NURSES WEEK

SPECIAL

Leadership
in nursing practice
Its been said that leaders are born. But these skills can also be learned.
By Richard L. Pullen, Jr., EdD, MSN, RN, CMSRN

26 Nursing made Incredibly Easy! May/June 2016

Sure got style!

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

Servant
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
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 considerationthe degree
to which the leader focuses on each followers needs; 2) intellectual stimulationthe
degree to which the leader changes assumptions, challenges the status quo, and takes
risks; and 3) inspiration motivationhe or
she walks the talk. In other words, transformational leaders are role models for the
change process.

Democratic
Democratic leadership fosters a participative and teamwork approach to problem
www.NursingMadeIncrediblyEasy.com

Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.

DICK PALULIAN / ILLUSTRATION SOURCE

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
respecteda basic way to achieve selfactualization and establish a trusting culture. Leadership is the foundation that
brings an organizations 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 relationshipbuilding; 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.

www.NursingMadeIncrediblyEasy.com

May/June 2016 Nursing made Incredibly Easy! 27

Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.

solving. Its the democratic leaders responsibility to validate the importance of each
team members input and derive themes
from the totality of the teams work. For example, a democratic leader may say,

What leaders do
Model the way

Inspire a shared vision

Leaders:
know that to gain commitment and win
respect, they need to become exemplars of
the behavior they expect of others
value and respect each person
demonstrate a passion for nursing through
involvement in professional organizations,
service, and scholarly activities
have a commitment to excellence
possess compassion for people
have the courage to be candid with kindness, gentleness, and respect.
Leaders:
envision the future with exciting possibilities
that improve nursing practice
enlist others in a common vision by appealing to shared aspirations
think outside of the box
celebrate the ideas of everyone.

Challenge the process

Leaders:
search for opportunities to improve nursing
practice using evidence-based data
have a spirit of inquiry
measure improvement strategies to evaluate
action plans that have been implemented
arent afraid to take risks as change agents
arent afraid to fail (and when they do, they
get back on track).

Enable others to act

Leaders:
foster collaboration by building trust and
facilitating relationships
strengthen others by increasing selfdetermination and developing competence.

Encourage the heart

Leaders:
recognize contributions by showing
appreciation for individual excellence
celebrate values and victories by creating a
spirit of community
acknowledge everyone who walks their way
inspire others to motivate themselves.

Adapted from Kouzes JM, Posner BZ. A Coachs Guide to Developing Exemplary
Leaders. Hoboken, NJ: John Wiley and Sons; 2010.

28 Nursing made Incredibly Easy! May/June 2016

Weve had a good brainstorming session

and these are the important points Im
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.

Authoritarian/autocratic
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.

Laissez-faire
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
doesnt usually address problem areas or
empower others to celebrate their successes
or identify areas for improvement. Laissezfaire 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, its 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
www.NursingMadeIncrediblyEasy.com

Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.

Comparison of leadership and management statements

Nurse role

Management statement

Leadership statement

Nurse executive

Im assigning the nursing directors to

develop a policy on a new electronic health
record that well soon be using.

The teamwork of the nursing directors made the

new electronic health record policy successful. I
appreciate the hard work that each of you put into
this project.

Nurse faculty
(medical-surgical)

As my students in this clinical rotation,

youre to successfully complete each of the
competencies to pass.

Ill help guide you to be successful in this clinical

course. Good teaching and solid studying will help
you achieve the competencies.

RN charge nurse
(pediatrics)

Growth and development arent being consistently included on nursing assessments.

This must be accomplished each and every
time.

I want to thank my nursing team for providing

excellent patient care. Youre dedicated and I know
you work hard. By the way, Ive noticed improvement with growth and development assessments
in the electronic health record.

RN clinical nurse
(psychiatric mental health)

The unit policy is that staff members cant

wear an assistive device, such as an elastic
bandage wrap or arm cast, when on duty.
This is a patient safety issue. You cant come
to work if you have one.

I want to remind everyone that our policy is any

staff member with an assistive device cant be on
duty because it creates a safety issue for staff and
patients. I understand this may create a hardship
for you if you cant come to work.

LPN/LVN
(long-term care)

We need a better way to administer the volume of medications on this unit. The current
method and policies arent working well.

I have an idea to make the medication administration process better on our unit. Im going to propose it to the director of nursing. I hope she likes
it. My idea is a little different.

Nursing student
I assessed my patients abdomen to make
(clinical rotation: obstetrics) sure her uterus was firm. I used the checklist
from the course syllabus.

After learning how to assess my patients abdomen to make sure her uterus was firm with my
instructors supervision, I got to teach my patients
husband what I was doing and then two of my student peers. My instructor said that I was going to
be an excellent nurse.

