nurse foreground, surgery background

5 Leadership Styles for Clinical Nurse Leaders

Clinical nurse leaders are often responsible for keeping their respective departments organized in their efforts to achieve successful care outcomes. Therefore, they must be equipped with leadership competencies that, when combined with practical nursing skills, allow them to quickly make tough decisions. By incorporating executive leadership styles into their professional strategies, clinical nurse leaders can more effectively coordinate health programs, nurse-led procedures, and administrative activities within their places of employment. For nurse leaders, it is a good idea to adopt a leadership style that best fits their daily routine. But in order to refine their ability to adapt to constantly changing medical environments, it is crucial that nurse leaders understand the different leadership styles and when they are most applicable.

Transformational Leadership

As health care issues and the technology being designed to solve them become more complex, the ability to adapt to change is becoming an increasingly important trait for clinical nurse leaders. The transformational leadership style compels nurse leaders to teach their employees how to become leaders in their workplace by participating in the development of realistic solutions to logistical issues in their respective departments. Nurse leaders must consult with patients, colleagues and administrators to identify which areas of practice should be overhauled in order to improve the quality of care offered by the organization. To advance this effort, transformational nurse leaders must encourage their employees to become invested in care outcomes. In doing so, they may better engage individual employees in actively participating in the process of improving care.

In practice, talented transformational leaders employ effective communication and interpersonal relationship techniques to motivate and inspire their teams, gradually building up a reputation for trustworthiness upon which their employees can grow to depend. Such interpersonal communication skills are represented by a leader’s ability to elicit teamwork in groups by facilitating a working environment that encourages respectful sharing of ideas. This could be done subtly—not explicitly asking for employee input, but welcoming it in an open fashion. Or it may be more appropriate to solicit feedback through designated meetings or other forms of communication, like an online message board. Regardless of how they are sourced—as these ideas are expressed, the team works together to evaluate them through their own personal insights and group feedback in order to structure a comprehensive plan to solve performance problems. In these regards, transformational nurse leaders help health care organizations adapt to industry-driven changes by leveraging information to identify problems in their organization, encouraging their subordinates to contribute to the process of making positive changes, visualizing a solution to said problems, and building a foundation of collaboration between stakeholders to implement solutions successfully.

Democratic Leadership

Through a democratic leadership style, nurse leaders include other nurses in the decision-making process during procedural changes. Clinical nurse leaders collect the ideas and opinions of their staff, then distill them in hopes of finding practical ways to improve the quality of care that they are delivering. In order to maximize the effectiveness of democratic leadership, clinical nurse leaders should advise their staff to develop both professional and casual partnerships with one another, allowing open expression of disagreement regarding patient goals, progress and health outcomes. Rather than designating select members of the team to solve problems on their own, each available nurse should be offered an opportunity to participate by contributing their own individual expertise to clinical processes. But unlike transformational leadership, the democratic leadership style generally leaves final decisions up to the leader, restricting how extensively the group can impact decisions. This allows nurse leaders to maintain control over the decision-making process while still offering employees the chance to have their feedback acknowledged by their leaders.

Nurse leaders should note that a democratically led organization may generate a workplace environment that is founded upon the ideals of a select group of highly vocal individuals. This could lead to the timid nurses feeling less valued than their more vocal colleagues, leaving them unmotivated to express their opinions. This could be especially harmful to an organization if the nurses with reserved personalities have critical insights to offer, but instead choose to remain quiet to avoid conflict. Regardless of the slight flaws in this leadership style, an educated and experienced democratic leader can be highly effective at harnessing the power of employee thoughts, opinions, and ideas to coordinate successful policies and programs. To remedy this, clinical nurse leaders must actively solicit input from every employee who may be impacted by the decision being made. For example, if an acute care department is proposing changes to the patient release procedures, the nurse leader should solicit every nurse who is involved with that process, as they will likely want to contribute their own thoughts on how to optimize that area of the department.

Autocratic Leadership

Concentrating decision-making power at the top of the chain of command can be an effective method for completing simple tasks; rather than getting bogged down by conflicting opinions, autocratic leaders can ensure that quality care is delivered safely and efficiently, with minimal time wasted on deliberation. Autocratic leaders are adept in their ability to make critical decisions in time-sensitive circumstances where fielding employee input may only serve to complicate matters and therefore, pose a risk to the patient. As such, autocratic clinical nurse leaders must be clear, concise and direct when organizing employees, and ensure that they comply with their respective facilities’ standard procedures.

