What Are the 5 Most Influential Leadership Styles in Nursing?

The role of the nurse is to care for others, from support for basic physical needs to development and revision of systems aimed to improve overall care for the communities they serve. A skillful nurse balances the needs of patients with the technical demands of doing the job well.

For example, simply giving a medication to a patient requires a background of knowledge, the physical skills and the ability to administer it in whatever way the patient requires, the cognitive ability to manage time and educate the patient appropriately as well as the caring attitude that is the hallmark of nursing care. Less visibly, nurse leaders can be found paving the way for this juggling act through many roles within the healthcare system from the bedside to the boardroom.

So, What is a Nurse Leader?

"A nurse leader — or any leader for that matter — is an individual who has the propensity to inspire, influence and motivate nursing staff and other health care workers to work together to achieve their highest potential and common organizational mission and goals," said Dr. Mandy T. Bell, clinical faculty member of the nursing program at Southern New Hampshire University (SNHU).

Bell has over 25 years of clinical experience in nursing and another 18 years of experience as a nurse educator. She said nurse leaders hold profound influence and can impact the quality of care patients receive as well as staff retention rates.

Traditional examples of leadership in nursing included directors, managers, supervisors, administrators, chief officers and other authoritative roles. However, nurse leaders are becoming more visible as educators, mentors, preceptors, advocates, researchers, financial consultants, data analysts, case managers and through other formal and/or informal roles.

Regardless of their title, nurses in all roles are expected to demonstrate leadership, and must challenge themselves and the profession to develop effective leadership styles.

The American Nurses Association (ANA) has said that “Strong leaders in nursing are vital to help navigate the constant evolution of health care.” As such, nurses have a unique responsibility to demonstrate skill and competency in leadership for the improvement of healthcare.

Learn more about nurse leadership.

What Are 5 Leadership Styles in Nursing?

As a nurse leader, it's important to identify and adapt a leadership style that best aligns with your organization's mission and goals, according to Bell. "The type of nurse leadership style the individual employs will serve as framework to direct decision-making, staff communication and engagement," she said.

There are 5 major leadership styles that can be emulated among influential nurse leaders. These are:

Transformational Leadership

Transformational leaders use a collaborative leadership style that leverages a shared vision, encouragement and inspiration to facilitate change. These leaders are often described as extroverted, open to new experiences, charismatic, secure in their sense of self, creative and future oriented in vision.

"A major component for Magnet designation, transformational leadership is also known as 'visionary leadership'" Bell said.

A transformational leader encourages innovation and is tolerant of error. In healthcare, transformational leaders are most successful in situations where the system is in need of larger changes or overall improvements that can be directed, encouraged and overseen by a unifying, guiding force.

According to Bell, transformational leadership is a favorite leadership style for many and is generally associated with higher levels of satisfaction in patient outcomes and successful change implementation.

Democratic Leadership

A democratic leader engages in a shared leadership style in which they use participation of members of the group to guide decision-making and management. Sometimes, this is called participative leadership. Democratic leaders are often characterized as mutually respectful, collaborative, encouraging, empowering and supportive of innovation but only tolerant of error.

In healthcare, democratic leaders may be best suited for situations where new relationships are being built between leadership and a group. For instance, in healthcare, when a system or process improvement is imperative, a democratic leader may step in to direct a group of assigned nurses to identify changes to a policy or guideline.

"One downside is that it may not be effective in independent decision-making situations," Bell said of this style.

Laissez-faire Leadership

A laissez-faire leadership style is a facilitative one in which a leader makes few decisions. Instead, this style of leader facilitates the group to drive decision-making and develop solutions to work-related problems with a “hands-off” approach. This is the opposite of autocratic leadership.

Characteristics of laissez-faire leaders are often reported as trusting, encouraging and tolerant of innovation as well as error. These leaders must be critical when necessary, but they allow and encourage the group to make decisions and develop solutions to work related problems, reserving the ability to step in, delegate and/or take over when necessary.

"Since this leadership style is a 'hands-off' leadership approach and is characterized by minimal supervision or guidance for the nurse leader, it works best where the staff are self-directed, highly educated, experienced and skilled," Bell said.

Autocratic Leadership

Autocratic leadership is a unilateral style in which the leader delegates to others with rules and orders. These leaders are intolerant of innovation and error and are the opposite of laissez-faire leaders.

Similar to those who are considered authoritative, autocratic leaders are generally characterized as self-reliant, highly structured, rapid decision-makers, authoritative and ultimately “the boss.” This leadership style may be useful in healthcare during emergency situations, traumas or disaster management when clear, definitive, rapid decisions and directions benefit all involved.

However, Bell noted that this style has drawbacks, too. "Also, known as an 'authoritarian' leadership style, autocratic leaders tend to micromanage staff which may lead to lack of trust, low morale and staff turnover," she said.

Servant Leadership

Finally, servant leadership is defined as a supportive style in which the leader provides team members with skills, tools and relationships they need to perform to the best of their ability.

"The focus is on the professional and personal needs of the team members," Bell said.

