Transformational Leadership Nursing CE Course

ses must understand the difference between leadership and management. These terms are often used interchangeably, but they are inherently different. The relationship between leadership and management has frequently been a topic of debate, with many believing that leadership is superior to management; however, both fill essential needs. Some sources argue that leadership is one of the functions within management, while others posit that leadership requires more complex skills and that management is only a part of the leadership role. A manager can be a manager and not a leader; a leader can be a leader and not a manager (Finkelman, 2024; Huston, 2023).

Management is the process of directing all or part of an organization by deploying and manipulating resources. A manager holds a formal administrative position and focuses on planning, organizing, and controlling. In contrast, leaders are out front, taking risks and challenging the status quo. They gain their leadership role through their ability to influence others and not necessarily through a formal title (Finkelman, 2024; Huston, 2023). Refer to Table 1 for a comparison of traditional management and leadership components.

Table 1

Comparison of Traditional Management and Leadership Components

Managers	Leaders
Have specific duties and responsibilities they are expected to do	Focus on group processing, feedback, information gathering, and empowering others
Are assigned a position in an organization	Often do not have delegated authority but obtain power through influencing others
Have a legitimate source of power due to their position	Have a wider variety of roles
Influence the environment, time, money, and other resources to achieve the goals of the organization	May or may not be part of the formal hierarchy of an organization
Emphasize control, decision-making, analysis, and results	Emphasize interpersonal relationships
Have a formal responsibility and accountability for the control of others	Have goals that may or may not reflect those of the organization
Direct willing and unwilling subordinates	Direct willing followers

(Finkelman, 2024; Huston, 2023)

Given the complexity of the health care system, nurse managers must shift from a traditional focus on operational task completion to incorporating leadership skills such as collaboration, communication, delegation, motivation, and coordination. They must also recognize the importance of data and outcomes, manage resources, build teams, improve staff performance, and evaluate the effectiveness of interventions. They need to use critical thinking, clinical reasoning, and clinical judgment, and be flexible and adaptable to change. Integrating management and leadership skills is crucial to the success of health care organizations. Successful clinical nurse leaders can balance good management and leadership skills (Finkelman, 2024; Huston, 2023).

Historical Development of Leadership Theories

Historically, strong management skills were considered more valuable than leadership skills. As a result, leadership theories were not discussed until the 20th century, when early theories focused on broad conceptualizations of leadership. From 1900 to 1940, the Great Man theory and trait theories were predominantly discussed. The Great Man theory asserts that leadership is inherent at birth: some people are born to lead, while others are born to be led. This theory also posits that great leaders will arise when the situation demands it. Similarly, trait theories suggest that people are born with certain characteristics or personality traits that make them better leaders than others. Researchers identified numerous traits that define great leaders by studying the lives of prominent people in history. However, trait theories did not account for the impact of followers and the situation. Although many identified traits are still used today to describe effective leaders, opponents of trait theories argue that leadership is not just inherited but can be a skill that is developed (Huston, 2023). Refer to Table 2 for the characteristics associated with effective leadership.

Table 2

Characteristics Associated with Effective Leadership

Adaptability	Ability	Decisiveness
Alertness	Tact	Emotional intelligence
Integrity	Prestige	Skillful communication
Critical thinking	Collaborative priority setting	Intelligence
Enlisting cooperation	Knowledge	Creativity
Diplomacy	Independence	Emotional balance and control
Social participation	Oral fluency	Self-confidence
Interpersonal skills	Judgment	Cooperativeness
Charisma	Personable	Risk-taking

(Huston, 2023)

From 1940 to 1980, researchers shifted away from studying the traits of leaders and focused more on the behaviors of leaders (i.e., the leadership style). The first three leadership styles identified were authoritarian, democratic, and laissez-faire. Authoritarian leadership can be found in large bureaucracies such as the armed forces. With an authoritarian leadership style, staff derive security from this approach’s high productivity and predictability. However, this approach limits autonomy, creativity, and self-motivation (Huston, 2023). The following behaviors characterize authoritarian leaders:

• decision-making is unilateral
• communication flows downward
• strong control is maintained over the staff
• emphasis is on the difference in status
• criticism is punitive
• staff are directed with commands and motivated by coercion (Huston, 2023)

