Impact of nursing leadership on performance of nurses
Creating conducive working environments for nurses will require fundamental changes
throughout the nursing units – in the manner personnel get deployed, work is designed and the
culture of the healthcare organizations understanding of patient safety. These changes demand a
type of leadership that has the capacity of transforming not only the physical environments but
also the nurses’ practices and beliefs when delivering care. This paper aims to critically assess
the nursing leadership- transformational leadership and the barriers faced in implementing this
type of leadership. This paper evaluates the various ways nurse leaders dispense their leadership
and its impacts on nurse performance. This paper consists of five major sections; the introduction
which will introduce the research topic; method chapter which is a brief methodology of research
metrics applied. The literature review chapter will critically evaluate available literature on the
impact of transformational leadership on nurse performances. The Discussion chapter shed
lights on the evidence based practice, which will be summarized in the conclusion chapter.
Impact of nursing leadership on performance of nurses 2
Leadership is one great essential component in most aspects of a nurse role. However,
this aspect is not considered as essential as other areas of nursing such as the clinical skills.
Today’s health care environment is fast changing and uncertain which makes it important for
effective nurse leadership skills (Malloy & Penprase, 2010; Giddens & Morton, 2010). Research
indicates that competent leaders influence their work environments positively, improve the
patient safety and the quality outcomes of the organizations. Therefore, healthcare organizations
are advised to continue develop and support leadership training in order to maintain and to
promote its development in practice. When leadership competencies are effectively taught and
integrated in nursing practice, it positively impacts the leadership skills as well as their practices
(Crosby & Shields, 2010)
Research indicates that nursing practice is bureaucratic. Therefore, it is very important
for nurses to be equipped with leadership skills. These skills are enhanced by the leadership
styles in their nursing unit. Nurse leaders who follow transformational leadership style have the
capacity to identify the needed changes, and have the capacity to integrate change by inspiring
the team members and establishing an environment that creates some sense of commitment
(Rudisill & Thompson, 2012). Such type of nurse leaders feels more confident and comfortable
when interacting with their follower; which is associated with positive outcomes. Therefore, it is
important that in nursing realm, the nurse leaders should apply this type of leadership so as to
grow the skills sets necessary for future nurse leaders. However, the impending lack of
transformational nurse leaders within nursing unit and healthcare overall is a proportionately
critical concern is yet to receive much attention. In this context, this paper provides insights on
Impact of nursing leadership on performance of nurses 3
importance of developing leaders in academic and clinical arenas is important for nursing
professions, and it mandates critical awareness (Hutchinson & Jackson, 2013).
The research methodology used in this paper is systematic literature review. To obtain
the appropriate research literature for this literature review study, papers were searched from
peer-reviewed databases. The peer reviewed articles in this study were those with recent studies.
Although finding recent publications was a challenge, the use of the available search engines
revealed many nursing leadership studies published recently. The studies provided an effective
comprehensive pool of information, which helped in compiling the literature review.
The key words applied during the study search were ‘leadership,’ ‘nursing,’ and
‘practice.’ In most of the paper, these words were used together and in a particular order. The
database used included the Ebschost, ProQuest website, and Cochrane. The Google Scholar and
Google search engine were very instrumental for this study. The other websites that were used
were the Canadian Nurses Association (CAN), American Nurse Today website, the nursing
world organization and the American Nurses Association (ANA).
Approximately half of the sources used in this paper were obtained from the Google
Scholar. The rest of the papers were from the electronic nursing journals mainly from healthcare
facilities that operated within the American healthcare sector. The variation of the sources used
was done in order to obtain information from diversified institutions, in order to make the
information gathered to be evidence based practice, and to be relevant in similar healthcare
settings in the USA and the world (Malloy & Penprase, 2010; Giddens & Morton, 2010).
Impact of nursing leadership on performance of nurses 4
In healthcare, leadership is defined as “ the process of engaged decision making linked
with actions taken in the complex face, uncharted and perilous circumstances in clinical
scenario’s that have no standardized solutions” (Curtis, De Vries, & Sheerin, 2011). Creating
conducive working environments for nurses will require fundamental changes throughout the
nursing units – in the manner personnel get deployed, work is designed and the culture of the
healthcare organizations understanding of patient safety. These changes demand a type of
leadership that has the capacity of transforming not only the physical environments but also the
nurses’ practices and beliefs when delivering care (Kouzes & Posner, 2012).
The characteristics of an effective leader includes being visionary leaders, leaders
who are equipped with effective strategies and plan as well as desire to direct their teams to
meet future goals. The leaders should be adequately equipped with problem solving skills
in order to effectively develop nurses self esteem and group identification. The leaders
should also be dynamic, motivational and passionate to their followers (Malloy & Penprase,
2010; Giddens & Morton, 2010). Transformational leadership styles apply these
characteristics to their work, which enables them to win respect and trust of the team
members. Evidence based practice indicates that applying these characteristics to their
work enables the nurses to be in a position to influence development of each other, and in
ensuring that professional standards and code of ethics are maintained. Transformational
leaders are the source of inspiration and role models for nurses (Malloy & Penprase, 2010).
