Leadership in Nursing: Styles and Impact


The leadership characteristics and styles differ from one individual to another and from one context to another. However, it is worth noting that leadership influences the organizational culture and climate. This then affects the levels of motivation, attitudes to work and the considerations of ethics as well as the willingness of people to be led and follow the guidance of their leader. This paper focuses on the aspects of transformational leadership, the impact of engaging leadership on performance, attitudes to work and wellbeing at work, social constructs of followership, ethical leadership and leadership that focuses on the social identity and leading from within the group with applications to the cardiac Intensive care unit context.

Analysis of Leadership Aspects

Leadership in Context

The author provides an in-depth critical exploration of transformational leadership including its suitability and applicability to the present nursing setting. She places significant emphasis on how transformational leadership grows in nurse managers. As the name of the article suggests, transformational leadership is about causing change. This is because transformational leaders provide motivation, energy and empowerment to their employees for the achievement of common goals and vision (Caliguiri et al., 1998). This argument is adequately supported by the fact that in nursing specifically, it is not just dependent on professional education, but also the personal traits of the nurse managers which are seen in how they influence the nurses and the patients that they serve.

However, it is worth noting that although the leader has the role of motivating the followers, there are other sources of motivation which are vital in the lives of the followers such as the work environment and also an intrinsic source of motivation. It is important to note that transformational leaders should not just focus on influencing, but also fulfilling their main objectives in management with a clear vision and strategy. This is supported by Ozaralli (2003) who focuses on “the effect of transformational leadership on the empowerment and effectiveness of teams” (p. 335).

Ozaralli (2003) further argues that transformational leaders have followers who record exemplary performance that surpasses the initial expectations which however has to depend on the motivation levels of these followers. As a result, an organization in which there is transformational leadership is governed by personal values and mutual respect. The effects of this are supported by Kark, Shamir and Chen (2003) who focused their work on the empowerment and dependency faces of transformational leaders. They argued that transformational leadership leads to personal identification of the followers with their leaders as well as social identification with the organization.

Transformational leaders are able to influence their followers by touching on their feelings of identification (Dvir et al., 2002). As a result, they are able to influence their followers by touching on their feelings of identification and create dependence among their followers on their leaders. This however is detrimental to the effectiveness of leadership since the followers are not able to do things on their own with the central focus to the leader. It is necessary for followers to have their own identities to avoid duplication so that the individual differences are effective in complementing the organization.

The cardiac ICU unit is composed of many different specialists who work together in the assisting of patients in congenital or acquired heart diseases on a collaborative effort. Transformational leadership applies since it is a proactive section that requires the consideration of best care in either surgery and recovery of patients to increase the chances of getting well. This is thus effective since the possibilities of the cause of the heart problem with the analysis of the respiratory, cardiology, right prescriptions are to be made. Additionally, this kind of leadership allows the followers to not just receive orders, but to also learn what is expected of them.

This is very necessary considering that the patients can be in need for example of respiratory checks and adjustments which can be done by a nurse in the unit without having to wait for the respiratory specialists. This improves the image of a unit with considerations of quality care.

Leadership and Organizational Dynamics

The aim of the work by Alimo-Metcalfe et al. (2008) was to look into the associations between the quality of leadership and the attitudes of employees towards their work, their sense of wellbeing and the overall performance of the organization. They rely on Baptiste (2007) who explores the effects of the practices of human resource management to the performance and well being of employees. He argues that there is a difference between the HRM practices of high performance and those focused on improving the well being of employees with the best leadership being those focused on the well being of employees.

The argument is that the well being of employees influences their attitudes to work and their efforts in performing their roles. Alimo-Metcalfe et al. (2008) found out that the quality of leadership is a predictor of employees’ behaviours particularly their motivation, their motivation to surpass their expectations, their commitment to the job, their commitment towards the organization they work for, their job satisfaction levels and their level of stress irrespective of the context. This is supported by Song and Kim (2008) who focus on the commitment to the organization and the job by exploring the characteristics of the perceptions of the individuals and the cultural characteristics of the organization in a Korean context.

The authors argue that engaging leadership predicts the levels to which employees are willing to attain the goals. However, unlike what was asserted in the study by Murphy (2003), they assert from their study, that leadership capabilities do not influence organizational performance. In their argument, they believe that having certain leadership capabilities is not enough to harness the collective efforts of employees. This is however controversial since the attitudes of staff towards work based on the quality of leadership are likely to increase their performance which would amount to an increase in the entire organization.

