Skills for success in nursing leadership and management

Good nurse leadership makes care more effective and keeps staff motivated and patients safe. Ruth Brooks describes what it takes for nurses to be top-flight leaders and managers.

Nurse leaders can be found at all levels of nursing practice in the health service, whether that’s newly qualified nurses who aren’t afraid to speak up for the individual patients in their care, to nurse managers responsible for leading high quality care across whole departments.

But what all nursing leadership has in common is being effective and a good role model in delivering the best patient care, whether that’s at the level of healthcare teams or whole organisations. Here we look at some of the management skills and competencies that nurses needs for leadership success, wherever they work in the healthcare system.

Speaking up for patients

Listening to patients and speaking up for them is a core leadership skill which sits at the very heart of nursing, whatever a nurse’s career level.

There is a body of research which shows that when health care professionals choose to speak up they can contribute to preventing serious adverse events for patients. That might include noticing errors in a patient’s medication, spotting signs of serious infections like sepsis or even pointing out errors in surgical procedures where surgeons mistakenly operate on the wrong site on a patient’s body, for example.

Results from one BMJ study involving 980 nurses and 93 nurse managers showed that if nurses perceive that their leaders take patient safety seriously - by role modelling good behaviour, creating safety awareness, showing their commitment to safety and encouraging participation - they felt safer and more willing to speak up about patient safety concerns. This suggests that nursing leadership roles can have a strong influence not only on the nursing team but also on quality of care and patient outcomes.

“Leadership is especially important when it comes to the people in your care - being their voice when they most need it. It can take courage to speak up for what you know is right for the patient or for your team, particularly if you’re not in a senior role – but speaking up is real leadership,” says Martyn Davey, a Nurse Associate who works in general practice.

Creating a positive work environment 

“Show me the environment and I will tell you the kind of leadership in that place. If staff are smiling and welcoming it’s because the leader is smiling and welcoming. Staff follow the leader as role model, and the leader’s relationship with their team translates into making such a big difference to the care provided,” says Wendy Olayiwola, National Maternity Lead at NHS England and NHS Improvement.

Nurses in management roles must be able to provide close support to team members who are often providing nursing care under considerable pressure. Those pressures might include dealing with low staff to patient ratios, or supporting patients with mental health issues, cancer diagnoses or families having to deal with a bereavement, all of which can nursing staff feeling drained.

Small actions like checking up on the wellbeing of a team member who has dealt with a difficult situation and fostering strong teamwork spirit can go a long way when it comes to effective leadership in these situations.

“Teams caring for very vulnerable people often find themselves in highly stressful situations,” adds Martyn Davey. “They need their leader to ensure they’re supported emotionally and physically and managed in the best interest for everyone, including the patient and staff.”

These thoughts are echoed by Paul Edwards, Director of Clinical Services at Dementia UK: “Giving nurses the chance to share and reflect, and get support for the challenges they face, has been absolutely vital in my experience. If nurses can’t access clinical supervision and support, they can get burnt out. And this carries a risk to patients. As a leader you realise you have to make that happen, it doesn’t just happen naturally.”

The influence of leadership style

Healthcare organisations can be viewed as social systems in which human resources play a critical part. Leadership is important, therefore, because it can affect outcomes for not only healthcare professionals and patients but also the overall work environment.

A 2021 systematic review which looked at the correlation between leadership styles and nurses’ job satisfaction found that 88% of the studies included showed a significant correlation between the two.

The review findings were published in the International Journal of Environmental Research in Public Health. They showed that transformational leadership style - which empowers people to accomplish positive change through big vision, inspiration, and a call to action - was most strongly correlated with job satisfaction. This was followed by authentic style (honest and direct), resonant style (emotionally intelligent) and servant style (a more democratic leadership style involving teamwork, shared decision-making, and ethical behaviour). However passive-avoidant and laissez-faire leadership styles (characterised by avoidance of responsibility) showed a negative correlation with job satisfaction across the board.

Adopting an autocratic approach also had a negative impact on employee performance measures, the research suggested, showing that much direction or too little communication from a manager may leave staff feeling unmotivated and neglected.

“In this challenging environment, leaders need to promote technical and professional competencies, but also act to improve staff satisfaction and morale. It is necessary to identify and fill the gaps in leadership knowledge as a future objective to positively affect health professionals’ job satisfaction and therefore healthcare quality indicators,” the authors conclude.

Some other essential skills for nursing leadership

Any aspiring nurse leader will also need to add these strings to their bow, according to nursingprocess.org:

Communication skills: communication is a vital tool to enable nurse leaders to motivate their team members, lead clinical teams, advocate for patients and be effective leaders; not just verbal skills but non-verbal and written communication skills too.

Integrity: being forthright and honest, keeping confidences and being trustworthy make leaders good role models to colleagues and enable them to offer the best care delivery to patients.

Critical thinking: this can positively influence the problem-solving and decision-making tasks nurse leaders face each day. It helps leaders to challenge assumptions, come up with creative solutions to problems, and understand the cause of patient and work problems.

Mentoring skills: share your expertise and you will raise your credibility, build trust and show genuine interest in your colleagues’ success.

Strong ethics: Cast-iron ethics in a nursing leader creates a positive, safe work environment for their team.

Professionalism: exhibit this and your team communication is improved, there is more accountability within the interdisciplinary team, and the work environment is more positive, improving staff retention.

Authenticity: by being true to yourself, your personality, values, and life principles you’ll build respect, credibility, trust and hope within your teams, boosting patient and staff satisfaction and employee motivation and performance towards common goals.

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