Running Head: NURSING LEADERSHIP STYLES

Nursing Leadership Styles

Helen McDonald
Nursing Health Policy NUR503
December 18, 2015
State University of New York Polytechnic Institute Utica Rome

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Abstract

By 2020, National supply and demand projects a nursing shortage of 29% due to a 40%
increase in demand (Swearingen & Liberman, 2004). Between the years 2000 and 2030 the
population of 65 year old and over is expected to double (Swearingen & Liberman, 2004).
Nurses are also aging; in 2004 an estimated 40-60% of the nursing workforce was estimated to
retire before 2020 (Swearingen & Liberman, 2004). Hospitals can offer costly incentives and
provide accredited diploma programs to keep and find nurses (Swearingen & Liberman, 2004).
But, the fact remains, retention and new employment rates are poor in hospitals (Swearingen &
Liberman, 2004). Unless hospital workplace environments are corrected, they will continue to be
poor. Effective leadership holds the power to transform hospital workforce environments and
improve nursing recruitment and retention (Swearingen & Liberman, 2004). This paper will
review current literature available, representing transformational and transitional leadership
styles. It will present a balanced review of these topics, representing both sides, to improve
nursing leadership ideals and meet hospital organizational and nursing goals.

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Nursing Leadership Styles

Overview
Leadership is a complex process of collective goal setting with staff motivation and
support to meet prospective goal outcomes (Mannix, Wilkes & Daly, 2013). Effective leadership
is essential in organizations to meet objectives in a chaotic, complex and highly variable
environment (Mannix, Wilkes & Daly, 2013). Nursing atmospheres are influenced by shortages,
multi-generational and ageing workforce concerns, staff skill mixes, clinical education
challenges, diminishing resources, greater patient acuity levels, and amplified workplace
violence, resulting in burnout and increased turnover rates (Mannix, Wilkes & Daly, 2013).
Job satisfaction and self-rated performances are shown to improve with authentic
leadership processes, positively influencing staff nurse outcomes (Wong & Laschinger, 2013).
Nurses have a sense of empowerment, improved work satisfaction and enhanced reported
personal performance when they observe managers as authentic with self-awareness and high
ethical standards (Wong & Laschinger, 2013). Leadership effectiveness is contingent on the
leaders ability to instill a sense of support (Hamstra, Van Yperen, Wisse & Sassenberg, 2014).
Nursing variables can influence and interact with leadership processes (Hamstra et al., 2014).
Leadership behaviors are dynamic and fluctuate daily with its short-term effects impacting
nursing outcome (Breevaart, Bakker, Hetland, Demerouti, Olsen & Espevik, 2014). The leader
needs to engage its nurses emotionally and intellectually (Doody & Doody, 2012).
Different leadership styles can affect leaders emotions, regulation strategies and burnout
(Arnold, Walsh, Connelly & Martin-Ginis, 2015). These styles expect a certain amounts of
emotional display by leaders to meet organizational goals, causing some leader stress (Arnold et

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al., 2015). There are three defined types of emotional regulation; surface acting, deep acting, and
genuine emotion (Arnold et al., 2015). These strategies are processes that influence which
emotions leaders display, when they display them and how they experience and express them
(Arnold et al., 2015).
Surface acting is used when an individual needs to display an emotion during a given
situation and their personal emotions are not the same (Arnold et al., 2015). Deep acting occurs
when an individual changes their internal emotions to meet the emotion required for the
situation, actively feeling the emotion that must be displayed (Arnold et al., 2015). Leaders need
to regulate emotional intensities and make accurate positive and negative emotional judgements
while considering how displayed emotions will affect nursing staff (Arnold et al., 2015).
Two distinct types of leadership styles were first described by Bass in 1985 as
transformational and transactional (Tremblay, 2010). Effective leaders will display each of these
styles to varying degrees (Tremblay, 2010). The use of these styles depends on the environment
of which each is employed (Tremblay, 2010).
Transformational Leadership
Transformational leadership encourages promotion-focused strategies (Hamstra et al.,
2014). Transformational leaders set high expectations with long-term visionary goals (Hamstra et
al., 2014). They provide freedom and autonomy allowing nurses to organize independent
behavior, goals and unique viewpoints (Hamstra et al., 2014). These leaders arent afraid of
personal risk emphasizing progress and innovation (Hamstra et al., 2014). Transformational
leaders prompt ideal states of business (Hamstra et al., 2014). They are optimistic about visions,

