Leadership in Nursing

Leadership in Nursing

Clinical Leadership

Florence Nightingale summed up the essence of leadership when she stated that, “Let whoever is in charge keep this simple question in her head … how can I provide for the right thing to be always done?” (Downey, Parslow, and Smart, 2011) Clinical leaders strive always to do the right thing, ensure that their support and staff services always do the right thing for the patients, and go further to look for best interventions for best outcomes (Bowers, 2019). Therefore, clinical leadership focuses on the healthcare and client teams, such as the ones that advocate for patients, communicating with patients, healthcare teams, and families. Patrick et al. (2011) define clinical leadership as nursing behaviours that provide support and direction to clients and the entire healthcare team in patient care delivery. A clinical leader is a Registered Nurse (RN) who can coordinate and influence healthcare teams, patients, and their families to integrate the care that they provide to achieve positive patient results and outcomes (Robert, Hinds, Nelson, and Robinson, 2014). Basing on this definition, therefore, all RNs are clinical leaders, especially those RNs who are at the bedside.

Leadership vs. Management

The terms leaders and managers are the most commonly used interchangeably in the business world. However, these two terms have entirely different meanings, and their applications are distinct. A manager is a staff member responsible for carrying out the four most important functions, such as organizing, planning, controlling, and leading (Pihlainen, Kivinen, and Lammintakanen, 2016; Institute of Medicine, 2010). Leaders, on the other hand, do not necessarily occupy a managerial position in an organization. A leader does not have to have authority in the organization, and anyone can be a leader provided they possess specific leadership attributes (Grohar-Murray, DiCroce, and Langan, 2016).  Typically, there is no formal authority given to leaders, but temporary power can be given to them based on their ability to continuously inspire and motivate others.

Effective nursing leadership

Effective nursing leadership is crucial for the optimization of healthcare services in all healthcare facilities. Nurse leaders can get training on interdisciplinary leadership strategies and use them in their practice to make sure that their teams and followers are well motivated to provide high-quality care for their patients (Chappell, Richards, and Barnett, 2014). Practical nursing entails certain qualities that must be practised in healthcare facilities.

Change Management

The healthcare setting is always transforming, and therefore, nursing leaders should be able to guide their teams as they adapt to new situations and challenges in their workplaces. This capability requires transparency and patience because each person has different mechanisms for coping with change in the field (Reem, Kitsantas, and Maddox, 2014; Walton et al., 2015). Nursing leaders should always anticipate and plan for changes transparently and openly, as this allows the staff to participate and voice their concerns regarding the change (West et al., 2015). Effective nurse leaders should note staff members who may resist specific organizational changes and look for ways to explain to them the benefits of successful change implementation (Chappell, and Richards, 2015; Kear, 2019). As health facilities continue to introduce multiple changes, effective nurse leaders should also aim to identify team members who are likely to adopt early to changes, because such employees will help others to understand the significance of the changes being made.

 Service-Oriented

In busy situations, the number of tasks that nurse leaders coordinate is usually overwhelming. No matter the amount of pressure and the challenges they face, effective nurse leaders should strive to achieve the highest levels of patient satisfaction. However, sometimes, a personalized emphasis on patient-satisfaction is not enough (Stanley and Sherratt, 2010). Nurses who are effective also focus on devotion to implementing a culture of service orientation that all employees should embody (Curtis, de Vries, & Sheerin, 2011). Effective nurse leaders can attain this through planned activities such as nurse training on how to use scripts to give directions for public interactions (Curtis, de Vries, & Sheerin, 2011). Developing such a system helps nurse leaders to foster a positive environment that is welcoming, comfortable, and friendly to patients and their families, even in frustrating or stressful times.

Creating Learning Opportunities for Employees

When employees are uncertain about how to complete difficult tasks, effective nurse leaders are tasked with three primary responsibilities. They should find an alternative person to perform the job, perform the task themselves, or teach the employees how to complete the task (Reem, Nassar, and AL-Dossary, 2017). Effective nurse leaders should make an extra effort to choose other alternatives as often as possible. Patient safety and satisfaction should take priority over staff training and education, and so effective nurse leaders should leave potentially dangerous or time-sensitive tasks to only competent employees (D’Innocenzo, Mathieu, & Kukenberger, 2014). Dedicated leaders should assess a current situation and act on it to ensure that employees know what to do in case such a situation occurs again.

