Leadership Styles in Nursing and Their Impact on Patient Outcomes

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DNP leadership team

As leaders, nurses who have earned a Doctorate of Nursing Practice (DNP) are expected to ensure a nursing staff is providing the best possible patient care through evidence-based practice methods. Studies show that when nurses have proper leadership, medical facilities exhibit improvements in patient satisfaction, fewer medical complications and better patient safety outcomes.

Nurses with DNPs are increasingly being asked to provide patients with better healthcare encounters. Cultivating an effective nursing leadership style plays a vital role in ensuring DNP-educated nurses can effectively manage staff nurses. Nursing leadership has been described as critical for well-coordinated and integrated care.

Nursing leadership “is essential regardless of where care is delivered (e.g., clinics or inpatient units, long-term care units or home care facilities), especially for those who are directly involved with patients for long periods of time,” researchers wrote in “Importance of Leadership Style Towards Quality of Care Measures in Healthcare Settings: A Systematic Review.”

For advanced practice registered nurses (APRNs) who are considering a career as a DNP-prepared nurse, finding a DNP curriculum that focuses on leadership styles in nursing, such as Duquesne University’s online DNP program, is important. Duquesne University DNP students complete coursework and residencies in leadership to correspond with a clinical or executive doctoral track.

Different Management Styles in Nursing

Different nurse leaders such as advanced practice registered nurses will implement different management styles in their nursing careers, since they each have unique personalities and exhibit distinct approaches to their work. While a certain leadership style in nursing, such as autocratic leadership, may work well for one nurse manager, it may not work for another.

Since nursing students go through several years of clinical training and educational coursework, it may take a while for them to establish their own leadership styles in nursing. When nurse managers and leaders have honed their own leadership styles and what works best for their teams, they can work together effectively to improve patient outcomes.

DNP Leadership Styles

Nurse managers and leaders who work with different teams of nurses may find that nurses in one unit are more naturally motivated or dedicated to their work than nurses in another unit. If this is the case, nurse managers can implement different leadership styles in nursing, as they take on a more laissez-faire role with the former unit and a more authoritative role with the latter unit. This will allow nurse managers to give the naturally motivated nurses the ability to work on their own, and will allow nurse managers to remain in control of the less dedicated nurses.

If nurse managers find that their nurses put more effort into their work when they are rewarded with promotions based on their good actions, they can implement a transactional leadership style, and enforce what works for their unit of nurses. When a team of nurses responds best to a collaborative environment in which they can help make decisions, nurse managers can become more democratic leaders.

Studies have shown how different leadership styles impact morale, productivity and positivity in all workplace settings. The five most common types of leadership styles contribute to the welfare of the staff and the patients and merge enthusiasm, ability and skill.

Transformational Leadership in Nursing

Transformational leaders build positive relationships and motivate individual staff members and teams as a whole. Transformational leaders are enthusiastic, charismatic and focused on successful outcomes.

The transformational leadership style in nursing is widely seen as the gold standard in nursing leadership because it promotes improved patient outcomes and greater job satisfaction among staff nurses, studies show. The American Nurses Credentialing Center recognizes transformational leadership as an essential component to hospitals receiving the coveted Magnet designation.

Transactional Leadership in Nursing

Transactional leaders motivate employees through a system of rewards and punishments (or transactions) to get daily tasks accomplished. Also called managerial leadership, transactional leadership focuses on getting specific tasks completed by managing each portion.

Unlike transformational leaders who emphasize positive changes, transactional leaders are mainly focused on getting the job done without significant change. They believe in extrinsic motivation (either positive or negative), rules, standards and procedures to gain compliance.

Transactional leadership in nursing has been criticized for hindering long-term relationships and being a negative influence on nurses’ job satisfaction.

Autocratic Leadership in Nursing

Autocratic leadership is demonstrated when a leader makes all the decisions without considering other input. Also called authoritarian leadership or micromanaging, autocratic leaders use negative reinforcement and punishment to enforce the rules.

