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Literature Review
March 2007
ARNNL Nursing Leadership Literature Review
Table of Contents
Introduction ......................................................................................................... 1
Leadership ........................................................................................................... 1
Theories...................................................................................................... 2
Nursing Leadership Skills/Attributes ......................................................... 3
Leadership Competencies........................................................................... 3
Leadership Issues in Health Care ........................................................................ 4
Leadership Barriers & Facilitators ............................................................. 6
Implications for Leadership........................................................................ 6
Leadership Development..................................................................................... 7
Models & Theories..................................................................................... 7
Programs..................................................................................................... 8
Leadership Strategies ................................................................................. 9
Conceptual Framework for Leadership Development
in Newfoundland & Labrador............................................................................ 12
Summary............................................................................................................ 13
References ......................................................................................................... 15
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ARNNL Nursing Leadership Literature Review
Introduction Leadership
The health care system has undergone The terms leader and leadership have
dramatic reforms in recent years as been conceptualized in various ways
organizations attempt to reduce or in the literature. There is general
maintain costs while increasing qual- agreement that a leader is one who
ity and outcomes. There is a renewed has a vision, moves forward, takes
interest in leadership development in risks, influences and guides.
acknowledging the central role it Tourangeau (2003) stated that “ exem-
plays in relation to complex health plar leaders are those who challenge
care issues. the process, inspire a shared vision,
enable others to act, model the way,
In this review, the meaning of leader- and encourage the heart” (p. 625). A
ship will be explored. An overview of leader is sometimes addressed through
selected theories and research related identification of roles/attributes, in-
to leadership will be presented as a cluding advocate for quality care, col-
background to understanding the con- laborator, role model, articulate com-
tinuing development of the concept. A municator, mentor, risk taker, and vi-
discussion of leadership in health care sionary (RNABC, 2001). “One of the
will include an analysis of issues, primary roles of leadership is to en-
highlighting facilitators of and barri- courage and inspire others in a way
ers to leadership in practice, and im- that keeps them committed to the di-
plications for nursing leadership. Dis- rection and values of the organiza-
cussion of leadership development tion” (Porter O’Grady, 2003a, p. 109).
will include selected models and pro-
grams and suggested strategies as The discussion of leadership and man-
identified in the literature. A concep- agement is often interrelated in the
tual framework for leadership devel- literature, and there is not always
opment in Newfoundland and Labra- clear distinction between a leader and
dor will be presented. a manager (Hibberd, Smith & Wylie,
2006). Management involves an obli-
Nursing leadership exists at all levels gation to achieve organizational goals; Nursing leadership exists
(Ferguson-Pare, Mitchell, Perkin, & leadership emphasizes interpersonal at all levels (Ferguson-
Stevenson, 2002). While nurses in relationships. Leadership is essential Pare, Mitchell, Perkin, &
direct care roles have content exper- for management effectiveness. Effec- Stevenson, 2002). While
tise, nurses in leadership and manage- tive managers apply leadership strate- nurses in direct care roles
ment roles have context expertise, gies, and leaders consider manage- have content expertise,
attending to the environment and re- nurses in leadership and
ment implications. Leaders may be
management roles have
sources required for the provision of formal or informal and do not always context expertise, attending
direct care. “Both context and con- have delegated authority. to the environment and
tent knowledge is critical to ensure resources required for the
quality patient/client care is provision of direct care.
achieved” (Ferguson-Pare ,et َ al., p. 6)
This review will address leadership at
all levels, including nurses in direct
care positions.
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At a time of change and uncertainty in Leatt and Porter (2003) applied the
health care, leaders must create an concept of life-long learning to a lead-
environment that supports quality out- ership development model. It should
comes for patients and professional include formal education, manage-
practice for nurses. ment training (field experiences, fel-
lowships, etc.), assessment and feed-
back, formal mentoring, and intense
Leadership Development leadership development experience.
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grams in schools of nursing, core con- (CHSRF, 2004; Thyer, 2003; Trofino,
cepts are identified based on literature 2000). A variety of strategies are dis-
findings (Heller et al., 2004). Other cussed as contributing to leadership
recommendations are made through development:
discussion of research findings. An-
trobus and Kitson (1999) recom- 1. Activities that support profes-
mended that leadership programs in- sional nursing practice contribute
clude the development of clinical to leadership development and
leadership skills, and the knowledge quality patient outcomes
and skills to work within academic, (Ferguson-Pare َet al., 2002).
management, and political domains. They include:
a. nursing newsletter and pro-
Learning activities include: small fessional publications that
group activities with peers for analy- include input from all
sis and reflection of issues (Leatt & nurses, including managers
Porter, 2003), professional coaching; (Trofino, 2000)
i.e., internal and external coach part- b. attendance at professional
nering in developing and implement- meetings (Trofino)
ing program (McNally & Lukens,
2006), interactive learning activities 2. Academic and continuing edu-
(Collins, 2000; Mills, 2005), experi- cation initiatives support lead-
ential learning (Cook & Leathard, ership development (Heller et
2004; Heller et al., 2004; Collins), and al., 2004; Sullivan, Bretschnei-
mentoring (Sullivan et al., 2003; der, & McCausland, 2003).
