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Nursing Leadership Theory

Ashley Buccio

Delaware Technical Community College

Nursing Leadership NUR 400

Patricia Wessell

November 20, 2023

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Nursing Leadership Theory

As a fairly new nurse, I am constantly asking for new ideas on better ways to do things.

However, I have been a nurse for long enough that I know when to delegate tasks and who to

delegate them to. I feel like I am a democratic leader, I rely a lot on my team for help and I give

others feedback when they need help. Constantly relying on other staff can sometimes be an

issue when it comes to making decisions independently. “Democratic leaders who always

depend on the group may struggle when needing to make decisions independently” (Sadler,

2023, para. 15). I occasionally struggle when making decisions independently. When I do ask for

help, I make sure it is explained to me what they are doing so that I can do it on my own and be

more self-sufficient. As I gain more experience my leadership style is changing. I originally was

a laissez-faire leader, now I am a democratic leader as I have become more confident and gained

more knowledge and skills. I believe I can become a transformational leader.

I would most like to emulate the transformational leadership style. Transformational

nurses are nurses who “Instead of assigning tasks from the top, transformational leaders coach

people to think critically about their work — and not just do what they are told” (Sadler, 2023,

para. 23). Transformational leadership is one of the most effective leadership styles of today due

to the constantly changing healthcare system. “It is also recognized as the most effective style in

the IOM report on leadership” (Finkelman, 2020, p. 17). The transformational leadership style

“is focused on change and how the leader adopts change as [an] opportunity for improvement”

(Finkelman, 2020, p. 18). A nurse leader inspires the nurses to take on new roles and

responsibilities. Anyone can be a leader, “a leader doesn’t have to be an authority figure in the

organization” (Duggal, 2023, para. 22). Even I can be a transformational leader.

I plan on taking on the role of a transformational leader by using my current skills and

knowledge. As I reach the two-year mark as a nurse, I will be better at leading and making
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decisions on my own and will have the confidence to lead others. Right now, I am still learning

but I believe within the next couple of months I will have the experience and the trust of other

nurses to be a transformational leader. The biggest challenge to being a transformational leader

on my unit is that many nurses have been working on the unit for ten or more years. These nurses

are stuck in their ways. Some older nurses do not respect the newer nurses like me. The more

seasoned nurses believe that they know more and have been a nurse for long enough that they do

not need to listen to new nurses and refuse to work as a team. A few of the older nurses are very

resistant to change and get upset when new rules are put in place. The older nurses take longer

and need more explanation and convincing to change. “Transformational leadership is based on

the trust and respect that employees feel about their leader and therefore are motivated to do

much more than is expected from them” (Krepia et al., 2018, para. 1). Once I get to know the

seasoned nurses better I can gain their trust and respect.

The first step to becoming a leader is knowing myself. I know what qualities I have, what

skills I am good at, and what skills I need to improve upon. Some qualities and characteristics of

“transformational leaders are self-confidence, self-direction, honesty, energy, loyalty,

commitment, and the ability to develop and implement a vision” (Finkelman, 2020, p. 18). I had

issues at the beginning of my career with my self-confidence. I have been slowly gaining

confidence as I have continued to work as a nurse and continue to learn and trust my judgment.

Another area I feel needs a little more improvement is self-direction, which is similar to

independence. I still need help sometimes with solving a problem as it comes along. As I am still

kind of new, I am coming across things that I have never seen before and need help with them.

Self-direction goes hand and hand with self-confidence. I am loyal to my coworkers and the

company. I feel that some of my coworkers are not yet loyal to me. As I said earlier there are a
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lot of nurses on my unit that have been working for years and do not yet respect me as I am a

newer nurse. Therefore, they are not loyal to me yet. As I gain experience and get to know my

fellow nurses, I feel more comfortable working with the older nurses and feel I will gain their

loyalty. I already have some of the other qualities such as honesty, energy, commitment, and the

ability to develop a vision. I still need help with implementing the visions. I feel like I am good

at explaining things in multiple different ways so that everyone can understand them. I believe

this is why I will be a good preceptor. I plan to become a leader by becoming a charge nurse and

preceptor. March will be the mark when I have been working as a nurse for two years. My nurse

manager typically starts training people to be a preceptor or charge nurse around their two-year

mark. At my quarterly check-in with my nurse manager, I plan to ask if I can start the training to

be a preceptor. A preceptor has many leadership roles and responsibilities when training newly

hired nurses. Transformational leaders are the perfect people to be preceptors because they focus

on “relationship building while putting followers in power and emphasizing values and vision”

(Ystaas et al., 2023, para. 1). Once I am comfortable with precepting I will ask to be trained to be

a charge nurse. Charge nurses oversee all of the other nurses on the unit. The charge nurse has a

lot of responsibility which includes knowing a little bit about every patient on the unit, running

codes, and ensuring we have a safe number of nurses on the unit every day.

