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Leadership in nursing practice

Pullen, Richard L. Jr. EdD, MSN, RN, CMSRN

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Nursing Made Incredibly Easy!: May/June 2016 - Volume 14 - Issue 3 - p 26-31
doi: 10.1097/01.NME.0000481442.05288.05
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What do nursing and leadership have in common? Caring and compassion. Leaders do more than organize, direct, delegate, and have vision; they use interpersonal skills to help others achieve their highest potential. A recurrent theme in the literature is that leadership involves influencing the attitudes, beliefs, behaviors, and feelings of other people. This results in a feeling of being genuinely valued and respected—a basic way to achieve self-actualization and establish a trusting culture. Leadership is the foundation that brings an organization's mission and vision to fruition (see What leaders do).

Keep in mind that leadership and management skills are different. Whereas managers are adept at controlling processes, making decisions, and coordinating resources, leaders empower others, inspire innovation, and challenge traditional practices. Leadership is about relationship-building; it facilitates management. However, these skill sets need to overlap to ensure safe, quality care (see Comparison of leadership and management statements).

As a nurse who may not be in a formal leadership position, how can you be a leader in your clinical area? By cultivating a positive leadership style, considering techniques such as leadership by walking around (LBWA) and mentorship, and continuing your education, nurses in every role and at all levels can be effective leaders.

Sure got style!

There are several different leadership styles: servant, transformational, democratic, authoritarian or autocratic, and laissez-faire. Let's take a closer look.


Servant leadership occurs when an individual influences others by developing relationships and team member skills. Servant leaders value diverse opinions, cultivate a culture of trust, have excellent listening skills, think long-term, and respond to the needs of individuals and groups with humility.


Transformational leadership creates valuable and positive change in individuals and social systems with the end goal of developing followers into leaders. Transformational leaders display three general characteristics: 1) individualized consideration—the degree to which the leader focuses on each follower's needs; 2) intellectual stimulation—the degree to which the leader changes assumptions, challenges the status quo, and takes risks; and 3) inspiration motivation—he or she “walks the talk.” In other words, transformational leaders are role models for the change process.


Democratic leadership fosters a participative and teamwork approach to problem solving. It's the democratic leader's responsibility to validate the importance of each team member's input and derive themes from the totality of the team's work. For example, a democratic leader may say, “We've had a good brainstorming session and these are the important points I'm hearing from the team.” The democratic leader embraces a spirit of collegiality so that everyone on the team feels valued in the problem-solving process. Effective communication techniques, especially listening skills, are important tools that the democratic leader uses.

What leaders do


Authoritarian or autocratic leadership is demonstrated when a person makes every decision without considering input from others. Negative reinforcement and punishment are often common with this leadership approach. The focus may be on blame rather than continuous improvement of imperfect processes. However, this leadership style is often effective during a crisis or emergency when a decision must be made immediately.


Conversely, the laissez-faire leader provides little or no direction or supervision. Generally weak at supporting the mission and vision of the organization, this type of leader doesn't usually address problem areas or empower others to celebrate their successes or identify areas for improvement. Laissez-faire leaders let things happen rather than make things happen.

The change process is best accomplished using the servant, transformational, and democratic leadership approaches. These three styles often result in people who are motivated through inspiration. When clinical nurses say that they want to be just like their supervisor, it's a strong indication that the supervisor puts people first and is a transformational leader.

Walk this way

LBWA is a powerful and simple strategy to ensure that your nursing team feels valued and outcomes are achieved. Remember that your nursing colleagues may see you as a leader even though you may not necessarily be in a position of authority. The idea is to get out and see how things actually work, visiting with people and gaining insight into who's doing what. To operationalize this strategy, the sole goal of LBWA is meeting with people rather than taking care of business issues.

Comparison of leadership and management statements

For example, as you move from one person or group of people to the next, ask questions or make comments, such as the following: “How was your weekend?” “How's it going today?” “How was your son's high school graduation?” “Have you and your spouse made those cruise reservations yet?” “I saw your daughter's engagement announcement in the newspaper.” Make sure you're alone when you walk around, your sincerity shines through with a smile and good listening skills, and you involve everyone. Don't circumnavigate anyone.

One strategy while visiting with someone is to ask them “May I have a seat?” and then share a story or situation about yourself unrelated to work. Take time to share your aspirations. When you share something about yourself, people feel needed, valued, and important. Be funny and use humor as appropriate. People will see that you're real and down to earth. On occasion, plan to walk around when you know people are engaging in specific activities of which they're proud. Show up during the activity and acknowledge the team's excellent work, expressing how proud you are of them. You'll find that managing people and processes is more effective when you use the LBWA method.

