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Leadership styles and theories

Giltinane CL (2013) Leadership styles and theories. Nursing Standard. 27, 41, 35-39.
Date of submission: January 23 2013; date of acceptance: April 11 2013.

of Health (2007) suggests that the essence of

Abstract clinical leadership is to motivate, to inspire, to
promote the values of the National Health Service
It is useful for healthcare professionals to be able to identify the
(NHS), to empower and create a consistent focus
leadership styles and theories relevant to their nursing practice.
on the needs of the patients being served.
Being adept in recognising these styles enables nurses to develop their
A leaders role is to elicit effective performance
skills to become better leaders, as well as improving relationships with
from others. This involves leading and influencing
colleagues and other leaders, who have previously been challenging
the development of shared values, vision and
to work with. This article explores different leadership styles and
expectations to enhance their organisations
theories, and explains how they relate to nursing practice.
planned goals and overall effectiveness (Feather
2009). Traditionally, leaders were seen as having
Author different personality traits from those of followers
Charlotte Louise Giltinane (Winkler 2010). Grimm (2010) described these
District nursing sister, Cambridgeshire Community Services, Cambridge. traits as confidence, purpose, courage, ethical
Correspondence to: [email protected] fitness and ability to prioritise.
Whitehead et al (2009) proposed that although
Keywords some people are natural leaders, everyone can be a
leader, given the necessary knowledge and skills.
Emotional intelligence, leadership, leadership styles and theories
Mahoney (2001) and Cummings et al (2008)
suggested that leadership skills can be advanced
Review through education. One way is by using the
All articles are subject to external double-blind peer review and Leadership Framework (NHS Leadership Academy
checked for plagiarism using automated software. 2011), which was designed to enable healthcare staff
to understand their progression as leaders, and to
Online help and support nurses who are recognised as
potential leaders. Consisting of seven domains, the
Guidelines on writing for publication are available at
framework is based on the belief that leadership is
www.nursing-standard.co.uk. For related articles visit the archive
not restricted to people with designated leadership
and search using the keywords above.
roles, and that everyone can contribute to the
leadership process. Crevani et al (2010) supported
this by describing leaders as members of a group,
leadership is complex, comprising many with potential to influence that group.
definitions and qualities (Grimm 2010). One Successful organisations develop their leaders
definition of leadership is a multifaceted process of emotional intelligence by enhancing their
identifying a goal, motivating other people to act, self-awareness, self-management, social awareness
and providing support and motivation to achieve and social skills (Feather 2009). Emotional
mutually negotiated goals (Porter-OGrady 2003). intelligence has been defined as the ability to manage
Leadership, specifically in clinical practice, has the effect of emotions on relationships with others
been defined as direct involvement in clinical care (Walton 2012). Goleman (1998) believed that the
while constantly influencing others to improve the most effective leaders possess emotional intelligence.
care they provide (Cook 1999). The Department He suggested that even with high-quality training,

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 Art & science professional issues

