Collegian (2015) 22, 439—444

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier.com/locate/coll

Leadership in nursing: The importance of

recognising inherent values and attributes
to secure a positive future for the
profession
Natashia Josephine Scully, BA, BN, PGDipNSc, MPH, RN, MACN ∗

School of Health, University of New England, Australia

Received 13 December 2013; received in revised form 9 September 2014; accepted 10 September 2014

KEYWORDS Summary Nursing is a dynamic and challenging profession requiring engaging and inspiring
role models and leaders. In today’s ever changing and demanding healthcare environment, iden-
Leadership;
tifying and developing nurse leaders is one of the greatest challenges faced by the nursing pro-
Management;
fession. The concept of leadership is a complex and multi-dimensional phenomenon; research
Nursing;
conducted for over a century concludes that although it is one of the most-observed concepts,
Future
no universally accepted definition or theory of leadership actually exists. There is increasing
clarity surrounding what true nursing leadership is, and how it differs from management.
This discussion will outline the nature of nursing leadership and importance of nurse leaders
in advancing the profession; clarify definitions and differentiate between nurse managers and
nurse leaders; describe the evolution of nurse leadership by identify theories and styles of
leadership relevant to nursing practice; and highlight the importance of identifying leaders in
the nursing profession. The paper also serves as a caution to recognise, avoid and discourage
‘‘negative’’ leaders in the pursuit of a bright future for the nursing profession.
With appropriate identification, support and development of future nurse leaders, an
acknowledgement of the shifting paradigm of leadership theory and the context in which future
nurse leaders are destined to grow, the ultimate goal of the nursing profession — excellent in
person-centred care — can be achieved. It is essential to the future success of the nursing pro-
fession that informal, negative ‘‘leaders’’ be discouraged and positive leaders, possessing the
evidence-based qualities of leadership be identified and nurtured to lead the profession.
© 2014 Australian College of Nursing Ltd. Published by Elsevier Ltd.

∗ Correspondence to: Room 217, Patricia O’Shane Building, Armidale 2351, Australia. Tel.: +61 0413 789 556; fax: +61 6773 3666.
E-mail addresses: nscully2@une.edu.au, natashiascully@rocketmail.com

