The Importance of Leadership in the Nursing Profession

The foundations of leadership in nursing

Over the past two centuries, nurses have pioneered medical innovations and practices that revolutionized healthcare. Since they were rarely given professional training and were submissive to physicians’ orders, nurses did not have the skills or power to improve the quality of care that patients receive. Yet, while located on the frontlines with patients, nurses instituted hygienic protocols, and invented the crash cart, feeding tube, and sanitary pads. This made procedures and recovery more effective, and slowly gained the nursing profession the respect and authority it deserved.

In the 20th century, nursing education increasingly moved to formal academic settings. This resulted in more structured levels of authority within the nursing profession. These levels refer to general categories of scope of practice for included positions, and the specific degrees and training required for it.

The levels of nursing are:

  • Nursing assistants, nursing aides, and certified nursing assistants: though not technically nurses, they are a regular point of contact between medical staff and patients, and they are responsible for everyday patient care and may also dispense medication.
  • Licensed practical nurses (LPNs): responsible for communicating with patients about their care plans, monitoring their health, and providing basic care.
  • Registered nurses (RNs): they handle a patient’s medical history, design their care plans, monitor health and symptom progress, perform tests, and administer more advanced care in coordination with physicians.
  • Advanced practice registered nurses (APRNs): they perform all the duties of a registered nurse, but also have many responsibilities of a physician depending on the state in which they are practicing. A nurse practitioner can make care referrals, diagnose and treat illnesses, and evaluate test results to determine options for care.

As mentioned above, each of these positions have different levels of educational and training requirements. Within the category of advanced practice registered nurses, there are different types of specialties such as nurse administrators, researchers, or anesthetists. Such roles might have management or supervisory rights over positions such as registered nurses and nursing assistants. Another category is a designated nurse leader, whose position would focus less on direct practice and more on areas such as budgetary management, productivity, education, and staff and patient satisfaction.

The profile of a leader in nursing

There is no one specific profile for a nurse leader. Nonetheless, there are a collection of skills and abilities that a successful leader within the nursing field will have. Leadership is more than just managing a team or making decisions that impact lots of people. The actions of a leader will influence people and unite them around a common goal. Nurses need to be able to think strategically for large-scale planning, but also personalize smaller projects so they are relevant to those affected.

Examples of typical leadership duties for a nurse include personnel and budgetary management, enforcing and overseeing established protocols and procedures, setting goals for the organization, and being advocates for other nurses and patients. Nurse leaders must be organized, literate in finance and policy, confident, and approachable.

Before they begin their education and training, nurses are expected to develop particular skills and qualities for the role. Walsh University outlines common qualities of a good nurse leader. These are qualities emphasized during a typical nursing program, whether at an undergraduate or graduate level. In addition, specific clinically relevant leadership skills are taught. This includes effective communication, interpersonal skills, self-awareness, reflection, empathetic support, role modeling, and strong moral character.  One way to hone vital skills is through an advanced education, such as in Walsh University’s online DNP programs.

Leadership in the nursing profession is not limited to those in official positions of authority. As the early history of nursing demonstrates, those who interact directly with patients often have good insight as to their care. The feedback provided by those at the lower levels of nursing practice, who spend more time with patients, informs other medical professionals about how to provide better patient care. Every member of a medical team plays a key part in managing conflict or resolving patient problems.

For the day-to-day care of patients, nurses at all levels experience pressure to make difficult decisions while also balancing safety and budgetary concerns, personnel shortages, and quality patient care. Every individual has an impact on the morale and culture within a healthcare setting, and has an obligation to share best practices with co-workers.

Impact on the organization and staff

Strong nursing leadership allows the policies and procedures undertaken by nursing staff to be more efficient and personalized. Nursing leaders can design projects that decrease staff turnover, improve workplace morale, and reduce waiting times for services. In order to make such an impact, leaders need to obtain the trust of others so they can gain relevant and timely information to inform their decisions. They also need their colleagues to trust their judgment so that they willingly listen to and accept new ideas and advocate for their proper implementation.

Many projects require cooperation between different levels of healthcare professionals, and nursing leaders help mitigate any difficulties or miscommunications. They also serve as a point of contact for news and feedback. Finally, the insight and reflections of nursing leadership are crucial to determining what needs to be changed and how to do it effectively. Without the knowledge to comprehensively understand a problem and what solutions are practical and realistic, even the most charismatic leader can fail to make positive changes. And without the ability to monitor progress and evaluate the overall impact of such changes, leaders may fail to ensure sustainable implementation of their ideas.

Impact on patient care

Research has shown that effective leadership in medical settings can lead to a variety of positive patient outcomes. When nurses develop leadership skills or are led by those with such skills, this can significantly lower staff turnover, reduce sick leave, and improve staff morale. As a result of this, nurses have higher-quality interactions with patients, colleagues work more efficiently together, and patients experience more consistent care. Patients are more satisfied with procedures, they recover faster and better, and they receive safer care.

Nurse leaders often play the role of mentor to other nurses, sharing knowledge and skills with those who are unaware or need more support. This then ensures a higher quality and standard of care for patients by raising the overall capacity of staff. Without good leadership, there may be disagreements about the direction or priorities of care for patients — strong leaders are able to define the standards of care so they can be applied with less administrative thought and more time spent on direct clinical practice. Furthermore, with proper support, nurses are encouraged and supported to apply new skills and knowledge in ways that allow them to progress into leadership roles themselves and influence other areas of care.


Nurses no longer play a passive role in healthcare settings, deferring to physicians’ judgment and knowledge. As a result of standardizing the educational and training requirements for the various levels of nursing, the scope of practice has been refined to allow for safer and more efficient patient care. With the development of nurse leaders and support for greater leadership skills within the general nursing population, outcomes for medical organizations and patients will continue to improve.