Why good leadership is important in nursing?

In this assignment i am going to explain why good leadership is important in nursing, the goals and objectives of good leadership and how the outcomes can impact on patient care. I will be discussing and identifying different types of leadership and how they are implemented in care. I will talk about what makes a good leader and the process it takes to become a good leader. I will be using evidence from the Open University resources and also a wider range of research to explain my findings, as well as personal experience from two placements i have been on and comparing the different leadership styles used by the sisters on their ward.

I will also look at how being a manager differs from leadership, and comparing them with each other. Any names used in this assignment have been changed to protect confidentiality Nursing and Midwifery Council (NMC, 2008).

Leadership is a key skill for all nurses, they need to be confident and have the skills and knowledge to lead others.

To be a good leader a person needs to have certain qualities, although it is said some people are born natural leaders McKenzie Manley (2011,), Mike Myett cited in (Forbes, 2013) believes not everyone should or can be a leader, he believes this can be identified by the fact they don’t get good results and care more about the process than the people. However, Frampton (2009) cited in (McKenzie, Manley, 2011, pp.35-37) argues that anyone can become a leader if they are given the right training and if they want it, and Mahoney (2001) and Cummings et al (2008) also believe this can achieved through the right education.

As leader you need to be able to inspire, empower and motivate people, to see where change is needed and be able to make change happen.

To be able to achieve this you need to have good knowledge, ethics and be confident, as well as good communication skills. Being a good listener, interpreting and understanding the people you are leading, as well as being able to evaluate and reflect on practice (Hardy, Titchen et al, 2011, pp. 25-37). When you have a good leader it helps motivate staff and keep up morale within the department, Adair (2002) and Alimo-Metcalf (2003) believe individuals are effective when they are confident and competent, being aware of their strengths and weaknesses helps them work well within a team. This has a positive impact on performance, which is cited in Royal College of Nursing (RCN 2014). Showing that you value your staff and acknowledging that they do a good job will encourage them to go that extra mile and to take their responsibilities seriously. Involving staff members in decisions making, knowing their views and skills will inspire and motivate them, not only to do a good job but also to inspire them to become a good leader (Middleton, 2008).

Jonas, McCay et al, cited in (Stanley 2012) describes clinical leaders as people who inspire others and promote values and vision; they ensure that the patient is at the forefront of that vision. Stanley suggests that effective clinical leadership leads to innovation that leads to change and improvement in care. However, he also says that change for change sake can have a negative effect, and change is not a process or structure, it is about people who are prepared to act, (Stanley 2012). The National Health Service (NHS) framework brings leadership principles and best practice together, providing a consistent approach to leadership and developing staff, which in turn leads to better patient care. Within the NHS a lot of emphasis has been placed on both leadership and management , it is argued by Deming (1986) that management actually creates organisational problems, and that emphasis is being placed on leadership(RCN 2014, p.130- 31).

The Francis report (2011) also says that a lot of emphasis is being put on leadership, but they believe that management skills should be considered a priority as well, because managing staff and resources is the bread and butter of healthcare workers. The report also says that there is a correlation between leadership and management, but without the management the NHS would come to a holt. A quote from West Burnham (1998) says that leadership is about path making, doing right things. Management is about path following, doing things right. Administration is about path tidying, doing things (KYN292, 2010 unit 12, p. 54). Together effective management, inspirational leadership and strong administration are needed to make a department work. This is supported by the National Health Service (NHS), described in the Kings fund Report (2011) as, excellence is needed in both leadership and management, and leadership should come from the board to the ward.

There are many styles of leadership, the Peterborough and Stamford NHS trust in their nursing challenges and nursing leadership framework explain about some of the different styles like; directive leadership; getting immediate compliance, affiliative leadership; creating harmony, and visionary leadership; providing long term direction. However i am going to talk more about my understanding of, congruent, transactional and transformational leaders. Congruent leaders do not have to be staff that are high up in the ranking, they are people who believe in what they are trying to achieve and can motivate others. They show others by doing and get others to follow; it is what they are doing, the here and now. They have good values, beliefs and principles; they build good relationships and are effective communicators.

Congruent leaders match their values and beliefs to their actions (Stanley, 2012). Within the NHS trust nurses like infection control and link nurses are an example of congruent leaders. Transactional leaders work on a reward and punishment style of leadership; there is one leader and everyone else follows. They obey instruction and are monitored to see if they have achieved the set goal. Cherry, writes, transactional leadership can work for simple straightforward tasks, however it is said that it can stop both leader and follower from reaching their full potential (Cherry). Bass (1985) believes transactional leadership is more common place than transformational, although less dramatic in consequences and is more management style than one of leadership. He also believes that the best leaders are both transformational and transactional and disagrees with Burns (1978) that transactional and transformational leadership are at the opposite end of the scale (Timothy, Judge, et al 2004, p.755).

Transformational leadership is driven by its mission and not its rules, it challenges ideas rather than maintaining the status quo, it inspires its followers to see and make change; they seek opportunities for others so they can fill their full potential. Although seen as more complex it focuses on communication and team building, Bass (1985) and Riggio (2008) research shows, that this leadership style can have a positive effect on a group, producing higher levels of satisfaction and performance. They believe this is achieved because the leaders have gained the trust of their followers, and they believe in their leaders (Cherry) From a personal perspective, i like everyone has experienced many different types of leadership in all parts of my life. However it is in my role as a student where i observed and experienced two different types of leaderships within similar situations that has influenced me most in my nurse training. Both the situations are based on my time when i was on placement.