http://dx.doi.org/10.1016/j.colegn.2014.09.004
1322-7696/© 2014 Australian College of Nursing Ltd. Published by Elsevier Ltd.
440
1. Introduction
Nursing is a dynamic and challenging profession requiring
engaging and inspiring role models and leaders. In today’s
ever changing and demanding healthcare environment,
identifying and developing nurse leaders is one of the great-
est challenges faced by the nursing profession. The concept
of leadership is a complex and multi-dimensional phe-
nomenon; research conducted for over a century concludes
that although it is one of the most-observed concepts, no
universally accepted definition or theory of leadership actu-
ally exists (Atsalos & Greenwood, 2001; Grossman & Valiga,
2012; Mannix, Wilkes, & Daly, 2013). There are almost as
many definitions and theories of leadership as there are
authors who have written on the topic, however there is
increasing clarity surrounding what true nursing leadership
is, and how it differs from the related — not synonymous —
role: management (Grossman & Valiga, 2012).
This discussion will outline the nature of nursing lead-
ership and importance of nurse leaders in advancing the
profession; clarify definitions and differentiate between
nurse managers and nurse leaders; describe the evolution
of nurse leadership by identifying theories and styles of
leadership relevant to nursing practice; and highlight the
importance of identifying leaders in the nursing profession.
In exploring these issues, the ability to identify emerging
leaders and encouraging their development becomes
increasingly possible, ultimately resulting in excellent
person-centred care. This paper identifies and highlights
the vital need to correctly identify future leaders to posi-
tively nurture the profession, indeed it serves as a caution
to recognise, avoid and discourage ‘‘negative’’ leaders in
the pursuit of a bright future for the nursing profession.
2. The nature of nurse leadership
Inherent in the nursing profession — and particularly in the
current climate — is the concept of chaos; an environment
of constant and unprecedented change, through which nurse
leaders are required to guide the profession in order to con-
tinue its advancement (Grossman & Valiga, 2012). As noted
above, while much commented-upon, the precise impor-
tance of nursing leadership has rarely been enunciated in
clear terms. Quite simply, nurse leaders are essential to the
profession for maintenance of adaptability and to remain
competitive in today’s dynamic environment; considering
the various economic, technological and academic chal-
lenges facing nurses (Mannix et al., 2013). Nurse leaders
are necessary to establish direction, align people, motivate
and inspire colleagues towards a common goal (Antrobus &
Kitson, 1999; Callaghan, 2007).
Until the late 1990s, most nurse leadership research
focused on the development of nursing practice; subse-
quent scholarly focus views nursing leadership as a vehicle
through which both health policy and nursing practice
can be influenced, with the aim of improving patient
outcomes and further advancing the profession (Antrobus
& Kitson, 1999; Callaghan, 2007). Nurse leaders possess
knowledge of broader contemporary issues in nursing and
an understanding of factors which may promote or inhibit
the future of nursing as a whole, and play a key role
N.J. Scully
in facilitating and enabling the development of nursing
knowledge (Antrobus & Kitson, 1999). Indeed leadership
(as well as autonomy, expertise and research) is seen as
an essential component for the continuous development
of advanced practice roles and the nursing profession
(Callaghan, 2007). Advanced practice nurses in all fields
— including clinical, academic, executive and political —
provide a vision for the next generation of nurses, leading
them to achieve extraordinary things through inspiration
and motivation towards a common goal (Callaghan, 2007).
3. Dissociating leadership and management
Highlighted by many researchers is the problematic nature
of the definition of leadership. Analysis of the literature
reveals several definitions, with a better understanding
achieved from looking at the very foundations of the con-
cept (Antrobus & Kitson, 1999; Atsalos & Greenwood, 2001;
Alleyne & Jumaa, 2007; Callaghan, 2007; Caplin-Davies,
2003; Grossman & Valiga, 2012; Nielsen, Yarker, Brenner,
Randall, & Borg, 2008). First appearing in the English lan-
guage in c. 1800, the word ‘‘leadership’’ denotes the
pioneering of unexplored territory and showing others the
path they need to take (Callaghan, 2007; Rigoloski, 2013).
Conversely, the term ‘‘management’’ denotes the han-
dling of situations by controlling and maintaining the status
quo; this involves exercising formal authority over work-
ing practices (Atsalos & Greenwood, 2001; Callaghan, 2007;
Grossman & Valiga, 2012; Rigoloski, 2013). Particularly in
nursing circles, management is often given more attention
and focus than leadership (Atsalos & Greenwood, 2001).
Indeed, as Grossman and Valiga (2012) identify, many nurses
and nurse theorists alike use the terms management and
leadership interchangeably, implying that the only person
who can provide leadership to a group is one already in
a management position. This is erroneous, as can be seen
clearly in Table 1, which provides an outline of some key
differences, in several domains, between leadership and
management.
Dissociating leadership from management is an impor-
tant factor in this discussion, but the aim is not to create a
negative view of management (as is the tendency in much
workplace and industrial relations discourse), rather to dis-
tinguish the nature of each essential role in the workplace.
Managers can be leaders, but leaders also need relative free-
dom from the constraints of management to perform their
duties. This is not to claim total independence for leaders,
as indeed, leaders themselves often need management — in
the form of the managing of their schedules and appoint-
ments for example — to enable them to carry out their work
more efficiently and effectively.
Leadership includes supporting clinical colleagues and
purposefully enlisting willing and enthusiastic colleagues;
inspiring followers to transform themselves and their sit-
uations through development of talents and formation of
reciprocal relationships; and subsuming the management
role (Caplin-Davies, 2003). One of the most important points
to note is that — contrary to the general usage of terms
‘leadership’ and ‘management’ mentioned above — lead-
ership is not necessarily tied to a position of authority
(Grossman & Valiga, 2012; Rigoloski, 2013).
Leadership in nursing: the importance of recognising inherent values 441

Table 1 Showing leadership and management characteristics.

