Feature

essential leadership skills for

motivating and developing staff
An empowered team is enthusiastic about its work and will deliver high quality care.
The key, argue Elizabeth Curtis and Rhona O’Connell, is transformational leadership

For the purpose of this article, leadership is defined

summary
as ‘the art or process of influencing people so
Achieving and sustaining high quality patient care that they will strive willingly and enthusiastically
and containing costs are important aspects of a nurse toward the achievement of group goals’ (Weihrich
manager’s role, and a successful manager needs to and koontz 2005). This means that, while leaders
have the skills and ability to motivate and develop are ideally the managers of groups, teams or
staff. This article focuses on how effective leadership organisations, leadership skills can be present in any
can increase motivation and empowerment among member of the groups.
nurses, examines the relevance of transformational According to Bass (1985), there are two styles
leadership to motivation, and suggests practical ways of leadership:
of maintaining a motivated work environment. ■■ Transactional, which describes the relationship
between leaders and employees as one in which
Keywords employees exchange some form of compliance
Motivation, empowerment, transformational for reward.
leadership ■■ Transformational, which is concerned with more
than just compliant behaviour from employees.
The skills needed to be a good clinical nurse are Transformational leaders can achieve greater
different from those necessary to manage wards performance by stimulating innovative ways
or service areas (sullivan and Decker 2009), and of thinking and transforming followers’ beliefs
nurse managers often assume expanded roles and and aspirations. They can see the importance
responsibilities without adequate support, resources of organisational change, have vision, and can
or education (Mathena 2002, Acree 2006). They also marshal commitment to that vision to support the
face competing priorities in their work and, when changes required.
resources and support are limited, opportunities to skilled communication is the main tool used by
develop effective leadership skills can be overlooked. transformational leaders to promote self-confidence
in a changing healthcare environment nurse within their teams and inspire trust. This style of
managers with effective leadership skills are vital leadership can result in a relationship of mutual
to maintaining high standards of nursing practice, stimulation and provide junior staff with the support
ensuring staff retention, improving standards to develop effective leadership skills (Burns 1978).
of care and increasing patient satisfaction levels Transformational leadership results in higher
(Raup 2008). To do this requires leaders with the levels of employee performance than that produced
ability to motivate and empower employees (Medley by transactional leadership (Bass 1985). Positive
and larochelle 1995) and develop their leadership relationships have consistently been found between
skills. This is particularly important in the current transformational leadership styles and employee
economic climate. motivation; research demonstrates higher levels
of employee effectiveness, and greater employee
Theories and customer satisfaction in comparison with
There is a plethora of leadership theories, and non-transformational leadership styles (Dvir et al
disagreement about definitions (hughes et al 2006). 2002, hetland and sandal 2003, ilies et al 2006).

32 September 2011 | Volume 18 | Number 5 NURSING MANAGEMENT

 Feature

Transformational leadership vision to empower their staff; Ohman (2000)

