Articles / Leadership Theories in Nursing: Models That Shape Healthcare
Leadership Theories & ModelsExplore leadership theories in nursing including transformational, servant, and situational models. A comprehensive guide to frameworks shaping healthcare leadership.
Written by Laura Bouttell • Fri 9th January 2026
Leadership theories in nursing provide evidence-based frameworks that guide how nurse leaders influence patient outcomes, staff wellbeing, and organisational effectiveness—drawing from both general leadership scholarship and healthcare-specific research to address the unique demands of clinical environments. Understanding these theories enables nurse leaders to choose approaches suited to their context rather than relying on intuition alone.
Florence Nightingale demonstrated that nursing leadership shapes not just immediate care but entire healthcare systems. Her statistical analysis of mortality rates in Crimea—and subsequent public health campaigns—showed leadership as a force multiplying clinical expertise into systemic change. Modern nursing leadership theories build on this foundation whilst incorporating contemporary understanding of motivation, change, and organisational behaviour.
This guide examines the leadership theories most relevant to nursing practice, exploring how each applies in clinical settings and what evidence supports their effectiveness.
Several leadership theories have proven particularly relevant to nursing contexts, each offering distinct perspectives on effective leadership.
Transformational leadership remains the most researched approach in nursing contexts. This theory emphasises inspiring and motivating followers to exceed expectations through vision, individualised consideration, intellectual stimulation, and idealised influence.
Core Components:
Research consistently links transformational nursing leadership to improved patient safety, reduced medication errors, lower nurse turnover, and higher job satisfaction scores. A meta-analysis across healthcare settings found transformational leadership correlates significantly with patient outcomes, staff engagement, and safety culture measures.
Transactional leadership operates through clear expectations, contingent rewards, and management by exception. Whilst sometimes viewed as less sophisticated than transformational approaches, transactional elements prove essential in nursing.
When Transactional Works:
Most effective nurse leaders blend transactional and transformational elements—using transactional approaches for non-negotiable safety protocols whilst applying transformational leadership for culture development and innovation.
Servant leadership places follower needs and development at the centre of leadership activity. Robert Greenleaf's framework aligns naturally with nursing values of caring and service.
Servant Leadership Characteristics:
Research suggests servant leadership in nursing correlates with reduced burnout, improved job satisfaction, and enhanced patient-centred care. The approach resonates with nurses who entered the profession with service motivations.
Situational leadership theory, developed by Hersey and Blanchard, argues that effective leadership adapts style to follower readiness and task requirements. This flexibility proves particularly valuable in nursing.
| Style | Leader Behaviour | Appropriate When | Nursing Example |
|---|---|---|---|
| Directing (S1) | High task, low relationship | Low competence, low commitment | Newly qualified nurse learning complex procedure |
| Coaching (S2) | High task, high relationship | Some competence, variable commitment | Developing nurse showing potential but lacking confidence |
| Supporting (S3) | Low task, high relationship | High competence, variable commitment | Experienced nurse needing encouragement during difficult period |
| Delegating (S4) | Low task, low relationship | High competence, high commitment | Senior specialist nurse working autonomously |
Nursing teams typically include members at vastly different developmental stages—from students and newly qualified nurses to clinical specialists with decades of experience. A single leadership approach cannot address this diversity effectively.
The ward sister leading a team might appropriately direct a newly qualified nurse through medication administration whilst delegating entirely to an experienced clinical nurse specialist managing complex care. Situational awareness of what each team member needs enables this flexibility.
Application Principles:
Authentic leadership theory emphasises self-awareness, relational transparency, balanced processing, and internalised moral perspective. This approach has gained significant attention in nursing leadership research.
Self-Awareness Understanding your own values, strengths, limitations, and how you affect others. Nurse leaders with high self-awareness recognise their emotional responses to clinical challenges and manage these effectively.
Relational Transparency Openly sharing information, expressing genuine thoughts and feelings, and presenting your authentic self. This transparency builds trust essential for psychological safety in clinical teams.
Balanced Processing Objectively analysing relevant information before making decisions, including viewpoints that challenge your own assumptions. In clinical contexts, this means genuinely considering input from all team members.
Internalised Moral Perspective Self-regulating behaviour according to internal moral standards and values, even under external pressure. Nurse leaders demonstrate this when maintaining ethical standards despite organisational or financial pressures.
Studies suggest authentic leadership in nursing correlates with:
The emphasis on values alignment proves particularly relevant in nursing, where ethical tensions frequently arise between institutional demands and patient-centred care.
Shared governance represents a structural approach to nursing leadership that distributes decision-making authority to clinical nurses. Rather than a single theory, it operationalises principles from empowerment, participative leadership, and professional practice models.
Council-Based Model:
Shared governance draws from multiple theories:
Kanter's Structural Empowerment: Access to information, resources, support, and opportunity enables effectiveness. Shared governance creates structures providing this access.
Magnet Model Principles: Professional practice environments require nurse autonomy and decision-making authority over practice.
Transformational Leadership: The distributed model transforms the leader role from decision-maker to facilitator and coach.
Research suggests shared governance improves nurse satisfaction and retention, though implementation quality varies significantly. Success requires genuine authority delegation, not merely advisory roles that leadership can override.
