Leadership in Nursing: The Importance of Recognising Inherent Values and Attributes To Secure A Positive Future For The Profession
Leadership in Nursing: The Importance of Recognising Inherent Values and Attributes To Secure A Positive Future For The Profession
Leadership in Nursing: The Importance of Recognising Inherent Values and Attributes To Secure A Positive Future For The Profession
ScienceDirect
Received 13 December 2013; received in revised form 9 September 2014; accepted 10 September 2014
KEYWORDS Summary Nursing is a dynamic and challenging profession requiring engaging and inspiring
role models and leaders. In today’s ever changing and demanding healthcare environment, iden-
Leadership;
tifying and developing nurse leaders is one of the greatest challenges faced by the nursing pro-
Management;
fession. The concept of leadership is a complex and multi-dimensional phenomenon; research
Nursing;
conducted for over a century concludes that although it is one of the most-observed concepts,
Future
no universally accepted definition or theory of leadership actually exists. There is increasing
clarity surrounding what true nursing leadership is, and how it differs from management.
This discussion will outline the nature of nursing leadership and importance of nurse leaders
in advancing the profession; clarify definitions and differentiate between nurse managers and
nurse leaders; describe the evolution of nurse leadership by identify theories and styles of
leadership relevant to nursing practice; and highlight the importance of identifying leaders in
the nursing profession. The paper also serves as a caution to recognise, avoid and discourage
‘‘negative’’ leaders in the pursuit of a bright future for the nursing profession.
With appropriate identification, support and development of future nurse leaders, an
acknowledgement of the shifting paradigm of leadership theory and the context in which future
nurse leaders are destined to grow, the ultimate goal of the nursing profession — excellent in
person-centred care — can be achieved. It is essential to the future success of the nursing pro-
fession that informal, negative ‘‘leaders’’ be discouraged and positive leaders, possessing the
evidence-based qualities of leadership be identified and nurtured to lead the profession.
© 2014 Australian College of Nursing Ltd. Published by Elsevier Ltd.
∗ Correspondence to: Room 217, Patricia O’Shane Building, Armidale 2351, Australia. Tel.: +61 0413 789 556; fax: +61 6773 3666.
E-mail addresses: nscully2@une.edu.au, natashiascully@rocketmail.com
http://dx.doi.org/10.1016/j.colegn.2014.09.004
1322-7696/© 2014 Australian College of Nursing Ltd. Published by Elsevier Ltd.
Please cite this article in press as: Scully, N.J. Leadership in nursing: The importance of recogni-
sing inherent values and attributes to secure a positive future for the profession. Collegian (2014),
http://dx.doi.org/10.1016/j.colegn.2014.09.004
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COLEGN-285; No. of Pages 6 ARTICLE IN PRESS
2 N.J. Scully
Please cite this article in press as: Scully, N.J. Leadership in nursing: The importance of recogni-
sing inherent values and attributes to secure a positive future for the profession. Collegian (2014),
http://dx.doi.org/10.1016/j.colegn.2014.09.004
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COLEGN-285; No. of Pages 6 ARTICLE IN PRESS
Leadership in nursing: the importance of recognising inherent values 3
Leadership Management
4. The evolution of leadership theory was concerned with the nature and purpose of leadership,
leadership styles, leadership characteristics and the devel-
As there are several definitions of leadership, so there are opment needs of those aspiring to leadership (Antrobus &
several theories of leadership, each having evolved over Kitson, 1999). There had notably been little consideration
time, and more are emerging with further research. The of external influences, such as socio-political factors and
‘‘great man’’ theory of leadership — among the earliest, health policy which have both affected and been influ-
and now largely outmoded — asserts that a leader is born enced by the development of nursing leadership, and in
to lead, sometimes specifically into the ‘‘right’’ family, the emerging neoliberal environment of the 1990s (where
thus inheriting unique characteristics (Grossman & Valiga, the old certainties of protected universal health-care
2012). Though originating in much earlier times, the mid- systems could no longer be taken for granted) a recogni-
19th century was a key formative moment for ideas of tion of this gave rise to the concept of the renaissance
‘‘great man’’ leadership — more generally via the thought leadership style (Antrobus & Kitson, 1999; Cook, 1999).
of Carlyle (1841) (Cook, 1913; Strachey, 1918). The more Renaissance leaders have knowledge of contemporary issues
nuanced extensions of this theory, personal trait theories, in nursing and an understanding of factors which may pro-
attempt to identify universal characteristics of leadership mote or inhibit the future of nursing (Antrobus & Kitson,
(Grossman & Valiga, 2012). Situational theories, in compari- 1999).