Conflict Resolution

Conflicts are inevitable in any collaborative setting, including healthcare settings. Disputes can occur among nurses, between nurses and physicians, pr among other members of the staff. However, competent nurses must have adequate training in conflict resolution and problem-solving. Although there are many possible responses to adverse situations, compromise, and collaboration often produce positive results (Bressan et al., 2016). Being aware of how to reach agreements provide effective leaders with the tools and techniques they required to resolve altercations between their team members before they escalate. A competent nurse should be able to determine whether or not to intervene in the conflict (Farag et al., 2017). However, if the dispute is likely to harm the organization, effective nurse leaders should work towards getting to the root of the conflict and assume the role of an arbitrator; making sure that communication lines remain open long enough for a solution to occur (Dixon-Woods et al., 2014). After recognizing the goals and motivation of both parties in the conflict, effective leaders should leverage the information to help the parties reach a mutual solution.

Dedication to Excellence

Effective nurse leaders are experts who take control of offsetting goals for their departments. Commitment to excellence requires nurse leaders to focus on making sure that their teams provide quality patient care (Cummings et al., 2008). As a professional, nurse leaders should always strive for staff excellence by setting goals and committing to meet them within a specific timeframe.

Roles of nurses in healthcare

Nurses play a crucial role in the healthcare system. Nurses are at the forefront of everyday catering to the sick, counselling patients, and improving healthcare processes through the entire system. Nurses play many roles in the system, as stipulated by their job description. These include:

Patient Care

Nurses act as caregivers for patients and help to manage their physical needs, prevent illnesses, and treat certain health conditions. To perform these tasks, nurses need to monitor and observe patients, documenting any relevant changes to aid in making decisions about their treatment (Bodenheimer & Bauer, 2016). Through the entire treatment process, nurses follow their patients’ progress and act accordingly to their patient’s best interests. Nurses provide care that goes beyond medicine administration and other medical therapies. Nurses are tasked with holistic patient care, which includes the physical, psychological, cultural, spiritual, and developmental needs of the patients (Chavez, Kelly, Kunisch, and Karth, 2019).

Advocating for patients

Patients are the number one priority for nurses. Therefore, nurses are responsible for advocating for the patients’ best interests and maintaining the dignity of the patients throughout the care and treatment process (Gureje et al., 2019). This advocacy may include providing suggestions for patient treatment plans with other professionals in the field. This is an essential role because patients who are not well may be unable to understand or comprehend medical situations and behave as they would typically (Gureje et al., 2019). Nurses have the responsibility of supporting the patient and representing their best interests at all times.

Planning of Care

Nurses are directly involved in the process of decision-making regarding the treatment of patients. It is, therefore, important that nurses have critical thinking skills during the patient assessment to identify potential issues to enable them to make appropriate and accurate recommendations and actions (Dubree et al., 2018). Like other health experts such as doctors and physicians are usually responsible for making decisions for final treatment, nurses should also communicate vital information about the patient’s health effectively. Nurses are more conversant with specific individual cases because they monitor their symptoms continuously and should, therefore, collaborate with other professionals to improve patient outcomes (Salbakken, Bondas, and Kasen, 2019).

Patient Education and Support

Nurses also have the responsibility of ensuring that patients understand their health status, conditions, treatment procedures, and medications as best as they can. This is essential, especially when patients are discharged from hospital and need to control their medications and treatments (Halcomb et al., 2016). Nurses should take extra time to explain to patients and their families what to do next and the expectations they should have after leaving the medical facility. They should ensure that patients feel supported and are aware of the procedures to take in case they need additional information.