Leadership Management

Position Selected or allowed by a group of Appointed by someone higher in the

followers organisational hierarchy
Power base From knowledge, credibility and Arising from the position of authority
ability to motivate followers
Goals/vision Arise from personal interests and Prescribed by the organisation
passion, may not be synonymous with
organisational goals
Innovative ideas Developed, tested and encouraged Allowed provided their do not
among all group members interfere with task accomplishment,
not encouraged though
Risk level High risk, creativity and innovation Low risk, balance and maintaining
are involved status quo are involved
Degree of order Relative disorder seems to be created Rational and controlled
Nature of activities Related to vision and judgement Related to efficiency and cost
effectiveness
Focus People Systems and structure
Perspective Long range with an eye on the horizon Short range with an eye on the
bottom line
Degree of Freedom Freestanding, not limited to Tied to designated position within
organisational position of authority the organisation
Actions ‘‘Does the right thing’’ (Bennis & ‘‘Does things right’’ (Bennis & Nanus,
Nanus, 2003) 2003)
Source: Bennis and Nanus (2003) and Grossman and Valiga (2012).

4. The evolution of leadership theory
As there are several definitions of leadership, so there are
several theories of leadership, each having evolved over
time, and more are emerging with further research. The
‘‘great man’’ theory of leadership — among the earliest,
and now largely outmoded — asserts that a leader is born
to lead, sometimes specifically into the ‘‘right’’ family,
thus inheriting unique characteristics (Grossman & Valiga,
2012). Though originating in much earlier times, the mid-
19th century was a key formative moment for ideas of
‘‘great man’’ leadership — more generally via the thought
of Carlyle (1841) (Cook, 1913; Strachey, 1918). The more
nuanced extensions of this theory, personal trait theories,
attempt to identify universal characteristics of leadership
(Grossman & Valiga, 2012). Situational theories, in compari-
son to personal trait theories, acknowledge the significance
of a particular situation on the effectiveness of a leader
(Grossman & Valiga, 2012).
More recent theories of leadership — combining aspects
of both personal trait and situational theories — recog-
nise that effective leadership depends on the personality
of the leader, the situation at hand and the qualities of the
followers (Grossman & Valiga, 2012). Leadership is not a hap-
hazard occurrence, rather involves vision, communicating
that vision to others, planning to make it a reality and serv-
ing as a symbol and source of energy for the team (Grossman
& Valiga, 2012). It is therefore an extension of the notion of
‘bringing order to chaos’, noted above as being intrinsic to
nursing leadership.
Until the 1990s, much of the research done on nurs-
ing leadership had been internally focused; meaning it
was concerned with the nature and purpose of leadership,
leadership styles, leadership characteristics and the devel-
opment needs of those aspiring to leadership (Antrobus &
Kitson, 1999). There had notably been little consideration
of external influences, such as socio-political factors and
health policy which have both affected and been influ-
enced by the development of nursing leadership, and in
the emerging neoliberal environment of the 1990s (where
the old certainties of protected universal health-care
systems could no longer be taken for granted) a recogni-
tion of this gave rise to the concept of the renaissance
leadership style (Antrobus & Kitson, 1999; Cook, 1999).
Renaissance leaders have knowledge of contemporary issues
in nursing and an understanding of factors which may pro-
mote or inhibit the future of nursing (Antrobus & Kitson,
1999).
Political ideology and policy govern the external agenda
which nurse leaders are trying to influence, thus these fac-
tors are driving forces behind professional, and therefore
leadership, agendas (Antrobus & Kitson, 1999). Arguably,
because they inhabit workplaces and contexts still imbued
with pre-1990 concepts of ‘workers’ and ‘employers’ (and
which have had neoliberal conceptions of management,
‘stakeholders’, ‘consumers’, and the language and ideology
of economic rationalism imposed upon them from outside),
the ideology and language used by nurses differs from that
used in policy and by policy-makers. This therefore creates
a policy-practice divide in which nurse leaders are required,
to provide an essential interpretation role to enable nursing
to be understood and considered a priority, and to com-
municate external, ideological and policy concerns to their
colleagues (Antrobus & Kitson, 1999).
442
As early as 1978, Burns described two types of leader-
ship: transformational and transactional, echoed in later
research (Atsalos & Greenwood, 2001; Avolio & Bass, 1988;
Bass & Avolio, 1994; Burns, 1978; Callaghan, 2007; Cleary,
Freeman, & Sharrock, 2005; Corrigan, Steiner, McCracken,
Blaser, & Barr, 2001; Hutchinson & Jackson, 2013; Kleinman,
2004; Nielsen et al., 2008; O’Neil, Morjikian, Cherner,
Hirschkorn, & West, 2008; Pillai & Williams, 2004). The
