Characteristics and Examples of Transformational Leadership in Nursing

Today’s healthcare leaders continuously face the challenge of meeting high expectations and adapting to change. Transformational leadership, the preferred management style of Magnet®-designated hospitals, has been shown to transform teams to higher levels of practice.

With staff retention currently as a top priority for many healthcare organizations, the connection between strong leadership and retaining employees is clear. If your employees do not have the leadership they need, they are more likely to leave their roles. High turnover can strain your remaining staff and incur significant replacement costs.

But high turnover usually occurs after employees have definitively concluded that they no longer want to work for your organization. There are many reasons to strengthen leadership before that happens. Good leaders boost productivity, increase employee satisfaction, and improve performance. Many organizations have achieved success toward these goals by educating their nurse leaders about the transformational leadership model.

What is transformational leadership?

Transformational leadership is a management style that motivates employees to take ownership of their roles and perform beyond expectations. Instead of assigning tasks from the top, transformational leadership teaches people how to think — rather than just do what they are told.

Transformational leaders inspire and motivate employees to find better ways of achieving a goal. They mobilize people into groups that can get work done — raising the well-being, morale, and motivation of a group through excellent rapport. These leaders also excel at conflict resolution. Sometimes called quiet leaders, they lead by example.

Transformational leaders specialize in:

• Working to change the system
• Solving challenges innovatively when old patterns do not work
• Seeking to know what needs to change
• Maximizing their teams’ capability and capacity

The history behind transformational leadership

Political scientist and historian James MacGregor Burns initially developed a leadership theory in 1978 that he called transformational leadership. Burns was interested in the leadership styles used by key historical figures such as Mahatma Gandhi, Franklin D. Roosevelt, and John F. Kennedy.

Burns described transformational leadership as occurring when “two or more persons engage with others in such a way that the leader and followers raise one another to high levels of motivation and morality.” This theory differed significantly from older leadership styles, such as transactional leadership, because it proposed that meeting the needs of followers is vital to achieving high work performance.

Characteristics of a transformational leader in nursing

• Sets clear goals
• Is a model of integrity and fairness
• Has high expectations
• Encourages others
• Provides support and recognition
• Stirs people’s emotions
• Gets people to look beyond self-interest
• Inspires people

Healthcare organizations have traditionally used transactional leadership strategies. Although a transactional leadership style can help organizations meet their goals in the short term, it will not provide the inspiration to create and nourish a new, better culture for healthcare organizations.

Transactional leadership is known for:

• Task-and-reward orientation
• Management by exception
• Few opportunities for creative thinking
• Decision-making by senior management
• Limited opportunities for employee involvement

How transformational leadership benefits an organization

Managers who use transformational leadership principles create a climate where employees have a greater commitment to their organizations and higher levels of morale, job satisfaction, and work performance.

Increased patient safety

Healthcare organizations that adopt transformational leadership see gains in staff satisfaction, which has the important effect of reducing the rate of medical errors. The Institute of Medicine (IOM), a private, nonprofit institution (now called the Health and Medicine Division of The National Academies of Sciences, Engineering, and Medicine), reported that transformational leadership and evidence-based practice create a work environment that promotes patient safety. A study in Belgium found that transformational leadership exerts a significant positive impact on the safety performance of nurses.

Nearly 20 years ago, the IOM stated that the culture of an organization — the way the organization designs the work and deploys its personnel — affects how it understands and acts to ensure safety. Culture transforms a physical healthcare environment by changing the beliefs and practices of nurses that shape that environment. Culture also determines whether an organization becomes highly reliable, with fewer errors, and whether it becomes a “learning organization” that continually improves in its quest to keep patients safe.

Better employee retention

The transformational leadership style is associated with employee retention. Those who work for transformational leaders typically devote significant effort to ensure that their organization is successful and are more likely to stay in their jobs because they feel their work is valued.

Having a good manager makes employees want to stay, but the relationship goes further than that. Newer research has examined additional benefits of transformational leadership that affect retention. These include boosts to organizational identity, which influences workers and how they feel about their organization.

Encouraging creativity contributes to better group unity and preparedness and the proliferation of desirable behaviors. Less turnover creates a positive cycle of lower disruption that prevents additional departures.

Achieving recognition

One of the best uses of the transformational leadership style is for organizations that have aspirations — such as receiving Magnet designation or reducing patient readmittance rates — and want to change and adapt to get there. A transformational leader can influence the structure of the organization and motivate employees to buy into a new direction.

The American Nurses Credentialing Center (ANCC), which oversees the Magnet Recognition Program®, recognizes that earning this designation is not a “one and done” achievement. Organizations must achieve a longstanding commitment to excellence by aligning nursing goals to improve patient outcomes. This type of concerted effort requires a culture change to make sure leaders across the organization employ the same tactics to transform the entire organization.

Instilling joy

During the COVID-19 pandemic, many nurses experienced fatigue, exhaustion, and burnout. The joy and passion that initially brought them to the profession may have been forgotten. Encouraging your nurses by providing inspiration and support using transformational leadership principles — such as individual mentoring, development, and coaching — can help them reframe their professional goals and restore their outlook and optimism.

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB, VP of Quality at Relias, observed, “When leaders encourage employees to set their own goals and provide the autonomy to do so, employees feel more empowered and in control of their work and less likely to experience burnout.”

Pros and cons of transformational leadership

Transformational leadership works well in organizations where change is needed. It likely won’t be the right fit for new organizations where no structure exists. To get something done quickly, an organization needs a leader who can provide clear direction and a path to completion, depending on the situation at hand.

Transformational leadership pros

• Excellent at communicating new ideas
• Good at balancing short-term vision and long-term goals
• Experience building strong coalitions and establishing mutual trust
• Backed by integrity and high emotional intelligence

Transformational leadership cons

• Ineffective in initial stage or ad-hoc situations
• Requires an existing structure so that growth can occur — meaning it’s not ideal for new organizations
• Bad fit for bureaucratic structures

Where leaders live

In truly highly reliable organizations, leadership skills are valuable throughout the organization. While it’s often common to focus leadership efforts at the highest levels of a hospital or health system, middle management — such as nurse leaders — are key to an organization’s success and directly impact many frontline caregivers and healthcare workers.