What Are the Leadership Theories in Nursing?

by | Apr 26, 2022 | Nursing School and NCLEX®, Nursing Student | 1 comment

Good leadership is a trait sought after in many professions, but it’s necessary for nurses. The best nurses can step up and take control of a situation even when no one else can. They have the insight to know what changes need to be made and the willingness to make those changes happen as smoothly as possible.

As much as everyone would love to say, “I’ve got this,” every time a difficult patient or family member comes into the picture, not everyone has these strengths naturally. Some people have to develop them over time, while others may never feel comfortable taking charge in certain situations.

Fortunately, there are leadership theories in nursing that anyone can use as a guide for becoming an effective nurse leader. But first, let’s see what exactly leadership theory is.

What Are the Leadership Theories in Nursing?

What is a Leadership Theory?

A leadership theory is a framework or set of ideas that explains how individuals become effective leaders and how they can best lead others. Leadership theories can help to identify the traits, skills, and behaviors that are associated with effective leadership and can provide guidance on how to develop and improve these qualities.

Types of Leadership Theories in Nursing

There are many types of leadership theories, all of which apply to nursing. Let’s dig into each theory and how it could apply to the field of nursing.

Transformational Leadership Theory in Nursing

James McGregor Burns developed transformational leadership theory in the 1970s. The transformational leadership theory focuses on how a leader’s vision can influence a group to accomplish goals they never thought possible. In turn, the group members are more likely to trust this visionary who inspires them.


This leadership theory emphasizes the importance of inspiring and motivating followers to achieve their full potential and accomplish organizational goals. It involves the leader taking a proactive role in developing and nurturing their followers rather than simply directing and delegating tasks.

Transformational leaders inspire their followers to be creative and innovative by creating a vision for the future that resonates with their followers. They encourage their followers to think beyond their self-interest and focus on the group’s needs as a whole.

Transformational leaders also develop a strong sense of trust and respect with their followers, providing them with support, guidance, and mentoring. They use their charisma, vision, and emotional intelligence to motivate and engage their followers, encouraging them to work towards a common goal with a shared sense of purpose.

Overall, the transformational leadership theory emphasizes the importance of empowering and developing followers, inspiring them to achieve their full potential, and contributing to the organization’s success.

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In nursing, it is imperative to have transformational leaders who hold positions in which they are influential over large numbers of nurses. Rather than an individual unit, these leaders are extremely effective in the roles of Directors of Nursing, Chief Nursing Officers, and Nurse Executives. Not only are they aware of what it takes to provide shift-to-shift bedside care, but they are also forward-thinking about issues that will impact the entire nursing workforce at an organization.

They have to influence not only the nursing staff, but also the other leaders in the hospital who are not nurses but are in a place to make decisions that impact nurses. Finally, these leaders should be in their leadership positions for an extended period, as it takes time to build trust and rapport. Of all of the leadership theories in nursing, this one is the most big-picture and requires the most advanced skills to sustainably lead in this manner.

(There are many transformational nurse managers. However, my guess is they will be promoted to director-level soon!)

Famous Leaders Who Exemplified the Transformational Leadership Theory

Nelson Mandela, Martin Luther King Jr., Malcolm X, and Steve Jobs.

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Transactional Leadership Theory (AKA Management Style) in Nursing

Transactional leadership theory is a leadership approach that emphasizes the importance of setting clear expectations and providing rewards or punishments based on performance. This leadership style focuses on the transaction or exchange between the leader and the followers, where the leader provides guidance and direction, and the followers comply with the leader’s directives.


In this theory, leaders focus on maintaining the status quo and managing day-to-day operations rather than developing a long-term vision or inspiring followers to be creative and innovative. Leaders use rewards such as bonuses or promotions to motivate high-performing employees and punishments such as reprimands or demotions for low-performing employees.

Transactional leaders are often seen as managers rather than true leaders, focusing on maintaining control and adhering to established procedures rather than inspiring change or growth. They are effective in maintaining order and ensuring that tasks are completed efficiently, but they may not be as effective in motivating and engaging employees over the long term.

While this leadership theory doesn’t sound as positive as a transformative leader, this style is highly effective for Nurse Managers of nursing units. This is because these managers are often responsible for dozens of newly licensed nurses, nursing assistants, and others who must have clear expectations. This is helpful for appropriate professional development. Being a successful bedside nurse is complex and requires adherence to many protocols, policies, and procedures.