Democratic leadership promotes autonomy and collaboration between staff and administrators. This leadership style is appropriate for staff who work together for extended periods or when collaboration is necessary. However, the collaborative process can be time-consuming, causing frustration among the staff (Huston, 2023). The following behaviors characterize democratic leaders:

• emphasis is on the team rather than the individual
• communication flows up and down
• decision-making involves the team
• less control is maintained
• criticism is constructive
• direction occurs through suggestions and guidance
• economic and ego awards are used to motivate (Huston, 2023)

Laissez-faire leadership is a nondirected leadership style appropriate when problems are poorly defined and brainstorming is needed to generate potential solutions. In this type of leadership, the formal leader turns over the decision-making to the group and steps away from participation. This leadership style can be highly productive when group members are self-directed and motivated. However, when group members are distracted or poorly motivated, this style can result in frustration and disinterest in the group (Finkelman, 2024; Huston, 2023). The following behaviors characterize laissez-faire leaders:

• spreads decision-making throughout the group
• does not criticize
• emphasizes the group
• uses upward and downward communication between group members
• is permissive and provides little to no direction
• motivates by support when requested by group members (Huston, 2023)

From 1950 to 1980, theorists began to challenge the idea that leaders had a singular, predominant leadership style that they used consistently in every situation. Instead, many theorists posited that most leaders fell on a continuum between authoritarian and laissez-faire. The idea that leadership style was dynamic, moving along a continuum in response to different situations, was known as situational or contingency theory. With situational or contingency theories, a person’s leadership style is based on the nature of the situation, the manager’s skills, and the group members’ abilities (Huston, 2023).

From 1970 to the present day, theorists have integrated even more variables that influence leadership style, including organizational culture, the environment, the work, the values of the leader and the followers, the influence of the leader, and the complexity of the situation. The integration of these factors led to interactional and transformational leadership styles. Interactional leadership theory involves the relationship between the leader’s personality and the specific situation. This style is a dynamic two-way process where the leader and the follower contribute to the working relationship. This leadership style challenges the authoritarian approach and holds that effective leadership is accomplished through synergistically working with others. Effective leadership requires maintaining group effectiveness; communicating well; and demonstrating fairness, competence, and dependability (Huston, 2023).

Transactional and Transformational Leadership

In 2003, Burns introduced the premise that leaders and followers can raise each other to higher levels of morality and motivation (i.e., transformational leadership). He suggested that there are two primary types of leadership, transactional and transformational. Transactional leadership is a traditional management style in which the manager is concerned with day-to-day tasks and operations. Transactional leaders give directions, set goals, and use rewards to reinforce behaviors to meet established goals (Burns, 2003).

In contrast, a transformational leader has a vision and can empower others with that vision. Theorists argue that collective empowerment is one of the crucial tenets of transformational leadership. Burns (2003) developed this theory to address the aspects of an organization that lead to success, encourage enthusiasm, and identify the values employees place on their work. Other characteristics of transformational leaders include the ability to elevate followers to higher morals (i.e., do the right thing for the right reason), treat others with compassion, and encourage followers to be more innovative. The goal is for the leader and the employee to discover meaning and purpose in their work while also growing and gaining maturity. The American Nurses Association (n.d., 2023) suggests that transformational leaders do more than delegate; they help others achieve their highest potential (Huston, 2023).

Kouzes and Posner (2023) are known for furthering the work on transformational leadership. They suggest five exemplary leadership practices that, when employed, foster a culture where relationships between leaders and followers thrive (Huston, 2023). These five practices include the following:

1. modeling the way: requiring self-awareness and value clarification so that behaviors are congruent with values
2. inspiring a shared vision: a vision that encourages followers to participate in goal attainment
3. challenging the process: identifying opportunities and taking action
4. enabling others to act: fostering trust, collaboration, and sharing of power
5. encouraging the heart: recognizing, appreciating, and celebrating followers’ achievements of shared goals (Kouzes & Posner, 2023)