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possibilities and outcomes (Hamstra et al., 2014). They concentrate on opportunities with
confidence and high expectations of nurses (Hamstra et al., 2014).
Transformational leaders motivate nurses to perform beyond basic expectation and
encourage risk taking behavior (Hamstra et al., 2014). They create supportive, safe environments
for followers to risk and extend boundaries of thinking and doing; creating energy, originality
and innovation (Doody & Doody, 2012). Nurses are therefore more encouraged to try new novel
ways of working (Hamstra et al., 2014).
Transformational leadership displays positive emotions which positively affects
followers and organizational outcomes resulting in resource gain (Arnold et al., 2015). They use
deep acting to gain authenticity with followers by becoming empathetic and take on others
perspective (Arnold et al., 2015). Genuine emotion can also be displayed spontaneously because
they have support from followers and they dont worry about resource loss because of its
abundance (Arnold et al., 2015). These leaders are less likely to have mundane interactions with
staff because they stimulate and motivate, inspiring them to think in new ways (Arnold et al.,
2015).
Nurses respect and trust transformational leaders. The leader has a profound set of
internal values and ideas which appeals to and motivates nurses (Doody & Doody, 2012). They
are motivated by their leader's creative communication of appealing and optimistic future visions
(Breevaart et al., 2014). Leaders are mentors and recognize every nurses individual needs and
abilities (Breevaart et al., 2014). They challenge nurses to rethink ideas and take different
perspectives on problems faced in the work environment (Breevaart et al., 2014). They

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encourage nurses to actively search for resources independently by inspiring independent

thinking and decision making (Breevaart et al., 2014).
These leaders are flexible and adaptive to changes in organizational structure and nursing
staff challenges (Doody & Doody, 2012). New ways of knowing are created in environments of
shared responsibility (Doody & Doody, 2012). They are able to persuade, not coerce, staff to
sustain the greater good rather than individual interest (Doody & Doody, 2012). Bass, Hall et al
and Barbuto (as cited in Doody & Doody, 2012) identified four components of transformational
leadership; idealized influence, inspirational motivation, intellectual stimulation, and individual
consideration (p 1212).
Idealized influence. Idealized influence provides followers with a sense of mission by
building self-confidence, appreciation, trust and respect (Doody & Doody, 2012). Effective
nursing leaders have personal attributions of charisma, persuasiveness and self-confidence which
in turn cause affection and commitment from staff (Doody & Doody, 2012). They are respected
for high moral standing and sense mission (Doody & Doody, 2012). Nursing leaders are role
models that staff wants to emulate, producing less resistance to change (Doody & Doody, 2012).
A mission statement is created involving stakeholders in its design and implementation,
generating a shared vision (Doody & Doody, 2012).
Inspirational motivation. Inspirational motivation encourages staff to achieve personal
and organizational goals simultaneously (Doody & Doody, 2012). Motivation is communicated
by leaders with high expectations affecting staff performance and client care (Doody & Doody,
2012). Unit leaders represent frontline staff and ensure staff is represented on committees that
influence executive decisions within the organization (Doody & Doody, 2012). Reinforcement

