Leadership and Management in Nursing


The success of any organization is highly dependent on the kind of leaders and managers that head it. Different managers apply different management styles, and each of these styles has different effects on the organization (Dion, 2012). It should be noted that the style that is to be applied is dependent on the organizational goals and objectives as well as the personality of the manager or leader (Miner, 2013). In this regard, there are organizations that have a management or leadership culture. In such organizations, any leader who comes in will be required to follow the culture. For those organizations that do not have such a culture, the leader or the manager applies his or her style (Jefferson, Klass, Lord, Nowak, & Thomas, 2014). Another point that is important to note is the fact that leadership and management are two different terminologies that are used to describe different styles. Leadership is executed by a leader while management is for a manager.

Leadership refers to a practical skill that is possessed by an individual who can lead an organization to its set objectives. A leader can motivate and influence the rest of the employees so that they work towards the same goals (Ray, 2013). Management, on the other hand, is more focused on the ability to make things happen using the available resources (Derler & Weibler, 2014). In this regard, the major roles of a manager are to plan, organize, control, direct and coordinate people and resources within an organization so that they can achieve certain objectives. The manager ensures that the available resources are used and applied effectively and efficiently so as to attain the organizational goals (Michel, Shaun, & Newness, 2014). While there are leaders who are managers, not all managers can be leaders. A leader could be holding any position within the organization. In other words, a leader is not necessarily a top position holder in the organization.

This paper will discuss the various leadership and management theories and how these leadership and management theoretical concepts can impact a health organization and improve the quality of patients outcomes. Also, the paper will compare and contrast the concepts of leadership and management. Finally, it will discuss the ways in which a nurse unit manager can utilize his or her knowledge of contemporary leadership and management theory as well as the concepts of clinical governance and patient safety to aid in the fulfillment of their vital roles. These are the skills that will assist in the success of a nurse unit manager in their capacity to lead a health organization.

Nurse Unit Manager Roles

As it has been mentioned earlier, a leader is someone who can influence others so that they can achieve a particular set goal or objective. He or she should be able to motivate people and relate to them well so that they can follow him in return. A nurse unit manager acts as a leader in a health organization and has the responsibility to lead the rest of the employees so that they can achieve the organizational goals (Urick, 2016). His or her roles as a manager include leading, directing and coordinating care in the ward.

In his role as a leader, the nurse manager is responsible for ensuring that everything in the ward is executed in the right way (Peterson & Kim, 2012). He ensures that all the employees working in the ward are well motivated and that all their needs are met. The needs include good remuneration, rewards for their efforts as well as promotions among others (Rumsey, 2013). This will ensure that they work hard and work for the betterment of the health organization.

As a director, the nurse manager will issue instructions on what needs to be done. It is important to note that a manager normally has better exposure and experience on the job and hence they have sufficient knowledge regarding what should be done (Peterson & Kim, 2012). He is, therefore, able to instruct the rest of the employees on what they should do to achieve the objectives.

Finally, the nurse unit manager should be able to co-ordinate all the activities that are taking place in the ward. In doing so, he ensures that the right resources are assigned to the various tasks and that all the employees are working towards the same goals. He ensures that all sections work as a system and towards similar objectives.

Extant Theories of Leadership and Management

Clinical Organizations Leadership Theories

Transactional leadership theory; is a theory that is also highly applicable to many organizations. This theory is at times referred to as the exchange theory. Leaders who employ this theory focus on mutual benefits for themselves and their followers (North & Hughes, 2012). Therefore, a leader will focus on ways in which both parties will benefit. In this regard, a leader will be highly motivational to employees as well as to the clients. Among the reasons why the leader will focus on motivating the employees is the fact that this will translate directly to the performance of the whole organization (Winkler, 2010). Once the organization performs well, it is the manager who will receive accolades from the outside world.

This type of leadership will be beneficial to a health organization if it is employed by a nurse unit manager (Zydziunaite, Lepaite, Åstedt-Kurki & Suominen, 2015). They will focus on ways in which they will help the other nurses benefit. The nurse unit manager will concentrate on offering the employees good pay and rewards. He will also give them any other necessary benefits. As a consequence, the nurses will be motivated to provide the best services to the patients. Hence, the patients will receive high-quality services that will satisfy them. The general performance of the health organization will also be good.