son to personal trait theories, acknowledge the significance Political ideology and policy govern the external agenda
of a particular situation on the effectiveness of a leader which nurse leaders are trying to influence, thus these fac-
(Grossman & Valiga, 2012). tors are driving forces behind professional, and therefore
More recent theories of leadership — combining aspects leadership, agendas (Antrobus & Kitson, 1999). Arguably,
of both personal trait and situational theories — recog- because they inhabit workplaces and contexts still imbued
nise that effective leadership depends on the personality with pre-1990 concepts of ‘workers’ and ‘employers’ (and
of the leader, the situation at hand and the qualities of the which have had neoliberal conceptions of management,
followers (Grossman & Valiga, 2012). Leadership is not a hap- ‘stakeholders’, ‘consumers’, and the language and ideology
hazard occurrence, rather involves vision, communicating of economic rationalism imposed upon them from outside),
that vision to others, planning to make it a reality and serv- the ideology and language used by nurses differs from that
ing as a symbol and source of energy for the team (Grossman used in policy and by policy-makers. This therefore creates
& Valiga, 2012). It is therefore an extension of the notion of a policy-practice divide in which nurse leaders are required,
‘bringing order to chaos’, noted above as being intrinsic to to provide an essential interpretation role to enable nursing
nursing leadership. to be understood and considered a priority, and to com-
Until the 1990s, much of the research done on nurs- municate external, ideological and policy concerns to their
ing leadership had been internally focused; meaning it colleagues (Antrobus & Kitson, 1999).
Please cite this article in press as: Scully, N.J. Leadership in nursing: The importance of recogni-
sing inherent values and attributes to secure a positive future for the profession. Collegian (2014),
http://dx.doi.org/10.1016/j.colegn.2014.09.004
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4 N.J. Scully
As early as 1978, Burns described two types of leader- education and practice — this form of leadership is emerg-
ship: transformational and transactional, echoed in later ing as of fundamental importance, given it involves a process
research (Atsalos & Greenwood, 2001; Avolio & Bass, 1988; to influence individuals to work towards not only their own
Bass & Avolio, 1994; Burns, 1978; Callaghan, 2007; Cleary, goals, but those of the group or community in which they
Freeman, & Sharrock, 2005; Corrigan, Steiner, McCracken, are involved (Sahoo & Das, 2012). In the current climate
Blaser, & Barr, 2001; Hutchinson & Jackson, 2013; Kleinman, of inter-professional education and practice, this growing
2004; Nielsen et al., 2008; O’Neil, Morjikian, Cherner, connective leadership theory has some merit in extending
Hirschkorn, & West, 2008; Pillai & Williams, 2004). The the way in which nurses can act as leaders moving into the
transformational leadership model involves leaders motivat- future.
ing followers to perform beyond expectations by creating a In their critical discussion of the predominant the-
sense of ownership in reaching a shared vision; followers ory of leadership in nursing, transformational leadership,
of this form of leadership were motivated to meet higher Hutchinson and Jackson (2013) suggest the time has come
order needs (a transformation) (Burns, 1978; Grossman & for a more comprehensive and contemporary interpreta-
Valiga, 2012; Hutchinson & Jackson, 2013). Once motivation tion of nursing leadership — one taking into account the
is achieved, the transformational leader no longer sets goals modern complexities and environment in which nurses func-
which others are expected to attain, rather she/he is seen tion. Given the emergence of inter-professional education
as an agent who inspires change and mediates in an environ- and practice, this theory of connective, or shared, lead-
ment of empowerment (Callaghan, 2007). Transformational ership appears a relevant one to consider — it is dynamic
leadership inspires followers to work beyond the basic level and collaborative, reflecting the modern practice world
of competence, shaping, altering and elevating their poten- of nurses today. The move towards connective leadership
tial, to achieve excellence in patient care for its own sake requires confidence, collaborative networks and mecha-
(Callaghan, 2007; Nielsen et al., 2008). nisms to ensure views are respected by stakeholders (other
Transformational leadership is popularly identified as health care workers as well as the general community).
