Leadership Styles in Nursing

As frontline medical workers, nurses operate in an unpredictable and fast-paced environment. Considering the broad scope of diseases, illnesses, and injuries that can occur on any given day, the nursing profession requires a “be ready for anything” attitude, poise under pressure — and exceptional leadership.

Nurse leaders are the individuals who oversee teams of nurses or entire health care departments. They are coaches, mentors, advocates, and vast resources of information. How a team of nurses operates is usually a direct reflection of their leadership; however, there are numerous leadership styles in nursing, each with its distinguishing characteristics, advantages, and disadvantages.

Successful nurse leaders are not only familiar with the main styles of leadership in nursing, but they also possess the wherewithal to employ the style that best suits the situation. Moreover, nurse leaders possess a skill set and clinical knowledge that can only be earned through years of experience and an advanced nursing degree . 

Why Is Nurse Leadership Important?

Nurse leaders set the tone in terms of workplace culture and the morale of the environment, both of which have a direct impact on patients and how they perceive the health care facility and its staff. When nurses are burnt out, undertrained, and disorganized, it’s not only noticeable to patients, but it’s also likely to reduce the quality of care that is provided. By contrast, nurses who are motivated, organized, self-assured, and in good spirits are more likely to have positive interactions with patients and deliver high-quality care.

Effective nurse leaders:

• Promote a patient-centered approach
• Foster a positive work environment
• Ensure their staff adheres to standards, protocols, and best practices
• Encourage professional growth and development
• Push for innovation and self-improvement
• Keep their composure during a crisis
• Can adapt to any situation
• Welcome interdisciplinary collaboration
• Build trust and confidence with patients and nursing staff
• Advocate for resources and improved conditions on behalf of their team
• Strategically shape the future of their department or facility

7 Types of Nurse Leadership

Leadership styles in nursing are what define the relationship between nurse leaders and their teams. By extension, nurse leaders shape how nurses feel about their own career and their own approach to treating patients. 

The following seven leadership styles are among the most popular in health care.

Transformational Leadership

Transformational leaders inspire and motivate their nurse teams through a shared vision and a commitment to personal and professional growth. Nurse leaders who employ a transformational leadership style are usually upbeat, highly energetic, and extremely passionate about their line of work. This dynamic leadership style goes beyond traditional models, inspiring nurses to reach new heights of excellence, foster innovation, and create positive changes in the health care environment.

According to leadership studies researcher Bernard M. Bass, transformational leadership consists of the following four main components.

1. Instilling idealism through influence
2. Creating motivation by inspiring others
3. Encouraging and supporting others through individual attention
4. Fostering creativity and innovation through intellectual stimulation

Transformational leadership contributes to increased job satisfaction among nurses. By recognizing and valuing their staff’s contributions, fostering a positive work culture, and providing opportunities for professional growth, transformational leaders create an environment where nurses feel fulfilled in their roles.

The ripple effect of transformational leadership extends to patient care. The focus on continuous improvement and innovation directly influences patient outcomes, contributing to a positive health care experience.

Transformational leadership results in nurses feeling empowered, motivated, and a valued part of a team. By extension, this leads nurses to feel personally invested in their work and creates a sense of loyalty toward their nurse leader. Transformational leaders generally have low turnover rates and are highly skilled in attracting top nursing talent. 

Transactional Leadership

Transactional leadership is characterized by its focus on clear expectations, structured processes, and goal-oriented interactions. It plays a crucial role in addressing the daily challenges faced by nurse teams. Originally developed by sociologist Max Weber, transactional leadership operates under the following four assumptions.

1. A workforce can only reach its potential when the chain of command is clearly defined.
2. Workers are motivated by two things: rewards and punishments.
3. The primary goal of a workforce is to obey the commands of the leader.
4. A workforce must be closely monitored to ensure it is meeting expectations.

Transactional leaders in nursing focus on achieving specific goals and objectives with clearly established guidelines. They use a system of rewards, recognition, and punishment to motivate nurses to meet established targets, creating a goal-oriented work environment where performance is directly linked to incentives, recognition, or corrective action.

