The field of health-care is labor intensive and based on powerful know-how (Kanste, 2008). In contemporary medicine both therapeutic as well as nursing tasks are performed by a team, rather than an individual, being it a doctor or a nurse, respectively. No team work can be effective without a leader; this is also true for good nursing in which the leadership is very crucial and vital. “All the results of good nursing …may be spoiled or utterly negative by one defect, viz: in petty management” (Florence Nightingale as cited in McEachen & Keogh, 2007, pg.01). The health care environment becomes more competitive every day. There are few professions in which the complications of poor performance are as serious as in nursing and there are few professionals who feel the pressure of responsibility more keenly than nurses (Kenmore, 2008). This paper presents discourses on the contemporary leadership styles and highlights the characteristics and development of an effective leader and discusses the impact of effective leader on organisation’s potential to succeed.

Leadership styles

The continued search for good leaders resulted in the development of many leadership theories. Although leadership is not a new concept, and its fundamental function is well documented, there is no theoretical agreement or a universal definition of leadership (Farag, Mc Guinness & Anthony, 2009; Mahoney, 2004 and Murphy, 2005). However, some scholars believe that certain leadership characteristics or personality traits are innate in effective leaders (Murphy, 2005). Thus the perspectives of Great man or trait theories which dominated until 1950’s, states that leader are born and not made (Murphy, 2005). In the 1950’s, behavioural and social scientists began to analyse leadership behaviour. The behavioural theory says that leaders are not born to lead, but learn leadership behaviour (McEachen & Keogh, 2007). The efforts of these researchers were fundamental in isolation of three common leadership styles: autocratic, democratic and lassiez-faire (Murphy, 2005). The Contingency theory by Fiedler was further expanded by Herset, Blanchard and Johnson as the Situational theory (Murphy, 2005).

Later, some contemporary leadership theories such as the charismatic, transactional, transformational and shared leadership theory gave rise to the contemporary leadership styles (Murphy, 2005). The contemporary leadership styles include quantum, charismatic, transactional, transformational, relational, shared and servant leadership (Murphy, 2005).Though there are many leadership styles identified in the literature, laissez-faire, transactional and transformational leadership styles are the primary leadership styles identified in the nursing and management studies (Farag et al., 2009).

Laissez-faire leadership indicates the absence of leadership (McGuire & Kennerly, 2006). This leadership style is ineffective in promoting purposeful interaction and it contributes to organizational demise (McGuire & Kennerly, 2006).

Transactional leaders view the leader-follower relationship as a process of exchange (McGuire & Kennerly, 2006). On the other hand, transformational leadership is a process that motivates followers by appealing to higher ideals and moral values (Trofino, 2005). The transactional leader sets goals, gives directions and tends to gain compliance by offering rewards for performance (McEachen & Keogh, 2007). Whereas, by inspiring a shared vision through clear roles, effective teamwork and providing feedback on individual or team performance transformational leaders enables the staff to explore their professional practice (Halm, 2010). The three elements of transactional leadership are: contingent reward, where the leader provides reward that is dependent on the performance; passive management by exception, where the leader takes corrective action when problems arise and active management by exception, where the leader takes corrective action in anticipation of problem (Chen, Beck & Amos, 2005; McGuire & Kennerly, 2006; Rukmani, Ramesh & Jayakrishnan, 2010). Similarly, the four elements of transformational leadership are idealized influence, inspirational motivation, intellectual stimulation and individualized consideration (McGuire & Kennerly, 2006; Halm, 2010). The expected outcome of transactional leadership is enhanced role clarity, job satisfaction and improved performance (McGuire & Kennerly, 2006). On the contrary, the ultimate outcome of transformational leadership is to change the mental model of employees, to link desired outcome to values held by employees and to build strong employee identification within the group or organization (McGuire & Kennerly, 2006; Halm, 2010).