Heller et al.). They include:
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Concepts of Model
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Summary
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References
Aiken, L. H., Clarke, S. P., & Sloan, D. M. (2002). Hospital staffing, organization
and quality of care: Cross-national findings. International Journal for Qual-
ity in Health Care, 14(1), 5-13.
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002).
Hospital nurse staffing and patient mortality, nurse burnout and job satisfac-
tion. The Journal of the American Medical Association, 288,1987-1993.
Canadian Health Services Research Foundation. (2006). What’s ailing our nurses?
A discussion of major issues affecting nursing human resources in Canada.
Ottawa: Author.
Canadian Nursing Advisory Committee. (2002). Our health, our future: Creating
quality workplaces for Canadian nurses. Ottawa: Health Canada.
Canadian Nurses Association. (2006). Toward 2020: Visions for nursing. Ottawa:
Author.
Cook, M.J., & Leathard, H. L. (2004). Learning for clinical leadership. Journal of
Nursing Management, 12, 436-444.
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Donner, G. J., & Wheeler, M. M. (2004). New strategies for developing leadership.
Canadian Journal of Nursing Leadership, 17(2) Available online: http://
www.nursingleadership.net/NL172/NL172Donner.html.
Ferguson-Pare , M.,
َ Mitchell, G., Perkin, K., & Stevenson, L. (2002). Academy of
Canadian Executive Nurses background paper on leadership. Canadian Jour-
nal of Nursing Leadership, 15(3), 4-8.
Heller, B. R., Drenkard, K., Esposito-Herr, M. B., Romano, C., Tom, S. & Valen-
tine, N. (2004). Educating nurses for leadership roles. The Journal of Con-
tinuing Education in Nursing 35(5), 203-210.
Hibberd, J. M., Smith, D.L., & Wylie, D.M. (2006). Leadership and leaders. In J.M.
Hibberd & D. L. Smith (Eds.), Nursing leadership and management in Can-
ada (3rd ed., pp. 369-394). Mosby: Toronto
Laschinger, H. K. S., & Leiter, M. P. (2006). The impact of nursing work environ-
ments on patient safety outcomes: The mediating role of burnout/
engagements. Journal of Nursing Administration, 36(5), 259-267.
Leatt, P & Porter, J (2003). Where are healthcare leaders? The need for investment
in leadership development. Healthcare Papers, 4(1), 14-31.
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Marquis, B. L., & Huston, C. J. (2006). Leadership roles and management func-
tions in nursing: Theory and application (5th ed.). Philadelphia: Lippincott.
McGillis Hall, L., Doran, D., & Pink, G. H. (2004). Nursing staffing mix models,
nursing hours, and patient safety outcomes. Journal of Nursing Administra-
tion, 34(1), 41-45.
Mills, C. (2005). Developing the ability to lead. Nursing Management, 12(4), 20-
23.
Morgan, S. H., Lahman, E., & Hagstrom, C. (2006). The magnet recognition pro-
gram: Transforming healthcare through excellence in nursing services. Jour-
nal of Nursing Care Quality, 21(2), 119-120.
Porter-O’Grady, T. (1999). Quantum leadership: New roles for a new age. Journal
of Nursing Administration, 29(10), 37-41.
Porter-O’Grady, T. (2003b). A different age for leadership, part 2: New rules new
roles. Journal of Nursing Administration, 33(3), 173-178.
Rogers, A. E., Hwang, W. T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004).
The working hours of hospital staff nurses and patient safety. Health Affairs,
23(4), 202-212.
Sherman, R.O. (2005a). Don’t forget our charge nurses. Nursing Economics, 23(3),
125-143.
Sherman, R.O. (2005b). Growing our future nursing leaders. Nursing Administra-
tion Quarterly, 29(2), 125-132.
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Tracey, C., & Nicholl, H. (2006). Mentoring and networking. Nursing Management,
12(10), 28-32.
Wright, K., Rowitz, L., & Merkle, A. (2001). A conceptual model for leadership
development. Journal of Public Health Management Practice, 7(4), 60-66.
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ARNNL is the professional organization representing all 6300 Registered Nurses and 89 Nurse Practitioners in
the province. In pursuit of its vision, “Healthy People in Newfoundland and Labrador,” ARNNL exists so there
will be excellence in nursing, public protection, quality health care, and healthy public policy.