good ideas and an analytical mind, a leader will not Although staff may dislike autocratic leaders, they
be great without emotional intelligence. often work well under them (Bass 2008). Schoel
While research on emotional intelligence has et al (2011) found that well-liked leaders might
developed, the concept remains controversial and be perceived as ineffective while disliked leaders
studies to test its effectiveness are rarely done well might be perceived as effective.
(Cavazotte et al 2012). Few studies have tested Autocratic leaders can be effective because they
whether emotional intelligence is associated with create good structure, and determine what needs
leadership emergence over and above cognitive to be done (Bass 2008). They provide rewards
intelligence, personality traits and gender (Ct for compliance, but punish disobedience (Bass
et al 2010). In studies examining emotional 2008). However, autocratic leaders can be abusive,
intelligence, it is difficult to control the personality create fear among staff and often make decisions
traits that might affect leadership styles. This can without consulting the team (Bass 2008). Followers
make emotional intelligence difficult to measure of an autocratic leader can rely heavily on their
(Cavazotte et al 2012). team leader and may underperform in the leaders
For leaders to identify followers emotions absence. Although the Nursing and Midwifery
accurately, they need to be aware of their own Council (2008) advises that all nurses are
feelings and emotions. Health care is constantly accountable for their actions, an autocratic leader
changing, which some employees may find will take full accountability. In this situation, leaders
overwhelming. Emotionally intelligent leaders will experience significant pressure while followers
not rush to fix, cure or control the responses of staff remain relatively stress-free.
to change, but are empathetic to their concerns, Transactional leaders can be categorised
allowing people to express their feelings without into three types: contingent reward, where
judgement, pressure or guilt (Feather 2009). These rewards are offered if certain criteria are met;
leaders recognise that emotions can change from one management by exception-active, where leaders
situation to another. By managing these emotions, aim to intervene in followers behaviours before
leaders can deal with the stress of failure or decisions they become problematic; and management by
that have led to poor outcomes (Feather 2009). exception-passive, where leaders do not intervene
until followers behaviour becomes problematic
(Horwitz et al 2008).
Transactional leadership When leadership is weak, poor performance is
Offering rewards to others in return for compliance not addressed, resulting in poor-quality patient
is defined as transactional leadership (Sims care and unacceptable behaviour being allowed
et al 2009). Burke et al (2006) suggested that to flourish (Bassett and Westmore 2012). The
transactional leadership, based on contingent management by exception-passive style is similar
rewards, can have a positive effect on followers to the laissez-faire style of leadership, in which
satisfaction and performance. However, a leaders have little control and provide minimal
transactional leader focuses on management tasks, direction (Marquis and Huston 2009). Unlike
and will not identify shared values of a team. By transactional leaders, the laissez-faire leader does
contrast, transformational leaders inspire others not plan or co-ordinate and there is little co-operation
with their vision and work together with their from followers. Laissez-faire leaders are likely to
team to identify common values (Marquis and be inefficient and unproductive (Marriner Tomey
Huston 2009). The transactional approach is 2009). Whitehead et al (2009) suggested that
task-orientated and can be effective when meeting mature followers can thrive under laissez-faire
deadlines, or in emergencies such as when dealing leadership as they need little guidance; however,
with a cardiac arrest. This approach can lead to others may struggle. Box 1 provides a reflective
non-holistic patient care, because nurses focus on description of working for an autocratic leader.
the task they need to complete, rather than the
patient as a whole (Bach and Ellis 2011).
Autocratic leadership is an example of Transformational leadership
transactional leadership. Autocratic leaders have Transformational leaders recognise followers
been described as controlling, power-orientated potential, but in terms of Maslows (1987) hierarchy
and closed-minded (Bass 2008). They stress of needs, will go further to satisfy their higher
obedience, loyalty and strict adherence to the needs such as self-esteem and achieving their full
rules (Bass 2008). Autocratic leaders may be potential to engage followers fully. Vinkenburg
disliked by their team, but this may evolve into et al (2011) suggested that transformational leaders
appreciation and fondness once the positive results inspire their followers to go beyond the call of duty
of their leadership become evident (Bass 2008). and act as mentors. Rolfe (2011) stated that leaders