transformational leadership model involves leaders motivat-
ing followers to perform beyond expectations by creating a
sense of ownership in reaching a shared vision; followers
of this form of leadership were motivated to meet higher
order needs (a transformation) (Burns, 1978; Grossman &
Valiga, 2012; Hutchinson & Jackson, 2013). Once motivation
is achieved, the transformational leader no longer sets goals
which others are expected to attain, rather she/he is seen
as an agent who inspires change and mediates in an environ-
ment of empowerment (Callaghan, 2007). Transformational
leadership inspires followers to work beyond the basic level
of competence, shaping, altering and elevating their poten-
tial, to achieve excellence in patient care for its own sake
(Callaghan, 2007; Nielsen et al., 2008).
Transformational leadership is popularly identified as
central to nursing practice as leaders are challenged to
master situations in an ever changing environment, indeed
many nurse leadership researchers advocate this approach
(Arnold, Turner, Barling, Kelloway & McKee, 2007; Atsalos
& Greenwood, 2001; Callaghan, 2007; Furlong & Smith,
2005; Grossman & Valiga, 2012; Hutchinson & Jackson, 2013;
Nielsen et al., 2008; Pillai & Williams, 2004; Rigoloski, 2013).
Whilst acknowledging the vast amount of evidence suggest-
ing the benefits of transformational leadership, Hutchinson
and Jackson (2013), assert that with the dominance of the
transformational theory of leadership in nursing scholarship,
the interpretation of nursing leadership has become limited.
In contrast, transactional leadership involves both the
leader and the follower receiving something for their
efforts; asserting that the leader gets the job done and
the follower gets money, promotion or other benefits from
partaking. Followers of this form of leadership are moti-
vated by reward for compliance (a transaction) (Burns, 1978;
Grossman & Valiga, 2012; Hutchinson & Jackson, 2013).
Where transactional leadership is task-oriented and reward-
motivated, transformational leadership possesses a higher
level of morality and inspires teamwork and embracing
change (Cleary et al., 2005; Corrigan et al., 2001; Kleinman,
2004; Nielsen et al., 2008). The success of transactional
leadership ultimately depends on the development of a
leadership culture which allows a proactive, supportive and
enabling environment to be created (Callaghan, 2007).
Taking some characteristics from the theories of transfor-
mational and renaissance leadership and moving away from
the transactional theory, connective leadership (or shared
leadership) is a form of leadership perceived as an activity
that can be shared or distributed among members of a team
depending on the needs of the situation (Sahoo & Das, 2012).
Connective leaders can perceive common ground and pos-
sibilities where some more traditional leaders see division
and difference (Sahoo & Das, 2012). Connective leadership
represents a paradigm shift in the philosophy of leader-
ship, and as we move into a more interdependent setting —
with the advent of interdisciplinary and inter-professional
N.J. Scully
education and practice — this form of leadership is emerg-
ing as of fundamental importance, given it involves a process
to influence individuals to work towards not only their own
goals, but those of the group or community in which they
are involved (Sahoo & Das, 2012). In the current climate
of inter-professional education and practice, this growing
connective leadership theory has some merit in extending
the way in which nurses can act as leaders moving into the
future.
In their critical discussion of the predominant the-
ory of leadership in nursing, transformational leadership,
Hutchinson and Jackson (2013) suggest the time has come
for a more comprehensive and contemporary interpreta-
tion of nursing leadership — one taking into account the
modern complexities and environment in which nurses func-
tion. Given the emergence of inter-professional education
and practice, this theory of connective, or shared, lead-
ership appears a relevant one to consider — it is dynamic
and collaborative, reflecting the modern practice world
of nurses today. The move towards connective leadership
requires confidence, collaborative networks and mecha-
nisms to ensure views are respected by stakeholders (other
health care workers as well as the general community).
5. Identifying future nurse leaders:
recommendations and warnings
There are a number of scholarly articles identifying char-
acteristics of good, established nurse leaders, but little
on the means by which such individuals may be identified
early and how to cultivate them, thus helping them grow
as leaders and establishing effective succession-planning
(Conners, Dunn, Devine, & Osterman, 2007). As (Grossman &
Valiga, 2012) asserts, leaders are not born (as old-fashioned
‘great man’ theory would have it), rather they emerge and
continuously evolve based on a range of experiences and
interactions with a variety of people. Conners et al. (2007)
identify that nursing has been slow to develop strategies
to recognise future nurse leaders and that with the current
nursing shortage, this is more important than ever.
There are now several postgraduate courses available