The examples i am using are two ward sisters and looking at the different ways they lead their team. Lewin, K., Lippit, R. et al, (1939) cited in (Hutchinson M, Jackson D, 2012) recognise there are different styles of leadership and it is down to choice and personality which one you become. My first experience was ward sister Mary, she had been on the ward for about six months, she had started to gain confidence from the staff, as well as getting to know them, Hutchinson M, Jackson D, (2012) believe getting to know people and being able to communicate builds trust, then followers will see what your trying to achieve and work with you. Mary would come on to the ward each morning and have about a ten minute meeting with as many staff as possible on a ward; she included all staff from domestics, physiotherapists to doctors. Mary wanted to make change as the ward had previously been under achieving. In the meetings she would listen to staff and the challenges they had on that shift. Mary would advise them on any problems they had and encourage them to look at how they could change things or do it in a different way.

The meetings were only brief, but Mary fed back the latest news on any change, she put up information on the boards in the staff room and made it clear her door was always open. Mary gave feedback on ideas, some could be implemented and those that couldn’t she gave a reason why. I was only on the ward for six weeks, but talking to the staff they said morale was really good they felt valued and part of a team, which had not been the case a few months before. I feel Marys was a transformational style of leadership, she inspired others to make change, work as a team and made them feel their views and values were important. My second experience was with ward sister Jane, when i met her she was a nice person and seemed kind, however she was rarely seen on the ward. Jane had been on her ward for a good few years and the staff knew her well.

Jane was liked as a person, but looking back i felt she managed the ward as opposed to lead it. This seemed to be a managing/ transactional style of leadership, however there wasn’t any rewards or punishment involved, and Jane supported her staff. According to the Francis report (2011) managing is just as important as leadership. After handover and no emergencies Jane would meet with the co-ordinator, they would talk through the handover and see where the priorities lie. Jane would then tell the co-ordinator what she wanted doing by which staff member, this was then relayed to the relevant member of staff to complete the task. Although this ward was not an unhappy ward, a lot of the staff felt they were not given chance to show what they could or what they wanted to do, and if they saw something they felt would benefit from change they weren’t really given a opportunity to see if it could work. To conclude this i would say, there are many different leadership styles and the way you lead is very much down to the individual.

Personality, knowledge and skills play a large part in the type of leader a person could become. It is agreed that some people are born natural leaders, but is argued that you can teach someone to become a good leader, or should be a leader. The NHS needs good leaders from all levels to be able to see and make change happen, but only when change is needed. A good leader will be able to identify others strengths and weaknesses and be able to work with those and encourage them to become a good leader. Many articles have been written and they all describe the learning styles in the same way, with transformational leadership appearing to be the way forward in healthcare. However, when it comes to the debate about management verses leadership some many feel good leadership is the way forward in the NHS, but when reading reports like the Francis report it seems they believe management should be given as much priority as leadership. When comparing my own experiences on the wards i found that both got the results, but the leadership style made the staff feel more valued and part of a team.


Adair J, (2002) Alimo-Metcalf B, (2003) Royal College of Nursing http://www.rcn.org.uk/development/practice/clinical_governance/leadership [Accessed 18 February 2014] Bass B, (1985) http://changingminds.org/disciplines/leadership/theories/bass_transformational.htm [Accessed 24 February 2014] Cherry K, http://psychology.about.com/od/leadership/a/transformational.htm [Accessed 25 February 2014] Hardy S, Titchen A, McCormack B, Manley K (Eds) (2011) Person-centred care: Principle of Nursing Practice D. Nursing Standard

Hutchinson, M. and Jackson, D. (2013), Transformational leadership in nursing: towards a more critical interpretation. Nursing Inquiry,
20: 11–22. Kerridge J, Ryder S, Francis report (2011) http://www.nursingtimes.net/Journals/2013/03/01/l/r/i/Why-management-skills-are-a-priority-for-nurses-050313.pdf McKenzie C, Manley k (2011) Leadership and responsive care: Principle of Nursing practice H. Nursing Standard http://www.rcn.org.uk/__data/assets/pdf_file/0020/380801/Nursing_Standard_Principle_H_May11_94KB.pdf. Middleton J, (Eds) (2008) What Leadership Styles should Senior Nurses Develop, Nursing Times http://www.nursingtimes.net/nursing-practice/leadership/what-leadership-styles-should-senior-nurses-develop/1811643.article [Accessed 21 February 2014] Mike Myatt (2013) Why Your Not a Leader, Forbes http://www.forbes.com/sites/mikemyatt/2013/01/23/why-youre-not-a-leader/ [Accessed 18 February 2014] Nursing and Midwifery Council (2008) The Code; Standards of conduct, Performance and Ethics for Nurses and Midwives NMC London Rowling E, (Eds) (2011) http://www.kingsfund.org.uk/sites/files/kf/future-of-leadership-and-management-nhs-may-2011-kings-fund.pdf [Accessed 21 February 2014]

Stanley D, (2012) Clinical leadership and innovation: Journal of Nursing Education and Practice, May 2012, Vol. 2, No. 2 The Open University (2010), KYN292, Refining Adult Nursing Practice, Block 2, ‘Leading, Managing and Delivering Care’, Milton Keynes, The Open University

Timothy A. Judge and Ronald F. Piccolo, (2004) Transformational and Transactional Leadership: A Meta-Analytic Test of Their Relative Validity, Department of Management, Warrington College of Business, University of Florida.

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