Research work on behavioral work force effectiveness and health services as well as the
organizational disasters identify few management practices associated with successful
implementation of initiatives of safety (Frazzini & Fink, 2011).. These includes practices such
as a) balancing the organization tension that exist between reliability and efficiency, b) creation
Impact of nursing leadership on performance of nurses 5
as well as maintaining trust in the organization, c) active management of change processes, d)
integration of employees in decision making that pertains to work design and work flow, and e)
use of management knowledge to establish a “ learning organization.” These practices are very
essential in maintaining nurses and patient environment conducive. Evidence based research
indicates that to fully secure these five management practices, the transformational leadership are
needed (Gillam & Siriwardena, 2013).
The transformational leadership theory was first developed in 1978 by James McGregor
Burns. The theory was developed with the aim of addressing the components that lead success in
an organization, and identification of strategies that will improve employee’s commitment and
enthusiasm in their work place. This style of leadership works by identifying the employee’s
values at their work place. According to evidence based studies, the transformational leadership
styles works by inspiring the employees to discover their purpose and meaning in relation to
their work, which improves employee’s growth and maturity (Malloy & Penprase, 2010).
Research indicates that staffing problems arise due to poor delegation of skills and
poor response by the leaders to address to clinical economic factors and patient
demographics, which ultimately affects the organizations goals. The ultimate of any
healthcare organization is to influence the quality of care. This is achieved through
effective nursing leadership. Transformational leadership helps the leader influence the
nurses to gain a better understanding of patient needs and values, which in turn increases
patient satisfaction (Malloy & Penprase, 2010; Giddens & Morton, 2010).Research indicates
that empowered nurses often are eager to implement evidence based practice because they
tend to be highly motivated and well informed. This kind of leadership enables the nurses
to be committed to better patient’s outcome by promoting staff ability and competence,
Impact of nursing leadership on performance of nurses 6
which in turn increases nurse expertise. Hospital environment have significant effect on the
patient outcomes. Therefore, the nurse leaders should encourage the nurses to seek
maximum and minimum standards in order to achieve and maintain high quality
benchmarks (Raes et al. 2013).
The central function of leadership is attaining the organization’s collective purpose.
Leadership is observed as the essential precursor of attaining safety in most of the industries,
which is a critical factor in ensuring success of most change initiatives and in sustaining the
organization competitiveness. A study conducted in USA on healthcare facility reengineering
initiatives for a period of one year (1996-1997), indicated that the type of leadership in any
healthcare organization is influenced by the type of leadership, and also determines the
organization’s productivity, organizational commitment, job satisfaction and retention (Malloy &
Penprase, 2010; Giddens & Morton, 2010).)
Pulitzer Prize- winning study on leadership outlined the essential characteristics of
leadership. In his study, James Burns’s distinguished transactional leadership from
transformational leadership by stressing that leadership in the organization is based on the
relationship between the leader and his followers. In contrast to exercise of power, effective
leadership is one that has the capacity to identify and to respond to the needs and goals of the
leader and his/her team members (Nadeem et al. 2013). Therefore, it is effectively exercised by
integrating the followers during the decision making which in turn motivates them to work
towards achieving their specific goals which represent the motivations, values and organizations
expectations. According to Burn, the genius of leadership depends on the manner in which the
leaders see his/her follower’s values and motivations, and in satisfying the follower’s values
(Paterson, Henderson, & Trivella, 2010).
Impact of nursing leadership on performance of nurses 7
Transformational leaders are very effective when they generate visions that enables
them gain trust and convince their followers to make the necessary action. This involves
listening to the followers concerns in order to deal with objections. However, this type of
leadership can be ineffective if it is not properly followed. For instance, there are risks on
improper use of influence by the leaders (Spinelli, 2006; George & Lovering, 2013). This is
because transformational leaders act as role models to their respective followers. Therefore, if
the leaders are involved in unethical behaviors, the entire organization suffers. The other
drawbacks associated with transformational type of leadership includes risks of following
wrong decisions especially in cases where leaders makes harsh decisions out of emotions.
Recent study associated the transformational type of leadership with employee burnout. This is
because when the employees are inspired to attain the organization goals, they tend to overwork
themselves in order to achieve the organization’s goals. Consequently, they tend to become
dissatisfied (Heuston & Wolf, 2011).
Despite the demerits, research indicates that transformational leadership is the most
effective type of leadership in nursing unit. This is because it helps establish organized
environment by building cohesive team and in setting a common goal. However, several barriers
of transformational type of leadership have been established. These include lack of teamwork
and change resistance by some of the team members. Some of the followers feeling that the
leaders assign the subordinates too much work and tends to become too personal with them.