Emotional intelligence, whilst not a leadership theory per se, has become central to understanding nursing leadership effectiveness. The ability to perceive, understand, use, and manage emotions—in yourself and others—proves essential in emotionally demanding healthcare environments.
| Component | Definition | Nursing Leadership Application |
|---|---|---|
| Self-Awareness | Recognising your emotions and their effects | Understanding personal stress responses |
| Self-Regulation | Managing disruptive impulses and moods | Remaining calm during clinical crises |
| Motivation | Internal drive toward achievement | Persisting despite systemic challenges |
| Empathy | Understanding others' emotional states | Supporting staff through difficult cases |
| Social Skills | Managing relationships effectively | Navigating multidisciplinary team dynamics |
Research links nurse leader emotional intelligence to:
Notably, emotional intelligence can be developed through training and coaching, making it a valuable focus for leadership development programmes.
Healthcare operates in continuous change—new technologies, evolving evidence, regulatory requirements, and organisational restructuring. Several theories address how nurse leaders navigate change effectively.
John Kotter's eight-step change model provides structure for nursing leadership initiatives:
Kurt Lewin's simpler model—unfreezing, changing, refreezing—remains relevant for nursing. His force field analysis helps nurse leaders identify driving forces supporting change and restraining forces opposing it, enabling strategic intervention.
Healthcare change presents unique challenges:
Effective nurse leaders adapt general change theories to these realities rather than applying models mechanically.
Clinical leadership—leadership by and for clinicians—requires theoretical frameworks that honour clinical expertise whilst developing leadership capability.
Many healthcare systems have developed competency frameworks guiding clinical leadership development. Common elements include:
Personal Qualities
Working with Others
Managing Services
Improving Services
Setting Direction
Leadership development research suggests capability builds through:
This model implies nurse leadership development should emphasise practical experience supported by relationships and training, not primarily classroom education.
No single theory addresses all nursing leadership situations. Effective nurse leaders develop theoretical literacy enabling flexible application.
| Context | Theory Most Applicable | Rationale |
|---|---|---|
| Building positive culture | Transformational | Vision and inspiration needed |
| Ensuring safety compliance | Transactional | Clear expectations and accountability |
| Supporting stressed team | Servant | Prioritising staff wellbeing |
| Developing diverse team | Situational | Adapting to individual needs |
| Navigating ethical tensions | Authentic | Values-based consistency |
| Implementing new practice | Kotter/Lewin | Structured change process |
| Empowering experienced staff | Shared governance | Distributing authority appropriately |
Assess the situation: What does this context require? Crisis management differs from culture building.
Consider your team: What do your specific team members need from leadership right now?
Play to strengths: Which approaches align with your natural leadership style?
Adapt continuously: Leadership needs shift; your approach should shift accordingly.
Evaluate outcomes: Does your chosen approach produce intended results?
Transformational leadership has the strongest evidence base in nursing contexts, correlating with improved patient outcomes, staff satisfaction, and safety culture. However, effectiveness depends on context—transactional elements remain essential for safety compliance, situational approaches help manage diverse teams, and servant leadership may better suit certain unit cultures. Most effective nurse leaders blend multiple theories rather than adhering rigidly to one.
Transformational leadership improves patient care through multiple mechanisms: inspiring staff commitment to excellence, stimulating innovative problem-solving, developing individual nurse capabilities, and modelling professional standards. Research shows transformational nursing leadership correlates with reduced adverse events, lower infection rates, improved patient satisfaction, and better safety reporting. The impact operates through culture, engagement, and practice quality.
New nurse managers often benefit from situational leadership's practical framework—assessing each team member's competence and commitment, then matching leadership style accordingly. This approach provides structure whilst acknowledging that one style doesn't fit all situations. Combining situational flexibility with authentic leadership's emphasis on self-awareness helps new managers develop genuine leadership presence whilst meeting immediate demands.
Nursing leadership theories draw heavily from general leadership scholarship but adapt concepts to healthcare realities: patient safety imperatives, 24/7 operations, multidisciplinary complexity, emotional labour demands, and ethical tensions. Research focuses specifically on nursing outcomes—patient safety, nurse retention, care quality. Some models, like shared governance, emerged specifically from nursing's professional practice movement rather than general management literature.
Leadership development occurs primarily through experience, not formal position. Nurses develop leadership skills by leading projects, precepting students, championing practice changes, serving on committees, and influencing colleagues informally. Many leadership theories—particularly transformational, authentic, and situational approaches—apply to influence without authority. Formal management positions provide additional development opportunities but aren't prerequisites for leadership capability.
Emotional intelligence proves particularly important in nursing leadership given healthcare's emotional intensity. Nurse leaders with high emotional intelligence manage their own stress responses effectively, recognise and respond to staff emotional needs, navigate conflict constructively, and create psychologically safe environments. Research links nurse manager emotional intelligence to retention, engagement, and team functioning. Unlike personality traits, emotional intelligence can be developed through deliberate practice.
Shared governance operationalises empowerment theory by distributing decision-making authority to clinical nurses. It reflects transformational leadership's developmental focus, authentic leadership's transparency emphasis, and servant leadership's commitment to follower growth. The council structure creates forums for participative leadership whilst maintaining accountability. Effective shared governance transforms the leader role from decision-maker to facilitator, coach, and resource provider.
Leadership theories in nursing provide frameworks for intentional leadership rather than mere intuition. No single theory solves all challenges, and dogmatic adherence to any model limits effectiveness. The goal is theoretical literacy enabling flexible, context-appropriate leadership that serves patients, supports staff, and advances the profession. Florence Nightingale's example reminds us that nursing leadership shapes not just immediate care but entire systems—a responsibility worthy of thoughtful, theory-informed practice.