While there is definitely an art to nursing, it takes time to develop those skills (we’re talking years), and therefore, a transactional leader is actually extremely beneficial to novice, advanced beginners, and even competent nurses.

The vast majority of nurses on an inpatient unit thrive with very clear expectations, acknowledgment and incentives for exceptional performance, and clear consequences for failure to comply with unit standards.

Famous Leaders Who Exemplified the Transformational Leadership Theory

Jack Welch (known for his “rank and yank” policy, which involved firing the bottom 10% of employees every year), Rudy Giuliani (as mayor of NYC who focused on law and order and being tough on crime), and Vince Lombardi.

Situational Leadership Theory in Nursing

Situational Leadership Theory is a leadership model developed by Paul Hersey and Ken Blanchard. This model proposes that the most effective leaders are those who can adapt their leadership style to fit the needs and maturity levels of their followers in different situations.


The model is based on two key concepts: leadership style and follower maturity level. Leadership style refers to how a leader interacts with their followers and includes four different styles: directing, coaching, supporting, and delegating. Follower maturity level refers to the level of knowledge, skills, and experience that a follower has in a particular task or situation.

The model proposes that there are four possible combinations of leadership style and follower maturity level:

  1. Directing: This style is most effective when the follower is new to a task or lacks the necessary skills and experience. In this situation, the leader must provide clear instructions and closely supervise the followers to ensure they can complete the task.
  2. Coaching: This style is appropriate when the follower has some knowledge and experience but requires guidance and support. The leader should provide direction and feedback to help followers improve their skills and gain confidence.
  3. Supporting: This style is most effective when the follower has developed the necessary skills but still lacks confidence or motivation. The leader should offer praise and recognition to build the follower’s confidence and provide support as needed.
  4. Delegating: This style is appropriate when the follower is highly competent and committed to the task. The leader should provide support as needed but should otherwise delegate responsibility to the follower.

Naturally, a situational leader is effective on a nursing unit. Situational leaders could be in the position of a charge nurse, unit manager, or supervisor. They are individuals who know their staff well and adapt to their needs as they see fit and learn the individuals. This is impactful for nursing units because there are often nurses across the professional development spectrum (novices, advanced beginners, those who are competent, proficient, and experts) who would require different leadership to thrive.

A novice nurse who has a leader who is focused mainly on the success of how their unit fits into the entire organization would not be ideal. They need leadership to help them to be able to safely provide nursing care as fast as possible. Of all of the leadership theories in nursing, this is the most practical.

Conversely, an expert nurse doesn’t need a leader to provide clear instructions for basic nursing tasks they mastered 10 years ago. Rather, they have established they can be trusted to be safely delegated to.

Famous Leaders Who Exemplified the Situational Leadership Theory

Oprah Winfrey, Colin Powel, and Howard Schultz. Please note that this theory is widely applicable across many different industries and contexts, and many other leaders have likely used its principles without explicitly referencing the theory itself.

Autocratic Leadership in Nursing

Autocratic leadership in nursing is a leadership style where the nurse leader assumes complete control and decision-making power over their team members. This leadership style is characterized by a hierarchical structure, where the leader is seen as the ultimate authority figure, and team members are expected to follow their directives without question.


In an autocratic leadership style, the leader maintains strict control over their team members and often makes decisions without seeking input or feedback. They may use fear or coercion to maintain their position of authority and enforce their decisions.

While this leadership style can be effective in certain situations (crises), it can also create a negative work environment and decrease job satisfaction and motivation among team members. Autocratic leadership can stifle creativity and innovation, as team members cannot contribute their ideas and perspectives.

In nursing, autocratic leadership may be necessary in situations where quick decisions need to be made, such as during a medical emergency. However, it is generally not recommended as a long-term leadership style, as it can lead to increased turnover rates and decreased morale among team members.

Of the leadership theories in nursing, it is the most appropriate way to lead a code or a medical emergency. It is natural to slip into this leadership style during these situations, but it is important to follow up afterward to ensure appropriate communication and recovery. Notice if and when you get into this mode so that you can support your team appropriately once the dust has settled.