The Bass (1998) theory of transformational thus found a positive correlation between
leadership has four main components, which are: transformational leadership and previous leadership
■■ idealised influence, or charismatic leadership, experience.
where leaders are admired and respected by Meanwhile, studies in other disciplines have
those they lead. demonstrated positive relationships between
■■ inspirational motivation, where leaders inspire transformational leadership and motivation and
others with a team spirit and enthusiasm for the the development of junior staff (kane and Tremble
work at hand. 2000). in Norway, for example, when hetland
■■ intellectual stimulation, created by leaders with and sandal (2003) looked at transformational
problem-solving skills, creativity and the capacity leadership in five public and private sector
to advance knowledge or practice. companies, they found a strong relationship between
■■ individualised consideration, where leaders’ skills transformational leadership and satisfaction, work
are supportive of individuals’ needs. These leaders motivation and effectiveness, regardless of whether
provide mentorship to support and encourage the ratings were from superiors or subordinates.
staff to develop and advance their careers.
in contrast, transactional leadership is based Staff motivation
on individuals working at an agreed level of A transformational leadership approach can help
performance in return for a reward. it also means nurse managers to increase or maintain a motivating
that leaders intervene only if something goes wrong work environment. Although motivation is a
or standards are not met. multifaceted phenomenon, several strategies can
be used to increase employee motivation. Those
Theories in practice described below are based on work by Argyris (1964),
Carney (2006) suggests that 21st century health Rainey (1993), Daft (2004), Weihrich and koontz
care requires leaders to articulate a vision that (2005), and Marquis and huston (2009).
can motivate employees to adapt to changing
environments. leaders must recognise the culture Work environment This can affect employees’
of their organisations and be able to develop an development and potential. however, many
environment that is healthy and conducive to change. organisations do not encourage employees to behave
Transformational leadership embraces shared in a ‘mature’ way, in other words, work activities
accountability, responsibility and power, and are reduced to routine tasks and staff are not
empowers employees to help leaders and managers encouraged to be creative or invited to participate in
achieve organisational goals. This style of leadership decision making (Argyris 1964).
is consistent with the goals of contemporary By improving communication processes, for
healthcare environments. example through staff meetings, patient care
The importance of positive leadership styles has activities and team briefing meetings, organisations
emerged as an issue for nursing because of their can encourage innovation and creativity which, in
influence within healthcare work environments. For turn, will promote job enlargement and enrichment
example, one systematic review of a range of nursing (Argyris 1964).
leadership styles highlighted that a transformational,
or relationally focused, style was associated with Participation Technical ability and knowledge are
higher job satisfaction, improved organisational not sufficient for increasing nurses’ motivation levels
commitment, reduced stress, greater productivity (Vilma and egle 2007), but participation in decision
and greater empowerment (Cummings et al 2010). making is a strategy that can be used to achieve this
Transformational leadership is a recognised (Weihrich and koontz 2005).
element in employees’ attachment to an organisation Most employees are knowledgeable about their
(Chiok Foong loke 2001, leach 2005), and it also jobs and can usually find solutions to problems
has an impact on nurse retention (Force 2005), job that arise, so asking the right employees to
satisfaction and wellbeing (Nielsen et al 2008). in participate in decision making can increase their
contrast, transactional, instrumental, task-oriented motivation and assure them that they are valuable
or ‘laissez faire’ leadership styles are associated with to the organisation.
negative outcomes (Cummings et al 2010). Where employees perceive that their
Ohman (2000) reports that critical care nurse contributions are valued, their sense of affiliation
managers had high levels of transformational and loyalty towards organisations is increased.
leadership behaviours, and used motivation and Being given opportunities to plan and delegate

NURSING MANAGEMENT September 2011 | Volume 18 | Number 5 33

 Feature

care, solve problems, make decisions and conduct by various types of organisations to improve their
research are also important factors for improving working environments (Rainey 1993).
staff motivation. Managers should consider These programmes are considered one of the
open-door policies, one-to-one discussions or most appealing approaches to motivating employees
exchanges, and improved communication as and have made significant contributions to the
strategies for increasing employee participation development of job enrichment (Weihrich and
(Rainey 1993). koontz 2005). Managers regard QWl as a useful
strategy for addressing poor productivity, while
Work enhancement Working practices change over employees and unions have endorsed its use to
time, and the jobs and tasks that support this work improve working conditions and defend pay
also change. in general, managers can deal with the negotiations (Weihrich and koontz 2005). in fact,
effects of sudden changes to work practices, but some government agencies have found QWl
gradual changes can significantly alter how a ward programmes beneficial for increasing productivity
or unit works. Managers are usually required to and reducing industrial disputes (Weihrich and
carry out periodic assessments of work practices to koontz 2005); for example, the Midland health Board
ensure that the jobs supporting the work are aligned in the Republic of ireland introduced such a
with new practices (layman 2007). Factors that programme in 2002.
contribute to work or job redesign include changes The QWl strategy stresses the importance of the
in health care or organisations, but they can also be human aspects of work by exploring the relationship
the result of a decline in employees’ motivation or between employees and work environments, and
performance, or an increase in stress. generally addresses areas such as work-life balance,
Job redesign refers to altering or adapting roles health promotion and staff appreciation activities.
to improve employees’ satisfaction, control and
interest. The approaches used to achieve this are Empowerment This is another strategy for
usually referred to as ‘job enrichment’, ‘job improvement adopted by leaders (hughes et al 2006).
enlargement’ or ‘job rotation’ (ho et al 2009). Job in addition to enhancing motivation, empowerment
enrichment and enlargement are different concepts, can reduce resistance to change and is therefore
although this is not always made clear in the essential to successful implementation of change
literature (Daft 2004, Weihrich and koontz 2005). (kappelman and Richards 1996). it is, however,
another term with a range of interpretations.
Job enrichment This refers to the integration of hughes et al (2006) suggest two definitions:
higher level motivators into work, for example, the first is when empowerment is concerned
offering variety, freedom to make decisions about the with delegation and accountability, in which
job or task, greater participation in decision making, a top-down approach is used by senior managers
more responsibility, giving feedback on performance to communicate the organisations’ goals that
and involvement in change initiatives. employees are responsible for achieving. The second
uses a bottom-up approach and emphasises trust,
Job enlargement This is about decreasing the ownership and change, and encourages employees
monotony associated with simple, repetitive jobs by to ask questions and make decisions.
combining a set of related tasks to create a broader The two approaches have different implications
job. in other words, the scope of the job is increased for leaders and employees. hughes et al (2006)
by including more of the same kind of tasks, but suggest that it is this conceptual imprecision that
with no added responsibility. has led to the failure of empowerment programmes.
it is, therefore, important that healthcare managers
Job rotation This occurs when employees are moved adopting this strategy to increase motivation
from one job to another, which can increase the consider the different concepts of empowerment.
number of tasks they might be required to undertake One study that explored nurses’ experiences
without increasing the complexity of the job. One of work motivation and satisfaction found that
example is nurse rotation from day to night duty. motivation levels decreased (Vilma and egle 2007),
when they were not empowered or did not engage
Quality of work life This describes a set of values in autonomous activity.
that advocates that people are the most valuable
asset in an organisation and should be valued and Role models Managers can also affect employees’
treated with respect and dignity (Raduan et al 2006); motivation, and those with optimistic and
quality of work life (QWl) programmes are used enthusiastic outlooks can have positive and