Role of a Nurse Leader

Over the past decades, nurses have adopted more significant roles and responsibilities. As the nursing roles transform from doctor’s assistants to that of crucial members of the healthcare and life-saving team, there emerged the role of the nurse leader. Nurse leaders are responsible for guiding nurses and ensuring that they adhere to high-quality standards and safety (Nagel & Andenoro, 2012). Nurse leaders are tasked with three primary responsibilities. First, nurse leaders should ensure quality and safe care delivery, and so they must be familiar with all safety policies and regulations of their field and their facility. They should supervise nursing team members to make sure that all patients receive quality and safe care. Secondly, nurse leaders need to maintain evidence-based services within their practices (Hardacre et al., 2011). Thirdly, nurse leaders have a role in monitoring the quality of care that other nurses offer to patients to ensure that nurses are working towards optimizing quality nursing standards at all times. Nurse leaders are expected to take patient concerns seriously and provide appropriate solutions to them. Nurse leaders are expected to promote and improve the quality of life for all patients and their families by providing the highest standards of care.

The relevance of Nurse Leadership

Nursing leadership is relevant in the health sector for a variety of reasons. First, nurse leaders play a crucial role in sustaining the production, cost-effectiveness, and efficiency of nursing services. Effective leaders empower their subordinates while providing care that directs and supports the needs of patients, their families, and the entire organization. Furthermore, nursing leadership has positive impacts on the quality of care and patient safety (AL-Dossary, Kitsantas, and Maddox, 2016). It is also essential to highlight the effects that nursing leadership has on patient outcomes. Nurse leaders prioritize patient safety while performing nursing duties such as management of medication, infection control, patient education, and wound care. All these services improve patient care to achieve optimal results and outcomes (Wong, Cummings, and Ducharme, 2013). There is a positive correlation between nursing leadership activities and patient outcomes.

Effective nursing leadership is associated with low hospital stays, lower medical errors, infections, and falls in patients. It also improves the quality of care given to patients, thus improving patient outcomes and reducing the mortality of patients (Keys, 2014). Effective nurse leaders positively influence medical settings and enhance the safety of patients. It is, therefore, evident that nursing leadership helps to achieve quality and safe care, as well as optimal results, all of which reinforce its importance (AL-Dossary, Kitsantas, and Maddox, 2016). Nurse leaders must acknowledge challenges and welcome them without fear or resentment. They must accept and recognize the limits or challenges and recognize the potential of failure. Nurse leaders should also admit that they do not have answers to all questions and present nursing views concerning their leadership roles.

Factors behind Ineffective Nursing Leadership

Nursing leadership is mostly concerned with the personal attributes and skills of the nurse. However, some external and internal factors may also contribute to ineffectiveness in nursing leadership. Ineffectiveness may also have adverse effects on patient care and the overall success of the organization. Some of the factors that contribute to inefficiency in nursing leadership include

Time Constrains

Hospitals are generally busy places with a buzz of activities. Nurses are sometimes expected to beat deadlines within a specified period for them to achieve effectiveness. However, the time allocated may not be enough for nurse leaders to attain set goals, and this may lead to ineffectiveness (Dwyer, 2011). For example, nurse leaders may be expected to conduct nurse training within a week. This time may not be enough for them to have imparted adequate knowledge to ensure effectiveness.

Lack of Leadership Education

Sometimes, nurses assume leadership roles without adequate or proper leadership education in their area of specialization. For example, a nurse may take a leadership position in organizational change. However, without appropriate skills and training about effectively implementing organizational change, the nurse may face resistance for the change, and the project may end up failing (Elliott, Begley, Sheaf, and Higgins, 2016). Adequate leadership education is essential for effectiveness.

Lack of Organizational Support

There are many times when nurse leaders may want to accomplish specific deals or initiatives within the organization, but they lack support. Many times this support is in the form of funds, resources, and even time (Elliott et al., 2016). Management may feel that ideas by the nurse leader are costly and irrelevant. Without proper support, nurse leaders may not achieve effectiveness in their duties.