Autocratic leaders withhold information from nurses in an effort to retain power. When mistakes are made, leaders blame individuals rather than a faulty process. While the autocratic style may not work in day-to-day situations, it is helpful in emergencies when there is little time for collaboration or discussion. Autocratic leadership helps enforce policies and procedures but does little to promote trust or communication.

Laissez-Faire Leadership in Nursing

Laissez-faire leadership, also called the absence of leadership, promotes a hands-off approach to personnel management, allowing nurses to work without direct supervision or guidance.

Studies show how the laissez-faire leadership style in nursing can be dangerous because it negatively contributes to unit socialization and creates a culture of blame. However, laissez-faire has also been shown to be an effective leadership tool when working with highly skilled and motivated staff.

Rene Steinhauer, RN, EMT-P, said nursing leadership should strike a balance in applying laissez-faire leadership.  Steinhauer wrote in Sigma Theta Tau’s Reflections on Nursing Leadership: “Nurses do not need managers to look over their shoulders every minute.”

Democratic Leadership in Nursing

Democratic leaders encourage staff nurses to openly communicate and contribute to decision-making. A democratic leader focuses on building relationships with an eye on job satisfaction and staff development. Democratic leadership aims to improve systems and processes, rather than blame individual team members for mistakes. It encourages consensus building.

With democratic leadership, however, the decision-making process is slow due to the increased participation of all team members. In some cases, the participation may create anxiety for nurses who have less experience, while allowing more experienced nurses to have disproportionate influence in decision-making.

DNP-Educated Nurses as Transformational Leaders

Of the many leadership styles, transformational leadership has been lauded as the most effective for nurse leaders, including those with a DNP. A study by the Institute of Medicine’s Committee on the Work Environment for Nurses and Patient Safety found transformational leadership promotes the pursuit of jointly held goals in healthcare.

Because of their educational and experiential backgrounds, nurses with DNPs are prepared to undertake leadership roles that encourage exploration, communication and evaluation. In the Journal of Hematology Oncology Pharmacy, Gary Shelton, DNP, said the terminal degree “assures a viable healthcare setting for organizational growth and improved patient outcomes.”

“The defining concept of DNP coursework is that of creating the transformational leader,” Shelton wrote in “Pursuing Nursing’s Terminal Clinical Degree, the DNP: The Practical Benefits.” “The nurse leader has a variety of attributes, complete with a vision for developing an interdisciplinary team able to be collaborative and autonomous.”

At Duquesne University, DNP students explore the many aspects of leadership, including how it relates to ethics, clinical quality, safety initiatives and organizational development.

About Duquesne University’s Online DNP Program

Duquesne University’s online DNP program prepares graduates to assume leadership roles in policy and decision-making to impact healthcare needs across communities. Duquesne’s DNP curriculum builds on existing knowledge for a comprehensive education that boosts leadership skills.

Students who work toward a DNP at Duquesne’s online DNP program have the added advantage of being able to continue to uphold their career and family responsibilities while pursuing the degree. Those interested in learning how to implement different leadership styles in nursing can explore how Duquesne University’s online Doctor of Nursing Practice can help students pursue their professional goals.


Recommended Readings

Advantages of Investing in Nurse Manager Training

Doctors of Nursing Practice and Interprofessional Collaboration

How Nurse Managers Play a Role in Policy Decision-Making



ANCC, “Magnet Model — Creating a Magnet Culture” 

Healthcare, “Importance of Leadership Style Towards Quality of Care Measures in Healthcare Settings: A Systematic Review” 

IntechOpen, “Leadership Styles in Nursing” 

Integrative Review, “Leadership and Nursing Work Satisfaction: An Integrative Review” 

The Job Network, “5 Nursing Leadership Styles You’ll Come to Learn as a Nurse”

MAS Medical Staffing, “7 Types of Leadership Styles in Nursing (Which One Are You?)” 

Reflections on Nursing Leadership, “Transformational Leaders: Change Agents for Good”