Leadership Theories in Practice

Today, published writings and peer-reviewed articles from online repositories offer a rich pool of scholarly discourse on leadership styles based on proposed theories; citing instances of practical application within the contemporary workplace environment. Yet, one of the most common critiques is limited practical application by healthcare providers and a virtual absence in nursing practice.  Leadership theories solely rely on evidence-based practice (EBP), which is why concern has been raised over the failure of leading nurse practitioners (NPs) and healthcare organizations to emphasize on practical application. My discussion will evaluate the efficacy and implications of the application of leadership theories evaluated in published scholarly resources and how these skills and behaviors are implemented by leaders in a clinical environment.

            Leadership, in a healthcare environment, is viewed as one of the primary elements of management and crucial when aspiring to boost employee output and quality of care. According to Boothe & Marshall (2021), transformational leadership is, arguably, one of the most influential frameworks in healthcare since it increasing the overall likelihood of clinicians ultimately morphing into influential leaders.  In proposing this theory, Bernard Bass envisioned the implementation of a leadership framework where strong interpersonal relationships between upper management and subordinate employees took precedence. The implementation of the transformational theory of leadership, therefore, meant that improved workplace relations would improve the quality of care provided in a clinical environment by practitioners. This is majorly a consequence of the inspiration and motivation provided by senior leadership given the assortment of challenges that nurses have to contend with while discharging their duties. An example of a transformational leader is Judd Strauss, a clinical nurse leader from Pottstown Hospital’s orthopedic unit. Her exceptional leadership skills were evident in an endless clamor for better working conditions for clinical staff, referring to evidence-based practice to inform changes in the current system, and always looking to improve the nursing profession (Media News Group, 2021). The application of a transformational leadership framework ensured the capability of each employee was maximized to pave the way for cumulative improvements within the organization.

            The position of a leader in today’s nursing environment provides a unique opportunity to evaluate the efficiency of the healthcare system and propose feasible changes to boost overall competence.  Moss (2019) asserts that the theory underpinning transactional leadership offers one of the best frameworks for change management when aiming for an improvement in patient outcomes while boosting productivity. Proper execution of the basic defining tenets of this behavioral framework triggers motivation among employees due to the presence of rewards as incentives for meeting key performance indicators (KPIs) or sanctions for underperformance.

This guarantees top-notch performance by a highly motivated group of employees keen on completing assigned tasks while improving their overall level of skill within their current station. As a management approach, leadership models fashioned from the transactional theory foster diligence among nurses keen on implementing a robust patient care delivery framework for posterity. Steve Ford, an Advanced Practice Registered Nurse (APRN) and senior editor for Nursing Times, is an example of a transactional leader. His leadership style combines the application of structured nursing procedures, adherence to prevailing care standards, and keen focus on short-term goals (Nursing Times, 2017). This has allowed him to set achievable goals for his staff, reduce confusion within different levels of leadership and the subsequent simplification of the decision-making process.

            Moreover, leaders are expected to influence followers positively and shape work ethic by leading by example. According to Men & Jia (2021), the substitutes for leadership theory provides a feasible model for nurses given that it is task-oriented and aspires to embolden subordinates while guiding them in the decision-making process. The application of this theory provides an inimitable opportunity for a nurse leader to identify individual positive characteristics present in their subordinates and hone them to become useful human resource to the organization. Employees working under the substitutes for leadership theory are commonly known for their diligence and their ability to complete a wide array of clinical tasks under limited supervision. This ensures each member from individual units within the larger framework of a healthcare facility is aware of their role in the overall scheme of operations and can, thus, specialize in individual tasks while aspiring to improve output.

Lauren Greene, a Registered Nurse (RN) from Mt. Ascutney Hospital and Health Center, is an example of a task-oriented leader. Her application of the substitutes for leadership theory recently earned her DAISY award during the National Nurses Month in May 2021 (“Mt. Ascutney hospital names 2021 DAISY and P.E.T.A.L.S. Award winners,” 2021). Greene is known for partnering with her subordinates to schedule tasks relevant to their expertise while providing exceptional care to her patients.

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