34 September 2011 | Volume 18 | Number 5 NURSING MANAGEMENT

 Feature

motivating effects on employees and the climate in should consider providing training in enthusiasm for
which they work. Conversely, unhappy managers their managers.
can have a negative effect on employees’ morale
(Marquis and huston 2009). Conclusion
sirota et al (2005) claim that employees’ job health care operates in a busy and changing
satisfaction declines after they have worked for environment, so to maintain high standards of
an organisation for about six months; one of the patient care and effectively and efficiently manage
reasons cited for this is that managers do not show services requires a special kind of leadership.
concern for their employees. To maintain employees’ Transformational leadership is a suitable choice
enthusiasm, managers must move away from the for nursing because it promotes participation and
notion that they require constant supervision and empowerment and increases staff motivation.
instead acknowledge that they require social contact There are several strategies in this leadership
Online archive
and friendship, and should be treated with fairness, style that nurse managers can use to maintain or For related information, visit
our online archive of more
respect and dignity (sirota et al 2005). increase motivation, including creating a work
than 6,000 articles and
Research on ‘work locus of control’ and ‘work environment that encourages employees to behave search using the keywords.
excitement’ suggests a significant correlation in a mature and creative way, enabling participation
between the two (erbin-Roesemann and simms 1997); in decision-making processes, enhancing work
This article has been subject
in other words, those who have control in their work environments by aligning changes in practice to to open review and has been
will experience higher levels of ‘work excitement’. the jobs and tasks that support them, increasing checked using antiplagiarism
This is defined by erbin-Roesemann and simms workers’ empowerment, and offering a better quality software. For author
guidelines visit the Nursing
(1997) as ‘personal enthusiasm and interest in work of work-life balance. Management home page at
as evidenced by creativity, receptivity to learning, Nurse managers should also consider developing www.nursingmanagement.co.uk
and ability to see opportunity in everyday situations’, junior staff’s leadership skills, particularly in
Elizabeth Curtis is lecturer
they suggest that work should be reorganised so that situations where there are nurse shortages or at the school of nursing and
employees experience greater excitement. where nurses are reluctant to undertake leadership midwifery, Trinity College Dublin
Meanwhile, Glassman and McAfee (1990) roles. leadership in nursing is critical to ensuring
Rhona O’Connell is lecturer at the
claim that the absence of enthusiasm is a major consistent standards across all aspects of care and school of nursing and midwifery,
shortcoming in leadership and that organisations building an environment for excellence. University College Cork

