Nursing Leadership

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Table of Contents
Introduction ............................................................................................................................................ 3
Leadership in Healthcare ........................................................................................................................ 3
Theories of Leadership ............................................................................................................................ 4
Diversity in Healthcare ............................................................................................................................ 6
Australia .............................................................................................................................................. 6
United States and Canada ................................................................................................................... 6
United Kingdom .................................................................................................................................. 6
Discussion................................................................................................................................................ 7
Conclusion ............................................................................................................................................... 8
References .............................................................................................................................................. 9
















Introduction
Leadership as a concept which conjures up a variety of images, thoughts and actions has been
explicitly discussed in literature. Among various definitions for the term leadership that
have been defined in literature, most common expressions suggest that leadership is the art of
influencing beliefs, behaviours, attitudes and feelings of other people in a manner that they
begin to willingly strive towards the achievement of group goals. The concept of leadership
has significantly evolved in its approach over time and had developed to include aspects of
having a vision, developing trust and empowering others (Srensen et al, 2011).
Reflecting on this concept, the main aim of this paper is to examine leadership, its styles and
influences in the healthcare domain with a specific emphasis on the aged care and disability
healthcare sector. The paper begins with defining the concept of leadership and critically
discussing the evolution of leadership styles from heroic concepts. This is followed by
identification of appropriate leadership theories which might be applied to the healthcare
domain. Diversity in the western healthcare system has been discussed with specific
implications for individual and community decision making. Lastly, various types of
leaderships have been discussed in terms of their applicability to the domain of aged care and
disability healthcare and practical examples have been presented in order to support
arguments.
Leadership in Healthcare
Although the concept of leadership has been extensively discussed in management as well as
organizational literature, comparatively less attention has been paid to nursing leadership or
leadership in healthcare. In accordance with available viewpoints, leadership in healthcare
might be defined as a process of developing administrative competence, clinical expertise,
business skills and a thorough understanding of principles which govern leadership. Nurse
educators and executives believe that the concept of leadership as applicable to nursing is
different from general leadership as it emphasises the influence and improvement of practice
environment. In other words, leadership in the healthcare domain has its roots in actual
clinical practice (Sandstrom et al, 2011). Common expressions used to describe leadership in
healthcare include empowering others, developing appropriate healthcare knowledge,
facilitating learning, assisting others and working with others to achieve success. Literature
on nursing leadership also suggests that contrary to organizational scenarios where leader-
follower relationships might be clearly defined, every healthcare professional might be a
leader in some context. For example, a staff nurse might be a leader for patients/clients that
she/he is responsible for. Alternately, a ward manager might be a leader for all healthcare
team members (Curtis et al, 2011).
Looking at the historical evolution of leadership, it might be suggested that the modern day
leadership concepts in healthcare and otherwise have been developed from Galtons Great
Man Theory in the 1990s. The Great Man Theory or Heroic Leadership advocated that
certain individuals (such as those with a family history of traditional healing) possessed
inherent qualities required to lead others and achieve success. People followed traditional
healers and their practices without questioning them (Cummings et al, 2010). This theory
eventually gave rise to Trait Theories during the 1920s. These theories attempted to identify
traits of leaders and were based on the belief that leaders would certainly possess some
universal qualities which others dont. The behavioural approach came around much later
and focussed on actual work responsibilities of good leaders as opposed to their traits and
qualities. As leadership approaches further evolved, the aspect of situation became important.
It was fashioned that leaders were required to alter their style in context of the presenting
situation. For example, a nurse leader might have to be autocratic in order to deal with a
difficult patient. Alternately, participative approach might work better for others. Refinement
of the situational approach led to the development of contingency approach which focussed
on identification of particular situational variables which might influence leadership styles.
The contingency or transactional approach finally gave way to the transformational approach
of leadership that is best known today (Richardson & Storr, 2010).
Transformation leadership derives its strength from five different pillars of strength namely
living ones ideals, inspiring motivation, stimulating others, coaching each individual for
development and commanding respect, trust and faith (Cummings et al, 2010).
Theories of Leadership
While any of the leadership approaches as discussed above might be able to guide nursing
professionals in leading, transformational leadership has been strongly advocated as the most
appropriate choice. Transformational leadership is a process where leaders take actions so as
to increase the awareness of their associates. Transformational leaders strive to provide their
associates with a sense of purpose and take the initiative of building organizations that are
high performing. Transformational leaders live by their values and ideals and discuss the
importance of trust in an organization. They tend to inspire others by being enthusiastic and
optimistic in nature. They articulate a compelling vision of future possibilities and re-
examine critical assumptions at every step. They seek differing perspectives and encourage
thinking that is non-traditional in nature. They encourage individuals to look at problems
from a variety of perspectives and suggest new ways of problem solving. Transformational
leaders spend time coaching others and helping them take on leadership responsibilities in the
future. They instil pride in others and reassure others at every step (Brady Germain &
Cummings, 2010).
Transformational leadership in the domain of healthcare has been particularly related with the
aspect of having a vision, building trust, empowering others and sharing a bond with
followers. Literature presents evidence to the fact that transformational leadership in
healthcare facilitates innovative nursing practice and serves to increase quality of care offered
by nursing and other healthcare professionals. Transformational leadership in the domain of
healthcare helps in boosting confidence and capability of the healthcare staff (Kelly, 2011).
In addition to transformational leadership, the situational approach might be of particular
importance in healthcare. Fiedlers Contingency model advocates that no single leadership
style might be labelled as best for a professional and situations would have a heavy influence
on leadership style requirements. In this context, a healthcare professional faced with difficult
patients who do not tend to listen and stay committed to their treatment plan might have to
adopt an autocratic or dictator type of leadership style to benefit her patients (Vogelsmeier &
Scott-Cawiezell, 2011).