Fictive Scenarios Displaying Different Leadership Styles

1. a) Noelle is a nurse leader at St. Mary’s Hospital. She leads by dictating orders and always has the highest expectations from employees. She does not ask or expect any feedback from her subordinates and is always in control at all times. Noelle does not give employees a chance to air their opinions; instead, she makes decisions on her own and employs her workers to adhere to them. If her employees perform contrary to her expectations, she does not hesitate to give harsh punishment to serve as a lesson to others. Noelle believes that knowledge is power, and so she withholds vital information from her team as a way to maintain her authority. She does not tolerate mistakes and always blames individuals for errors and not the flawed process that may have caused them. Noelle does not provide any direction, supervision, or monitoring of specified duties. She takes on a more hands-off approach and only expects results in the long run. Noelle is an autocratic leader.
2. b) Unlike Noelle, Doctor Hillary is more democratic. Within the hospital, Dr. Hillary consults his subordinates before making any changes or decisions. He understands that employee opinions are a great contributor to useful insights and ideas. Hillary expects feedback from all employees and asks for their suggestions on the ways forward. He takes on a more hands-on approach and leads by example. He has a charisma to communicate the overall vision of projects and is confident enough to act in ways that inspire his subordinates. Often, Hillary delegates leadership tasks and responsibilities to the staff and supervises how they perform them. Hillary cherishes feedback and accountability from his team members. Relationships with his employees are essential to Hillary, and he places great emphasis on system processes, employee training, quality improvement, and feedback. Hillary does not believe in blaming employees for any mistakes; rather, he first evaluates faults in the process before assigning blame to any particular employee. Hillary is a democratic leader.

Leadership Styles

Leadership styles are behavioural patterns adopted by a leader to influence the characters and behaviours of their followers, such as the strategies he uses to give instructions to his employees and motivate them to reach targeted goals. It is the approach and manner of providing directions, developing plans, and motivating people to accomplish specific goals (Cope & Murray, 2017; Kaiser, 2017). Leadership styles include the complete pattern of implicit and explicit actions performed by leaders in certain areas. Leadership styles can be classified based on situational approaches or behavioural approaches.

Relational leadership style

Some people think that good leadership is about telling the employee what to do and ensuring that they do it. However, relational leadership style is a process that involves people working together with a shared goal to accomplish a goal or make a difference for the common benefit of all. The relational leadership style includes five primary components, i.e., inclusion, purposefulness, empowerment, ethical behaviour, and process orientation (Bernardes et al., 2019; Giltinane, 2013). Integration means the leader involves every person and listens to all their ideas. Empowerment is significant in leadership success. Leaders empower others by allowing them to be involved in all levels, including decision-making (Bittner, 2019). Purposefulness in relational leadership means having individual dedication and commitment to a set goal while establishing s common ground with other people sharing the same purpose. A relational leader not only identifies the goals of the group but also envisions the outcomes and involves others in the process of building the vision. Ethical Behavior underscores moral standards and values that drive relational leaders (Kear, 2019). They use these moral values to make ethical and moral decisions and to model actions and behaviours that others in the team may emulate. These components are crucial for any effective leader, whether in trying to resolve conflicts or lead a collaborative project.

Task-oriented Leadership Style

The most precise definition of task-oriented leadership is doing whatever it may take to get a task completed. Task-oriented leadership tends to be partially autocratic and emphasizes on completing tasks to meet organizational goals (Henkel, Marion, and Bourdeau, 2019). Although many people practice task-oriented leadership in organizations today, it lacks attention and consideration of the team members’ well-being, and this may be deficient in many scenarios. Task-oriented leaders emphasize plans, schedules, and structures for getting tasks completed. This style of leadership may include:

• Step by step organizing and punishment/reward systems
• Continuous definition of goals and structures
• Putting priority in the achievement of specific goals
• Adhering to rigid schedules and timeframes
• Asking employees to set goals and develop a plan to complete them

Generally, leaders should base their style of leadership in each situation they face uniquely. If particular members of the team have poor time management skills, leaders should employ the task-oriented approach (Henkel, Marion, and Bourdeau, 2019). Also, organizations with strict time deadlines would benefit from task-oriented leadership. Since task-oriented leadership is autocratic, it may lead to problems with employee retention and motivation. Leaders should replace task-oriented leadership with more friendly approaches such as transformational and situational leadership.

Delegative Leadership Style

Delegative leadership, also known as Laissez-faire leadership, is a leadership style where leaders are hands-off, thus allowing team members to make decisions. This is the leadership style that has been found to have the lowest rate of productivity among members (Afshari et al., 2017). Delegative leadership has both advantages and disadvantages, and there are certain situations or settings where this type of leadership can be appropriate. Delegative leadership is characterized by:

• Little or no guidance from leaders
• Complete decision-making by followers
• Leaders may provide tools needed
• Group members solve problems on their own
• Leaders take accountability for the group’s actions and decisions.