Because transactional leadership is based on a system of rewards and punishments, it is considered a behavioral approach to motivating workers to generate desired outcomes. When nurses perform well, they are praised, offered more favorable shifts, promoted, and given raises. By comparison, when nurses don’t meet expectations, they are provided constructive feedback or may be reprimanded for their performance. Transactional leaders monitor their nursing staff closely, regularly assessing their adherence to established standards and protocols.

By employing a transactional leadership style, nurse leaders:

• Prevent miscommunications using clear and concise language and directives
• Are more effective in crises because work structures and protocols are clearly defined
• Foster effectiveness, efficiency, and consistency of patient care using standardized processes and clear expectations
• Link incentives to performance using a system of recognition, rewards, and correction
• Mitigate risk by closely monitoring team performance and emphasizing adherence to established protocols

The relationship between nurses and nurse leaders who employ a transactional leadership style can be described as an exchange. Motivated nurses who thrive on rewards and recognition do well under this leadership style. Nurses who fail to meet expectations are pushed to improve or face punishment. 

Democratic Leadership

Democratic leadership is characterized by inclusivity, participation, shared decision making, and open communication. Although nurse leaders ultimately make the final decisions, democratic leaders in nursing actively seek input and participation from all team members. Not only does this show how much they value the perspectives and ideas of others, but it also fosters a sense of inclusion.

The main components of democratic leadership include:

• Encouraging and rewarding new ideas and creativity
• Keeping members of the workforce engaged so that everyone feels included
• Using collaboration to share thoughts and opinions

Democratic leaders oversee collaborative discussions, allowing nurse staff to contribute to the decision-making process. Open and transparent communication is a hallmark of this style of leadership. Even if there are dissenting opinions or unpopular points of view, democratic leaders will not attempt to silence them. For democratic leadership to work, nurses must feel they can be open and honest without experiencing reprisals.

The democratic leadership style in nursing also embraces diversity and values the unique strengths each team member brings to the table. Leaders celebrate differences, ensuring the nurse team is a melting pot of perspectives, experiences, and expertise, enriching the overall quality of patient care. This approach gives teams a collective sense of feeling valued and essential to the overall health care mission.

Nurse leaders who employ a democratic leadership style:

• Generate feelings of trust and inclusivity among their workforce
• Create an environment where everyone feels heard and valued
• Take direction on their decisions from their employees

The collaborative and engaged work environment fostered by democratic leadership directly influences patient care. Because nurse teams feel included and valued, they are more likely to deliver high-quality, patient-centered care, positively impacting health care outcomes.

Moreover, democratic leadership actively addresses the factors that contribute to burnout. By keeping nurses involved and creating an open communication environment, leaders mitigate feelings of powerlessness and frustration, contributing to a healthier work-life balance and boosting team morale. 

Laissez-Faire Leadership

Laissez-faire leadership, characterized by a hands-off approach, is a unique management style that empowers nurse professionals to take ownership of their roles. When employing this style of leadership, nurse leaders allow their workforce to make their own decisions and solve problems independently. Laissez-faire leaders will check in with their staff from time to time to offer feedback and support but generally allow teams to oversee themselves.

The main components of laissez-faire leadership include:

• Allowing employees to make their own decisions with autonomy
• Remaining available to employees should they need guidance or feedback
• Promoting a sense of empowerment among the workforce
• Demonstrating to employees that they are trusted and capable of making the right decisions

Laissez-faire leaders in nursing encourage a high degree of autonomy among their team members. By allowing self-motivated nurses to make decisions independently, they effectively take control of their work processes and patient care responsibilities. Because nurses aren’t required to run every decision by nurse leaders, it makes for a much faster decision-making process.

Laissez-faire leadership also values the creativity and innovation of nurse professionals. By promoting autonomy and self-empowerment, leaders encourage nurses to think outside the box, explore new approaches to patient care, and contribute to the development of best practices within the health care setting.

However, there are some key considerations to make when employing a laissez-faire leadership style. Most notably, because laissez-faire leaders allow employees to largely oversee themselves, it is the leadership style most associated with low productivity and high error rates. Additionally, employees who benefit from a motivational leadership style with guidance and structure tend to underperform with laissez-faire leaders.