Examples of autocratic leadership in nursing may include a nurse leader who makes all decisions without seeking input from their team members or a leader who uses fear or intimidation to enforce their decisions. This could also be the code team leader who gets into go-mode during the code (who hopefully pulls themself out of it after). This leadership style can be particularly problematic when collaboration and teamwork are essential to providing quality patient care.

Democratic Leadership Style in Nursing

This style of leadership is more common than you might think. It is where group members participate in decision-making and work towards a clearly defined goal. While it can be difficult to implement, democratic leadership has been known to increase motivation and overall group performance while decreasing the chances of mistakes on the task at hand.


In this leadership style, the leader allows team members to have an equal say in decision-making processes. In this style, the leader acts as a facilitator, allowing team members to vote or express their opinions, and the decision is made based on the majority vote. This style is particularly effective when team members have similar levels of expertise or knowledge and when the leader values the opinions and ideas of all team members equally.

This leadership style may help establish specific rules for the unit or organization that will directly impact the staff (how to schedule holidays, how to rotate floating, how to deal with call-outs). However, given the nature of leading a unit or organization of nurses, not all decisions can/should be made democratically. Things like personnel issues, disciplinary issues, and regulatory requirements are not always appropriate for group decision-making.

Participative Leadership in Nursing

Participative leadership is a leadership style in which the leader actively involves team members in decision-making processes, encourages input, and values their opinions and ideas. The leader ultimately retains responsibility for making the final decision, but team members play an active role in the process. This leadership style is particularly effective when the leader has more expertise or knowledge in a particular area but values input and collaboration from team members to achieve the best outcome.


Democratic vs. Participative

These two are similar but have a distinct difference that is important to understand. The difference between Democratic and Participative is that in Democratic, the leader does not retain ultimate responsibility. Rather, they work towards collective decision-making and vote. In Participative, the leader will involve the team and get everyone’s perspective, but the leader will ultimately decide and be responsible for that choice.)

Servant Leadership in Nursing

Servant leadership in nursing is a leadership style in which the nurse leader prioritizes the needs of the nursing team and patients over their own needs. The servant leader in nursing focuses on serving the nursing team and empowering them to achieve their full potential, leading to high-quality patient care.


In servant leadership, the nurse leader supports the nursing team by providing the resources they need to perform their duties effectively. This may include access to continuing education, mentorship opportunities, resources to improve patient care, or information and support to continue their education. The nurse leader also listens to the concerns and feedback of the nursing team and takes their opinions into account when making decisions that affect the team.

While this sounds like a phenomenal type of leadership, it is not without cost. A servant leader may become too focused on meeting the needs of the nursing team and patients to the point of neglecting their own needs. This can lead to nurse burnout and decreased job satisfaction for the leader, ultimately impacting their ability to provide effective leadership to the nursing team.

Further, servant leadership may lead to the perception that the leader is weak or ineffective. This is because the servant leader may be seen as placing too much emphasis on meeting the needs of others at the expense of setting clear expectations and holding team members accountable. Of the theories of leadership in nursing, this is the most risky for leader burnout.

Using Leadership Theories in Nursing

Effective leadership theories can be incredibly useful for nurses looking to become better charge nurses, managers, directors, and chief nursing officers. They provide strategies for interacting with each unique team member and help you determine which situations are best served by letting go and which require a firmer presence.

In addition, learning about what makes a good leader can encourage nurses who may not feel confident enough to step up into these roles because it gives them the tools they need for success.

Ultimately, being armed with this knowledge is helpful for you and those under your charge. Even if it doesn’t come naturally to you at first, being aware of how you interact with others will allow you to improve while respecting those around you. Educational degrees can really help prepare people to excel in leadership positions. Check out these options!

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Qualities of an Exceptional Nurse Leader

An exceptional nurse leader possesses several essential qualities that enable them to lead and inspire their team effectively. Let’s go through the most important ones.

Effective communication

Exceptional nurse leaders are skilled communicators who communicate clearly and effectively with their team members, patients, and other healthcare professionals.


An exceptional nurse leader is empathetic and can understand and relate to their team members and patients’ needs and concerns. They also possess the emotional maturity to exercise empathy with boundaries, as getting too deeply connected to the experience of others can result in secondary trauma and other long-term issues.


A great nurse leader is visionary and has a clear vision for their team and the organization. They have an overarching picture in mind of where they see the team in 1, 2, and even 5-year increments and what will be necessary to achieve that goal.