Transformational leadership qualities are considered highly desirable; however, other theorists caution against using this leadership style alone. Instead, many theorists suggest that transformational leadership should be combined with some traditional transactional qualities, going as far as to say that transformational leaders will fail without some conventional management skills. This premise has led to the creation of a full-range leadership model (FRLM), a leadership style that applies transformational, transactional, and laissez-faire principles. FRLM includes elements of transformational leadership (i.e., building trust, acting with principle and integrity, inspiring others, innovating, and developing others), transactional elements (i.e., contingent reward and management by exception), and laissez-faire leadership. It is hypothesized that transactional elements, such as goal setting, can be augmented by the transformational engagement of followers. The laissez-faire style is included because leaders may also need to step back and allow the team to do the work they can. Further work by Rowold and Schlotz (2009) on FRLM has suggested nine factors impacting leadership style and affecting followers. Table 3 outlines the nine factors of FRLM (Garzon-Lasso et al., 2024; Huston, 2023).

Table 3

Factors in the Full-Range Leadership Model

Factor	Leadership Style
Inspirational motivation: a leader’s representation of the vision	Transformational
Idealized influence (attributed): the charisma of the leader to create trust and confidence in followers	Transformational
Idealized influence (behavior): creating a collective sense of mission and values and prompting followers to act on the values	Transformational
Intellectual stimulation: leaders challenge the assumptions of followers’ beliefs and analyze possible solutions	Transformational
Individualized consideration: leaders individualize followers, recognizing unique strengths, needs, and challenges	Transformational
Contingent reward: a leader provides followers with meaningful rewards based on task completion	Transactional
Active management-by-exception: a leader actively searches for deviations from rules and takes corrective action when necessary	Transactional
Management-by-exception passive: a leader intervenes only after errors have been detected or standards have been violated	Transactional
Nonleadership: absence of leadership	Laissez-faire

(Huston, 2023; Rowold & Schlotz, 2009)

Leadership Style and Outcomes

Health care organizations are tasked with providing safe, high-quality, evidence-based care while controlling health care costs. Research has shown that the leadership styles of managers and other organizational leaders can impact staff performance and health care organizational performance. The complexity of the health care system requires leaders to use a variety of leadership styles—more specifically, an FRLM—to create a flexible and efficient work environment. Nurse managers have various roles and responsibilities, including managing the day-to-day workflow, training and supervising staff, and empowering staff to provide high-quality, safe, patient-centered care. Given the challenges of the current health care environment (i.e., staffing shortages, limited bed availability, and more complex patient care needs), nurse managers must have the appropriate leadership and managerial training to be successful. Contrary to their title, the nurse manager role goes beyond administrative duties. Unfortunately, nurses are often promoted into positions of leadership without proper training. Health care organizations must recognize the need for and support leadership training to optimize patient and staff outcomes. This training should focus on developing skills and fostering characteristics associated with effective leadership; (refer to Table 2). Influential leaders can use a combination of effective leadership styles, including transformational, transactional, and, at times, laissez-faire (Alloubani et al., 2019; Pishgooie et al., 2018; Specchia et al., 2021).

Patient Outcomes

Nurse leaders are critical in enhancing the safety and quality of the care their nursing staff provides. Safety and quality of care are recognized as priorities for health care organizations worldwide. However, health care organizations are prone to errors, increasing the risk of adverse patient outcomes. The IOM report, To Err Is Human, estimated that preventable medical errors cause 98,000 patient deaths and 1 million injuries annually. The physical and economic impact of these errors is significant, making prevention a top priority for organizational leadership. Research has shown that patient safety is linked to the quality of nursing care and leadership effectiveness. Many studies have linked transformational leadership with reduced adverse patient safety outcomes. Boamah and colleagues (2018) investigated whether transformational leadership impacted patient safety outcomes using a mediating factor of structural empowerment. Their findings suggest that managers with a transformational leadership style improve the quality of patient care by creating work environments that empower nurses to provide high-quality care. These results are consistent with other studies that linked leadership style to better patient outcomes and fewer complications (Boamah et al., 2018). Alloubani and colleagues (2019) also investigated the impact of leadership style on the quality of care. They found a significant positive correlation between a transformational leadership style and high-quality nursing care. Similarly, Alotaibi and colleagues (2022) found that transformational leadership can reduce adverse events and medication errors.

