The NHS is one of the most complex organisations to manage and lead. As a nurse and a senior manager in the NHS, I recognise the vital role that nurse leaders play in shaping the culture, effectiveness and resilience of our healthcare teams. Nurse leaders are pivotal in bridging the gap between frontline care delivery and higher level organisational strategy, making their leadership indispensable for improving patient care and staff wellbeing.
The Royal College of Nursing (RCN) has outlined an array of leadership roles from team leader to director of nursing (RCN, 2023). These roles embody more than just managerial responsibilities; they involve acting as role models and change agents, upholding the highest standards of care and inspiring colleagues to do the same.
There is an ongoing discussion within healthcare circles about the interplay between management and leadership (Hill, 2017). Managers often focus on the immediate issues of administration and control. Leaders, however, look to inspire and innovate, aiming for long-term improvements (Samarakoon, 2019).
One of the key challenges that nurse leaders often face is navigating through an environment of constant change and regulatory scrutiny. Balancing the daily operational duties with the need for strategic planning and innovation is a complex task (Hill, 2017). The skills honed through specialised training are invaluable in achieving this balance.
Nurse leaders have significant influence over work environments and staff behaviour. It is crucial to understand the impact of various leadership styles.
‘Transactional leadership’ focuses on ‘transactions’ between leaders and team members (Hill, 2017; Samarakoon, 2019). The leader specifies tasks and expects compliance. Although this ‘get the job done’ approach can be useful in emergency settings or when under tight deadlines, it often falls short in promoting holistic, value-based care.
In contrast, ‘transformational leadership’ aims to elevate both leaders and followers to higher levels of motivation and morality. Transformational leaders communicate a vision, inspiring staff and fostering a workplace where team members feel energised, valued, and invested in making a difference (Hill, 2017; Samarakoon, 2019).
‘Situational leadership’ theory suggests that effective leadership adapts according to the team's skills, knowledge, and situation. The approach uses a blend of four leadership styles tailored to varying levels of staff ‘maturity,’ thus offering a balanced way to meet the diverse needs of health professionals (Hill, 2017; Samarakoon, 2019).
The Francis report (2013) on the Mid Staffordshire Hospitals tragedy highlighted the need for such adaptability. Neither a purely transactional nor a transformational approach could have single-handedly addressed the failures in clinical management. A balanced, situational approach – adapting to the specific needs and challenges presented – could have potentially mitigated some of the issues. Leaders must become adept at shifting between these styles.
Clinical leadership has a direct impact on patient care and workplace culture. A study by Sabbah et al (2020) examined how nurses' perceptions of their managers' leadership styles affected their wellbeing. It found that transformational leadership positively influenced most aspects of nurses' quality of life, while transactional leadership had a limited positive impact. A ‘laissez-faire’ style, however, was linked to lower scores in emotional and physical wellbeing.
Nurse leadership demands a balanced skill set of management prowess and inspiring leadership. The demands are high, but the rewards, in terms of patient care and professional development, are unparalleled. If you are a nurse contemplating a leadership role, I highly encourage you to take that step and be the change you wish to see in the NHS.