Transformational theory; this theory posits that the best way that a leader can motivate employees and other members of the organization is by first creating a good rapport through positive interaction. This is a theory that has been applied by many leaders in the recent couple of years. It helps the employees feel appreciated and be a part of the organizations in which they work (Nichols & Erakovich, 2013). Also, a leader who applies this theory can change the situations in any organization to make them better. As the name suggests, the leader can transform the organization as well as the employees. The starting point of changing or transforming the employees will be creating a good rapport with them and hence a good communication network. The leader will then be able to get direct and good feedback from the employees (Witzel & Warner, 2013). This will help him or she implement the right transformational strategies.

The theory could also be highly beneficial for nurse unit managers as they will be able to positively influence the organizational employees. This style of leadership will also enhance communication as employees will be able to give feedback with more ease (Dyson, 2012). In the end, patients will receive high-quality services since nurses will be motivated. The leader will also be in a position to transform the health care organization to make it better in terms of performance and quality offered.

Leadership styles

Various leadership styles can also be applied to health organizations. Among them are authoritarian and democratic leadership styles. The authoritarian leadership style refers to the kind of style whereby the leader dictates what is to be done. He or she does not give others an opportunity to contribute. This kind of leadership is necessary in that urgent and important decisions can be made without major delays and substantial mistakes. In a health organization, most of the decisions require expertise. As it has been mentioned earlier, managers are usually experts in the various fields in which they work (Jefferson et al., 2014). Therefore, most of the decisions that will be required at the ward will require the expertise of the nurse unit manager. In this regard, the best style to use in implementing these decisions is authoritarian. This reduces the number of errors that could be made. However, it is demoralizing to employees since they feel as they are not part of the decisions (Kopelman, Prottas, & Falk, 2010). In a clinical organization, this kind of leadership is important since there are some major decisions that the nurse manager is required to make urgently. Other decisions have little or no propensity for errors and hence they have to be made by one or a few people.

The democratic kind of leadership, on the other hand, is the kind of leadership whereby all the members of an organization are given the opportunity to contribute to a decision. It is important that all employees are highly likely to support the decision. Under democratic leadership, all employees are consulted and allowed to give their views regarding any decisions. It is important to note that the only decisions that the entire members of the organizations should be included in making are those that are not urgent and do not require special expertise. In a health organization, the nurse manager should apply this style, especially in situations where the decision involves the members (Renz, 2010). Members should be allowed the opportunity to make decisions that have a direct effect on them since this will facilitate their support.

Other leadership styles such as paternalistic and laissez-faire may not be very applicable in a health organization. The paternalistic leadership style is where the leader who is an authoritarian treat the rest of the employees as members of an extended family, while the laissez-faire style is where all decision-making powers are in the hands of the workers. Under paternalistic leadership, the leader may not be in a position to execute full authority. This could lead to some favoritism and hence poor job results. As a result, this kind of leadership is not necessary and could not be effective in a health organization (Sarros, Luca, Densten, & Santora, 2014). The nurse unit manager should not apply it. Laissez-faire, on the other hand, gives power to all employees, an issue that will affect decision-making and the hierarchy of authority. It will be difficult to know the levels of command and the different people who are responsible for various tasks (Yahaya & Ebrahim, 2016). It is therefore not easy to hold anyone responsible if a task is failed. A health organization requires one source of authority who will give directions and coordinate activities. These two styles may not be very effective in a health organization setup.

Extant Theories of Leadership and Management

Clinical Organizations Management Theories

Just like the leadership theories, management theories have existed for an extended period. Various people have contributed to the theories while others have used them for studies and research. The main reason why management theories are applied is to increase the productivity and efficiency of an organization (Sarros et al., 2014). There are some theories that have been developed over time. Some of these are still around while others ceased to exist. The most popular management theories are chaos theory, contingency theory, and systems theory (Esen, 2015).