There are also some pitfalls and limitations of transactional leadership. Transactional leadership might not yield the same results across culture; such as, most North American culture which emphasize individualism, whereas many Asian culture emphasize collectivism (McGuire & Kennerly, 2006). Hence, transactional leaders need to understand at which level to establish their reward system- individual or collective reward (McGuire & Kennerly, 2006). Transactional leaders cannot provide leadership over task areas in which they have no expert knowledge (McGuire & Kennerly, 2006). Likewise, there are some limitations to transformational leadership. Transformational leaders need to be updated in their knowledge and skills (McGuire & Kennerly, 2006; Halm, 2010). There is a growing demand for evidence-based decision making, where, to show leadership, a transformational leader need to cite hard and factual evidence, as transformational leaders have nothing worth saying without strong evidence. Finally, the transformational leaders will be needed to inspire flexible, multi skilled work forces to bridge the barriers established by rigid job description and functional departments (Trofinio, 2004). “Transformational leadership is not an alternative to transactional leadership, but it augments transactional leadership” (Spinelli, 2006). Therefore, an effective leader achieves a balance between transformational and transactional behavior, thus creating a leadership style which matches the needs of followers (McGuire & Kennerly, 2006). The current shortage of nurses at the bedside magnifies the importance of having a strong, clear, and supportive and inspiration leadership across health care organization (McGuire & Kennerly, 2006).

Characteristics and development of effective leader

While there is disparity amongst the theorist definitions of leadership, there is consensus pertaining to qualities necessary to realize effective leader (Murphy, 2005). There are various traits of an effective leader mentioned throughout the literature. Having a vision is a key feature of effective leadership and it is the clarity of vision evolved by the leader about the future of the organization that distinguish them as effective (Joyce, 2009). An effective leader has a vision for the future, which helps him to set objectives, aims, goals and standards and to achieve the set goals; the leader has a plan to implement (Fletner, Mitchell, Norris & Wolfe, 2008). Tomey (2009) mentions some of the essential leadership traits which also empower people. These include accessible, collaborative, communicative, flexible, good listener, honest, influential, knowledgeable, positive, supportive and visible (Tomey, 2009). An effective leader should also posses’ job knowledge, positive attitude, delegation skills, positive partnership and should be a role model, dependable, motivating, and compassionate (Fletner et al., 2008; Cook & Leathard, 2004).

An effective leader must recognize the individual strength and weakness of each person involved, shifting focus as necessary in an effort to elevate each person’s level of effectiveness as an individual and as a part of a team (Fletner et al., 2008). As Joyce, 2008, rightly quotes that “effective leaders ‘walk the talk”. Consequently, there is consistency between their values, vision, standards and behavior (Fletner et al., 2008; Joyce, 2008). A good leader should ideally possess all of the identified characteristics, or at least a majority of them (Fletner et al., 2008). Fletner et al. (2008) also reveal that any characteristics can be a leader’s strength or weakness depending on the situational needs and persons involved in the given scenario. Neither there is just one characteristic that defines a leader, nor should, the entire identified characteristic be required when determining whether an individual would be an effective leader (Fletner et al., 2008). Likewise, to say one characteristic is more important than the other is to fragment the idea of leadership (Fletner et al., 2008).

A leader with insufficient leadership training might become exhausted in trying to achieve the organizational goals and thus, in turn, a leader might burnout and dissatisfaction among subordinates might increase (Chen, Beck & Amos, 2005). One of the greatest challenges we face in nursing profession is to develop future nurse leaders (Jumaa, 2008; Kleinman, 2004; Mahoney, 2004; Murray & DiCroce, 2003). Hence, training effective leaders has been proposed as a key to increase professionalism in nursing (Chen, Beck and Amos, 2005). Although it remains unclear, how to best prepare effective leaders, evidence suggest that graduate education may be an important precursor to the development of effective leadership style (Kleinman, 2004; Mahoney, 2004). Developing a relationship with specific academic provider of registered nurse to Bachelor of Science in nursing programs and graduate education in nursing administration may facilitate nurse managers returning for advanced education (Klienman, 2004). Onsite and distance education programs may offset obstacles of scheduling and geography (Kleinman, 2004). The feasibility of mandating graduate education requirements for all practicing nurse managers is limited; therefore, continuing education strategies must focus on nurse manager leadership training (Kleinman, 2004; Mahoney, 2004; Wilson, 2005). An effective continuing educational program should consider providing monetary incentive and an organizational commitment that allows sufficient time to be spent on course work, in addition to management responsibilities (Kleinman, 2004). Conley, Branowicki and Hanley (2007), recommend a three component orientation for nursing leaders including nurse manger competencies, precepting by supervisor and written and classroom resources. Learning about the history of nursing, and especially about people who greatly influenced the development of nursing, has a fundamental meaning in fulfilling the vocation for nursing (Kosinska & Niebroj, 2004). In this context, the statement saying that ‘history is a teacher of life’ seems to be true and of paramount importance for creating leaders (Kosinska & Niebroj, 2004).