References
Acree C (2006) The relationship between experiment. The Academy of Management Kane T, Tremble T (2000) Transformational Ohman K (2000) The transformational
nursing leadership practices and hospital Journal. 45, 4, 735-744. leadership effects at different levels of the leadership of critical care nurse-managers. Morr
nursing retention. Newborn and Infant Nursing army. Military Psychology. 12, 2, 137-160. Dimensions of Critical Care Nursing. 19, 1, betwe
Erbin-Roesemann M, Simms L (1997) job s
Reviews. 6, 1, 34-40. 46-54.
Work locus of control: the intrinsic factor Kappelman L, Richards T (1996) Training, Admi
Argyris C (1964) Integrating the Individual and behind empowerment and work excitement. empowerment, and creating a culture for Raduan C, LooSee B, Jegak U et al (2006)
the Organization. John Wiley, New York NY. Nursing Economics. 15, 4, 183-190. change. Empowerment in Organizations. Quality of work life: implications of career
4, 3, 26-29. dimensions. Journal of Social Sciences. Bucc
Bass B (1985) Leadership and Performance Force M (2005) The relationship between
2, 2, 61-67. at an
Beyond Expectations. Free Press, New York NY. effective nurse managers and nursing retention. Layman E (2007) Job redesign and the health
JONA: The Journal of Nursing Administration. care manager. Health Care Manager. 26, 2, Rainey H (1993) Work motivation. in 1, 11
Bass B (1998) Transformational Leadership.
35, 7-8, 336-341. 98-110. Golembiewski R (ed) Handbook of Organisational McNe
lawrence erlbaum, New York NY.
Behavior. Marcel Dekker, New York NY. produ
Glassman M, McAfee B (1990) enthusiasm: Leach L (2005) Nurse executive transformational
Burns J (1978) Leadership. harper & Row, comm
the missing link in leadership. SAM Advanced leadership and organizational commitment. Raup G (2008) The impact of eD nurse
New York NY. Admi
Management Journal. 55, 3, 4-6, 29. Journal of Nursing Administration. 35, 5, manager leadership style on staff nurse turnover
Carney M (2006) Health Service Management: 228-237. and patient satisfaction in academic health Wong
Hetland H, Sandal G (2003) Transformational
Culture, Consensus & the Middle Manager. Oak center hospitals. Journal of Emergency Nursing. betwe
leadership in Norway: outcomes and personality Marquis B, Huston C (2009) Leadership Roles
Tree Press, Cork. 34, 5, 403-409. syste
correlates. European Journal of Work and and Management Functions in Nursing: Theory
Chiok Foong Loke J (2001) leadership Organizational Psychology. 12, 2, 147-170. and Application. sixth edition. lippincott, Sirota D, Mischkind L, Meltzer M (2005) 15, 5
behaviours: effects on job satisfaction, Williams & Wilkins, Philadelphia PA. The Enthusiastic Employee: How Companies in
Ho WH, Chang CS, Shih YL et al (2009) effects
productivity and organizational commitment. Profit by Giving Workers What They Want.
of job rotation and role stress among nurses on Mathena K (2002) Nursing manager leadership
Journal of Nursing Management. 9, 4, 191-204. Wharton school Publishing, indianapolis iN.
job satisfaction and organizational commitment. skills. Journal of Nursing Administration.
Cummings G, MacGregor T, Davey M et al BMC Health Services Research. 9, 8. 32, 3, 136-142. Sullivan E, Decker P (2009) Effective Leadership
(2010) leadership styles and outcome patterns and Management in Nursing. seventh edition.
Hughes R, Ginnett R, Curphy G (2006) Medley F, Larochelle D (1995) Transformational
for the nursing workforce and work Prentice hall, Upper saddle River NJ.
Leadership: Enhancing the Lessons of Experience. leadership and job satisfaction. Nursing
environment: a systematic review. International
Fifth edition. McGraw-hill, Boston MA. Management. 26, 9, 64-69. Vilma Z, Egle K (2007) improving motivation
Journal of Nursing Studies. 47, 3, 363-385.
among health care workers in private health
Ilies R, Judge T, Wagner D (2006) Making Nielsen K, Yarker J, Brenner S-O et al (2008)
Daft R (2004) Management. sixth edition. care organisations: a perspective of nursing
sense of motivational leadership: the trail from The importance of transformational leadership
Thompson/south Western, Mason Oh. personnel. Baltic Journal of Management.
transformational leaders to motivated followers. style for the well-being of employees working
2, 2, 213-224.
Dvir T, Eden D, Avolio B et al (2002) impact Journal of Leadership & Organisational Studies. with older people. Journal of Advanced Nursing.
of transformational leadership on follower 13, 1, 1-22. 63, 5, 465-475. Weihrich H, Koontz H (2005) Management:
development and performance: a field A Global Perspective. McGraw-hill, singapore.

NURSING MANAGEMENT September 2011 | Volume 18 | Number 5 35