Nurse Outcomes

One of the most significant challenges facing health care organizations today is the critical shortage of experienced nurses. Health care organizations have been tasked with finding effective strategies to increase nurse recruitment and retention. In addition to the quality of care provided, as discussed previously, research has shown that a nurse manager’s leadership style is linked to various nurse outcomes, including stress, job satisfaction, and retention (Magbity et al., 2020; Pishgooie et al., 2018; Specchia et al., 2021). Boamah and colleagues (2018) found a relationship between a transformational leadership style and nursing job satisfaction. They found that the transformational leadership component—inspirational motivation—had the most substantial impact on nurse outcomes. The researchers concluded that the strong relationship between staff empowerment and job satisfaction suggests that improving the quality of the work environment may be an essential strategy for nurse retention. Alloubani and colleagues (2019) noted that nurse managers most frequently used transformational and transactional leadership styles, with transformational leadership seen as more inspirational. They found a significant positive correlation between a transformational leadership style, leader effectiveness, and job satisfaction. Health care organizations must foster nursing leaders trained in various leadership styles to ensure safe, high-quality care and boost nurse satisfaction and retention (Magbity et al., 2020; Pishgooie et al., 2018; Specchia et al., 2021).

References

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Alotaibi, A. A., Alrashidi, M. M., Albouaqeel, S. A. A., Alnaami, A. A. M., Alybani, H. A. T., Alrashdi, A. M., Alotaibi, Y. K. I., Aldossari, T. A., Alqarni, A., Alshahrani, A. S. M., & Altwal, A. H. (2022). The impact of nurse leadership on patient outcomes. Journal of Population Therapeutics & Clinical Pharmacology, 29(3), 725–731. https://doi.org/10.53555/jptcp.v29i03.5614

American Association of Colleges of Nursing. (n.d.). Trailblazing innovation: Integrating the documentary 5B into nursing education. Retrieved October 14, 2025, from https://www.aacnnursing.org/5B-Tool-Kit/Themes/Leadership

American Association of Colleges of Nursing. (2024). Nursing workforce fact sheet. https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet

American Nurses Association. (n.d.). Leadership and excellence. Retrieved October 15, 2025, from https://www.nursingworld.org/continuing-education/ce-subcategories/leadership

American Nurses Association. (2023). What is transformational leadership in nursing? https://www.nursingworld.org/content-hub/resources/nursing-leadership/transformational-leadership-in-nursing

Boamah, S. A., Spence Laschinger, H. K., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing Outlook, 66(2), 180–189. https://doi.org/10.1016/j.outlook.2017.10.004

Burns, J. M. (2003). Transforming leadership. Grove Press.

Finkelman, A. (2024). Professional nursing concepts: Competencies for quality leadership (4th ed.). Jones & Bartlett Learning, Inc.

Fischer, S. A. (2016). Transformational leadership in nursing: A concept analysis. Journal of Advanced Nursing, 72(11), 2644–2653. https://doi.org/10.1111/jan.13049

Garzon-Lasso, F., Serrano-Malebran, J., Arenas-Arango, S., & Molina, C. (2024). Full range leadership style and its effect on effectiveness, employee satisfaction, and extra effort: An empirical study. Frontiers in Psychology, 15, 1380935. https://doi.org/10.3389/fpsyg.2024.1380935

Huston, C. J. (2023). Leadership roles and management functions in nursing: Theory and application (11th ed.). Wolters Kluwer.

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Kouzes, J. M., & Posner, B. Z. (2023). The leadership challenge: How to make extraordinary things happen in organizations (7th ed.). Jossey Bass.

Magbity, J. B., Ofei, A. M. A., & Wilson, D. (2020). Leadership styles of nurse managers and turnover intention. Hospital Topics, 98(2), 45–50. https://doi.org/10.1080/00185868.2020.1750324

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Specchia, M. L., Cozzolino, M. R., Carini, E., Di Pilla, A., Galletti, C., Ricciardi, W., & Damiani, G. (2021). Leadership styles and nurses' job satisfaction. Results of a systematic review. International Journal of Environmental Research and Public Health, 18(4), 1552. https://doi.org/10.3390/ijerph18041552

Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients' outcomes: A systematic review. Nursing Reports, 13(3), 1271–1290. https://doi.org/10.3390/nursrep13030108

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