Exceptional nurse leaders are collaborative and value input from their team members. They work with their team to develop policies and procedures in the organization’s and its patients’ best interest. When issues arise, they work together with their nursing team to create a realistic solution. They do not solve problems in isolation.


Great nurse leaders hold themselves and their team members accountable for their actions and decisions. They take responsibility for their mistakes and work to rectify them. They also encourage others to be accountable and do not shame people who do so.


An exceptional nurse leader is professional in their conduct and actions, setting a positive example for their team members. They do not gossip, embarrass, or demean others. They are up front about their expectations and trustworthy. You are not concerned about them sharing something you told them in confidence.


Great nurse leaders are knowledgeable about the nursing profession, healthcare systems, and the latest research and best practices. They are committed to ongoing education and professional development. They are someone you go to for answers, who is also honest when they do not know something.


Exceptional nurse leaders are supportive of their team members and work to create a positive work environment that fosters growth, development, and engagement. They possess a combination of technical, interpersonal, and leadership skills that enable them to lead their team and provide high-quality patient care effectively.

Why Do Leadership Theories in Nursing Matter?

Nursing leadership theories matter because they provide a framework for understanding how influential nursing leaders can inspire and influence their teams to provide high-quality patient care. Nursing leadership theories help identify the traits and behaviors associated with successful nursing leadership, and they guide how to develop and improve these skills.

Furthermore, nursing leadership theories can help healthcare organizations to identify and develop future nursing leaders. By identifying individuals with the traits and behaviors associated with effective nursing leadership, healthcare organizations can provide training and development opportunities to help these individuals grow and develop into influential nursing leaders.

How to Develop Leadership Skills and Become a Nurse Leader

Being a registered nurse is a great way to begin your leadership journey. Your patients and family members likely already look to you as a leader. Should you decide to further your leadership potential into formal roles like charge nurse, nurse manager, director of nursing, and beyond, here are some things you can do to begin.

Ask Questions

If you’re afraid of asking questions because people might think you’re dumb, don’t be! Your fellow nurses look up to you and want to help you grow as a professional, so don’t be shy about seeking out the information you need to do your job well. Demonstrating that you’ve got the courage and desire to get the correct answer is a sign of maturity and leadership.

Give Feedback

Whether it’s good feedback for a coworker who did a great job with a difficult patient or constructive criticism about a coworker who could improve their communication skills, giving feedback when needed without being too critical of others is essential.

If you struggle with giving feedback, we go in-depth on how to do that in our course, Preceptor Pro. There is definitely an art to gracefully giving feedback, so don’t feel bad if it takes time to really develop this skill.

Recieve Feedback

While it’s important to be able to tactfully give feedback, you must also be able to receive it. Don’t take it personally. Check your initial knee-jerk reaction, appraise the feedback from an objective place, and consider any changes you need to make going forward. Giving and receiving feedback is a natural part of professional growth. Those who have earned leadership positions have learned how to gracefully receive feedback and turn it into something to improve themselves.

Remember That You’re Part of a Team

While we think we may know the way something should be done, an effective leader will ask others for their perspective and even present their own and ask what the team thinks (“Hey, here are my thoughts. Poke holes in my theory so we can get to the right answer!”)

Get Curious

Good leaders don’t lean into challenges or missteps with anger or judgment. Instead, they lead with curiosity. Instead of, “Why did you do that?!” they approach it from more of a “Hey, can you tell me more about your thought process here” tone.

Ending Thoughts on Leadership Theories in Nursing

Leadership theories are essential to nursing practice because leadership skills are imperative to leading a group of nurses to provide safe care successfully. The best nurse leaders can assess situations and customize their approach based on their staff, and because they’ve invested the time and energy to get to know everyone – they know the best way to go about it.

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    Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

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    1 Comment

    1. Beth Boynton, RN, MS, CP

      This is a great article! Nurse leaders who develop these leadership styles and skills can have a huge and positive influence on the care we provide and the health and wellbeing of the workforce. I’d like to add, “Complexity Leadership” as another model. First introduced into nursing by Diana Crowell, RN, PhD in her groundbreaking book, “Complexity Leadership: Nursing’s Role in Health Care Delivery”. Her pioneer work focuses on understanding systems thinking and the importance of self care. (I was honored to co-author the 3rd Edition of this F.A. Davis textbook. )


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