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From the Editor

Section Editor(s): Sanford, Kathleen D. DBA, RN, FACHE, FAAN

Nursing Administration Quarterly: April/June 2019 - Volume 43 - Issue 2 - p 97–98
doi: 10.1097/NAQ.0000000000000346
From the Editor

Editor-in-Chief, Nursing Administration Quarterly

The author declares no conflict of interest.

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The most useful management resource I've ever owned is actually 3 editions of the same book. I was introduced to the first iteration of the Handbook of Leadership in the late 1970s.1 I bought one revised edition in the 1980s2 and purchased a second one in 2010.3 I'll be first in line to obtain the next updated version if another exceptional scholar steps up to continue the comprehensive work first compiled by Ralph Stogdill in 1974, updated by Bernard Bass in 1981, and then updated again in 1990 and 2008. I've never found another sourcebook that so completely summarizes centuries of management theories, models, and research.

As a firm believer in evidence-based practices (EBPs), both clinical and managerial, I appreciate and treasure this compendium of evolving knowledge. I believe that management is a specialty that requires distinct education, specific competencies, and continual learning, just like any other clinical specialty. The massive amount of evidence, and the integration of research included in the Handbook of Leadership, combined with new and continuing studies, provides empirical findings that should form the basis for widespread superior leadership practices today.

That's why I'm bemused and alarmed that so many health care managers either seem to be unaware that there are research-based, proven best leadership practices or choose not to employ the art and science of leadership even while touting the need for wide adoption of clinical EBPs. Some management authorities believe that despite the abundance of evidence that shows the need for ethical, honest, committed, and caring leaders, there is “a growing incidence of toxic leaders in organizations across the world.”4

Toxic Leaders are described differently by various authors, but most agree that they are bosses who create work environments that aren't healthy for employees, customers, communities, or countries. Employees recognize them as narcissistic, arrogant, vindictive, bullying, incompetent, manipulative, and autocratic. They can be described as people who take credit for others’ work, display mood swings, make promises they don't deliver, and practice verbal abuse. They are also executives who sometimes allow workplace inequities, including discrimination and harassment, to flourish. They tend to both criticize and blame others while needing effusive praise for themselves. There are a myriad of unpleasant adjectives describing practitioners of toxic leadership, but there are also a few that are considered positive. These individuals who are dedicated to self-interest can be charismatic, and they can achieve good financial results—in the short term.

In the long term, though, this type of leadership prevents individuals and organizations from reaching their full potential. Toxic leaders block transformation, and, if they wield a significant amount of organizational power, create unhealthy cultures where both employees and customers (patients) suffer. In health care, that leads to high turnover, poor quality, and poor stakeholder (subordinate managers, employees, patients, and medical staff) engagement. That's why the authors in this edition have written about the need to find management remedies in environments that exhibit these maladies.

I'd like to add one more thought to those of our writers. It's common today to say we need “more leadership,” from the bedside to the boardroom to the government. I think we're missing some very important words when we make that claim. If we want to make our organizations, communities, and country better for all of us, we need more effective, ethical, and loving leadership. After all, Hitler (among others) provided strong leadership and was the epitome of toxicity (to the point of evil) in power. At a time when we must transform health care, we need leaders who are transformative. I believe there is a deep well of untapped or partially tapped exceptional leadership among nurses. We need to encourage it, expose it, and support those who have the courage to openly practice the specialty of management with a balanced concern for all stakeholders. That is the true antidote to toxic leadership.

Thanks for choosing to lead.

Kathleen D. Sanford, DBA, RN, FACHE, FAAN


Nursing Administration Quarterly

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1. Stogdill RM. Handbook of Leadership: A Survey of Theory and Research. New York, NY: Free Press; 1974.
2. Bass BM. Stogdill's Handbook of Leadership: A Survey of Theory and Research, Revised and Expanded. New York, NY: Free Press; 1981.
3. Bass B, Bass R. The Bass Handbook of Leadership Theory, Research, & Managerial Applications. New York, NY: Free Press; 2008.
4. Williams R. The rise of toxic leaders and toxic workplaces. Accessed December 6, 2018.
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