Types of leadership: Nursing

Nurse Natasha works on the medical unit at a hospital and has noticed many of her nurse colleagues are not following the hospital policy to complete change-of-shift reports at the clients’ bedsides. Instead, they’re being done in the hallways or at the nurse’s station. Nurse Natasha knows that the policy exists because bedside reporting helps to reduce errors and increases communication and collaboration between the nurse and the client. She speaks to the unit manager and says, “I’d like to create a Bedside Reporting Team made up of other nurses on the unit to help solve the change-of-shift reporting issue we are experiencing.” Nurse Natasha will use what she has learned about types of leadership to determine how to lead this new team.

A leader influences a person or group of people to change behavior or actions in order to accomplish a goal. Leadership comes from a desire to make things better, bring people or groups together, improve communication, and work to achieve goals. A manager, on the other hand, is a particular kind of leader that concentrates on achieving the goals of an organization like decreasing costs or improving employee satisfaction. A manager is often placed in a position of authority within an organization. Therefore, a manager may act as a leader but a leader does not necessarily have to be a manager. Leaders who are not in an official position of authority are called ‘informal leaders’.

In nursing, leadership is crucial for solving problems, providing safe, effective, and cost-effective client care, and for promoting the health of clients and communities. In fact, every nurse can serve as a leader.

Just a few examples of nurse leaders include a nurse practitioner coordinating with a pharmacist to avoid drug interactions for a client, a nurse manager enforcing safe staffing ratios for a hospital unit, a community health nurse speaking to policy-makers to lobby for better access to public transportation and healthy food in the community, and a clinical nurse advocating for better pain management for a client.

Now, leadership can be categorized into traits, styles, and perspectives and it is helpful to understand these categories to help decide the type of leader you are or want to become.

Leadership traits are characteristics that can either come naturally to you or can work to develop over time to be an effective leader. Some traits that are important to leadership include passion, creativity, confidence, vision, trust, knowledge, communication, and courage. Nurse Natasha is displaying some leadership traits with her knowledge of the importance of bedside reporting as well as her passion to change the current habits of the unit.

Leadership styles, on the other hand, are tasks and behaviors that a leader may use to accomplish goals. Some common leadership styles include authoritarian, democratic, and laissez-faire which can be considered to be on a continuum from least to most freedom for followers.

The first leadership style is authoritarian leadership and gives the least amount of freedom to followers. An authoritarian leader directs the behavior of the followers with decisions made solely by the leader. This type of leadership works well when decisions need to be made quickly, like in an emergency or code situation. However, it can cause hostility in the followers and make them dependent on the leader.

So, if Nurse Natasha decides to use an authoritarian leadership style, she will come up with a plan without the input from her team and direct the Bedside Reporting Team to observe their colleagues during shift changes and report the nurses who are not following the policy to the unit manager.

Next is democratic leadership. A democratic leader uses group discussion and decision making to come to a consensus. This style of leadership helps the followers to feel valued and more accepting of changes. A disadvantage, however, is that decisions can be slow as finding a consensus can be difficult. Also, some minority groups may be underrepresented and their thoughts and opinions not as easily heard.