The value of mentorship

Simply stated, mentoring (or coaching) is a dynamic process of building supportive relationships to enhance professional growth and maximize individual potential (see Developing future nurse leaders). Mentorship is a means of sharing your knowledge, skills, attitudes, and behaviors with another nurse. The mentoring process may be as simple as providing words of encouragement. What are the qualities of a mentor and what do mentors do?

  1. Mentors have self-knowledge. They understand their roles within an organizational context and have the courage to identify ways to improve nursing practice. Mentors aren't afraid to acknowledge their weaknesses. They also understand the importance of celebrating their own strengths and the strengths of their mentoree and other nursing colleagues.
  2. Mentors have strategic vision. They have the ability to connect the essence of nursing practice—compassion and caring for people—to evidence-based approaches to continuously improve the quality of patient care. Having strategic vision involves being a risk-taker by “thinking outside of the box” and having an interprofessional methodology to achieving organizational goals. In short, mentors are successful change agents.
  3. Mentors are effective communicators. They're skilled in verbal and nonverbal communication skills, providing clear and articulate guidance and responding in ways that show respect. Calm and relaxed in countenance and body language, they're good listeners who give the mentoree time to process before speaking and indicate that they understand what he or she is communicating. Additionally, mentors aren't afraid to indicate that they're wrong and offer an apology.
  4. Mentors are supportive and encouraging. Effective mentors are patient, kind, and motivate the mentoree to problem solve. They're approachable, available, and trustworthy. They may use humor and have fun in the journey with their mentoree, but they always demonstrate genuine compassion.

Building the future

In order to advance nursing as a profession, we must continue our formal education. Patient outcomes are more likely to be achieved at a higher level as we further our education and experience.

In 2013, the Robert Wood Johnson Foundation released The Case for Academic Progression, which states that patients, employers, and the nursing profession benefit when nurses advance their education. In 2014, the American Association of Colleges of Nursing released a position statement titled The Impact of Education on Nursing Practice, strongly encouraging nurses to progress their education in support of the Institute of Medicine's 2010 Future of Nursing report call to increase the number of baccalaureate-prepared RNs to 80% by 2020. In 2015, the American Nurses Association and the Organization for Associate Degree Nursing released a joint position statement titled Academic Progression to Meet the Needs of the Registered Nurse, the Health Care Consumer, and the U.S. Health Care System that recommends seamless pathways in educational mobility for the RN pursuing advanced education.

Nurse leaders should develop an action plan for career mobility. The nursing education career ladder allows an individual to stay at one level or advance one step at a time to a higher level of education. For example, a practical/vocational nurse can set his or her initial goal to earn an associate degree in nursing to become an RN, with an eventual goal of earning a doctoral degree in nursing, such as the doctor of nursing practice. Nurses who wish to pursue an executive, academic, or NP role will need to earn at least a master's degree in nursing; however, doctoral degrees are becoming more of a standard in these roles. Don't forget the value of other graduate degrees, such as in education and interprofessional studies, as you evaluate your career goals.

Leaders also need to consider earning certifications in a nursing specialty area. And as a nurse leader, you'll need to continue enhancing your leadership abilities by attending conferences and workshops that have a nursing and interprofessional focus.

Celebrating nurses

There's a need for leadership at all levels of nursing practice. Although our roles may be different according to educational preparation and experience, we all have one common goal: to provide safe, quality patient care. Enjoy your journey in our wonderful profession.

Developing future nurse leaders

  • Experienced nurse leaders who are known leaders in any practice setting should be encouraged to serve as mentors for other nurses.
  • Mentors should be on the lookout for nurses in the practice setting who show characteristics associated with leadership. Mentorees may be nurses who've just graduated from nursing school or those who have many years of experience.
  • Mentors should encourage mentorees to continue their formal and informal education by attending leadership conferences and earning an advanced degree or certification. Mentors must also continue to learn.
  • Nurse leaders understand the value of service. They should routinely engage in community-wide service activities that support the foundations of nursing practice.
  • It's important to remember that leadership entails a commitment to improving nursing care through research. Keeping up to date with research findings is important at all levels, from practical/vocational to doctorally-prepared RNs.
  • Nursing students and new graduates who envision themselves as future nurse leaders should make a plan for professional development. They should be encouraged to collaborate with nursing faculty and nurses in practice as they develop their action plan.
  • Professional socialization is important. Leaders take part in professional nursing organizations and community-wide social events. The key is to be involved.


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