Nursing Leadership Theories



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Nursing Leadership and the New Nurse

Susan O. Valentine
University of North Carolina, Charlotte


While a fall in the number of nursing leaders may be attributed to the current nursing shortage, studies have noted that there is also a significant deficiency in the number of nursing leaders. In 2002, nurses are in a distinct position to influence healthcare policy and legislation. We need nursing leadership to exert that influence and by nurturing both leadership as well as clinical skills, we can. The nursing profession trains new nurses on operating the latest technology and complex medical equipment. In contrast, once at the bedside they rarely get the opportunity to apply even basic leadership principles. Nursing as a profession does a disservice to new nurses by not developing their leadership capabilities. This paper presents three leadership styles: quantum leadership, transformational leadership and the dynamic leader-follower relationship model and explains why each style can be integrated into the practice of entry-level nurses.


The current nursing shortage is a serious problem at all levels of nursing. Even at major research and teaching hospitals, chief financial officers are lamenting the scarcity of nursing staff (Singhapattanapong, 2002). Unfortunately an overlooked aspect of this nursing shortage is the dearth of leaders among nurses. Now more than ever nursing needs vibrant and dedicated leaders. We are at a distinct advantage to influence healthcare legislation and policy and yet our supply of leaders to pave the way has diminished. The reason is two-fold: smaller numbers are entering the profession, and we are not developing leadership characteristics as we develop clinical nursing practice. B.M. Perra (2000) notes two distinct factors influencing the nursing shortage—baby boomer retirement and fewer candidates entering the nursing field. For some, that is not surprising. However, it is not just the sheer number of nurses at the bedside affecting our leadership problems. Horton-Deutsch and Mohr (2001) wrote an opinion article based on BSN student clinical observations and evaluations. They found an "absence of nursing leadership" (p. 121) that directly contributed to student’s unfavorable opinions on their profession. They assert that nursing leadership now faces a challenge. The answer is to "develop one’s own leadership skills as well as those of one’s staff" (p. 60). At nearly every level of nursing we train nurses on the job to operate complex medical equipment and adhere to administrative procedures. Our own governing bodies dictate that we stay current with continuing education courses. We can also extend this attitude toward learning by training nurses at every level to be highly competent leaders. Leadership does not rest merely with administrators and high-level managers, but also can be developed and implemented at the bedside. Nursing has a responsibility to encourage and support new members of the profession, as they become competent clinicians. Nursing must also make them competent leaders.

Nursing Leadership Theories:

Quantum, Transformational, and Dynamic Leader-Follower Relationship Model

While there are several theories of nursing leadership, it’s important to review those most applicable to the new nurse. The three theories that can be best practiced as a new nurse are quantum leadership, transformational leadership and the dynamic leader-follower relationship model. These three theories are appealing specifically for their embrace of leadership at all levels. Five years ago Porter-O’Grady (1997) observed, "Leaders issue from a number of places in the system and play as divergent a role as their places in the system require" (p. 18). Porter-O’Grady (1997, 1999) opened up a new process of thinking about leadership by noting how the changing healthcare system required new leadership characteristics and roles. He observed that knowledge of technology has changed the traditional hierarchy of leadership. Traditionally, worker knowledge rose vertically as the worker moved up the chain of command. Typically, knowledge bases increase as position increases. Now leadership and the knowledge associated with it has shifted. As new nurses enter the profession with ever expanding skills, "Technology has made possible this growth in the horizontal connections…" (Porter-O’Grady, 1997, p. 17). Staff nurses at the bedside 24 hours a day, seven days a week are on the front lines and have a distinct power to influence sustainable outcomes and productivity. They are, in fact, at the first level of decision-making. By permitting some autonomy in their decision-making however slight, we lay the foundation of leadership. New nurses decide appropriate times to call a physician, choose applicable care plans and pertinent interventions. These early autonomous steps form the building blocks of leadership. We can effectively train nurses in this manner by evaluating their decisions with corresponding patient outcomes. To motivate leadership from the bottom up, mangers can "develop staff self-direction rather than giving direction" (Porter-O’Grady, 1999, p. 41). Again, these simple steps facilitate new nurses’ enhancement of their own leadership skills.

Transformational leadership merges ideals of leaders and followers (Sullivan & Decker, 2001). Its focus is to unite both manager and employee to pursue a greater good and "encourages others to exercise leadership"(p. 57). Transformational leadership can readily pertain to situations common among new nurses. Sofarelli & Brown (1998) favor the transformational leadership style and find it empowering. Transformational leadership promotes change and suites the extremely dynamic health care system. Its focus on change can be directly applicable to nursing. New nurses are in a unique position of evaluating end results of both new and old policies and procedures. Using transformational leadership, managers can motivate new nurses to submit feedback on how well unit specific procedures are carried out and implemented. The key is to actively listen and institute pertinent suggestions that not only promote client outcomes, but also again help to build a base of leadership with the new nurse. Not everyone can take direct action on issues directing affecting patient care by sitting in on an advisory meeting or voting on proposed legislation. Transformational leadership provides new nurses with a method of taking an active and participatory role in policy within a new nurse’s jurisdiction and power.

