did Maria demonstrate in preventing a nurse‐sensitive outcome of cardiac arrest?
Why is Maria considered a leader, even though she is not in a formal leadership or management position?
For all nurses, their knowledge of nursing and ability to apply that knowledge, is the basis of their leadership. Many people think that leaders are only top corporate executives and administrators, political representatives, military generals, or those who head an organization. This is because these leaders are highly visible and hold high‐profile positions. However, leaders are needed at all levels of an organization. With the advent of the information age, many professionals, including nurses, became known as knowledge workers. Nurses' education and specialized clinical preparation develops their expertise and leadership ability. Nursing knowledge workers are leaders. This idea of nursing knowledge workers contrasts with the manufacturing age, where the manager was the most knowledgeable person and closely supervised employees to carry out routine work. Leadership however is a basic competency for all nursing professionals. Leadership development is a necessary part of the preparation of nurses.
Nurses make a critical difference every day in the lives of their patients and patients' families, yet nurses believe those accomplishments are part of their ordinary work. Nurses are leaders, and by using their expert knowledge, they coordinate patient care and lead patients and families through health care journeys. Nurses lead themselves as they develop in their career and nurses lead change to improve patient outcomes and the quality of care. Nurses are leaders and lead without being in a management position.
Leadership and management are different. Leadership influences or inspires the actions and goals of others. One does not have to be in a position of authority to demonstrate leadership. Not all leaders are managers. Leaders have been characterized as people who do the right thing whereas managers are viewed as people who do things right (Drucker, 1993). Both leadership and management are crucial but different.
This chapter lays the groundwork for the development of knowledge about nursing leadership and management. Many concepts touched on in this chapter will be developed in depth in the chapters that follow. This chapter discusses leadership and provides a framework to differentiate leadership and management and explain emotional intelligence. Leadership characteristics, styles of leadership, and leadership theories are described emphasizing transformational leadership and complexity leadership. The chapter introduces the process of management and explains management and motivation theories. The content is developed for the beginning nurse preparing to graduate from a pre‐licensure program and enter the profession in the role of registered nurse. Benner's work describing skill acquisition of nurses uses a framework called, “From Novice to Expert” and labels this new graduate nurse as an advanced beginner (Benner, Tanner, & Chesla, 2009).
Definition of Leadership
Leadership is commonly defined as a process of influence in which the leader influences others toward goal achievement (Yukl, 2006). Nurses function as leaders when they lead themselves and influence others toward goal achievement. Influence is an instrumental part of leading others and leaders influence others, often by inspiring, enlivening, and engaging others to participate. Leadership can occur personally. It can occur between the leader and another individual; between the leader and a group; or between a leader and an organization, a community, or a society. Defining leadership as a process helps us understand more about leadership than the traditional view of a leader being in a position of authority, exerting command, control, and power over subordinates. There are many more leaders in organizations than those who are in positions of authority. Each person has the potential to set goals and enact leadership. What this means for nurses as professionals is that nurses set goals and are leaders.
Leadership can be formal leadership, as when a person is in a position of authority or in a sanctioned, assigned role within an organization that connotes influence, such as a nurse manager (Northouse, 2018). The traditional formal leadership roles in nursing include clinical supervisor, unit/department manager, director of nursing and the top‐level nurse executive, usually called the chief nurse executive or chief nursing officer. Other formal leader roles in nursing include the charge nurse of a patient care unit, the Chief Operating Officer, of a hospital the nurse who leads interprofessional team rounds and the nurse who represents her unit/department at an event or meeting.
An informal leader is a person who demonstrates leadership outside the scope of a formal leadership role or as a member of a group rather than as the head or leader of the group. The informal leader is considered to have emerged as a leader when she is accepted by others, is an opinion leader, and is perceived to have influence. Informal leader roles in nursing include examples such as the staff nurse who regularly sets personal, proffessional, and patient care goals, assuring the delivery of safe, evidence‐based, patient‐centered, high quality care, including responding quickly to a code.
Leaders and Followers
Leaders and followers are both necessary roles. Nurses are alternately leaders and followers when they work with other health care team members to achieve patient care goals, participate in meetings, and so forth. The most valuable followers are skilled, self‐directed employees who participate actively in setting the group's direction and who invest time and energy in the work of the team or group, thinking critically and advocating for new ideas (Grossman & Valiga, 2013). Good followers communicate and work well with others, being supportive, yet thoughtful, in their approach to new ideas.
Leaders Versus Managers
Kotter (1990a) describes the differences between leadership and management in the following way: Leadership is about creating change. He says that leaders establish direction, align people through empowerment, and motivate and inspire others toward achieving a vision and creating meaningful change; whereas managers focus on managing, defined as planning and budgeting, organizing and staffing, problem solving, and controlling complexity. Complexity has to do with interdependence; being dependent on others to carry out our work. Interdependence requires coordination and cooperation. Managers engage in controlling complexity to produce predictability, stability, and order (Kotter, 1990b).
Nurses function as leaders when they demonstrate leadership characteristics in their personal and professional roles and work with other nurses and health care staff to lead patients, families, and communities to their best health. See Table 1.1 for examples of selected nursing leadership characteristics and personal and professional role activities.
Table 1.1 Nursing Leadership Characteristics and Role Activities
| Nursing leadership characteristics. | Examples of personal and professional nursing role activities, |
| Leadership establishes direction. | Nurses set personal, professional, and patient care goals. |
| Leadership aligns people through empowerment. | Nurses demonstrate leadership when they model high quality practices as they work to empower and mentor other nurses. |
| Leadership motivates and inspires others toward achieving a vision and creating meaningful change. | Nurses motivate members of the interprofessional health care team toward the delivery of safe, evidence‐based, patient‐centered, high quality care |
| Leadership is about service. |
Service is helping others or doing work for others. The profession of nursing
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