Quantum leadership theory; this theory posits that change in an organization is inevitable. It incorporates both chaos and complexity theories. According to the theory, change will keep on happening in an organization no matter how one tries to avoid it. Therefore, a manager should be in a position to manage change. There are individual events in an organization that can be prevented and controlled (Willocks, 2012). However, there are others that cannot be avoided. Chaos theory depicts that change is one of those events that cannot be avoided. It is rarely controllable. As an organization continues to grow and develop, there is every possibility that it will become more and more complicated. More energy will be required to manage the new levels of complexity. Due to this increase in size, there will be a need to create new structural levels that will be used to manage these new complexities (Offord, Gill, & Kendal, 2016). Quantum theory recognizes the fact that a system will always evolve and keep on changing. In a health organization, there are several departments. There will be a need for more departments in the future (Latemore, 2015). The current departments will also keep increasing in size. It is important for the manager to have the capacity to manage these increases in size so as to ensure that the right structures are always created to handle the changes. A nurse unit manager should, therefore, be in a position to manage change and hence should have the skills to create the necessary structures.

Inspire and support others to achieve their potential

The manager should also be in a position to inspire the employees. He should apply the various motivational theories to inspire the leaders. In doing so, the managers help the employees to achieve their full potential. It is imperative to note that motivated employees are able to work hard so that they will give their best to the organization. In this regard, the manager should execute motivational theories in inspiring the employees.

Motivational theory; is the theory that focuses on the various needs of employees. Human beings have various needs that motivate them. According to Maslow’s theory of motivation, people’s needs are arranged in a hierarchy (Wong & Cummings, 2009). When one achieves one need, it ceases to motivate them and they start being motivated by the next need in the hierarchy. A nurse leader should be able to understand the needs and hence use them to motivate the employees in the health organization.

Theory X, Theory Y; this is a theory that is used by managers to motivate employees. According to the theory, the workers’ productivity is influenced by the attitudes they have towards work. There are managers who believe that a worker should be motivated and given incentives to work (Saeed, Almas, Anis-ul-Haq, & Niazi, 2014). Such managers employ theory X in their management. They ensure that workers are well paid and provide any incentives they require. These managers believe that workers naturally do not have ambitions and hence need to be motivated in order to work. Such managers also use authority to drive workers (Chapman, Johnson, & Kilne, 2014). On the other hand, there are managers who believe that workers are responsible and are naturally driven. These managers allow workers to participate in various eventualities and activities in the organization. The best theory that a manager in a health organization should employ is theory Y due to the fact that allowing participation of workers highly motivates them and makes them feel part of the organization in which they are working.

Compare and Contrast Concepts of Leadership and Management

As mentioned earlier, leadership and management are two different concepts that have different meanings. More often than not, these concepts have been used interchangeably. However, it is important to note that there is a difference between the two concepts, but there are some similarities between them. The various similarities and differences of the concepts will be discussed herein.


Both leaders and managers are focused on attaining organizational success. Despite the fact that they do it in different ways, their ultimate objective is to ensure that the organization is successful. A leader will lead people towards goals achievement while a manager will manage work and the available resources to ensure that the goals and objectives of the organization are attained.

Both leadership and management require good social skills. This is because their major tasks involve leading and directing people. While leaders lead people, managers direct them so as they can achieve the set objectives (Zydziunaite et al., 2015). A good manager and a good leader should be able to navigate good social skills. They should be able to relate to the people they manage.

Good management is said to be good leadership. In this regard, both managers and leaders should possess excellent leadership skills. They should be able to lead the organizations in which they work and ensure that it moves towards the right direction regarding goals achievement. They should have exceptional communication skills (Semmelrock-Picej & Novak, 2013). This is one of the major skills that every leader has to have. Also, they would better be able to communicate clearly to the people. Good management and good leadership involve dealing with people. Therefore, both managers and leaders should be able to deal with people, and this means having good leadership skills.


While leadership refers to the ability of an individual to influence and motivate others so that they can work towards the achievement of the set goals, management refers to the capacity of an individual to control, coordinate, direct and plan how the organizational goals will be achieved given the available resources. In this regard, a leader is more people-oriented while a manager is more resource-oriented (Wong & Cummings, 2009). While leaders lead people, managers on the other hand manage work. The other difference between the two is that a leader is not necessarily required to be in a top position to lead while a manager has to be in a top position. In other words, the leader can be just a member of the organization holding any position, but a manager has to be at either a top or a middle managerial position.