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theory, equity theory and goal-setting theory are examples of process theories that accent for how
motivation drives an individual to perform and helps leaders predict employee behavior in
different environments (Doody & Doody, 2012). Unit leaders anticipate staff development needs
and provide in-service, continuing education, training and orientation (Doody & Doody, 2012).
Unit leaders should combine motivational theories for a complimentary effect (Doody & Doody,
2012). To adopt inspirational motivation, the leader needs to influence staff with passion and
enthusiasm while creating a nearly fantasy-like vision, provoking staff to compromise their own
values for the greater good (Doody & Doody, 2012).
Intellectual stimulation. Intellectual stimulation challenges staff beliefs and encourages
problem solving innovation utilizing evidence-based practices (Doody & Doody, 2012).
Resources for education need to be made available for staff to uphold best practices, including;
nurse educators, libraries, computers and information technology ( Doody & Doody, 2012).
Organizations support informal and formal education (Doody & Doody, 2012). Unit leaders need
to encourage those who have undertaken further study to share their knowledge with other staff
(Doody & Doody, 2012). Leaders need to be aware of potential burnout and increased staff stress
when pressuring staff participation in intellectual stimulation (Doody & Doody, 2012).
Individualized consideration. Individualized consideration promotes leaders to support
individual needs to reach higher achievement levels (Doody & Doody, 2012). Positive feedback
and staff appraisals provide support, increase self-esteem and performance (Doody & Doody,
2012). Peer evaluation can increase personal development through constructive criticism (Doody
& Doody, 2012). However, they are time consuming and can become counterproductive without
rules and appropriate facilitation (Doody & Doody, 2012).

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Transactional Leadership
Transactional leadership encourages prevention-focused strategies and task oriented goals
(Hamstra et al., 2014). Transactional leaders use clear rules for nurses and pay close attention to
errors (Hamstra et al., 2014). They emphasize task-specific, short-term success while scrutinizing
performances (Hamstra et al., 2014). These leaders are concerned with rule making and
enforcement (Hamstra et al., 2014). Tasks are defined in concrete ways with detailed direction
(Hamstra et al., 2014). Nurses feel they need to do what is expected because leaders evaluate
compliance to rules and not individual thinking (Hamstra et al., 2014). Nurses view work in
terms of responsibility and obligation (Hamstra et al., 2014). Nurses aim for accuracy and
adherence to meet minimal performance standards. Leaders use reward to encourage positive
staff performance (Hamstra et al., 2014).
According to Baa and Riggio (as cited in Arnold et al., 2015), there are three substyles of
transactional leadership; management by exception (monitoring followers mistakes), laissezfaire (avoiding involvement), and contingent reward (rewarding followers achievements) (p
483).
Management by exception. Management by exception can be active or passive;
management by exception- active (MBE-A) and management by exception-passive (MBE-P)
(Arnold et al., 2015). MBE-A leaders actively monitor goal standard deviation and seeks out staff
mistakes (Arnold et al., 2015). MBE-P leaders passively wait for deviations. This leadership
style intensifies nursing emotional exhaustion and fosters high workplace conflict, resulting in
negative outcomes (Arnold et al., 2015). It has, inevitably, been associated with ineffective
performance improvement (Arnold et al., 2015).These leaders may use deep acting and genuine

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emotions sparingly, if at all, because they have few resources to expend (Arnold et al., 2015).
These leaders do not display empathy and are more likely to have analogous encounters with
their staff, fostering negative, unmitigated feelings (Arnold et al., 2015).
Laissez-faire. Laissez-faire leadership has been associated with poor resource gains,
spiraling resource losses, negative leader ability perceptions and negative outcomes (Arnold et
al., 2015). These leaders do not engage in surface or deep acting emotion regulations because it
requires too much cognitive effort (Arnold et al., 2015). They may use spontaneous genuine
emotion because staff interaction occurs rarely and they dont have the resources to grow
emotional regulation strategies (Arnold et al., 2015).
Contingent reward. Contingent reward is the most effective and positive part of this
leadership style (Arnold et al., 2015). Leaders make their expectations clear and offer recognition
or reward for meeting expectation (Arnold et al., 2015). Although this leadership style does
increase resource availability due to positive outcomes, it is not as effective as the
transformational leadership style (Arnold et al., 2015). They have fewer resources comparatively
and are less capable of displaying genuine emotion (Arnold et al., 2015). This may cost them
resources due to inappropriate displays of emotion (Arnold et al., 2015). Surface acting becomes
more effective with the contingent reward leader (Arnold et al., 2015). It is less time consuming
and more controllable than genuine emotion and is also less detracting from task focus (Arnold
et al., 2015). However, deep acting is needed with psychological rewards because staff may be
able to detect surface acting (Arnold et al., 2015).
Leadership Style Integration

