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 is founded on serving others in need of health care. Leadership is serving others through leading. This concept has been popularized as servant leadership (Greenleaf, 1970/2008; Keith, 2016). The premise is that servant leaders want to serve first, whereas other leaders lead first. |
| Leadership is about people and relationships. | Nurses demonstrate leadership and play roles in patient outcomes when they build relationships with patients and their significant others (Wong & Cummings, 2007). |
| Leadership is contextual. | Nurses demonstrate leadership when they adjust their leadership styles, to achieve nursing goals. A major context evolves around the interrelationships that nurses have with others (Spence Laschinger, Finegan, & Wilk, 2009). |
| Leadership is about using communication that inspires others. | Nurses demonstrate leadership when they monitor the meaning of what is being communicated, both verbally and nonverbally, and manage the situation to achieve goals for all involved, using communication that is clear and inspiring |
| Leadership is about balancing. | Nurses demonstrate leadership when they multitask and balance all that they do to achieve nursing goals. Leadership is also about pursuing a work and life balance in order to sustain one's personal and professional self and be available for others. |
| Leadership is about continuous learning and improvement. | Nurses demonstrate leadership by developing personal and professional goals and continuing to grow their knowledge and expertise. |
| Leadership is about effective decision making. | Nurses demonstrate leadership when they make effective, evidence‐based decisions. Nurses must be autonomous in their decision making yet also work with other health care team members to assure the best care for their patients (Wong & Cummings, 2009). |
| Leadership is a political process. | Nurses demonstrate leadership when they participate in the hospital and in the community, join hospital and community Boards of Directors, and participate in various political processes locally and globally. |
| Leadership is about integrity. | Nurses demonstrate leadership when they consistently model integrity, honesty, fairness, and morality. |
Note: Adapted from Moore, J. (2004). Leadership: Lessons learned. Terre Haute, Indiana, and the author's personal observations.
Leadership Characteristics
One popular way of characterizing leadership is by describing it as authentic leadership. The American Association of Critical Care Nurses in their landmark work, AACN Standards for Establishing Healthy Work Environments: A Journey to Excellence, cite authentic leadership as one of the key standards necessary for establishing a healthy work environment. AACN's belief is that to establish and sustain healthy work environments for nurses, leadership that is authentic is a critical element. Authentic leadership requires skill in the core competencies of self‐knowledge, strategic vision, risk taking and creativity, interpersonal and communication effectiveness, and inspiration (American Association of Critical Care Nurses (AACN), 2004; Raso, 2019).
Leaders are also described by fundamental qualities that effective leaders have been found to share (Bennis & Nanus, 1985). The first quality is a guiding vision. Leaders focus on a professional and purposeful vision that provides direction toward a preferred future. The second quality is passion. Passion expressed by the leader involves the ability to inspire and align people toward the promises of life. Passion is an inherent quality of the nurse leader. The third quality is integrity that is based on knowledge of self, honesty, and maturity developed through experience and growth. Other leadership qualities include self‐awareness—knowing our strengths and weaknesses—that can allow us to use feedback and learn from our mistakes (McCall, 1998). Daring and curiosity are also basic ingredients of leadership that leaders draw on to take risks, learning from what works as much as from what does not work (Bennis & Nanus, 1985).
Certain characteristic traits are commonly attributed to leaders. These traits are considered desirable and seem to contribute to the perception of being a leader; intelligence, self‐confidence, determination, integrity, and sociability (Stodgill, 1948, 1974). Research among 46 hospitals designated as Magnet® Hospitals by the American Nurses Center for Certification (ANCC) for their success in attracting and retaining registered nurses reported that nurse leaders who are visionary and enthusiastic, are supportive and knowledgeable, have high standards and expectations, value education and professional development, demonstrate power and status in the organization, are visible and responsive, communicate openly, and are active in professional associations are valued (Kramer, 1990; Kramer & Schmalenberg, 2005; McClure & Hinshaw, 2002; McClure, Poulin, Sovie, & Wandelt, 1983). Research findings from other studies on nurses revealed that caring, respectability, trustworthiness, and flexibility were the leadership characteristics most valued. In one study, nurse leaders identified managing the dream, mastering change, designing organization structure, learning, and taking initiative as leadership characteristics (Murphy & DeBack, 1991). Research by Kirkpatrick and Locke (1991) concluded that leaders are different from non‐leaders across six traits: drive, the desire to lead, honesty and integrity, self‐confidence, cognitive ability, and knowledge of the business. Although no set of traits is definitive and reliable in determining who is a leader or who is effective as a leader, many people still rely on many of these traits to describe and define leadership characteristics.
Leadership Theories