While laissez-faire implies an entirely hands-off approach, leaders may remain available and open to team members for feedback and consultation. Leaders may provide direction in the beginning but then offer little oversight to members moving forward. Such a leadership approach requires excellent trust, and leaders need to be confident that their team members have the knowledge and skills to complete a project without strict supervision.

Avoidant Leadership Style

Not much has been written about avoidant leadership, but it is a style of leadership where leaders are absent. This type of leadership comprises of two elements: management by exception (passive management) and laissez-faire style. In management by exception, leaders will take corrective measures only if something is amiss or standards are not met (Solbakken, Bondas, & Kasen, 2019). It is the unwillingness to take action until a mistake happens. Laissez-faire leadership style avoids making decisions or taking corrective action. It depicts irresponsibility, reluctance, loss of control and influence, and lack of involvement.

Emotional Intelligence

Emotional intelligence is a person’s ability to recognize and manage their own emotions and those of others. Emotional intelligence includes at least three skills such as self-emotional awareness, ability to harness emotions and apply them to problem-solving and thinking, ability to control emotions of oneself and others (Petrides et al., 2016). There is no valid psychometric test for emotional intelligence, and many people argue that emotional intelligence is not an actual construct but a method of describing interpersonal skills. Some people never let their tempers get out of control no matter the situation, or some people have the complete trust of their staff, listen to their concerns, easy to talk to, and always make careful and sound decisions (Serrat, 2017). These people can be said to have high emotional intelligence. Leaders must have emotional intelligence for success. There are five components to emotional intelligence:

• Self-awareness.
• Self-regulation.
• Social skills.

The more a leader can control these areas, the higher their emotional intelligence. Leaders who perform well in social-emotional intelligence are effective communicators and value the feelings of others. They are open to receiving bad and good news, and they are effective at garnering the support of their teams. They are always excited about venturing into new projects or missions (Lopes, 2016). Leaders who are self-motivated work relentlessly to achieve their goals and have high standards of work quality. Leaders who have empathy are invaluable in managing successful teams (Lopes, 2016). These leaders put themselves in other people’s positions and help to empower their team members, challenge those that are unfair, and give constructive feedback.

Criticism for Emotional Intelligence

Some people criticize Emotional Intelligence as not being a valid form of intelligence because it is still impossible for psychologists to define what makes up intelligence. Emotional intelligence is often perceived as mere semantics that plays a role in the development of psychological theories, but it is irrelevant to many other people. Others criticize emotional intelligence for not having the ability to give any appropriate predictions about a person’s success (Andrei et al., 2016). Critics argue that research may support some predictive elements within Emotional Intelligence, but they may be predicting other things that are not based on Emotional Intelligence. Critics also argue that Emotional intelligence is not an accurate measure because there is no real way of measuring its scale. Unlike IQ, which can be measured to determine whether or not someone is within the normal range, Emotional Intelligence has no specific measure numerically.

Resilience

Resilience is a quality that allows people to get walloped by life and still get up stronger than they were before. People with resilience do not let difficult circumstances or failure to get them down; they always find ways to rise from the dust (Aburn, Gott, and Hoare, 2016). Factors that make a person resilient include optimism, positive attitudes, ability to perceive failure as helpful feedback, and the ability to control emotions. Resilience reduces the effects of stress on the body and mind after traumatic events. It gives access to one’s cognitive resources, enabling them to have level-headed analyses of what might have gone wrong (Anderson, 2015). Resilience involves hard mental work to rise over hardships, but even after stressful events, resilient people can start and see what is next.