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 should be visible role models and empower followers they work well with each other. (Marriner Tomey
to become leaders. Empowered followers possess 2009). Democratic leaders consult followers before
increased organisational loyalty, motivation and job making decisions, but consulting many people can
satisfaction, reducing sickness levels and promoting be time consuming and the democratic style may
a positive work environment (Rolfe 2011). This may be frustrating for those wanting rapid decisions
be because leaders display the skills required (Marquis and Huston 2009). Whitehead et al (2009)
to develop successful relationships with followers, suggested that although democratic leadership can
in an environment where both leaders and followers be less effective than other forms of leadership, it can
aim to meet the organisational goals necessary to be more flexible, and usually increases motivation
fulfil the teams vision. and creativity. Box 2 provides a reflective description
Transformational leaders express a clear, of working for a democratic leader.
compelling vision of the future, intellectually When leading an individual, transformational
inspire followers, identify individual differences leaders aim to develop their full potential by
and assist followers to develop their strengths enhancing their abilities and skills, and improving
(Bass 2008). Sims et al (2009) suggested that self-esteem. They achieve this by taking an interest
transformational leaders provide inspiration in staff as individuals, and providing tailored
and motivation to invigorate others to pursue support. When dealing with groups, these leaders
the teams vision. If followers have input into the aim to express the significance of group goals,
teams vision they feel valued, and the relationship develop shared values and beliefs, and motivate
between leader and follower is enhanced. This a united effort to achieve group goals (Wang and
encourages followers to develop ownership of the Howell 2010).
teams vision and move towards achieving this, Effective transformational leadership requires
thereby increasing morale. Followers become trust between the leader and followers. If
motivated to develop their own leadership followers trust the leader they will do whatever
skills (Rolfe 2011). the leader envisions (Bach and Ellis 2011). Rolfe
Horwitz et al (2008) identified different types (2011) recommended that to develop trust,
of transformational leadership. Inspirational leaders should treat everyone in they way they
motivation is where leaders influence followers
through charismatic communication of a set of BOX 1
goals and motivate the team to achieve them. Reflective description of working for an autocratic leader
Individualised consideration occurs when leaders
I have worked with a transactional clinical leader who was considered by
help followers achieve their desired essential
some team members to be harsh and abrupt. However, she would reward
needs. Idealised influence is divided into idealised tasks completed to a high standard by being pleasant and complimentary
influence attributed, in which the leaders for the rest of the shift. This style of leadership appeared effective at the
charisma is used to form strong positive emotional time as shifts ran smoothly when she was in charge. However, she was
bonds with followers, and idealised influence not a popular leader. New team members could be fearful of her because
behaviour, in which idealised behaviour of the she would shout orders. This leader was authoritative and commanded
leader becomes apparent in collective values and obedience from all staff.
actions throughout the organisation. Finally, While she was good at issuing orders and getting work done, she
intellectual stimulation pushes followers to think would not recognise staff members personalities and traits, allocating
creatively, and pursue new and creative ideas. people to work together who did not get along, causing arguments and
friction in the team. She was oblivious to this disharmony, and would not
Transformational leaders tend to adopt a
intervene until situations created problems.
democratic approach to leadership. Democratic
(Bass 2008)
leaders believe workers are motivated to do well;
they seek autonomy and opportunities to prove
themselves (Bass 2008). Democratic leaders are BOX 2
considerate and share responsibility with their
Reflective description of working for a democratic leader
followers. This allows followers to develop their
own leadership skills and become independent, I have worked with a transformational leader who encouraged me to
while reducing the leaders stress and risk of burnout learn more about and subsequently take on parts of a new role. This
(Bass 2008). However, Whitehead et al (2009) leader recognised my strengths in organisation and time management,
suggested that democratic leaders have less control and enhanced these skills by encouraging me to take on the role of
shift co-ordinator, and by asking me to complete clinical audits. The
than autocratic leaders, because they provide
enthusiasm and belief in my skills motivated me to complete these tasks.
guidance to their followers rather than controlling
This leader was also a democratic leader; considerate, maintaining good
them. They ask questions and make suggestions, working relationships, and consulting followers before making decisions.
rather than issuing orders. This can work well if (Bass 2008)
followers have adequate knowledge and skills, and

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 Art & science professional issues

