Leadership is a professional responsibility shared by all registered nurses (RNs) at all levels of practice in all settings. The Institute of Medicine (IOM, 2010) report titled The Future of Nursing: Leading Change, Advancing Health calls for high-quality, patient-centered health care for all, which will require a transformation of the healthcare delivery system. Nurses as leaders must be essential partners in achieving success in this initiative.

No single definition covers all of leadership’s complex meanings and processes. Leadership is multifaceted and multidimensional; leadership does not “just happen” and is not limited to the few. The essence of leadership is the act or an instance of providing direction, guidance, and influence (Merriam-Webster, 2011; Mackenzie, 2006). It can be learned, is deliberate, and is not tied to a particular position in an organization. Many authors have defined various leadership characteristics, but no single definition is agreed on by all. The fundamental nature of leadership can be described as the ability to influence others toward accomplishing common goals. Leadership is not synonymous with management. Although their roles are often entangled, they have different functions (McCrimmon, 2010). Leaders influence people to change
direction. While leadership works through influence, management works by making sound decisions, thinking, solving problems, and executing plans. Regardless of the practice setting, nurses lead and manage every day.

All RNs provide direction and guidance and exercise the process of influence every day, in every aspect of practice. Bally (2007) calls for nurses to view leadership as a collective venture. Leadership is unequivocally a professional responsibility that is shared by all RNs in all aspects of our scope of practice. RNs must accept responsibility to be leaders. According to Kotter (2007), leadership defines what the future state should look like. It establishes direction. It aligns people with a vision, motivates them, and inspires them to make it happen.

Managers focus on execution. Their skills include being catalysts, coaches, and facilitators. Leaders who are in formal management positions upgrade the function of management. Those individuals are more facilitative, nurturing, developmental, and empowering (McCrimmon, 2010). Managers who are not leaders are not able to fully engage followers, envision a future state, and exercise judgment on how to get there. The RN leads in the practice setting and profession, thereby demonstrating a blend of leadership and management.

Leadership theories have evolved over time from the Great Man and Trait Theories to more recent Transformational, Complexity, and Quantum Leadership Theories. In the classic Leaders: Strategies for Taking Charge, Bennis and Nanus (1997) identify four critical dimensions of empowerment that include (1) significance, (2) competence, (3) community, and (4) joy. The effective leader creates a vision that gives workers the feeling of importance. The leader supports a sense of contribution. There is an appreciation and genuine feeling of making a difference (Bennis & Nanus, 1997). Leadership in nursing exemplifying this dimension involves supporting newly licensed nurses, coaching and mentoring nurses to pursue opportunities such as clinical ladder advancement or involvement in shared governance models, and providing opportunities for others to learn through teaching or precepting. Bennis and Nanus (1997) identified four major strategies in leadership: attention through vision, meaning through communication, trust through positioning, and deployment of self.

Some say that there is a leadership crisis in America in the twenty-first century (Zinni & Koltz, 2009) and that there is a serious need for new leadership approaches to the complexity of the world and health care. Much of the emerging leadership research builds on the interactive leadership theories of the end of the twentieth century. A paradigm shift is occurring early in this
century—moving from industrial-age leadership to relationship-age leadership. The leader cannot focus only on building relationships but must ensure productivity and achieve outcomes by integrating the two paradigms (Scott, 2006).

Sturm (2009) builds upon Greenleaf’s (1977) servant-leadership model. Sturm concludes that servant leadership is one of the top 10 characteristics of an agile organization. It supports personal and professional growth; empowers and increases nursing leadership; and encourages collaboration, satisfaction, and retention.

Authentic leadership is another emerging leadership theory and suggests that to lead, leaders must be true to themselves and act accordingly (Stanley, 2008). This approach differs from more traditional transformational leadership that suggests a leader’s vision and goals are greatly influenced by outside forces and that followers must buy in to them. Shirey (2006) describes five distinguishing characteristics of authentic leaders: purpose, values, heart, relationships, and self-discipline.

Quantum leadership is being used by leaders to better understand the dynamics of the healthcare environment. Health care and nursing are constantly changing—highly fluid, flexible, and mobile. This constant change calls for a very different and innovative approach to leadership (Porter-O’Grady & Malloch, 2007). The potential for organizational and personal conflict is high in times of rapid change, and the unexpected is becoming the norm. Therefore, leaders must be able to address and resolve conflict effectively. Using quantum leadership principles, nursing leaders work with staff members to identify common goals, build on opportunities, and empower each other to make decisions that increase organizational productivity.