Servant leaders are often noted to share power, listen actively, conceptualize problems, empathize with others and prioritize others over themselves. They are often noted to encourage and support others through actions and service to meet their needs to do the job well. Servant leaders continually evaluate the needs of the team in order to provide resources and facilitate work.

In healthcare, these leaders may be best suited to situations where alignment of diverse team members who already have expert skills is in place but lack resources or support to create a more effective unit.

Each style of leadership is unique; however, truly dynamic nurse leaders may exhibit the characteristics of different leadership styles in response to the different challenges they face.

For example, a nurse leader may find it necessary to employ a democratic leadership style when a new system or process improvement is generated. This may be for the creation of a new policy in response to an identified need. Yet, the same leader may find it more useful to employ a laissez-faire leadership style after the policy has been generated. The leader can then support the team function while allowing the team to drive ongoing improvement and updates.

Why is Nurse Leadership Important?

Leadership in nursing establishes the tone for adaptation to or establishes a culture for change. Great nurse leaders inspire and guide great nursing practice. Inspiring nurses to practice to the fullest extent of their education and licensure, nurse leaders are, as previously noted, found in many types of nursing roles.

The American Organization for Nursing Leadership (AONL) states its mission is to: “Transform health care through expert and influential nursing leadership.” This mission centralizes nurses as a powerful influence in improvement in health care within the United States.

Both the AONL and the ANA agree that nurse leaders are essential for 3 key reasons:

1. Nurse leaders ensure safety in the provision of patient care, the workplace and in the profession as a whole.
2. Successful nurse leaders establish, support and generate evidence-based practice.
3. Effective nurse leaders maintain quality in administration of healthcare at all levels, from patient care to systems facilitation and management.

Bell also noted that nurse leaders impact the overall culture of their team.

"They serve as role models to their staff and foster open communication, just culture, interprofessional collaboration, teamwork and a positive work environment," she said.

What Are the Qualities of a Good Leader in Nursing?

Influential and valued nurse leaders demonstrate and nurture many dynamic characteristic qualities and behaviors.

"Soft skills are critical for the nurse leader to enjoy good relationships with others in the workplace," Bell said. "For some nurse leaders, the hard skills are easy to master whereas the soft skills need to be consciously developed over time."

Several soft skills that are consistently noted include:

• Adaptability – The ability to effectively cope with and thrive during change.
• Critical Thinking – The ability to construct reasonable and informed observations and decisions.
• Communication – Clear, appropriate, articulate and intelligent written and spoken language corresponding with appropriate, professional and effective interpersonal interactions with others.
• Emotional Intelligence – The ability to manage the emotions of one’s self as well as to draw out and respond appropriately to the emotions of others.
• Professionalism – Formal conduct, attitude and behavior that reflects integrity of character and commitment to the profession as a whole.

Some other qualities that are especially important for nurse leaders include:

• Commitment to Quality & Safety – Ongoing dedication to delivery of the highest possible quality and safety outcomes for all who are engaged in the system (staff, patients and the community).
• Global Mindset – Orientation of openness toward other cultures and respect for diversity.
• Technical Proficiency – The ability to navigate technical elements of the healthcare system including IT as well as medical equipment and devices required for the specialty area as well as corresponding administrative roles.
• Politically Astute Mindset – Focus on what is right, best or good for the organization and/or profession.

How to Develop Leadership Skills and Become a Nurse Leader

Nurses in many roles have the opportunity to mentor, precept, educate, advocate, investigate and stimulate change. To formally develop these leadership skills, nurses can pursue education at the baccalaureate, master's and doctoral levels.

For some nurse leadership roles, a bachelor's degree could be necessary. According to the U.S. Bureau of Labor Statistics (BLS), medical and health service managers — including nurse leaders — typically enter the profession with at least a bachelor's degree. If you're thinking about one of these roles, you'll want to consider if earning a Bachelor of Science in Nursing (BSN) degree is worth it.

Separate from education, nurses can seek certification and recognition of advanced knowledge in their specialty to demonstrate leadership to the community at large.

"To be an effective nurse leader, it is important for the nurse leaders to frequently engage in self-reflection to adapt to complex changing healthcare environment, technology and workforce," Bell said.

Careful observation of the leadership styles of nurse leaders in an organization or community demonstrates that leadership styles are as diverse as the leaders who employ them. An astute nurse leader can observe the style of leaders in healthcare, as well as in other professions, and emulate their successes, while learning from their failures.

Perhaps most poignantly, nurses can develop leadership skills by embracing everyday challenges in their current roles. By seeking opportunities to make decisions, influence change, nurture the profession, and improve care, nurses can challenge themselves to evolve into more influential leaders.

Dr. Kimberly Gibbons, DNP, RN, CNM(ret), CNL, CNE has been a nurse, nurse-midwife, nurse educator and clinical nurse leader for over 30 years. She has taught undergraduate and graduate nursing for the past 20 years. Currently, Dr Gibbons serves as team lead, lead practicum coordinator, and nurse executive leadership instructor and coordinator for the graduate nursing program at SNHU. Dr. Gibbons holds a Doctorate in Nursing Practice from the University of New Hampshire and multiple specialty certifications in nursing education as well as clinical practice in nursing.