Learning Resilience

There are many ways through which one can learn to practice resilience. These include getting adequate sleep, exercising, and effectively managing stress. When the mind and body are healthy, people are better able to cope with life challenges (Aburn, Gott, and Hoare, 2017). Secondly, one can practice thought awareness. Resilient people do not allow negative thoughts and experiences to thwart their efforts. They consistently exercise positive thinking and correct any personalized, pervasive, or permanent negative statements in their minds (Woods, 2017). Thirdly, one can practice Cognitive Restructuring by changing the way you think regarding adverse events and negative situations. Learn from your mistakes, and do not give up until you find the lesson in the mistakes. Fourthly, Anderson (2015) indicates that to enhance resilience, one should choose one’s responses. We all go through bad days and crises, but you have a choice in how you respond to them. You can choose to be cynical about them or panic, or you can choose to stay calm and figure a way out (Woods and Cook, 2017). Fifthly, an individual needs to maintain perspective. To be resilient, you have to understand that even though a situation is overwhelming, it will not last forever and so remain calm and avoid overreacting. Sixthly, one should make SMART goals, and strive to achieve them to match your strengths and values. You are likely to be more resilient when you have a strong support network. Also, treat people with compassion and empathy.

Conclusion

Effective leadership is essential in any organization, and healthcare is no exception. Nurse leaders need to embrace practices that will ensure they get the best outcomes from the employees in order to achieve organizational goals successfully. Adapting effective leadership styles such as relational styles, transformational leadership style, and task-oriented leadership styles will enable leaders to gain trust and support from their subordinates and improve patient outcomes and satisfaction in the long run. Leaders should avoid using leadership styles such as the avoidant and Laissez-faire unless specific situations demand them to do so. With resilience, empathy, and strong emotional intelligence, nurse leaders will likely have success.

References

Aburn, G., Gott, M., and Hoare, K. (2016), ‘What is resilience? An integrative review of the empirical literature,’ Journal of Advanced Nursing, 72(5), pp. 980-1000.

Afshari, J., Moein, Z., Afshari, F., Sharifi-Rad, J., Balouchi, A., and Afshari, A. (2017), ‘A comparison of leadership styles concerning biographical characteristics,’ SA Journal of Human Resource Management, 15(1), pp. 1-7.

Al-Dossary, R. N., Kitsantas, P., and Maddox, P. J. (2016), ‘Residency programs and clinical leadership skills among new Saudi graduate nurses,’ Journal of Professional Nursing, 32(2), pp. 152-158.

American Hospital Association 2014, National Health Care Governance Survey Report Center for Healthcare Governance, American Hospital Association, viewed 17 November 2019, https://www.aha.org/news/headline/2015-01-21-podcast-2014-national-health-care-governance-survey

American Nurses Association 2016, Nurses on Boards, American Nurse Association, viewed 17 November 2019, https://www.nursingworld.org/resources/nurses-on-boards/

Anderson, B. (2015), ‘What kind of thing is resilience?’, Politics, 35(1), pp. 60-66.

Andrei, F., Siegling, A. B., Aloe, A. M., Baldaro, B., and Petrides, K. V. (2016), ‘The incremental validity of the Trait Emotional Intelligence Questionnaire (TEIQue): A systematic review and meta-analysis,’ Journal of personality assessment, 98(3), pp. 261-276.

Bernardes, A., Grivol, D. A., Gabriel, C. S., Carrara, G. L. R., and Baldo, P. L, (2016), Nursing Leadership and the Relation with Management Models Adopted in Healthcare, Sigma Repository, viewed on 17 November 2019, https://sigma.nursingrepository.org/handle/10755/602542

Bittner, A. (2019) ‘Mentoring millennials for nursing leadership,’ Nursing, 49(10), pp. 53–56.

Bodenheimer, T. and Bauer, L. (2016), ‘Rethinking the primary care workforce—an expanded role for nurses,’ New England journal of medicine, 375(11), pp. 1015-1017.

Bowers, D. (2019) ‘Healthcare then and now: Impact on nursing leadership. (cover story)’, Nursing Management, 50(9), pp. 26–29.

Bressan V, Tolotti A, Barisone M, Bagnasco A, Sasso L, and Aleo G. (2016), ‘Perceived barriers to the professional development of modern nursing in Italy – a discussion paper,’ Nurse Education in Practice, 17(3), pp. 52-57.

Chappell, K. B. and Richards, K. C. (2015), ‘New graduate nurses, new graduate nurse transition programs, and clinical leadership skills: A systematic review,’ Journal for nurses in professional development, 31(3), pp. 128-137.