The Leading Empowered Organizations(LEO) program, shared between United Kingdom and United State of America, is constructed around a model that identifies consensus decision making, interdependence, positive discipline, responsibility, authority and accountability as key areas of effective leading (Cook & Leathard, 2004). Recognizing the need to invest in nurse managers to reduce turnover, the Pacific Northwest Nursing Leadership Institute was created in Washington State, in 2002, to support the development and preparation of nursing leaders (Wilson, 2005). Thus, there are various programs, education and institutions, to encourage the development of leadership skills among nurses; which highlights the impact that an effective leader can have on the organization.

Impact of effective leadership on organization

The inability of hospital to retain staff nurses threatens the adequacy of health care delivery and increases personnel and patient care costs (Kleinman, 2004). Many factors have led to rising health care costs, which have increased faster than the general inflation over the past three decades (Spinelli, 2006). Performance standards for effective leaders require them to be accountable for transactional processes such as budgets, productivity and quality monitoring; while at the same time displaying transformational characteristics by acting as a coach, mentor and a leader (Kleinman, 2004; Spinelli, 2006).

A creative work climate has a strong relationship to job satisfaction and the nurse manager is an important link in creating such a climate (Sellgren, Ekvall, & Tomson, 2006; DeCasterle, Willemse, Verschueren & Milisen, 2008). Job satisfaction has been described as the most important predictor for nurses intention to remain employed (Sellgren et al., 2006; Carney, 2008). The perception of staff nurse’s towards the leadership behavior of their manager was significantly related to their job satisfaction (Sellgren et al., 2006; Klienman, 2004). Staff that perceives job satisfaction is essential for the ability to give high quality and safe care (Sellgren et al., 2006). Job dissatisfaction leads to absenteeism, problems of grievances, low morale and high turnover (Wong & Cummings, 2007). On the contrary, poor leadership was found to be one of the main reasons for dissatisfaction and intention to leave (Neilsen, Yarker, Brenner, Randall and Borg, 2008 and Sellgren et al., 2006). Altered performance, affecting patient outcome, which in turn results in higher employment cost is also found to be associated with decreased job satisfaction (Wong & Cummings, 2007).

The findings of the study done by Wong and Cummings (2007) and Kenmore, (2008), suggest that there is a relationship between leadership and patient satisfaction, patient mortality and patient safety outcomes, adverse events and complications. Positive leadership behavior increased patient satisfaction, and decreased incidences of patient mortality, adverse events and complication (Wong & Cummings, 2007). Effective nursing leadership is essential to the creation of practice environments with appropriate staffing level, that support nurses in preventing unnecessary death, adverse events and complications (Wong & Cummings, 2007). A recent study done in mental health service organizations show that, both organizational culture and organizational climate impact work attitude and subsequently staff turnover (Wong & Cummings, 2007). Effective leaders can also help in the recruitment process by recruiting staff as per the job description and thus help in the organizational development (Neilsen et al., 2008 and Sellgren et al., 2006). The study done by Wong and Cummings (2007), in Singapore, to determine the effect of leadership behavior on employee outcome, shows that in times of stress and chaos, leadership styles that transform, create meaning in the midst of turmoil and produce desirable employee outcome are more beneficial for organization’s existence and performance.

Conclusion

In conclusion, it is apparent that nurses can lead the health care industry as they comprise the major component of all health care employees; being on the front line and having the most frequent direct contact with the patients and their families. The increasing emphasis on fiscal accountability in global recessionary times places even greater emphasis on measuring organizational effectiveness (Joyce, 2009). The need to move a health care organization forward in an era of declining profit margin, diminishing capacity, manpower shortages and technological expansion cannot be overstated. The call for the nurses to become recognized leaders of health care industry; possessing the knowledge, skills and attitudes relevant for effective leadership and the necessity to use the technology of the 21st century to aim for an essentially global community are the key perspective significant to nursing leadership and management(Jumaa, 2008). Effective leadership behavior is the key to productive and happily satisfied nurses with great organizational commitment. Nevertheless, it is how the leader leads in the context of the setting which is paramount. To sum up, positive or effective leadership is critical towards achieving and driving organizational effectiveness.