Evidence based practice indicates positive correlation between job satisfaction and
transformational type of leadership (Pieterse & Schippers, 2010)
Work attitudes strongly influence the quality of nurse’s profession lives. Research
indicates that job satisfaction and the organization commitment are the variables that determine
Impact of nursing leadership on performance of nurses 8
the nurse work attitudes. Leadership, especially the transformational type of leadership is
associated with increased levels of satisfaction. Therefore, use of transformational leadership
helps improve the employee’s psychological wellbeing and jobs satisfaction. This is because the
higher the support from the nurse leaders and supervisors the higher the levels of job satisfaction,
which correlates to increased organizational commitment. This is associated with reduced
incidences of general health well being (Cathcart, Greenspan, & Quin, 2010)
Evidently, there is recognition in the healthcare arena of the need of transformational
nurse leaders. This is constitutes the Institute of Medicine report, the future of Nursing: Leading
change. This report focuses on the importance of nurse leaders in clinical settings. The
healthcare system in the world is dynamic and is increasingly becoming complex. The American
Nurse Association (ANA) continues to emphasize on the need for nurses to play a proactive role
of leadership in their healthcare set up, local and state level (Fennimore & Wolf, 2011).
Research indicates that the nature of the country’s healthcare system requires the nurse managers
to apply transformational leadership style. This leadership styles is supported by the evidence
based practice in that it facilitates the identification of areas that need change, and it guides
change by inspiring their team and establishing a sense of commitment. The qualities of
transformational type of nurse leadership allows the nurse managers to become confident and
comfortable of their practices, especially when engaging in healthcare developmental policies,
the dynamic aspects of healthcare technology and mentorship of young leaders (Sanford, 2011).
Nurse leadership primarily is about making decisions, deligating duties, acting with
utmost integrity and resolving of conflicts. The role involves nurturing the other nurses so that
they can understand the patients. These functions are the core elements that are necessary in
Impact of nursing leadership on performance of nurses 9
connecting nurse leadership with effective development of the other members (Fennimore &
Wolf, 2011). This is attained by working alongside the nurses and mentoring them as well as
coaching them. Every successful nurse leader seeks to develop the team members by facilitating
learning opportunities, supervising them and assessing their development (Raes et al. 2013). The
terminologies commonly used alongside transformational leader are teacher, supporter, assessor,
coach, supervisor and a role model. In most organization, the commonly used phrase is “just do
not tell me, show me.” This implies that the transformational leader should inspire the nurses by
showing them how to perform task. This involves establishing a culture of continual learning
empowers and motivates the followers. This kind of leadership and clinical environments is
essential in achievement of best practices (Polit & Beck, 2012).
The main roles of a transformational leaders in healthcare settings includes promoting
followers self esteem, encouraging teamwork, staff motivation and empowering of staff in order
to achieve high level of performance. This is achieved by making the nurses/ followers to be
involved in designing of procedures and policies of an organization. In this type of leadership,
the nurse leader is expected to portray trustworthiness and acts as a role model to the team
members. This type of leadership is vital in clinical areas as it promotes a healthy environment
for the employees, which is associated with improved job satisfaction, low turnover rates and
improved patient safety and satisfaction (Polit & Beck, 2012).
Further research studies indicate that training nurse leaders to apply transformational
style of leadership in clinical settings have a positive impact on the mental health as well as the
outcomes of the nurses. Therefore, more studies are needed in order to develop an evidence
based educational programs interventions to educate nurse leaders on how to integrate
transformational leadership into practice. Although much of the studies have focused on work
Impact of nursing leadership on performance of nurses 10
related stress such as nurse burn out, most of the studies focus on stress management at an
individual level. It is hypothesized that use of transformational leadership in clinical settings
enhances employee’s commitment to the organization’s vision (Smith, 2011). Evidence based
practice identifies transformational leadership style as the most appropriate style that leads to
better emotional well being of the nurses. The main implication of this leadership style is that it
offers a deeper understanding between the nurse leadership and his or her follower’s emotional
well being. On a more practical level, it implies that this type of leadership cam be used to
promote conducive working environments and the overall organizational health (Raes et al.
The main aim of this study was to establish a better understanding of the impact of
transformational nurse leadership on nurse’s performance. The study evaluated the available
literature that reveals the relationship of transformational leadership and job satisfaction, job
content and the overall organizations commitment as well as the employees well being. The
study concludes that the transformational leadership style influences the quality of nurses
working life through indirect pathways, which contributes to improved emotional well being and
organizational commitment. Therefore, transformational style of leadership is the most
appropriate nurse health and professional promotion intervention which should be applied within
the healthcare setting.
Impact of nursing leadership on performance of nurses 11
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