across Australia to Registered Nurses for the development
of leadership skills. Notably, at the highest levels of pol-
icy and governance of the profession, the Australian College
of Nursing recently introduced the ‘‘Emerging Nurse Lead-
ers’’ strategy to recognise and develop future generations of
leaders in nursing from an undergraduate level (ACN, 2013).
At the level of the individual workplace, however, there is
still a need for effective strategies for growing the next
generation of leaders ‘in-house’. Effective mentoring pro-
grammes and the development of cultures of excellence are
areas where managers can play a decisive role, and effect
something close to the ideal link between leadership and
management. This has the potential to ensure a further less-
ening of the impact of chaos across the full variety of nursing
workplaces, and continues the advancement of the profes-
sion in terms of practice and status (Dignam et al., 2012).
Effective mentoring and formal education programmes for
nurse leader development prove a continued challenge to
the profession (Dignam et al., 2012).
Leadership in nursing: the importance of recognising inherent values
Conners et al. (2007) recognise that leaders have drive,
energy and vision, self-discipline and flexibility, with the
ability to assemble a team and motivate others. These
authors assert that if the best performers are not identi-
fied as leaders, others fail to learn from them and quality of
care can be found lacking (Conners et al., 2007). As out-
lined above, identification of leadership qualities can be
a somewhat complex and often subjective process and is
something often lumped-in with allocation of management
roles in many workplaces.
Avoiding the fostering of people who are not well suited
to leadership is just as important as identifying and nurturing
those with more apt qualities. Key research from (Conners
et al., 2007) finds that often it is the louder and more
negative staff member who is given more influence than
the quiet, positive leader. These pseudo-leaders demon-
strate few of the traits found in positive leaders and
instead have a negative influence on the team as they are
disorganised and inconsistent, with little follow through;
yet they tend to be more vocal and may thus assemble their
own group of followers (Conners et al., 2007). These people
are often mistaken for leaders because they influence
and shape the actions of others; if this is left unmanaged
in an environment lacking strong positive forces, these
negative leaders can affect the cohesiveness of the team
(Conners et al., 2007; Nielsen et al., 2008). Critically,
as (Conners et al., 2007, p. 27) notes: ‘‘An organisation
that fails to develop its quiet leaders is apt to be left
with negative informal leaders who, while vocal, produce
little’’ and ‘‘[w]ithout an environment that fosters internal
growth, the best talent may be virtually unnoticed or go
elsewhere’’. With the ever-growing background knowledge
on positive leadership figures in nursing, it is important to
also be aware of this ‘‘negative leader’’ phenomenon, and
to counter its potential influence.
6. Conclusions
This paper has discussed the importance of leadership in
nursing and clarified the various definitions in the literature,
especially the concepts of leadership and management. The
discussion has identified the various theories and models of
leadership and has examined the major leadership styles evi-
dent in the literature and identified the attributes and skills
effective, positive nurse leaders should possess to enable
the nursing profession to flourish. With the aim of creat-
ing a safe, effective and encouraging working environment,
acknowledgement has been made as to the importance
of recognising positive leaders and avoiding negative col-
leagues who assume leadership responsibilities. Identifying
and developing nursing leaders is invaluable given the mod-
ern dynamic environment the nursing profession is entwined
in. Through transformational and connective leadership, the
leader motivates and inspires change and mediates towards
a shared vision in an environment of empowerment.
Clinical nurse leaders are crucial to the success of patient
care initiatives: good leaders help produce good care, and
poor leaders produce poor care; likewise for academic,
political and executive fields of nursing. With appropriate
identification, support and development of future nurse
leaders, an acknowledgement of the shifting paradigm of
443
leadership theory and the context in which future nurse
leaders are destined to grow, the ultimate goal of the nurs-
ing profession — excellence in person-centred care — can
be achieved. Along with the ability to identify and nurture
nurses to leadership, so it is essential to avoid fostering
those who either do not possess the adequate qualities
or display the loud and negative traits which have been
shown to be detrimental to the nursing team and work-
place. It is essential to the future success of the nursing
profession that informal, ‘‘negative leaders’’ be discour-
aged and positive leaders, possessing the evidence-based
qualities of leadership be identified and nurtured to lead the
profession.
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