would wish to be treated. Rolfe (2011) and Grimm The core competencies of situational leaders are
(2010) suggested that leaders should be honest, the ability to identify the performance, competence
acknowledge individual achievements, show interest and commitment of others, and to be flexible
in their working day, include followers in decision (Lynch et al 2011).
making and listen actively to what they are saying. Situational leadership has been defined as being
Trust between leaders and followers is important, based on a relationship between the leaders
because transformational leadership is an approach supportive and directive behaviour, and between
based on change. Leaders who use this approach the followers level of development (Grimm
are able to use their own qualities to motivate their 2010). Supportive behaviour involves the personal
followers to change (Grimm 2010). A leader who has involvement leaders have with their followers,
trust and support from his or her followers can lead a achievable by maintaining communication and
team through change more successfully than a leader providing emotional support. Directive behaviour
who does not (Bach and Ellis 2011, Rolfe 2011). is the amount of direction the leader provides to the
Transformational leadership is important for group, in terms of defining group roles. This can be
improving patient outcomes (Wong and Cummings achieved by the leader explaining the activities each
2007). Malloy and Penprase (2010) suggested role should complete and how these tasks are to be
that it can improve clinical environments so completed. The development level of the followers
clinical leaders can deliver quality agendas and is a result of their own experiences, willingness
ensure staff are engaged in the process. Research and ability to take on responsibility (Grimm 2010).
has shown that where there are well-developed This has also been referred to as the readiness level
transformational leaders, nursing teams take on a follower displays. For example, an enthusiastic
more responsibility, and have greater empowerment beginner would respond most effectively to directive
and job clarity (Dierckx de Casterl et al 2008). leadership (Papworth et al 2009).
The transformational leadership approach Clinical nurse leaders can apply the situational
is popular, but Bass (2008) and many other approach when supervising newly qualified nurses
management theorists have warned that or nursing students, as the leaders approach
transformational qualities need to be combined depends on the followers level of experience and
with traditional transactional management skills. confidence. A newly qualified nurse will have
This may require leaders to adopt an autocratic a base level of clinical knowledge, but will lack
style to manage staff sickness or conflict within the experience and confidence. In this case, the leader
team. This is reflected by Whitehead et al (2009), would adopt a more directive role until the nurse
who suggested that effective leaders need to have gains confidence and experience (Grimm 2010).
vision as well as a plan and structure if goals are to Situational leadership, also known as having
be accomplished. a contingency approach, has become popular, as
Although an effective approach, different situations require different leadership
transformational leadership does not address styles (Grimm 2010). Despite this, it has been
all relationship situations. Some management criticised for focusing too much on leaders and not
requirements of the leaders job can have a enough on group interaction (Parry and Bryman
negative effect on the relationship with followers. 2006), whereas transactional and transformational
For example, addressing issues such as sick leave theories are based on interactions between leaders
and team conflict can have a negative effect on and followers. People and leadership situations
relationships, yet they are essential to being an are complex, and therefore adaptability is
effective leader (Rolfe 2011). paramount to the situational leadership approach.
This approach encourages leaders to recognise
the complexity of work situations and consider
Situational leadership many factors when deciding which action to take
Since healthcare organisations face constant (Whitehead et al 2009). Box 3 provides a reflective
change, it is important for top-tier leaders to description of working for a situational leader.
encourage subordinate leaders to develop different
leadership styles to manage different situations
(Grimm 2010). This requires adoption of the Conclusion
situational leadership approach, where effective Various leadership styles and theories are relevant
leaders adapt their leadership style to manage to nursing practice. Despite studies examining
particular situations. For example, simple or and explaining leadership, no definitive theory has
complicated situations would be best handled emerged to guide leaders, and there is no definitive
through a task-orientated approach such as evidence on which theory is most effective
transactional leadership (Crevani et al 2010). (Rolfe 2011). Although many nurses prefer

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 the transformational leadership approach, the BOX 3
author believes a situational leadership approach
Reflective description of working for a situational leader
would be more suitable to cope with the ever-
changing NHS. Given the flexibility of situational In my role as mentor, I adapt my leadership approach to the students
leadership, leaders can adopt as many different knowledge and confidence. If I am mentoring a less confident or
leadership styles and theories as necessary. Nurses knowledgeable student, I provide more information and direction
than if I were teaching a more advanced and confident student. I also
are faced with many different situations every day,
perceive my clinical supervisor to be a situational leader. As well as a
and no particular leadership style is suitable for
great support to junior staff, she is approachable. However, she can be
all situations. Nurses should, therefore, be flexible autocratic in her role as a district nursing sister, which is essential when
in their leadership styles, and adapt these to fit making important decisions about caseload and staff management.
different circumstances NS

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