader will be prepared to take on the growing number of paths in their own career. With opportunities to impact patient care on a global level through policymaking, research studies, or new impactful initiatives across the care continuum—agile nurse leaders that are comfortable with thriving during times of unpredictably see the potential for greatness whereas others may see instability as a hindrance.
What additional practice behaviors do you believe describe an effective nurse leader?
The Importance of Leadership in Nursing
With the ever-evolving healthcare industry, one truth will always remain constant—leadership in nursing practice directly impacts an organization’s drive, performance, and people (caregivers and patients alike). As hospitals and health systems strive to improve patient care, an emphasis is placed on adopting characteristics of a highly reliable organization (an organization that works to create an environment in which potential problems are anticipated, detected early, and nearly always addressed early enough to prevent catastrophic consequences).
In truly highly reliable organizations, leadership skills are encouraged throughout the organization. While it’s often common to focus leadership efforts at the highest levels of a hospital or health system, middle-management leaders (such as nurse leaders) are key to an organization’s success and directly impact many front-line caregivers and healthcare workers.
Because nurses make up the largest segment of the healthcare workforce and spend more one-on-one time with patients than any other role in the industry, it’s clear to see the undeniable impact that nurses have on patient care (positively or negatively). Only with strong nurse leadership will nurses continue to grow and help shape smarter healthcare delivery of the future.
While physicians and healthcare executives certainly serve as key decision makers on an organization’s high reliability journey, the importance of leadership in nursing should not be underestimated, as nurses have an awesome responsibility to improve patient care that cannot be ignored. Only with strong, steady, and swift (agile) nurse leadership having a voice at the table will healthcare change for the better.
Improving Quality of Care & Patient Safety
Effective leadership in nursing practice has been linked to major contributions to the healthcare industry as whole. As discussed in the Institute of Medicine’s The Future of Nursing: Leading Change, Advancing Health report, nurses should be included as full partners (with physicians and other healthcare professionals) in redesigning healthcare in the U.S.
Due to the significant impact nursing leaders have on their direct units and teams, their leadership effectiveness is crucial to determining how patients will ultimately be affected. Studies continue to support a strong correlation between effective leadership and a high-quality work environment. This, in turn leads to a culture of safety that includes positive patient outcomes—further attesting to the importance of leadership in nursing.
Implementing Change as a Nurse Leader
Hospitals and health systems that understand the importance of nursing leadership in implementing change will be better equipped to make an impact on patient safety and quality initiatives. With the ever-changing healthcare landscape, nurses are constantly met with new challenges, practices, and opportunities.
Having a strong nurse leader in place to help navigate these changes can often make or break a nurse’s decision to stay or leave an organization. While nurses (both new and experienced) are generally understanding of the healthcare industry’s nature of change, they will be better prepared for success in their roles if leadership is able to implement change in a way that allows the unit/team to see the overall benefit of the change, in the least disruptive way possible.
5 LEADERSHIP STYLES IN NURSING
Top of Form
Bottom of Form
Today, nursing management is viewed as a profession of its own, requiring special training, skills, and characteristics (which typically come more naturally to some than others). As a fundamental component to drive a team’s motivation, performance, and job satisfaction, effective nurse management is of the utmost importance to hospitals and health systems. Building upon this logic, nurse managers with a solid understanding of their own nursing leadership style will be more successful in managing their team/unit, ultimately driving better patient care.
The most effective leadership styles in nursing management understand that both nursing staff and patients benefit from the unit acting as a team. Realizing that the success of the unit heavily relies on the strength of the nursing leader should implore nursing leaders to understand the different types of leadership styles in nursing management.
Once a foundational understanding of the leadership styles in healthcare is established, nursing leaders can take personal inventory of how they fall into current styles, while also assessing which styles they might be more successful with in the future. The American Association of Nurse Assessment Coordination (AANAC) recognizes the following five nursing leadership styles as:
Transformational leadership is a management style that motivates employees to take ownership for their roles and perform beyond expectations. Instead of assigning tasks from the top, transformational leadership teaches people how to think rather than just do what they are told. Sometimes called quiet leaders, they lead by example.
