Leadership and Decision Making in Nursing – Sample Paper


The practice of leadership is now broadly identified as a vital element in overall healthcare activities (Johns, 2017; Ellis, 2018). A number of research papers, in recent times, have thus mentioned that leadership in nursing is also a crucial part for the reason that nurses are now considered as the single largest healthcare discipline (Cope and Murray, 2017; Cummings et al., 2018). Different leadership theories support the practice of leadership and suggest that senior nurses embrace leadership capabilities in order to further enhance the healthcare setting and facilities (Taylor and Webster-Henderson, 2016). In this regard, this piece of writing is focused on analysing leadership in practice while demonstrating the awareness of what is leadership and how it is evident in the practice setting, supporting it by means of theory and literature. It is further reflecting on the instance/ scenario of leadership to illustrate what actions of leadership were being taken. Furthermore, the assignment unfolds the scenario with respect to leadership theory and leadership styles.

Instance/Scenario of Leadership

In an elderly ward, there are 4 side rooms and 4 bays with 6 beds each. The side rooms were occupied by patients that require barrier nursing. In bay A, 4 patients started to have loose stools. The nurse in charge delegated the responsibility of collecting samples of stool for the test. He also escalated the incident to the infection control team in order to look into the matter timely before it disturbs other patients. The infection control and lab results from the stool sample confirmed that there was an outbreak of diarrhoea meanwhile he discussed the solutions with staff members and consider their responses to implement. Hence, the in-charge nurse issued an order to close the bay after agreeing with all the staff members. He further provided the staff on the closure of ward/bay and reminded them regarding the infection control policies (such as hand washing, PPE and waste management) in order to limit the spread of diarrhoea and instructed them to pass the information to colleagues and visitors so that everyone remains uninfected.

The ward staff, on the instruction of in-charge nurse, advised control measures to Patients, Visitors (families and friends), and any other person who needs to enter the clinical area including, domestic staff, occupational therapists, physiotherapists, pharmacy staff, phlebotomists, porters, estates staff, chaplains, volunteers, staff in other departments that patients may need to visit for investigation/treatment which is deemed urgent e.g. x-rays. The nurse in charge also conducted an in-depth examination of Bay A and the diet of patients in this ward so as to ensure that no chances of spread are present and food that is consumed by the other two patients of this ward is hygienic.. While taking measures to limit the spread of infection and recover the infected patients from the infection, the nurse in charge ensured that there were adequate numbers of staff available to deal with this situation.

With the help of timely processes and protective measures while continuously monitoring the patients’ symptoms and keeping the bay closed until the patients were asymptomatic, this entire situation of sudden outbreak of infection was controlled. Once all the patients recovered from the infection, the infection control team after in-depth inspection, re-opened the bay. Here, in this scenario, different leadership actions were demonstrated by the in-charged nurse. First and foremost, he exhibited the capability of timely decision-making skills and perform delegation. While taking measures to control the spread of infection, another leadership action was foreseen where he instructed the guidelines to staff members. Bearing in mind that in-charged nurse also shown the leadership action of safe nurse staffing which is also very crucial in such circumstances where the spread of function is potential and other patients are also vulnerable.


Leadership Theory

As per the theory of leadership, defined in the research of Jasper, Rosser, and Mooney (2013), leadership in nursing is essentially about critical thinking, advocacy, and timely actions. Furthermore, Taylor and Webster-Henderson, (2016) state that nursing leadership is much different as compared to the concept of general leadership, for the reason that nursing leadership gives attention to taking the responsibility of practice environment along with the responsibility of improving and influencing it. Leadership in nursing can be understood as the impact of different healthcare settings and the effects of different educational backgrounds of nurse leaders. In a nutshell, leadership in nursing is all about guiding every member of staff that takes part in the welfare of patients in a specific unit of nursing (Marshall and Broome, 2017; Ellis, 2018).

However, the concept of leadership, in general, is associated with guiding and influencing others in order to enhance the working conditions. Yet it is noticed that leadership in business and leadership in nursing are distinct concepts in their respective manners. Nonetheless, the simple idea of leadership that fits well into the aspect of nursing leadership and business leadership is to influence other and guide them towards the correct way. It is found that nursing leadership entails more critical thinking aspects since the lives and wellness of many patients are dependent on the decision-making skills of nursing leaders.