In further support of their study, Alimo-Metcalfe et al. (2008) base on their past research in Alban-Metcalfe and Alimo-Metcalfe (2003). In this case, they provide a Leadership Climate and Change Inventory” (LCCI) instrument for the assessment of the well being of staff at work, their attitudes to work and leadership quality. This is as Patterson et al. (2004) suggest that the job satisfaction and other attitudes to work are the best indicators in the assessment of the organizational performance. The argument here is that leadership is not based on competencies, but rather in the relationships a leader creates with the followers.

The approach taken by the authors is in-depth and exposes the need for engagement in leadership and the influence a leader creates. Basically, the approach, in this case, is engagement of leadership and the focus on influencing the followers which is quite relevant due to the flexibility it requires of leaders rather than the rigid following of competence and belief in the leader.

In the cardiac ICU unit, the quality of leadership determines the motivation of followers. This is applicable in this context considering that it is made up of professionals who if involved in the processes such as surgery and offering of care get opportunities of learning and are committed to their work. The improvement of the well-being of the specialists has the likelihood of increasing their commitment. The specialists in the cardiac ICU engaged are able to see the results of their efforts which increase their motivation and the need for commitment (Arndt, 2009).

Social constructs of followership

The objective of the authors was the deconstruction of the term followership which was quite relevant to obtain the perspectives followers have of followership rather than leadership for the effective definition of such constructs. The authors found out that “definitions of followership are socially constructed around obedience, passivity and deference although there was an emphasis elicited on the need to question and challenge leaders” (Carsten et al., 2010, p. 547).

This is also influenced however by the personal characteristics of the follower in terms of being passive, active or pro active in their roles. The clear definition of roles enables the followers to know their rights in regards to questioning their leader based on the relationship they have with them. They relied on Jong (2009) on the styles of followership and their context of application as well as the description of followership that is effective. The influence the context has on followership is worth appreciating based on the work of Weick (1995) in which he suggests that the context of the organization as the culture and climate at the place of work influences the social constructs of both followership and leadership.

Further they focus on the work of Barker and Gerlowski (2007) regarding how followership affects the effectiveness of teams in an organization. They argue that there is no relation between effectiveness of teams and followership. In their argument, they suggest that the influence lies in the individual characteristics of each leader and follower. It is however worth noting that there is an influence of the relationship they have with their leader.

The ability to question and challenge leaders is influenced by the characteristics and knowledge of the followers to be able to know when their leader deviates from what is expected of him or her. The authors also found out that “the constructions of followership and the behaviors of followers were affected by the factors in context” (Carsten et al., 2010, p. 548). They create the relevance of the organizational climate in influencing what is perceived as leadership and whether to be under such by embracing followership which is largely determined by the style of leadership the leader uses.

The article deconstruct followership through the actual focus on what constitutes followership by considering the perspectives of followership based on Uhl-Bien and Pillai (2007) in respect to status differences. It is worth appreciating the pitfalls of followership from a followership perspective which is done from Jong (2009). This is relevant since in the course of following a leader, the inability to question him/her can influence the organization when s/he engages in a bad decision.

The application of the concept of followership in the cardiac ICU unit is very relevant. This is because for example in the processes of surgery, there has to be the guidance of the main leader who delegates responsibilities and directs the members on what to do. In this context, this is necessary since with many specialists in the unit, the lack of direction would lead to ineffective operations. Leadership that is important is collaborative and not issuing of orders since the followers are specialists aware of what is expected. This follower and leader agreement works effectively in the operations and the delegation of responsibilities such as the role of nurses, cardiologists, respiratory specialists, surgeons, social workers among others and how each comes in to enable the work to be effective (Baker & Gerlowski, 2007).

Ethical leadership

The authors examine professions as moral communities and explore how the possession of moral intelligence by professional leaders influences the perceptions of ethics in their communities. In this regard, they assert that ethical leadership is based on transformational leadership governed and motivated by the achievement of a moral good with the values of integrity, moral rectitude and trust upheld. Emphasis is given to Neubert, Carlson, Kacmar, Roberts and Chonko (2009) who examine ethical leadership based on job satisfaction of followers and the effect on their commitment to the organization.

It is relevantly applicable that ethical leadership creates a climate that allows for the upholding of ethics so that there is more job satisfaction and as such increases the commitment to the organization. The assertion that ethical leadership is largely influenced by the organizational culture is relevant since the culture of the organization defines what is morally acceptable and what is not. This is as Ireland and Hitt (2005) emphasize on the need for an ethical culture that upholds the moral good for the support of ethical leadership raising an important issue since ethical leadership has to be maintained through an ethical culture that allows the people to be aware of what is expected of them thus upholding ethics.