central to nursing practice as leaders are challenged to
master situations in an ever changing environment, indeed
many nurse leadership researchers advocate this approach
(Arnold, Turner, Barling, Kelloway & McKee, 2007; Atsalos 5. Identifying future nurse leaders:
& Greenwood, 2001; Callaghan, 2007; Furlong & Smith, recommendations and warnings
2005; Grossman & Valiga, 2012; Hutchinson & Jackson, 2013;
Nielsen et al., 2008; Pillai & Williams, 2004; Rigoloski, 2013). There are a number of scholarly articles identifying char-
Whilst acknowledging the vast amount of evidence suggest- acteristics of good, established nurse leaders, but little
ing the benefits of transformational leadership, Hutchinson on the means by which such individuals may be identified
and Jackson (2013), assert that with the dominance of the early and how to cultivate them, thus helping them grow
transformational theory of leadership in nursing scholarship, as leaders and establishing effective succession-planning
the interpretation of nursing leadership has become limited. (Conners, Dunn, Devine, & Osterman, 2007). As (Grossman &
In contrast, transactional leadership involves both the Valiga, 2012) asserts, leaders are not born (as old-fashioned
leader and the follower receiving something for their ‘great man’ theory would have it), rather they emerge and
efforts; asserting that the leader gets the job done and continuously evolve based on a range of experiences and
the follower gets money, promotion or other benefits from interactions with a variety of people. Conners et al. (2007)
partaking. Followers of this form of leadership are moti- identify that nursing has been slow to develop strategies
vated by reward for compliance (a transaction) (Burns, 1978; to recognise future nurse leaders and that with the current
Grossman & Valiga, 2012; Hutchinson & Jackson, 2013). nursing shortage, this is more important than ever.
Where transactional leadership is task-oriented and reward- There are now several postgraduate courses available
motivated, transformational leadership possesses a higher across Australia to Registered Nurses for the development
level of morality and inspires teamwork and embracing of leadership skills. Notably, at the highest levels of pol-
change (Cleary et al., 2005; Corrigan et al., 2001; Kleinman, icy and governance of the profession, the Australian College
2004; Nielsen et al., 2008). The success of transactional of Nursing recently introduced the ‘‘Emerging Nurse Lead-
leadership ultimately depends on the development of a ers’’ strategy to recognise and develop future generations of
leadership culture which allows a proactive, supportive and leaders in nursing from an undergraduate level (ACN, 2013).
enabling environment to be created (Callaghan, 2007). At the level of the individual workplace, however, there is
Taking some characteristics from the theories of transfor- still a need for effective strategies for growing the next
mational and renaissance leadership and moving away from generation of leaders ‘in-house’. Effective mentoring pro-
the transactional theory, connective leadership (or shared grammes and the development of cultures of excellence are
leadership) is a form of leadership perceived as an activity areas where managers can play a decisive role, and effect
that can be shared or distributed among members of a team something close to the ideal link between leadership and
depending on the needs of the situation (Sahoo & Das, 2012). management. This has the potential to ensure a further less-
Connective leaders can perceive common ground and pos- ening of the impact of chaos across the full variety of nursing
sibilities where some more traditional leaders see division workplaces, and continues the advancement of the profes-
and difference (Sahoo & Das, 2012). Connective leadership sion in terms of practice and status (Dignam et al., 2012).
represents a paradigm shift in the philosophy of leader- Effective mentoring and formal education programmes for
ship, and as we move into a more interdependent setting — nurse leader development prove a continued challenge to
with the advent of interdisciplinary and inter-professional the profession (Dignam et al., 2012).
Please cite this article in press as: Scully, N.J. Leadership in nursing: The importance of recogni-
sing inherent values and attributes to secure a positive future for the profession. Collegian (2014),
http://dx.doi.org/10.1016/j.colegn.2014.09.004
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Leadership in nursing: the importance of recognising inherent values 5
Conners et al. (2007) recognise that leaders have drive, leadership theory and the context in which future nurse
energy and vision, self-discipline and flexibility, with the leaders are destined to grow, the ultimate goal of the nurs-
ability to assemble a team and motivate others. These ing profession — excellence in person-centred care — can
authors assert that if the best performers are not identi- be achieved. Along with the ability to identify and nurture
fied as leaders, others fail to learn from them and quality of nurses to leadership, so it is essential to avoid fostering
care can be found lacking (Conners et al., 2007). As out- those who either do not possess the adequate qualities
lined above, identification of leadership qualities can be or display the loud and negative traits which have been
a somewhat complex and often subjective process and is shown to be detrimental to the nursing team and work-
something often lumped-in with allocation of management place. It is essential to the future success of the nursing
roles in many workplaces. profession that informal, ‘‘negative leaders’’ be discour-
Avoiding the fostering of people who are not well suited aged and positive leaders, possessing the evidence-based
to leadership is just as important as identifying and nurturing qualities of leadership be identified and nurtured to lead the
those with more apt qualities. Key research from (Conners profession.
et al., 2007) finds that often it is the louder and more
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Please cite this article in press as: Scully, N.J. Leadership in nursing: The importance of recogni-
sing inherent values and attributes to secure a positive future for the profession. Collegian (2014),
http://dx.doi.org/10.1016/j.colegn.2014.09.004