In a number of areas of this civilised realm, current healthcare facilities are confronted by number of challenges and demands such as workforce challenge, changing expectation of patients, increase in the demands for access to care, concerns and issues regarding care quality and safety, mandate to enhance patient-centred care, and provide timely assistance on all healthcare needs. Under these considerations, effective governance is very important and needed in order to maximize the health care and management effectively in the hospital setting. Therefore, a number of research papers and books have mentioned the role of leadership in the clinical setting (such as Cope and Murray, 2017). One of the most prominent aspects of leadership in healthcare which makes it an essential part is that nursing leadership ensures a high quality of health care system which reliably provides efficient yet safe care. Nurses that are assigned and given with the responsibility of leadership in health care make sure that they provide good care of the patient while monitoring and managing evidence associated with the safety, risk, and quality of outcomes which, in turn, ultimately enhance patient care.

Style of leadership

As there are different leadership styles present for business leadership; clinical and nursing leadership also possess different styles (Kaiser, 2017). Generally, transformational leadership is one style of leadership that focuses on the enabling and empowering others (Hawkins, 2017).In the research of Wong, (2015) the claim was explained that the transformational style of leadership support in reducing the mortality rates of the patient. On the other hand, Wong has also found that the satisfaction of patients can be increased when nursing leaders use transactional leadership. In many of the research papers, it was mentioned that there is no single style of leadership that can be regarded as best since the measure of best leadership varies in accordance with the situation (Giddens, 2018; Frankel and PGCMS, 2019).

Considering the scenario of leadership, the major focus of the nurse in charge was on reducing the spread of infection while making sure that patients that have been suffering from diarrhoea can recover as soon as possible. To this end, he must have selected transformational leadership style because it matches with the general definition of transformational leadership style as well as with the claim of Wong’s research. According to the research of Richards and Edwards (2012), it is evident that leadership styles in nursing have prominent impacts on two of the areas namely outcomes and experience of patients, and retention and satisfaction of nurses. It would not be wrong to state that first is influencing the latter area; yet it is very challenging to determine and decide what aspect makes good nurse leadership.

On the other hand, democratic leadership style also known as participative or shared style of leadership wherein group is involved decision making process (McKeown and Carey, 2015). In one research paper, it was found that the democratic style of leadership among nurses increases and improves the ability of junior nurses and staff to take part in the procedure of making decisions (Griffith and Dowie, 2017). It can be said that the nurse in-charge, in the given scenario, has also adopted the leadership style of democratic because he gave the opportunity to his staff members to discuss the solutions. On the contrary to this style of leadership, autocratic or authoritarian style leadership, in general, is defined as the style of controlling every decision by its own (Harms et al., 2018). Hence, in the context of nursing leadership where nurse leaders decide every solution on their own and only give directives and orders to all the team members (Gobet and Chassy, 2018). Since the leader’s role in the discussed scenario does not reflect this style of leadership at any instance therefore, we can say that the autocratic style of leadership is not adopted.

Servant leadership style refers to the style of leadership wherein leaders only consider serving for the followers hence (Gandolfi, Stone, and Deno, 2017), nurse leaders take care of those who assist the patients and knuckle down to achieve progressive outcomes, i.e., the members of staff (The Kings Fund, 2018). Since the scenario has mentioned that nurse in-charged has reminded their staff members regarding all the infection control policies so that they remain free from infection while taking care of patients implies that he also used servant style of leadership. In this way, the utilized leadership styles in the given case scenario are the transformational style of leadership, democratic style of leadership, and servant style of leadership. On the other hand, the leadership theory that will be used to explain the elucidated scenario states that leadership entail critical thinking in order to take timely decisions while ensuring the best possible outcomes for the safety of patients, staff members and other visitors (Ellis, 2018).

Leadership theory applied to the scenario

Since leadership theory defined in the previous section reflects that it is mostly related with the aspect of taking appropriate decision in the timely manner. In the instance of leadership, in-charged nurse had taken timely decisions in order to limit the spread of infection which connects it with the theory of leadership mentioned previously. Furthermore, influencing and guiding is also the part of leadership theory (The Kings Fund, 2018) which is also demonstrated in the instance of leadership in the form of guiding staff member to take protective measures demonstrate that theory is connected with the instance of leadership.

