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Showing the way with gracious leadership

Kroning, Maureen EdD, RN; Carey, Adrienne BSN, RN; Crawford-Rosso, Sophie MSN, RN, NE-BC

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doi: 10.1097/01.NURSE.0000657064.68013.7b
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NURSE LEADERS ARE ESSENTIAL for promoting healthy work environments in which the needs of both the healthcare staff and their patients are understood, respected, and supported. These professionals lead with grace, insight, optimism for the future of healthcare, and appreciation for their staff and the challenges facing individual nurses. In today's healthcare environment, nurses need leaders who are gracious. Following input from unit nurses at the authors' facility, this article discusses the attributes of a gracious nurse leader with the GRACIOUS mnemonic.

Defining gracious leadership

The concept of gracious leadership is not often discussed in the nursing literature. After extensive discussion and research to define the term, the authors characterize gracious leaders as those who lead by building strong relationships with their employees through empathy and compassion, serving as role models for desired behaviors and sharing their organization's vision in an inspirational and motivational way. They communicate their vision, invest in their staff as individuals, and understand that healthy relationships are essential to the work environment.

A review of the literature found numerous articles discussing servant leadership, which has similar attributes.1 For example, qualities such as listening, empathy, awareness, and commitment to growth are characteristics of both leadership styles.2 However, servant leaders prioritize their employees' needs above all when making decisions.1

Gracious leaders regard employee relationships and needs as a major priority while simultaneously promoting optimal outcomes for both the patients and the healthcare organization. They care more about the success of the unit, team, and organization than their own power. These healthcare professionals cultivate strategic relationships to build a community and help employees cope with adversity, thrive, and provide safe care to patients and families during challenging times.

The authors collaborated with nurses from their healthcare organization for feedback on the attributes of a gracious leader, as well as those who most aligned with these characteristics, and developed the acronym GRACIOUS to describe these qualities:

  • Giving: Gracious leaders give their time, listening and addressing the issues and concerns of their staff. They provide incentives and rewards for exemplary work. When leaders are giving, their employees know that they care for each member of the team and are invested in the organization.
  • Respectful: Gracious leaders respect each nurse's role in the healthcare facility by being acutely aware of what is said and how it is said when providing feedback. Respectful leaders make employees feel as though they matter and are valued as part of the team.
  • Appreciative: Gracious leaders are appreciative of the work each employee contributes, empowering and motivating nurses to do their best. They serve as a cheerleader, offering recognition for exemplary work and allowing staff to shine as valued and respected members of the team.
  • Caring: Caring is a core value in nursing, and gracious leaders care about each employee and patient within the organization. Caring leaders are reflective, strategic, and constructive. Their feedback can redirect negative employees, guiding and mentoring them to a more positive view of a situation.
  • Insightful: Gracious nurse leaders are insightful about the needs and wants of employees, patients, families, and the community. They understand how and what their nurses are feeling, as well as the challenges and concerns facing both the staff and the organization. They share authority and responsibility and remain humble, open to different perspectives, willing to take risks, and trusting of their employees.3
  • Optimistic: Gracious leaders are optimistic about the work accomplished by their employees to meet the vision and mission of the organization. Nurse leaders must show the nursing staff that they are hopeful and confident about the future. Even during challenging times, they must remain optimistic and encourage staff to evaluate, revise, and press onward.
  • Understanding: Gracious leaders understand how to meet not only the organization's goals but also their employee needs. They set clear goals, provide thoughtful and deliberate feedback, and allow their team to work autonomously. Nurse leaders must be understanding of what is occurring within the organization and how employees feel about it.
  • Supportive: Gracious leaders are supportive of the organization and each employee. They can support their staff by addressing concerns with encouragement and positive reinforcement. The frontline nursing staff often alerts nurse leaders to issues that can adversely affect patient care. Nurses are more likely to share concerns if they feel supported as part of the team; this is essential to ensure safe and competent patient care.

Creating healthy work environments

One role of a nurse leader is to help employees handle the stressors associated with working in healthcare. Gracious leaders remain empathetic and compassionate in the face of challenges such as increased patient acuity, an aging patient population and workforce, the fast pace of advancements in technology, a lack of staffing and resources, and the pressure to achieve excellent patient and staff satisfaction ratings.

The healthcare environment can be stressful and chaotic. According to The Joint Commission, inadequate leadership is a contributing factor to adverse events due to lack of support, reporting, and feedback related to staff burnout and patient safety vulnerabilities.4 Despite these challenges, nurses who accept leadership positions must realize the potential for a healthy work environment by utilizing effective team work strategies and developing strong bonds with the frontline staff.5 As the authors of one 2016 study put it, effective leaders “recognize that the crux of leadership is in the power of relationships.”5

When employees feel valued, they thrive in a healthy work environment, which subsequently increases productivity.3,6 Gracious leaders understand the importance of supportive feedback when employees share their concerns. This creates a team environment and shows that they empathize and feel compassion for their employees.

Gracious leaders work to create a team environment in which nurses find joy in working toward and achieving their goals. When employees find meaning in their work, they help establish and maintain a safe culture.4 According to The Joint Commission, the employees of organizations with a strong safety culture:

  • treat their coworkers and patients with dignity and respect.
  • are productive, engaged, collaborative, and continuously learning.4

Gracious leadership in action

Gracious leadership is a quality that requires some development. According to the Agency for Healthcare Research and Quality, nurse leaders serve as mentors, coaches, and teachers; offer counsel and support; and motivate and empower nurses to ensure patient safety.7 The ability to empathize with staff and be caring, understanding, and supportive is essential. Take the time to listen to each employee with respect and appreciation.

Employees want to know that administrators are open to their ideas and suggestions, and providing a sounding board, a shoulder to cry on, or an opportunity to vent will be appreciated. In the authors' experience, focusing on the elements of the GRACIOUS acronym may also contribute to more effective labor relations and the ability to come to mutually beneficial decisions.

Fostering success

Gracious leaders make their staff feel like an essential part of the team by working toward common goals for patients, employees, and the organization. Just as nurses promote caring and compassionate care that is respectful to the dignity and worth of each patient, nurse leaders are responsible for fostering an environment that is caring, compassionate, and respectful to each employee under their leadership. They must demonstrate that they value and believe in each nurse to meet the goals of the healthcare organization.


1. Savel RH, Munro CL. Servant leadership: the primacy of service. Am J Crit Care. 2017;26(2):97–99.
2. Fahlberg B, Toomey R. Servant leadership: a model for emerging nurse leaders. Nursing. 2016;46(10):49–52.
3. Grande D. The imperative of humble leadership. Am Nurse Today. 2018;13(3):12.
4. The Joint Commission. The essential role of leadership in developing a safety culture. Sentinel Event Alert. 2017;(57):1–8.
5. Dyess SM, Sherman RO, Pratt BA, Chiang-Hanisko L. Growing nurse leaders: their perspectives on nursing leadership and today's practice environment. Online J Issues Nurs. 2016;21(1):7.
6. Blatchley A. A nurse manager's guide to giving effective feedback. Nurse Lead. 2017;15(5):331–334.
7. Agency for Healthcare Quality and Research. CUSP toolkit, the role of the nurse manager, facilitator notes. 2012.

gracious leadership; leadership; nurse leader; servant leadership

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