Chappell, K. B., Richards, K. C., and Barnett, S. D. (2014), ‘New graduate nurse transition programs and clinical leadership skills in novice RNs,’ Journal of Nursing Administration, 44(12), pp. 659-668.

Chavez, F., Kelly, T., Kunisch, J. R., and Kurth, A.  (2019). ‘Systems leadership doctor of nursing practice: global relevance,’ International Nursing Review, 66(4), pp. 482–489.

Collette K (2015), ‘Leadership style and patient safety: Implications for nurse managers,’ The Journal of Nursing Administration, 45(6), pp. 319-324.

Cope V. and Murray M. (2017), ‘Leadership styles in nursing,’ Nursing Standard, 31(43), pp. 61.

Cummings G, Lee H, MacGregor T, Davey M, Wong C, and Paul L (2008), ‘Factors contributing to nursing leadership: A systematic review,’ Journal of Health Services Research and Policy, 13(4) pp. 240-248.

Curtis, E.A., de Vries, J., & Sheerin, F.K. (2011). Developing leadership in nursing: exploring core factors. British Journal of Nursing, 20 (5), 306-309.

D’Innocenzo, L., Mathieu, J. E. & Kukenberger, M. R. (2014). A meta-analysis of different forms of shared leadership – team performance relations. Journal of Management, 1-28.

Dickinson, H., Ham, C., Snelling, I., & Spurgeon, P. (2013). Are we there yet? Models of medical leadership and their effectiveness: An exploratory study. Retrieved from http://www.netscc.ac.uk/hsdr/files/ project/SDO_FR_08-1808-236_V07.pdf

Dixon-Woods, M., Baker, R., Charles, K., Dawson, J., Jerzembek, G., Martin, G., McCarthy, I., McKee, L., Minion, J., Ozieranski, P., Willars, J., Wilkie, P., and West, M. (2014). Culture and behaviour in the English National Health Service: an overview of lessons from a large multimethod study. BMJ Quality and Safety, 23 (2), 106-115.

Downey M, Parslow S, and Smart M (2011), ‘The hidden treasure in nursing leadership: Informal leaders,’ Journal of Nursing Management, 19(4), pp. 517-521.

Dubree, M., Kapu, A., Terrell, M., Pichert, J., Cooper, W., and Hickson, G. (2017), ‘Nurses’ essential role in supporting professionalism,’ Am Nurse Today, 12(4), pp. 6-8.

Dwyer, D. (2014), ‘Experiences of registered nurses as managers and leaders in residential aged care facilities,’ International Journal of Evidence-Based Healthcare, 12(3), pp. 187.

Elliott, N., Begley, C., Sheaf, G., and Higgins, A. (2016), ‘Barriers and enablers to advanced practitioners’ ability to enact their leadership role: A scoping review,’ International Journal of Nursing Studies, 60(3), pp. 24-45.

Farag A, Anthony MK, Tullai-McGuinnes S, and Burant C (2017), ‘Do leadership style, unit climate, and safety climate contribute to safe medication practices?’ Journal of Nursing Administration, 47(1) pp. 8-15.

Giltinane, C. L. (2013), ‘Leadership styles and theories,’Nursing Standard, 27(41), pp. 23-45.

Grohar-Murray, M. E., DiCroce, H. R., and Langan, J. C. (2016). Leadership and management in nursing. Pearson.

Gureje, O., Oladeji, B. D., Kola, L., and Bello, T. (2019), ‘Task-shifting must recognize the professional role of nurses–Author’s reply,’ The Lancet Global Health, 7(10), pp. e1330.

Halcomb, E., Stephens, M., Bryce, J., Foley, E., and Ashley, C. (2016), ‘Nursing competency standards in primary health care: an integrative review,’ Journal of clinical nursing, 25(9-10), pp. 1193-1205.

Hallock, A. B. (2019) ‘A Case for Leadership Development in Nursing Practice,’ Nephrology Nursing Journal, 46(3), pp. 325–328.

Hardacre, J., Cragg, R., Shapiro, J., Spurgeon, P., & Flanagan, H. (2011). What’s leadership got to do with it? London: The Health Foundation.

Harris, J. L., Roussel, L. A., and Thomas, T. (2016) Initiating and sustaining the clinical nurse leader role. New York: Jones & Bartlett Learning.

