Globally, the health and wellbeing of every individual is paramount to the success of every nation, hence the existence of a health industry that seeks to achieve the third goal of the Sustainable Development Goals (SDGs) thus Establish Good Health and Well-Being (1). The health industry has witnessed several challenges over the years with an estimated increase in chronic and communicable diseases in the coming years (2). Despite these catastrophic situations, the health workforce, especially nurses has been very committed and up to the task. These successes can be attributed to effective leadership. The role of effective leadership in health has been highlighted by some researchers(3–8).
Leadership is required in every sector, such as health, education, and the military (3). According to Curtis et al. (2011), “Leadership involves a blend of thoughts, reflections, and images, as well as having power, influence followership, amongst others. Weilhrich and Koontz (2005) also view leadership as the course of influencing others so as they can cheerfully and unreservedly work towards achieving organizational goals. According to Firth-Cozens and Mowbray (2001), leadership is required at any level in an organization and mostly involves management duties. Cummings et al. (2008), view leadership “as a process which entails influence and occurs within a group setting or context, and involves achieving goals that reflect a common vision”.
Leadership and management sound similar but differs (10). Curtis et al. (2011) citing (11) listed the following as the differences between leaders and managers;
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“Managers administer, leaders innovate
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Managers maintain, leaders develop
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Managers control, leaders inspire
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Managers have a short-term view, leaders have a long-term view
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Managers ask how and when leaders ask what and why
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Managers initiate, leaders originate
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Managers accept the status quo, leaders challenge it”.
Leadership is exhibited using different approaches and styles. Spector (2006) identified some approaches to leadership namely; the trait approach, the behaviour approach, the contingency approach, and the leader-member exchange approach. The trait approached deals with personal characters (such as communication style) which enhance effective leadership. The behavioural approach emphasizes the leader and their behaviours. The contingency approach indicates that leadership should be viewed from how a leader interacts, behaves in a situation. Also, the leader-member exchange deals with how leaders and their followers interact. On the other hand, Wong and Cummings (2007) termed these approaches as leadership styles and described them as a “structure” needed for the nursing leaders.
The common leadership styles are authoritarian, democratic, laissez-faire, and participative leadership with transformational leadership being the latest leadership style (14).
An authoritarian leader is described as being preventive, commanding, and directive; and whose decision is final. He or she does not take into consideration the view of his/her followers. A democratic leader focuses more on his followers while deploying the teamwork approach in making decisions, with regards to laissez-faire leaders, they have no skills regarding leadership and are unable to lead their followers to achieve the desired goal. Also, a participative leader tends to blend the characteristics of both an authoritative and a democratic leader in leading his or her followers. Transformational leaders are leaders who can affect the most appropriate change needed in their place of work as well as among their followers (14).
The nursing profession has been faced with major challenges hence the need for effective nursing leadership (2, 15) as leaders play an important role in the realization of the vision and mission of the organization (16). Holm and Severinsson (2014) recommend the transformational style of leadership for all nursing leaders. Effective nursing leaders see to it that there are adequate staff and resources which would help attain optimal patient outcomes (18) they also provide direction for dealing with sophisticated issues affecting nursing and create structures, implement strategies to produce desirable results (3).
Curtis et al. (2011) stress that leadership and nursing leadership are not the same due to their highlights on nurses taking up responsibilities to get the works done in their environment. Nursing leaders are expected to have “administrative competence, adequate education, business skills, clinical expertise and an understanding of leadership principles”. Furthermore, nurse leaders must actively participate in the stewardship and transformation of health delivery, its resources’ and policy to meet the desired goals of the general public (6).
According to Aboshaiqah, Hamdan-mansour, Sherrod, and Alkhaibary (2014) “leadership involves supporting persons to produce extraordinary performance in the face of challenges, changes, maintenance of constant performance and benefits”, hence the need to invest in nursing leadership (7) mainly in these five key areas;
Due to these, most countries have begun to focus on nursing leadership as well as the international council of nurses and her allies (21).
The Global Nursing Leadership Institute was started after an intense consultation to be a yearly leadership programme after its maiden programme in 2009 (21).
In the United Kingdom, effective nurse leaders are needed to fully implement and achieve the National Health Service Plan (7). Also in Canada, several policies and current writings have equally stressed the need to have nurse leaders in healthcare settings to see to the effective outcome of health delivery (13). Again in 2011, health players in South Africa held a summit on how to “Reconstruct and vitalize the nursing profession”, out of the six core areas addressed at the summit, two of these areas were tailored towards having effective nursing leadership and outcomes(22).
Nursing is well structured to lead many changes and predict future trends (23), and despite the numerous efforts and resources spent annually towards the development of effective nurse leaders (3) and its corresponding effect on the outcome, perusing nursing as a career does not develop the leadership capacities of newly enrolled nurses (24). Also in Africa, despite the introduction of nursing leadership at the various levels of health delivery, there is little investment and studies done on leadership (25), also leadership comes with many challenges which tend to affect the outcomes. These challenges are mostly overlooked for the outcomes; hence a better understanding of the challenges of nursing leaders is important to change the narrative in the health environments.