General leadership actions consist of guiding, assisting, influencing, and enhancing the performance of staff members and organisations. However, in the context of nursing leadership, it further entails the capability of thinking critically and taking actions that are best fitted to the situation (Marquis and Huston, 2012). Considering the theory of leadership illustrated in this assignment also asserts that nursing leadership is based on critical thinking and taking actions that provide best outcome for patients and staff. Hence the defined theory is clearly explaining the underpinning and foundational actions of leadership.

There are number of resources available in order to define and shape leadership in nursing. However, there are certain skills that are considered as essential skills for nurse leaders in terms of demonstrating their competencies. One major skill, that is discussed and accepted widely, is expert decision making skills embedded in the evidence based practice (Payne, 2015). In order to communicate with infection control team and escalate the issue, the nurse in-charge and all the staff member followed a proper procedure of communication while following the decision taken by in-charge nurse.

Leadership in the given instance showed that there was a highly developed collaborative team which mutually worked in order to limit the outbreak of infection in other wards. In this way, mutual efforts due to robust leadership produced positive outcomes for not only patients but also for staff and other members. Leadership also suggests that nurses must have ability to create organizational cultures that infuse quality health care along with the safety of workers and patient (Cummings et al., 2010; Pretz and Folse, 2011’ Huston, 2013). By taking measures that not only safeguarded patients but also protected member of staff, visitors, and non-direct heath care providers such as administrative staff, gardeners, security guard, or laundry team, the scenario clearly demonstrated the leadership action of maintaining quality care. With the help of these measures taken by the in-charged nurse as his leadership approach, he maintained the balance between authenticity and performance expectations which is one of its strengths in terms of getting most possibly best outcome. On the other hand, the weakness of this chosen approach or styles of leadership was based on neglecting the actual cause of infections’ outbreak in the Bay A, while remain concentrated only on the recovering the infected patients and protecting other patients.


Considering the theory and literature on leadership, it is shown that the instance of leadership defined in this assignment is reflecting on how a nurse leader should manage and deal with any sudden outbreak of infection or any chaotic situation while not disturbing other patients. With this example of leadership, the nurse leader has keenly and actively involved in every aspect of problem solving without taking much of the time to decide what they are required to do. The parallel working capability of nurse in-charge had surprised me regarding how one leader should utilize time to take necessary measures. However, the lacking point in this instance of leadership was based on only focusing the protection aspect of problem. There could be a team that would be responsible to analyse the reason behind the outbreak of infection along with inspecting other bays/ wards in order to ensure that other patients are safe and only require protective measures. With the help of this incident of leadership, learning about leadership has been cleared and it makes clear the difference between management leadership and nursing leadership. It elucidated that nursing leadership is way more than only influencing and directing the followers but it is more about critical thinking and quick decision making that is justifiable in the longer run (Giddens, 2018).


In my learning, I am now looking forward to develop the capability and learn the tactics of critical thinking. As per the evaluation and instance of leadership, I consider myself as a partial leader because I do not have skills of quick management and taking decisions under great pressure. Although I have the capabilities of transformational leadership or resonate leadership along with democratic leadership; yet the capability of adopting servant leadership needs to be developed. Hence, I will enroll myself in the nursing leadership program which helps me in enhancing my skills of leadership. However, it may take several months and I have decided to give four months of time in order to develop the lacking skills of leadership. Once I became capable of handling chaotic situation in a way that provide positive outcomes on the health and well-being of patients and staff members, I would consider that my leadership skills get nurtured.


In this assignment, the instance of leadership in nursing has been discussed wherein it was illustrated that the nurse in charge has exhibited great traits of leadership and showed how good he was at handling the situation. The outbreak of infection in one ward which affected some of its patients was handled timely due to the leadership capabilities of nursing. While discussing leadership styles, it was identified that in-charged nurses had undertaken several styles of leadership in accordance with the need of the situation such as transformational style, democratic style, and servant style of leadership. During the course of this module, I understood the basic importance and meaning of nursing leadership which professionally helped in showing how leaders act wisely and critically in unexpected situations.

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