Henkel, T. G., Marion Jr, J. W., and Bourdeau, D. T. (2019), ‘Project Manager Leadership Behavior: Task-Oriented Versus Relationship-Oriented,’ Journal of Leadership Education, 18(2), pp. 1 – 10.

Kaiser J. A. (2017), ‘The relationship between leadership style and nurse-to-nurse incivility: Turning the lens inward,’ Journal of Nursing Management, 25(2), pp. 110-118.

Kear, T. M. (2019) ‘Every Nurse Is a Leader: Building on 50 Years of Nephrology Nursing Leadership’, Nephrology Nursing Journal, 46(2), pp. 101–154.

Keys Y. (2014), ‘Looking ahead to our next generation of nurse leaders: Generation X nurse managers,’ Journal of Nursing Management, 22(1) pp. 97-105.

Lopes, P. N. (2016), ‘Emotional intelligence in organizations: Bridging research and practice,’ Emotion Review, 8(4), pp. 316-321.

Nagel, C. & Andenoro, A.C. (2012). Healing leadership: The serving leader’s impact on patient outcomes in a clinical environment. Journal of Healthcare Leadership, 4, 25-31.

NHS Leadership Academy (2013). The Healthcare Leadership Model. Leeds: NHS Leadership Academy.

Patrick, A., Laschinger, H. K. S., Wong, C., and Finegan, J. (2011), ‘Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey,’ Journal of Nursing Management, 19(4), pp. 449-460.

Petrides, K. V., Mikolajczak, M., Mavroveli, S., Sanchez-Ruiz, M. J., Furnham, A., and Pérez-González, J. C. (2016), ‘Developments in trait emotional intelligence research,’ Emotion Review, 8(4), pp. 335-341.

Pihlainen, V., Kivinen, T., and Lammintakanen, J. (2016), ‘Management and leadership competence in hospitals: a systematic literature review,’ Leadership in Health Services, 29(1), pp. 95-110.

Reem Nassar Al-Dossary 2017, Leadership in Nursing, Contemporary Leadership Challenges, Aida Alvinius, IntechOpen, viewed on 18 November 2019, https://www.intechopen.com/books/contemporary-leadership-challenges/leadership-in-nursing

Roberts-Turner, R, Hinds, P. S., Nelson, J, Pryor, J, Robinson, N. C., and Jichuan Wang (2014) ‘Effects of Leadership Characteristics on Pediatric Registered Nurses’ Job Satisfaction,’ Pediatric Nursing, 40(5), pp. 236–256.

Salvage, J. and White, J. (2019) ‘Nursing leadership and health policy: everybody’s business,’ International Nursing Review, 66(2), pp. 147–150.

Serrat, O. (2017). Understanding and developing emotional intelligence. Knowledge solutions. Singapore: Springer.

Solbakken, R., Bondas, T. and Kasén, A. (2019) ‘Safeguarding the patient in municipal healthcare—A hermeneutic focus group study of Nordic nursing leadership,’ Journal of Nursing Management (John Wiley & Sons, Inc.), 27(6), pp. 1242–1250.

Stanley, D. and Sherratt, A. (2010), ‘Lamplight on leadership: clinical leadership and Florence Nightingale,’ Journal of Nursing Management, 18(2), pp. 115-121.

Walton A, Lake D, Mullinix C, Allen D, and Mooney K (2015), ‘Enabling nurses to lead change: The orientation experiences of the nurse to boards,’ Nursing Outlook, 63(2), pp. 110-116.

West, M., Armit, K., Loewenthal, L., Eckert, R., West, T., & Lee, A. (2015). Leadership and leadership development in healthcare: the evidence base. London: The Kings Fund.

Wong, C. A., Cummings, G. G., and Ducharme, L. (2013), ‘The relationship between nursing leadership and patient outcomes: a systematic review update,’ Journal of nursing management, 21(5), pp. 709-724.

Woods, D. D. (2017) Resilience Engineering: Essential characteristics of resilience. Milton Park, Abingdon: Taylor & Francis Group.

Woods, D. D., and Cook, R. I. (2017) Resilience Engineering: Concepts and Precepts. Milton Park, Abingdon: Taylor & Francis Group.