While it may seem daunting to lead in this manner, autocratic leadership is highly effective in health care settings that follow strict routines, such as jails, prisons and military hospitals; it can also be effective within standard medical facilities faced with critical volumes of patients. Such facilities thrive when an autocratic leader provides them with orders broken down into basic steps, as an imbalanced ratio of patients to health care providers limits how many resources can be committed to the decision-making process. For instance, some autocratic leaders may set protocols that define when to admit/discharge patients based on time or other factors related to their condition, so the clinical nurse won’t need to make this decision based strictly upon their own judgement.

Bureaucratic Leadership

In nursing, rules are designed to ensure patient health and safety first and foremost; therefore, clinical nurses who adopt a bureaucratic leadership style are responsible for upholding protocol and ensuring that subordinate nurses adhere to the rules. This requires training employees to follow rules, and communicating with the institution’s administrators when policy changes may be necessary. Due to the invariable nature of bureaucracy, strict protocol normalizes treatment routines for patients in emergency situations, as well as high-volume and acute care facilities—similar to autocratic leadership. However, autocratic leadership is inherently more flexible, as the rules are less rigid; accountability starts and ends with senior nurse leaders instead of a fixed system of standards and practices.

Bureaucratic leadership approaches often create a tight web of rules that can potentially obstruct clinical nurse leaders from reaching their goals. These rules and regulations often stall the decision making process by creating unnecessary oversight in situations that would be better addressed through quick and direct actions. With these communication barriers in place, team members may lose motivation to contribute constructive feedback to their workplace, hampering patient outcomes and the organization’s growth. Therefore, an effective bureaucratic leader must regularly review the rules and suggest ways that their superiors can alter them to suit the current needs of patients, nurses, and administrators.

Laissez-faire Leadership

In stark contrast to the strictures of autocratic and bureaucratic leadership, laissez-faire leadership prioritizes employee freedom, allowing them to work with oversight, but little interference from personnel or policies. If clinical nurse leaders are to trust their team with minimum supervision, they must first build a team that is skilled and responsible enough to balance freedom with individual duties; this means promoting educational opportunities that improve the staff’s ability to resolve health care problems while providing motivation to continue advancing their expertise to achieve greater patient outcomes. They could do so by providing employees with resources that will help them find classes to take, or hosting those classes within their respective medical institutions.

Realistically, a laissez-faire leadership approach is most effective for new clinical nurse leaders who are in charge of a team of well-educated nurses who have extensive experience. While these nurse leaders may not have obtained enough experience to effectively make authoritarian choices, they can develop their leadership expertise by observing talented professionals and providing them with feedback when needed. The leader themselves may provide basic knowledge, but generally the employees are accountable for their own actions. As long as they maintain strong attention to detail and an eye for selecting competent, experienced employees, nurse leaders can utilize the laissez-faire style of leadership to allow more experienced nurses to thrive, improving their institution’s ability to serve patients.

Nursing leadership styles all come with relative costs and benefits, with each method impacting patient and staff satisfaction in different ways. When staff members are valued within their health care organizations, allowed to participate in patient care decisions, and given the opportunity to communicate their vision, clinical nurse leaders are better able to guide them toward solving pressing organizational issues that may limit the institution’s ability to provide exceptional care to patients. Although, sometimes a stricter leadership style may be necessary to maintain control and achieve desirable patient outcomes in institutions that are strained by high patient volumes. Through the completion of a Master of Science in Nursing degree program, educated clinical nurses can refine their understanding of fundamental nursing administration practices and develop a style of leadership that will empower their staff to proactively address clinical challenges.

Learn More

Norwich University has been a leader in innovative education since 1819. Through its online programs, Norwich delivers relevant and applicable curricula that allow its students to make a positive impact on their places of work and their communities.

Norwich University’s online Master of Science in Nursing program helps students hone their knowledge and skills to assume leadership positions in informatics, healthcare systems or nursing education. The program aims to develop students who could take a role in shaping health policy, in educating other nurses and healthcare professionals, and in providing advanced care to their patients. Norwich’s online nursing program coursework has been developed based on guidelines by the American Association of Colleges of Nursing, and the program is accredited by the Commission on Collegiate Nursing Education.

Recommended Readings:
The Affordable Care Act & Nursing
The Role of Nurse Leaders in Health Assessments
Leading Nurse Teams Through Change


Growing Future Nurse Leaders to Build and Sustain Healthy Work Environments at the Unit Level, The Online Journal of Issues in Nursing

The Future of Nursing: Leading Change, Advancing Health, National Academy of Sciences

Are you a transformational leader?, Nursing Management

Participatory Health Care: Perspective from a Nurse Leader, Society for Participatory Medicine

Online Graduate Nursing Programs

Get additional information about our Graduate Nursing Programs.

Learn More