The leadership model of a transformational leader is the type of leader who constantly

learns and adapts. As a nurse, we are constantly learning and adapting as different situations are

thrown at us. I will also continue learning after I get my bachelor's degree, I plan on getting my

master's degree and then becoming a nurse practitioner. After being a nurse for two years I can

continue advancing in my career and take a test to get board-certified in a specialty such as acute

critical care, medical-surgical, or geriatrics. I can also encourage my coworkers to get a

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specialized board certification as well to continue their learning. The higher the number of

specialty board-certified nurses that there are in the hospital the better the hospital looks. As a

future nurse leader, my goal is to become a preceptor and teach future nurses how to be more

confident and how to become nurse leaders. I believe patient advocacy is one of the most

important roles of a nurse. Many patients either are not able to advocate for themselves or do not

have family to advocate for them. When I become a preceptor, I plan on stressing the importance

of patient advocacy to the person I am precepting.

I can transform bedside nursing by being a transformational nurse leader and patient

advocate. Evidence links transformational leadership “directly to quality patient outcomes,

reducing the possibility of adverse patient outcomes and increasing the quality of care” (Ystaas

et al., 2023, p. 1283). When transformational leaders are put into the role of a bedside nurse they

improve patient care by improving themselves and being a role model to other nurses. “Rather

than seeing change as a barrier, the transformational leader is engaged in the change process and

draws staff into the process” (Finkelman, 2020, p. 18). I am currently transforming bedside

nursing. I am currently part of the unit practice counsel in which we identify needs on the unit,

brainstorm solutions to the needs, and then implement the solutions. It usually starts with looking

at the surveys from the patients as well as looking at the quarterly progress with the nurse-

sensitive indicators including amount of patient falls, hospital-acquired injuries, and hospital-

acquired infections. We then find a solution and collaborate with management to try and trial the

solution on the unit. By finding issues specific to the patient's needs and coming up with

solutions we are advocating for the patients. We then get feedback from coworkers on what they

think of the new solution. Drawing other staff into the process allows the change in bedside

nursing to occur more smoothly.

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In general, leaders need to have the skills to communicate with people who are above,

below, and at the same level as them. This means transformational nurse leaders can effectively

communicate with nurse managers and other nurse peers as well as CNAs and patients. One of

the qualities of a transformational leader is the ability to “implement a vision” (Finkelman, 2020,

p. 18). The implementation of a goal or vision cannot be accomplished without collaboration

with the entire healthcare team as well as with administrators. Therefore, transformational

leaders need to work side by side with the entire healthcare team as well as administrators.

“There is a general belief that transformative leaders, in order to achieve the desired outcomes,

aim at transforming the goals of their employees in order to be in line with the goals of the

governing body and to provide employees with an inspiring vision for the future” (Krepia et al.,

2018, para 16). To do this the leader has to work with the administrators to figure out their goals.

Implementation of new and better ways to do things can lead to recognition and

accreditation. Transformational leaders have a vision that they use to “become involved in

opportunities to improve” (Finkelman, 2020, p. 18). To achieve their vision they first need to

create a vision which they can do by assessing where care needs to be improved upon. They then

need to create a process for achieving the vision then need to assess the outcomes of the

implementation of the vision. One way to assess the outcome of the vision is to look at the

hospitals results of things such as nurse surveys and patient surveys. Another result that could be

looked at depending upon the vision is the nurse-sensitive indicators with things such as the

number of hospital-associated infections or injuries or the number of people readmitted in less

than thirty days from discharge. Having a transformational nurse leader can improve patient care.

“With wisdom, understanding and innovation from the leader, there will be a sense of confidence

from the nurse so as to increase work capacity and responsibility in achieving organizational
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success which leads to the quality of work life” (Suratno et al., 2018, para. 23). The

improvement in the care of the patients could be recognized by others outside of the organization

and lead to accreditation.

Overall as I gain more experience as a nurse, I gain knowledge and confidence. I also will

gain the respect and loyalty of other nurses. Soon I will be training the new nurses and can mold

them to be confident patient advocating leaders. I feel I will be able to become a great nursing

leader. I will lead as a transformational leader who advocates for the patients and works with

other nurses and management to achieve a vision.

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References

Duggal, N. (2023). Leadership vs management: Understanding the key difference: Simplilearn.

Leadership vs Management: Understanding The Key Difference.

https://www.simplilearn.com/leadership-vs-management-difference-article

Finkelman, A. (2020). Leadership and management for Nurses: Core Competencies for Quality

Care (4th ed.). Pearson.

Krepia, V., Katsaragakis, S., Kaitelidou, D., & Prezerakos, P. (2018). Transformational

leadership and its evolution in nursing. Progress in Health Sciences, 8(1), 189–194.

https://doi-org.libproxy.dtcc.edu/10.5604/01.3001.0012.1114

Sadler, F. (2023). 7 leadership styles in nursing - which is yours?. Relias.

https://www.relias.com/blog/7-leadership-styles-in-nursing

Suratno, K., Ariyanti, S., & Kadar, K. S. (2018). The Relationship between Transformational

Leadership and Quality of Nursing Work Life in Hospital. International Journal of

Caring Sciences, 11(3), 1416–1422.

Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., Constantinou, C.

S., & Gray, R. (2023). The Impact of Transformational Leadership in the Nursing Work

Environment and Patients’ Outcomes: A Systematic Review. Nursing Reports, 13(3),

1271–1290. https://doi-org.libproxy.dtcc.edu/10.3390/nursrep13030108