Pros of Transformational Leadership Style
Transformational leadership in nursing inspires and motivates employees to find better ways of achieving a goal, as these leaders excel at conflict resolution. They can mobilize people into groups that can get work done, raising the well-being, morale and motivation level of a group through excellent rapport.
Cons of Transformational Leadership Style
Transformational leadership in nursing may prove to be ineffective in initial stages of initiatives or ad-hoc situations. This type of leadership style requires an existing structure so that further development and growth can occur, meaning it’s not ideal for brand-new organizations.
The democratic leadership style welcomes and encourages input and communication from the team when making decisions. Relationships are highly valued by this type of leader, and it’s important to them that their team feels comfortable and willing to voice concerns, opinions, and ideas. A democratic leader also sees value in providing feedback to their team, truly viewing communication as a two-way street.
Pros of Democratic Leadership Style
Democratic leadership in nursing can work well to ensure the team feels valued and comfortable speaking up. High reliability organizations value transparency and input from team members with the most expertise, not necessarily seniority or highest rank, making this type of leader beneficial in creating a culture that promotes input from the entire team.
Cons of Democratic Leadership Style
Democratic leadership style in nursing can be detrimental to the team when a rapid response is required. In an environment where adverse events and emergencies occur, time is of the essence, and democratic leaders unable to make quick decisions independently and without input from the team might struggle to succeed.
Laissez-faire leadership in nursing is most often seen in new or inexperienced nurse leaders. Typically referred to as a “hands-off” approach, laissez-faire nursing leaders rarely provide direction or feedback to their team, but rather allow the team to function as they prefer, without strong supervision. These leaders are not thought of as strong decision makers.
Pros of Laissez-Faire Leadership Style
Because laissez-faire leadership in nursing does not micromanage or dictate how their team should function, a highly experienced and effective team may thrive under this type of leadership. This philosophy supports the theory that if something’s not broken, it doesn’t need to be fixed or changed, which a laissez-faire nursing leader wouldn’t take the initiative to do.
Cons of Laissez-Faire Leadership Style
Laissez-faire nursing isn’t necessarily a good fit for the healthcare industry, due to the constant state of change and need for quick decision making. With experienced nurses retiring and a surge in new nurse onboarding, it’s becoming increasingly unlikely that laissez-faire leadership in nursing will help the team succeed with being proactive vs. reactive to patient safety issues.
As a stark contrast to the laissez-faire leadership style, autocratic leadership in nursing is extremely “hands on” and includes a great deal of decision making. Nursing leaders using the autocratic leadership style are comfortable making decisions without input from their team, and often withhold information from the team in general. This type of leader has little tolerance for mistakes.
Pros of Autocratic Leadership Style
Autocratic leadership in nursing will be effective in making quick decisions when necessary. This may serve the team well in emergency situations, or when implementing “zero occurrence” policies (e.g., driving for zero pressure ulcers, etc.).
Cons of Autocratic Leadership Style
Autocratic leadership in nursing does not promote trust or communication amongst a team, but instead creates a culture whereby team members’ valuable insights and knowledge go untapped. This type of leader stifles collaborative decision-making and transparency, which hinder an organization’s journey to high reliability.
With a recent growth in popularity, servant leadership refers to leaders who influence and motivate others by building relationships and developing the skills of individual team members. Coined by Robert K. Greenleaf in 1970, the term refers to leaders that are drawn to serve first, which aspires them to lead. Servant leadership in nursing implies that a leader naturally cares about ensuring each team member has the resources and tools they need to succeed.
Pros of Servant Leadership Style
Servant leadership in nursing can be extremely beneficial when leading a multidisciplinary, diverse team. Servant leaders excel at meeting the needs of individual team members, regardless of their roles, specialties, and resource requirements.
Cons of Servant Leadership Style
A poor-performing team may continue to suffer under the servant leadership style, when overall, collective direction and guidance for the team would better move the needle. Servant leadership in nursing is not recommended when top-down decisions must be made with the goal of quickly aligning the entire team.
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