In terms of their personal styles, a leader is said to be brilliant, mercurial and one with great charisma. In most cases, leaders are seen to be loners and private people. This is as opposed to managers who are rational decision-makers and problem solvers. They are supposed to make some critical decisions on behalf of the organization (North & Hughes, 2012). They should solve problems that are seen as hindrances to the goals achievement of the organization. The focus of managers, therefore, is on reaching goals. The approach of leaders is also different from that of managers. While managers approach a task by looking at a problem and devising new, creative, as well as innovative ways of solving it, a manager on the other hand creates policies, strategies and that are to be combined to work smoothly (Semmelrock-Picej & Novak, 2013). In most cases, the policies and strategies that managers devise have been used before by other managers to solve similar problems. This is as opposed to a leader who will come up with new ways of solving problems. Their approaches to risks are also different. A leader is a risk-taker while a manager is risk-averse. As it has been mentioned earlier, a manager is more focused on achieving goals. In this regard, they are afraid to take risks since they fear failing in achieving their aims (McDermott, Kidney, & Flood, 2011). It is for this reason that they like to use methods that have been tested rather than new ones the outcomes of which are uncertain. Leaders, on the other hand, will go for these new methods.

Concerning quality, a manager is seen as a copycat of a leader. This is because managers rarely come up with new ways of doing things. In most cases, it is a leader who will come up with a new way of doing things and then a manager will use it when it has already been proven. Finally, the relationship between a manager and the organizational employees is determined by the hierarchical system (Subramaniam, Othman, & Sambasivan, 2010). The leader, on the other hand, has a close relationship with the employees regardless of the position they hold. Their relationship with employees does not depend on the hierarchical system.

The Outcomes of the Theoretical Concepts of Leadership and Management to Quality Patient Outcomes

The main objective of a leader and a manager in any organization including a health organization is to ensure that the best results are achieved by whichever means as long as they are ethical as per the code of ethics. In a health organization, the objective is to ensure the best outcomes for patients (Nichols & Erakovich, 2013). Therefore, the nurse unit manager should come up with the best theoretical concepts that will ensure good clinical governance. They should ensure that the most recent and relevant innovations are always embraced in the organization. As discussed earlier, there are some theoretical concepts from which the managers should choose. The theory to be employed is dependent on the objectives and goals of the organization. The following are some of the impacts that theoretical concepts of leadership and management will have on patient outcomes.

First, theoretical concepts allow leaders and managers to embrace the best theories that ensure good relations between them and the people they lead or manage. A clinical organization is one that deals with people. It offers health services to the people. The managers and leaders in these organizations, therefore, should ensure that employees are well motivated (Carnes, Houghton, & Ellison, 2015). Motivated employees will offer good services to patients and in the end, quality patients outcomes will be achieved. The best theories to guide these concepts are given by the managerial and leadership theoretical concepts.

Secondly, the theoretical and leadership concepts enable nurse managers to understand the complexities in clinical organizations. These are organizations that keep on changing rapidly and at the same time, they grow too fast (Allio, 2013). The managers and leaders should understand and embrace these changes. Theoretical concepts in leadership help them to achieve these complexities. Understanding these complexities will be effective in improving the quality of patient outcomes.

Theoretical concepts also help managers and leaders in clinical organizations to handle different situations in the organization. The world today is overwhelmed with a high level of complexities. Therefore, it is very likely that there will be different and unpredictable situations. These are situations that could otherwise affect the quality of patients’ outcomes.


Leadership is critical in nursing as it is with any other organization. Besides, management is also essential for the success of health organizations. A nurse unit manager should be in a position to apply the various management styles and theories to achieve success in the organization. Further, the unit manager should be able to apply certain leadership styles and theories. A nurse unit manager is even much better off when he or she has leadership skills on top of their managerial skills. There are different theories that are applicable in various situations. A manager in clinical organizations should be able to understand each of these theories and apply them at the right time and place in the health organizations. From the discussion above, the best theories in the case of a clinical organization are the quantum theory and the contingency theory. This is not to mean that other theories are less important. However, these two theories have high applicability in this case. The leader or a manager should understand both of these theories and understand the organization itself and the situations that affect it from time to time.


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