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 whos doing what. To operationalize this strategy, the sole goal of LBWA is
meeting with people rather than taking
care of business issues.
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? Hows
it going today? How was your sons high
school graduation? Have you and your
spouse made those cruise reservations
yet? I saw your daughters engagement
announcement in the newspaper. Make
www.NursingMadeIncrediblyEasy.com

sure youre alone when you walk around,

your sincerity shines through with a smile
and good listening skills, and you involve
everyone. Dont 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 youre real
and down to earth. On occasion, plan to
walk around when you know people are
engaging in specific activities of which
theyre proud. Show up during the activity
and acknowledge the teams excellent work,
May/June 2016 Nursing made Incredibly Easy! 29

Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.

expressing how proud you are of them.

Youll 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 arent afraid to acknowledge
their weaknesses. They also understand

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 whove 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.
Its 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.

30 Nursing made Incredibly Easy! May/June 2016

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 practicecompassion and caring for
peopleto 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.
Theyre 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,
theyre good listeners who give the mentoree time to process before speaking and
indicate that they understand what he or
she is communicating. Additionally, mentors arent afraid to indicate that theyre
wrong and offer an apology.
4. Mentors are supportive and encouraging. Effective mentors are patient, kind,
and motivate the mentoree to problem
solve. Theyre 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
www.NursingMadeIncrediblyEasy.com

Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.

titled The Impact of Education on Nursing

Practice, strongly encouraging nurses to
progress their education in support of the
Institute of Medicines 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 masters degree in nursing; however, doctoral degrees are becoming more of a
standard in these roles. Dont 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, youll need to continue enhancing your leadership abilities by
attending conferences and workshops that
have a nursing and interprofessional focus.

REFERENCES

Celebrating nurses

Wong CA. Connecting nursing leadership and

patient outcomes: state of the science. J Nurs Manag.
2015;23(3):275-278.

Theres 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.
www.NursingMadeIncrediblyEasy.com

American Association of Colleges of Nursing. Fact sheet:

the impact of education on nursing practice. www.aacn.
nche.edu/media-relations/EdImpact.pdf.
American Association of Colleges of Nursing. Nursing leadership: management and leadership styles. https://www.
aanac.org/docs/white-papers/2013-nursing-leadership
management-leadership-styles.pdf?sfvrsn=4.
American Nurses Association. Nine principles of nursing
leadership. www.americannursetoday.com/nine-principles-of-successful-nursing-leadership/.
Anonson J, Walker ME, Arries E, Maposa S, Telford P,
Berry L. Qualities of exemplary nurse leaders: perspectives
of frontline nurses. J Nurs Manag. [e-pub July 4, 2013]
Arzouman J. Leadership. Medsurg Nurs. 2015;24(1):5, 22.
Baker JD. Getting buzzed on innovative leadership.
AORN J. 2015;101(4):401-403.
Conard PL, Pape TT. Roles and responsibilities of the
nursing scholar. Pediatr Nurs. 2014;40(2):87-90.
Doody O, Doody CM. Transformational leadership in nursing practice. Br J Nurs. 2012;21(20):1212-1214, 1217-1218.
Foli KJ, Braswell M, Kirkpatrick J, Lim E. Development
of leadership behaviors in undergraduate nursing students: a service-learning approach. Nurs Educ Perspect.
2014;35(2):76-82.
Hodgson AK, Scanlan JM. A concept analysis of mentoring in nursing leadership. www.scirp.org/journal/
PaperInformation.aspx?paperID=36602.
Kotter JP. Leading Change. Boston, MA: Harvard Business
Review Press; 2012.
Kouzes JM, Posner BZ. A Coachs Guide to Developing
Exemplary Leaders. Hoboken, NJ: John Wiley and Sons; 2010.
Makaroff KS, Storch J, Pauly B, Newton L. Searching for
ethical leadership in nursing. Nurs Ethics. 2014;21(6):642-658.
Organization for Associate Degree Nursing. Organization
for Associate Degree Nursing and American Nurses
Association joint position statement on academic progression to meet the needs of the registered nurse, the
health care consumer, and the U.S. health care system.
www.noadn.org/files/apin/15062_OADN_ANA_
PositionStatement_Academic_Progression_2015_2.pdf.
Patterson BJ, Krouse AM. Competencies for leaders in
nursing education. Nurs Educ Perspect. 2015;36(2):76-82.
Robert Wood Johnson Foundation. The case for academic
progression: why nurses should advance their education and the strategies that make this feasible. www.
rwjf.org/content/dam/farm/reports/issue_briefs/2013/
rwjf407597.
Sullivan EJ. Becoming Influential. A Guide for Nurses. 2nd
ed. Upper Saddle River, NJ: Prentice Hall; 2012.
Vinales JJ. Mentorship part 1: the role in the learning
environment. Br J Nurs. 2015;24(1):50-53.

Richard L. Pullen, Jr., is the Dean of Nursing, Director of the ADN

Program, and a Professor at Amarillo (Tex.) College and a Nursing
made Incredibly Easy! Editorial Board Member.
The author has disclosed no financial relationships related to this
article.

DOI-10.1097/01.NME.0000481442.05288.05

May/June 2016 Nursing made Incredibly Easy! 31

Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.