A third nursing leadership theory that can be readily used by new nurses is modeled after Ida J. Orlando’s nursing model. Orlando’s middle-range theory concentrates on the process nurses’ use to identify a patient’s distress and immediate needs. It specifically draws on cues in the interpersonal process to reach those objectives. Using Orlando’s theory as a backdrop, Laurent (2000) proposes a dynamic leader-follower relationship model. The theory is that the leader and follower exchanges are dynamic. Both parties are vital to the success of the unit. "The leader provides direction to the employee, not control, allowing for maximum participation by the employee or a dynamic relationship" (Laurent, 2000, p.87). This type of interaction between manager and new nurse can instill motivation and commitment. At the time new nurses are finding their niche, they can simultaneously develop basic leadership principles facilitated by interaction with established nursing leaders.

Clinical and Leadership Proficiency

Central to the theme of new nurses as leaders is the fact that effective leaders are also proficient clinically. New nurses can incorporate leadership fundamentals while developing competency in their profession. However, not all authors subscribe to the notion that clinical proficiency and leadership are congruous. In exploring the Synergy model Kerfoot (2001) contends, "A leader cannot provide direct care. The leaders obligation is to create the environment in which good people can provide good care" (p. 101). Many leadership studies and professional opinions, including mine, disagree. In fact in the United Kingdom, a "lack of consensus on nursing leadership has led to leadership development programmes [sic] for nurses which have emphasized the development of corporate and political skills, often to the detriment of nursing knowledge" (Antrobus & Kitson, 1999, p.751).

Naturally, some will relinquish the title of leader and would rather follow. That is necessary for the system to operate. Leaders in the lower rungs have less responsibility, but still can act as a leader. This is leadership in training. Leadership within the confines of their position or authority. The fact is that while new nurses provide the majority of care and spend the majority of time with a patient, they are clearly not at the same power-level/structure as physicians or administrators. Few new nurses have input on major decisions affecting an organization. What new nurses can do is propose improvements to the existing status quo. They can submit new scheduling options, take the lead in presenting in service training or consult on retention and recruitment issues.


The leadership theory a nurse chooses should reflect her ideals and be one she can most effectively use. No one rates the theories as to most enlightened or best received. Once aware of the existing theories, a nurse can subscribe to whichever fits her personality best. Nurses are often encouraged to take leadership roles. At most nursing schools, there is some type of leadership and management course or lesson in the curriculum. The problem develops that once in the clinical area, there is no follow up. Yet when nursing leaders picked the top trends for 2000, their first topic noted how nurses will have an opportunity to become active leaders in the future healthcare delivery systems (Benefield, et al, 2000). This leadership can come from all levels. With an end to the nursing shortage nowhere in site, nursing does an injustice to itself by not training more leaders. In the new millennium nursing must make a dedicated effort to nurture its young to grow into effective, motivating leaders.


Antrobus, S. & Kitson, A., (1999). Nursing Leadership: Influencing and shaping health policy and nursing practice. Journal of Advanced Nursing 29, 746-753.

Benefield, L.E., Clifford, J., Cos, S., Hagenow, N.R., Hastings, C., Kobs, A., et al. (2000). Nursing leaders predict top trends for 2000. Nursing Management, 31(1), 21-23.

Horton-Deutsch, S.L., & Mohr, W.K. (2001). The Fading of Nursing Leadership. Nursing Outlook, 49, 121-126.

Kerfoot, K. (2001). The Leader as Synergist. MEDSURG Nursing, 10(2), 101-103.

Laurent, C.L. (2000). A nursing theory for nursing leadership. Journal of Nursing Management, 8, 83-87.

Perra, B.M. (2000). Leadership: The Key to Quality Outcomes. Nursing Administration Quarterly, 24(2), 56-61.

Porter-O’Grady, T. (1997). Quantum Mechanics and the Future of Healthcare Leadership. Journal of Nursing Administration, 27(1), 15-20.

Porter-O’Grady, T. (1999). Quantum Leadership: New Roles for a New Age. Journal of Nursing Administration, 29(10), 37-42.

Singhapattanapong, S. (2002, March 11). Nurse shortage hurts UCLA Medical Center. UCLA Daily Bruin, p.1.

Sofarelli M.. & Brown, R. (1998). The need for nursing leadership in uncertain times. Journal of Nursing Management, 6(4), 201-207.

Sullivan, E.J. & Decker, P.J. (2001). Effective Leadership and Management in Nursing (5th ed.). Upper Saddle River, NJ: Prentice Hall.


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