For laissez-faire leadership to work, nurses must be self-motivated, experienced, and possess exceptional clinical skills and problem-solving abilities. Perhaps most importantly, they should possess decision-making capabilities that promote optimal patient outcomes and adhere to previously established protocols and regulations.

Laissez-faire nurse leaders can get the most out of their teams by clearly communicating expectations, providing ongoing support in terms of training and professional development, and regularly checking in to provide feedback and guidance without micromanaging. However, it is advised to take a more active form of leadership during crisis management and high-intensity situations, such as delivering emergency acute care. 

Servant Leadership

Servant leadership, rooted in humility, empathy, and a commitment to supporting others, has emerged as a powerful and transformative approach in nurse management. Servant leaders in nursing prioritize the needs of others, putting the well-being of patients and the nurse team at the forefront of their decision-making. This selfless approach creates an environment where the focus is on serving and supporting those under their care.

The most prominent attributes of servant leadership include:

• Active listening
• Demonstrating an appreciation for others
• Building bonds of trust
• Caring for employees on a personal level
• Remaining humble

Servant leaders exhibit humility, prioritize collaboration, and view themselves as part of the team, working alongside nurse professionals to achieve common goals. Many leaders who employ a servant leadership style in nursing are referred to as “working managers” because they are just as hands-on with patient care as their staff. This approach promotes a sense of unity, trust, and shared responsibility within the nurse team.

Servant leaders also actively support the professional growth and development of nurse staff. By providing mentorship, training opportunities, and resources for career advancement, they empower nurses to reach their full potential, contributing to a skilled and motivated health care team.

Servant nurse leaders generally see the following results.

• Enhanced patient-centered care
• High levels of nurse satisfaction and morale
• Improved team collaboration
• Reduced burnout rates
• Positive organizational culture
• Emotional and physical well-being among staff

Servant leaders lead by example, demonstrating the values of humility, empathy, and compassion in their interactions with both patients and the nurse team. Consistency in these behaviors sets the tone for the entire health care environment. 

Autocratic Leadership

Characterized by a centralized decision-making process and a hierarchical structure, autocratic leadership can bring efficiency and structure to nurse management. Autocratic leadership is the most ‘militant’ of leadership styles in that there’s a clear chain of command, orders are clear and concise, and all decisions are made by the leader with little to no input from the team.

The main characteristics of autocratic leadership include:

• Creating structured and rigid work environments
• Using a streamlined communication style to establish rules, order, and chain of command
• Discouraging independent thinking and feedback
• Empowering leaders to make all the decisions themselves

Autocratic leaders are commonly associated with the phrase “running a tight ship” because it is the most regimented of all leadership styles. If an autocratic nurse leader is competent, can be trusted to make the right decisions, and properly motivates their team, it can foster a highly efficient and effective health care department.

On the other hand, if an autocratic leader has knowledge gaps, ignores good ideas, and is ill-tempered, it can lead to employees feeling discouraged and resentful. One of the major drawbacks of autocratic nurse leaders is they typically don’t lean on the expertise and creative thinking of their subordinates, which can lead to a lower quality of patient care and a higher level of staff turnover.  

Successful autocratic leaders strike a balance between maintaining authority and empowering their nurse team. While making centralized decisions, they recognize opportunities to involve team members in decision-making processes, fostering a sense of shared responsibility. This demonstrates that the efforts of the nurse staff are valued, contributing to an overall positive work culture. 

Situational Leadership

Situational leadership, characterized by its flexibility and responsiveness to different scenarios, has become a valuable framework in nurse management. As the name implies, situational leaders in nursing possess the flexibility to adapt their leadership style based on the specific dynamics of the situation. They recognize that different scenarios may require varying approaches, and they adjust their leadership strategies accordingly.

Situational leadership is attributed to Kenneth Blanchard and Dr. Paul Hersey, both of whom are authors of books about managerial styles and leadership. According to them, they suggest that situational leadership consists of four distinct approaches.

