Effective Approaches in Leadership and Management


Nurses make the biggest percentage of workers in a hospital setting and play a major role in the healthcare profession since they directly and indirectly, care to patients and hence they highly influence the quality of services offered at any hospital. Over the past few decades, the profession has experienced many emerging issues, which can lead to setbacks in the entire healthcare field. Among the emerging issues include nurse shortages and nurse turnover. The main causes of nurse shortage and turnover include unrealistic job expectations, unattractive work conditions, work demands that exceed allocated resources, poor relationships, and poor autonomy and control over practice. This paper will determine the roles played by nurse leaders and nurse managers to address the issue of shortage and turnover.

While nurse managers and nurse leaders play different roles, it is true that their different roles and leadership styles highly influence the decision of an employee to stay at the workplace. According to Cowden and Cummings (2011), nurse managers and leaders who practice relational leadership and ensure quality work environments are more likely to retain their staff.

Nurse leader

The roles played by a nurse leader that would address the issue of nurse shortage and turnover are numerous. One, a nurse leader is supposed to spearhead structural empowerment where nurses are fully involved in organization structure, which will result in them being able to fully practice as professionals. The structural empowerment will also increase nurses’ autonomy and control over practice. The empowerment structures of the hospital will include its policies and processes. Once the nurses are in a position to practice the highest levels of clinical excellence and professional practice they will be able to deliver good quality care and hence increased job satisfaction, which will lead to lower employee turnover. The effectiveness of autonomy is supported by the human relations theory, which emphasized on the capacities of individuals to act autonomously, creatively, and to gear management towards bringing out the potential of the people they employ. According to Laschinger and Finegan (2005), structural empowerment has a direct effect on interactional justice, respect, and organizational trust.

Two, as a nurse leader, one should spearhead psychological empowerment. A nurse leader should allow the nurses to experience how much they believe in their roles and their influence over the organizational success and their confidence to succeed. This will enhance meaningfulness in their work where the nurse’s contributions are given meaning and motivation and in return low nurses turnover.

Three, nurse leaders also have a role to spearhead transformation. They are commonly referred to as game changers. They are tasked will spearheading positive change. These changes include involving nurses in developing and redesigning policies and procedures, as well as, creating effective staffing models with the participation of nurses. As suggested by the leadership principle of hire for transformation, employees need to feel that the culture is open to change and to diverse views. When employees are involved in effecting changes they feel more involved and hence motivated and satisfied in their jobs (Leitch, Lancefield, & Dawson, 2016).

Four, a nurse leader should allow nurse autonomy and control over practice. This can be achieved by giving the nurses a chance to take charge and accountability of their decisions and activities in the practice. This is done by minimizing rules, restrictions, and commands to allow efficiency and innovative thinking. As supported by the leadership principle of creating multiple paths for raising and testing ideas, which states that by setting up ways for people to bring their innovative thinking to the surface, this can help them learn to make the most of their own creativity. According to Ajeigbe, McNeese-Smith, Leach, and Phillips (2013), active teamwork practice was associated with increased autonomy and control over practice.

Five, nurse leader should integrate nurses in decision-making. When the nurses are given the opportunity to participate in decision-making, they feel their worthiness and the importance of their opinions in decisions related to their practice. As supported by the leadership principle of distribution of responsibility, top leaders should push power down across the organization, empowering people at all levels to make decisions. In addition, this is supported by the participative theories, which suggest that the ideal leadership style is one that takes the input of others into account.

Six, a nurse leader should give positive and negative feedback. A nurse leader should be able to sit down with a nurse and recognize accomplishments for good performance and should point out where nurses need to improve. By doing this, the leader is expressing confidence in the high performance and leaving room for improvement, thus, encouraging the nurse to keep trying until they succeed. This is supported by the leadership principle of making it safe to fail, which states that you must enshrine acceptance of failure and willingness to admit failure early. Managers need to recognize the types of failures that turn into successes because employees need to learn how to manage the tensions associated with uncertainty, and how to recover from failure to try new ventures again.

Nurse Managers

Nurse Managers have a role to play in addressing the issue of nurse shortage and turnover. One is making budgetary allocations. The budget should cater for the selection and recruitment of competent nurses to ensure that the hospital is not in a shortage of nurses. For the nurse manager to ensure that the shortage problem is looked into, the budget will cater for the implementation of a policy that evaluates different factors. As such, this evaluation will help the hospital know the minimum level of staffing, which includes evaluating the volume of patients admitted to the facility and assessment of patients’ needs. The budgetary allocation will also cater for expenses that directly involve the satisfaction of nurses. For a nurse manager, one has to be cost-effective and at the same time satisfying the staff. The expenses involve employment costs and non-salary costs. Employment costs are salaries, wages, and commissions, for nurses to feel satisfied and motivated they need to receive their salaries and commissions on time. As supported by the management principle of remuneration that argues that the remuneration should be sufficient to keep employees motivated and productive (Halkos & Bousinakis, 2010).

Two, the nurse manager will be responsible for setting attractive work schedules since high work-life balance conflict can highly result in nursing shortage and turnover. As a nurse manager one will need to provide attractive working schedules that may include shifts, job sharing, compressed working week, and flexible working hours. With this flexibility, Nelson and Tarpey (2010) explain that nurses will be more satisfied, they will experience an improved work-life balance and they will be willing to stay at the job hence the manager will have achieved retention.