On similar lines, the Hersey-Blanchard Model of Leadership advocates that development
levels of subordinates significantly influence the kind of leadership style that might be
adopted. The theory is specifically based on three aspects namely task behaviour, relationship
behaviour and maturity. Task behaviour refers to the extent to which a leader might engage in
properly defining and spelling out responsibilities to followers. Relationship behaviour refers
to the extent to which a leader might engage in two way communications and maturity refers
to the willingness or ability of a subordinate to accept responsibility from the leader (Dzau &
Gilliss, 2013).
Diversity in Healthcare
Australia
In Australia, healthcare is provided both by government as well as private providers. National
health policy is administered by federal ministry for health while specific elements are
handled by state governments. Universal healthcare system in Australia is known as
Medicare and is funded by the Universal Healthcare Scheme. Medicare coexists with private
healthcare service delivery (Smith et al, 2010).
United States and Canada
Healthcare systems in Unites States and Canada are an amalgamation of public, private and
mixed healthcare systems. Public services are available through Canada Health Act and are
funded by public taxation. They are governed by a universal administration system and
service delivery includes private professional, private for profit, private non profit and public
facilities. Private services include provision of dental, vision, and alternate medicine and
OTC drugs. These are governed by private insurance providers and out of pocket payments.
Mixed goods and services include home care, prescription drugs and institutional care. These
services are funded both by public taxation and private insurance providers and are usually
administered by targeted public services (Bakker et al, 2010).
Healthcare system both in Canada as well as in United States is highly decentralised.
Provinces and territories are responsible for handling their single payer systems for universal
medical services. The federal government however does retain jurisdiction over certain
aspects of healthcare (Bakker et al, 2010).
Looking at the above discussion, it might be suggested that a participative style of leadership
is followed in Australia, U.S and Canada where federal government is responsible for policy
making and healthcare is provided both by private and government providers. This helps in
better empowering the community as well as individuals (Sandstrom et al, 2011).
United Kingdom
Department of health in UK is responsible for creating and updating health policy while the
delivery of care is the responsibility of trusts. 10 strategic health authorities in the UK are
responsible for disbursing funds on a regional basis and managing healthcare. These 10
health authorities are linked with NHS. NHS in the country is divided into primary and
secondary healthcare. Delivering primary care is the responsibility of primary care trusts and
they contract with general practitioners, dentists, surgeons and opticians. Secondary care is
the responsibility of secondary trusts and they are responsible for ensuring that acute care is
delivered in hospitals in an effective manner. 209 especially dedicated secondary care
hospital trusts oversee care provision in 1600 NHS care centres and hospitals (Mills et al,
2012).
Looking at the above structure, it might be suggested that the style of healthcare leadership is
more autocratic in nature and the resulting level of individual empowerment is limited (Mills
et al, 2012).
Discussion
In the present day context, it might be most appropriate for nurse leaders to endorse servant
leadership style while caring for the disabled and the elderly. This leadership style would
encourage them to adapt better to change and take control of their own life. The leadership
style focuses on building relationships with others and fostering development of individual
skills. A servant leader would serve to listen, commit to growth of the others, persuade and
organize. Citing a practical example of this form of leadership, it might be appropriate to cite
the case of a 64 year old woman who was recently diagnosed with diabetes. She had been
suffering from arthritis for the past 10 years and was diagnosed with CHF 5 years ago.
Working to transform her life, the nursing professional counselled her and her husband on
aspects like medication management, administration of insulin, diet management and
physical activity. The goal here was to develop individual abilities to transform lives
(MacPhee et al, 2012).
Alternately, participative leadership style might have to be utilised in certain situations. This
leadership style involves collaborating with patients, with other staff members and various
sections of the community in order to figure out the best possible alternatives. An example
might be cited from the manner in which care plans are devised for elderly individuals
admitted to various healthcare settings. Care plans are made by gathering patient
perspectives, support available in the community and healthcare personnel who would be
required to stay in touch with these elderly individuals (Smith et al, 2010).
In rare cases, the autocratic style of leadership might have to be utilised by nurse leaders.
This might be attributed to the fact that elderly or disabled persons in some cases might
completely refuse to listen to nurse leaders or comply with their medication requirements.
Under these circumstances, autocratic style of leadership would be most appropriate. This is
especially true with nurse leaders who are employed in the mental healthcare unit.
Complexities of the environment sometimes force nurse leaders to be autocratic in nature
(Srensen et al, 2011).
Conclusion
Looking at the above discussion, it might be concluded that leadership in nursing is an
amalgamation of developing administrative competence, clinical expertise, business skills
and a thorough understanding of principles which govern leadership. History of leadership
also suggests that its roots are instilled in the great man theory or heroic leadership. While
leadership development might be mapped with the help of several stages, transformational
leadership is most appropriate in todays context. However a mix of transformational,
participative and autocratic leadership might have to be utilised while caring for the elderly
and disabled persons.












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