The authors recommend the adoption of ethical leadership embodied on moral intelligence and the creation of a moral community by sharing values, upholding integrity, transparency and reciprocity and consistently adhering to the principles of such leadership. This however has to depend on the type of organization. This is because of the definition of moral good which may differ from one profession and context to another. In this case, their work is relevantly applied in the business context. They lay emphasis on ethics through their other earlier works. For instance, Sama and Shoaf (2002) consider the advancement of the web in promoting and selling goods to consumers.

Ethics are explored with the examination of the ethical rationales useful in decision-making in the consumer world. They adequately present the dilemmas companies face in relating to the welfare of customers in the web. Further, Sama and Shoaf (2005) consider the corporate governance issues in the US and Europe. In their contrast of these approaches rules and principle-based approaches to corporate dilemmas involving ethics, they focus on an ethical approach to corporate governance due to the influence of globalization. In this case, they suggest the inclusion of both rules and principles for corporate dilemmas which is quite in-depth and considers the modern challenges as they relate to ethics.

The hospital setting is an environment that requires ethical conduct due to the fact that the lives of patients are usually the consideration and is faced with high risks and decisions-making. The cardiac section is faced with the ethical decisions to be made especially due to the high costs involved, risks of death, sensitivity of the cardiac system and the age of the patient. The main patients in the cardiac ICU are infants and children which increases the concerns of ethics. The main ethical questions the specialists face are whether the operation on the children is the right thing to do, who should decide for the child concerning the need for operations, the costs of such operations and whether there is anything else that can be done for the patients.

Leadership: social identity and guiding from within

The author explores social identity in the context of a group and emphasizes on the need for leaders guiding their followers from within the group rather than separation from the other members of the group. This is adequately explored since it creates a hierarchical structure of relationships with the leader. Reicher, Haslam and Platow (2007) assert that “best leaders are those that are involved in the analysis and identification of the social identity of their groups, who base their leadership on the identified social identities and guide from within” (p. 25). This is relevant although the concept of “best” in terms of leadership is influenced by the context.

This is analytically applied in the health care context. The importance of identifying social identities lies in the divergent social identities the health sector has due to the difference in profession, geographical location and individual hospital and also the different units in the nursing context.

The author asserts that leaders have the responsibility of raising the performance levels of their organizations with identification of the social identity of the group considering factors such as the degree of centeredness on patients or the nurse, the mission, perceptions of leadership style and performance levels. Analysis is based on Van Knippenberg and Hogg (2003) who emphasize on the importance of identification of the social identity of a group by a leader to increase the power of influence which then creates shared vision.

The assessment of social identity based on a shared vision and addressing the gaps and commonalities between members of the group as well as the expectations of the individual members, is very necessary in ensuring effectiveness of such leadership. This is as Lutz (2007) points on the need for effective communication especially for a leader. This is very relevant since in listening, the leader is able to know the desires, expectations and values of the members to relevantly influence them.

Further as Hira (2007) points out, there is need to focus on the changes in the group composition with people of different generations and the need to adjust to fit in the group for clarity of identity of the group. This is very necessary since the desires, expectations are influenced by age, hence the need to incorporate all the various groups to avoid divisions. The author asserts that the leaders has a great role in shaping the values and desires of members and not impose on them. This assertion is more of influence the leader has on the members and the consideration of their views and expectations.

In the context of health care, effective leadership is necessary. For example the cardiac ICU is an area that requires collaboration and teamwork. Further, there is no way one leader or member can work on a patient alone. The ability of the leader to fit in the members increases their willingness to follow the guidance of such a leader. This is very necessary to avoid hierarchical relationships that are not effective in a cardiac section that requires decisions to be made wisely but fast enough for the lowering of the risks, increasing safety of the patients and saving lives. The professionals involved in the cardiac ICU are qualified in their own capacity. Therefore, there is the need for involving them in the decision making to ensure they feel part of the team.


This paper has focused on the aspects of transformational leadership, the effect of effective leadership on employees and organization, social constructs of followership, ethical leadership and leadership that focus on the social identity and leading from within the group with applications to the cardiac ICU context. Transformational leadership has been identified as very necessary because of its pro-activeness, outcome on patients and ability to complement transactional leadership. Further, the concept of followership is highly influenced by the organizational culture and the style of leadership with the ability to influence the behaviours of followers.

The well being of employees has been evaluated in the light of engaging leadership to influence their motivation and commitment to work though there is no guarantee of the influence o the performance of the organization. The cardiac unit has been relevantly considered due to the high costs involved, risks of death, sensitivity of the cardiac system and the age of the patient.

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