Three, nurses have the greatest potential to help in improving healthcare for their patients, but in order to realize that potential they have to operate in a safe, healthy, empowering, and satisfying environment. It is a nurse manager’s fundamental duty to ensure that nurses have a safe and healthy working environment, which according to Kirwan, Matthews, and Scott (2013), contributes highly to worker behavior, attitudes, motivation, and worker satisfaction. The nurse manager should create better support services, workflow with less complexity, an environment that supports autonomous nursing practices, and an overall environment that allows the nurses to work in accordance with professional standards. As supported by the management principle of order it is the responsibility of managers to ensure that the work environment must be safe, clean and tidy.

Fourth, nurse manager is at the helm of decision-making, as managers must make quick and reasonable changes. Decision-making is a key responsibility, which affects nurse shortage and turnover. For the nurses to feel as part of the facility and for their concerns to be taken into consideration, nurse managers are expected to work closely with staff, to find, and implement useful changes. As stated by the management principle of the degree of centralization, an organization should strive to strike a balance in the degree of centralization and decentralization (Hollenbeck, 2011).

Five, a nurse manager is expected to use communication skills when dealing with the nurses to be able to correctly respond to concerns and questions asked by them. The skills will help the manager to explain the policies and procedures to the nurses and be able to represent the rest of the nurses in meeting with the top management and in trade unions. A nurse manager should be able to support other nurses working under him or her who have no experience, or minimum education, you should be able to interact with them, establish a rapport and ensure communication is clear. When nurses’ concerns are listened to and responded, when their grievances are represented at the top management meetings and trade unions and when they are helped and mentored by their nurse managers, they feel appreciated, which leads to motivation and job satisfaction, a concept discussed by Riley (2015).

Six, a nurse manager should have conflict resolving skills. As a manager, the people under you are of different educational backgrounds, different ideas and opinions and hence occasionally conflicts may arise. As a manager one is expected to promote cohesiveness and collaboration among all the staff nurses under them. This conflict resolving need is supported by the management principle of esprit de corps which calls for the striving of the involvement and unity of the employees as examined by Pahi, Shah, Ahmed, and Umrani (2016). Managers are responsible for the development of morale in the workplace – individually and in the area of communication. Esprit de corps contributes to the development of the culture and creates an atmosphere of mutual trust and understanding.


            A leader has the ability to influence others through effective communication and interpersonal skills. Anyone can be a leader, but when one goes ahead and seeks formal management roles to be able to execute their leadership skills in their jurisdiction they become managers. As much as leaders and managers’ role are different, their roles complement each other. Therefore, it is important for both to collaborate in an organization and use their decision-making skills, critical thinking skills, effective communication, interpersonal skills, and leadership skills to be able to set realistic job expectations for the nurses. Collaboration enhances attractive working conditions, enhances colleague relationship among the nurses, and improves autonomy. Consequently, the organization will experience higher employee performance levels and decreased employee turnover, which will lead to overall good quality of health care services. To wrap it up, one would rather be a leader than a manager, because not every leader may be a manager but every manager should be a leader.


Ajeigbe, D. O., McNeese-Smith, D., Leach, L. S., & Phillips, L. R. (2013). Nurse-physician teamwork in the emergency department: impact on perceptions of job environment, autonomy, and control over practice. Journal of Nursing Administration43(3), 142-148.

Cowden, T., Cummings, G., & Profetto-Mcgrath, J. (2011). Leadership practices and staff nurses’ intent to stay: a systematic review. Journal of Nursing Management19(4), 461-477.

Halkos, G., & Bousinakis, D. (2010). The effect of stress and satisfaction on productivity. International Journal of Productivity and Performance Management, 59(5), 415-431.

Hollenbeck, J. R., Ellis, A. P., Humphrey, S. E., Garza, A. S., & Ilgen, D. R. (2011). Asymmetry in structural adaptation: The differential impact of centralizing versus decentralizing team decision-making structures. Organizational Behavior and Human Decision Processes, 114(1), 64-74.

Laschinger, H. K. S., & Finegan, J. (2005). Using empowerment to build trust and respect in the workplace: A strategy for addressing the nursing shortage. Nursing economics23(1), 6.

Leitch, J., Lancefield, D., & Dawson, M. (2016, May 18). 10 Principles of Strategic Leadership. Strategy & Leadership. Retrieved from: https://www.strategy-business.com/article/10-Principles-of-Strategic-Leadership?gko=25cec

Kirwan, M., Matthews, A., & Scott, P. A. (2013). The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach. International journal of nursing studies, 50(2), 253-263.

Nelson, M. F., & Tarpey, R. J. (2010). Work scheduling satisfaction and work life balance for nurses: the perception of organizational justice. Academy of Health Care Management Journal, 6(1), 25.

Pahi, M. H., Shah, S. M. M., Ahmed, U., & Umrani, W. A. (2016). Investigating the Issue of Nurse Job Satisfaction: Role of Esprit De Corps, Task Significance, Self-Efficacy and Resilience: A Case Study. Internasional Journal of Academic Research in Business and Social Sciences, 6(4).

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