• Telling: The leader provides clear instructions on what to do and how to do it.
• Selling: Leaders engage in a back-and-forth dialogue with employees and “sell” them on their ideas of how to approach things.
• Participating: Leaders provide less direction and take a more active role in generating ideas and making decisions as a group.
• Delegating: Leaders take a hands-off approach and allow their workforce to govern themselves.

Choosing the right situational leadership style depends on the maturity of the workforce, which Blanchard and Hersey have broken down into four levels.

• M1: The lowest level of maturity. Group members at this level lack the willingness, skills, and knowledge to complete the task.
• M2: Group members lack ability but are enthusiastic and willing to put in the work to complete the task.
• M3: Group members are unwilling to take responsibility for the task but possess the capability and skills to complete it.
• M4: The highest level of maturity. Group members are willing and possess the necessary skills and competencies to complete the task.

According to Hersey and Blanchard, the following are the most effective when matching leadership style with maturity level.

• M1 – Telling
• M2 – Selling
• M3 – Participating
• M4 – Delegating

Situational leadership directly influences patient-centered care. Leaders who can adapt their approach to match the needs of specific situations foster a collaborative and responsive environment, enhancing the nurse team’s ability to provide care that is tailored to individual patient needs.

Moreover, leaders can guide their teams through complex situations, fostering a problem-solving mindset that is essential for overcoming obstacles in patient care and health care delivery. Situational leadership also contributes to improved team dynamics. By recognizing and responding to the unique needs of each situation, leaders foster a collaborative environment where nurse professionals feel supported, empowered, and motivated to work together cohesively. 

Nurse Leader Qualities

Although leadership styles in nursing vary by characteristics and approach, some unifying leadership qualities benefit any health care professional who oversees a team. According to the American Nurses Association, all nurse leaders should possess the following qualities.

• Effective communication
• Advanced critical thinking and problem-solving skills
• Collaborative skills
• High education and the ability to embrace professional development
• A safety-first mentality that fosters a healthy environment
• High ethics and trustworthiness
• Clear professionalism
• The ability to be an effective networker that can build meaningful relationships
• Empathy and compassion for others

Take the First Step Toward Becoming a Nurse Leader

Effective leadership is paramount to ensure the delivery of exceptional patient care and to foster a positive and supportive work environment. Successful nurse directors and managers are not only familiar with multiple leadership styles in nursing, but they also know which situations warrant specific approaches.

Those who are interested in pursuing leadership roles in health care are encouraged to explore educational paths that will support their journey, such as the online Master of Science in Nursing (MSN) program offered at The University of Tulsa. Ideal for active nurses who possess a BSN degree, this program is designed to advance professional skills and education. Nurses can also choose an area of focus by selecting one of four specialty tracks.

• Informatics and Analytics
• Public Health Global Vision
• Education and Elevation
• Leadership and Innovation

Graduates of the MSN program can qualify for high-demand health care leadership roles, including those of charge nurse, director of nursing, and chief nursing officer. Learn more about the program to see how it supports your professional aspirations of becoming a nurse leader.

Recommended Readings

Nurse Case Manager Career Overview

How to Become a Chief Nursing Officer

What Can You Do With an MSN?

Sources:

American Nurses Association, Charge Nurse vs. Nurse Manager: What’s the Difference?

American Nurses Association, Chief Nursing Officer/Chief Nurse Executive

American Nurses Association, “How to Be a Good Nurse Manager”

American Nurses Association, “How to Become a Director of Nursing”

American Nurses Association, “Leadership in Nursing: Qualities & Why It Matters”

GoodRx Health, “What’s a Charge Nurse? Role, Duties, and Salary Information”

Indeed, “7 Leadership Styles in Nursing: Their Importance and Impact”

Indeed, “Director of Nursing Job Description: Top Duties and Qualifications”

Indeed, “Nurse Manager: What They Do, Skills and Job Requirements”

Indeed, “Nursing Leadership and Management: Role Definitions and Differences”

Indeed, “What Is a Chief Nursing Officer and How Do You Become One?”

Indeed, “What is Situational Leadership? (4 Styles and Examples)”

Investopedia, “Servant Leadership: Characteristics, Pros & Cons, Example”

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Tech Target, Transactional Leadership

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