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Leaders influence work engagement through influences on the hospital environment

(Breevaart et al., 2014). They shape and define work and social situations within the system
(Breevaart et al., 2014). An important condition to actively change work environments to the
benefit of nurses is through control over goal outcomes (Breevaart et al., 2014).
Healthcare delivery and consumer demands are easily meet with effective nursing
leadership (Doody & Doody, 2012). Downton (1973) first defined transformational leadership
and Burns (1978) distinguished transactional and transformational leadership differences,
describing them as opposite ends of a continuum (Doody & Doody, 2012). Effective leaders
demonstrate both of these leadership characteristics (Doody & Doody, 2012).
Transformational and transactional leadership encourage different goal-pursuit strategies
(Hamstra et al., 2014). Both leadership models are proven to be effective under particular
circumstances (Hamstra et al., 2014). Transformational leadership stresses higher goal outcomes
versus meeting minimum standards (Hamstra et al., 2014). Transactional leadership utilizes
contingent regard to meet a minimum performance standard, thereby, maintaining the status quo
and minimize deviation from expectation (Hamstra et al., 2014).
A multilevel regression analyses composed by Breevaart et al. (2014), showed
transformational leadership and contingent reward increased follower engagement (Breevaart et
al., 2014). Transformational and transactional leadership can help predict outcome variables such
as motivation, leader job performance, leader effectiveness and satisfaction with the leader
(Breevaart et al., 2014).
Specific behaviors of transformational and transactional leaders influence job resource
availability to nurses (Breevaart et al., 2014). Research has proven that these resources have

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motivating potential which leads to higher work engagement (Breevaart et al., 2014). Nurses are
intrinsically motivated; they enjoy work and are drawn towards it when they feel engaged
(Breevaart et al., 2014). Transformational leaders contribute to this intrinsic motivation by
providing meaningful rational for followers work (Breevaart et al., 2014). They use effective
communication and provide confidence in their staffs ability to contribute to an appealing
futuristic vision (Breevaart et al., 2014). Leaders stimulate nurses to help and learn from other
nurses to achieve a common goal (Breevaart et al., 2014). Nurses are stimulated to work to the
best of their ability and delegate tasks that match other staffs skill levels (Breevaart et al., 2014).
Contingent reward also has motivational power. Leaders who utilize contingent reward
are able to set clear goals and rewards which motivates staff to meet these goals (Breevaart et al.,
2014). Leaders are able to acknowledge good performance, develop skills, provide meaning to
work, and increases work engagement (Breevaart et al., 2014). However, these leaders lack
inspirational appeal (Breevaart et al., 2014). Transformational leaders are able to influence
follower work engagement after controlling the influence of contingent rewards (Breevaart et al.,
2014). Effects of leader behavior on staff my not always be apparent to the leader; feedback from
them can improve leaders understanding of this and initiate behavior changes (Breevaart et al.,
2014).
Conclusion
Transformational leadership is regarded as the most effective model (Doody & Doody,
2012). Transactional leaders can also be effective if staff performance is maintained with
contingent rewards. Management by exception and laissez-fair leadership strategies are
ineffective in hospital settings. Leaders who incorporate both transformational and transactional

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methods have been shown to have the greatest impact on nursing job satisfaction and
performance measurements. When the hospital workplace environment is transformed with
implementation of these leadership methods, nursing retention and recruitment will begin to
improve.

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