Nursing Leadership and Management

Words: 1198
Topic: Health & Medicine

In the past, nursing was an amorphous and unrecognized engagement that was often left at the discretion of close family members and relatives of patients. However, after the efforts of Florence Nightingale, it was recognized as a fully-fledged profession and was integrated into the healthcare system. As the profession grew in stature, concepts such as nurse leadership and nurse management emerged. A layperson may use the two concepts are interchangeable. However, within the healthcare context, these two concepts have some key differences that set them apart. This essay explores the similarities and differences between leadership and management in the nursing profession. It specifically focuses on how nurse leaders and managers perceive continuous quality improvement and patient satisfaction.

Overview of Continuous Quality Improvement and Patient Satisfaction

The quality of healthcare is a core concern of governments across the world. According to Heyrani et al. (2012), the concept of quality in the healthcare system is multifaceted. It entails resource management, personnel management, patient satisfaction, efficiency enhancement, and safety promotion, among other elements. Until recently, healthcare organizations underscored the importance of some of these elements and ignored others. This trend culminated in poorly performing healthcare systems that prompted the development of a comprehensive framework that incorporates all the tenets of quality in the healthcare system. The framework was named clinical governance. It requires every healthcare organization to commit itself to continuous quality improvement and accountability. Therefore, patient satisfaction is at the heart of this framework.

Similarities and Differences in how Nurse Leaders and Managers perceive Continuous Quality Improvement and Patient Satisfaction

Stanley (2006) describes nurse leaders as individuals, who do not necessarily have delegated authority but empower, motivate, inspire, and influence their colleagues. A nurse manager, on the other hand, is an individual who is formally appointed to oversee the operations of a healthcare organization or a section within the organization (Swansburg, 2002). Essentially, the nurse manager plays a conventional managerial role, but in a healthcare context. Both leaders exhibit the following similarities in their perception of continuous quality improvement and patient satisfaction.

Firstly, both of them think on a long-term basis (Swansburg, 2002). In their leadership positions, both nurse leaders and managers think beyond the horizon because the nurses in their teams look unto them for direction and motivation. Their ability to think beyond the present makes them indispensable to the healthcare system, especially considering the fact that continuous improvement of quality in the healthcare system requires people who can envisage future trends and steer nurses towards the right direction. Without this kind of leadership, the nursing profession would not cope with the fast-changing quality standards in the healthcare system.

Secondly, both nurse leaders and managers look beyond their units to understand the relationships that exist between their units and the immediate external environment (Swansburg, 2002). For instance, within a healthcare organization, both nurse leaders and managers have a clear understanding of how their units affect or are affected by other departments. This knowledge helps them to provide leadership that enables their units to contribute positively to the objectives of the organization. This type of thinking is pertinent to the continuous improvement of quality and patient satisfaction because it is not possible to improve quality by simply focusing on one unit within a system (Heyrani et al., 2012). Rather, the head of each unit should clearly understand the role their unit plays in the quality improvement process and then lead it to discharge that role effectively.

Thirdly, nurse leaders, and managers both have the political skill to contain the conflicting requirements of the multiple constituencies that exist within the healthcare system (Swansburg, 2002). While every well-meaning nurse might want to make the health care system better, balancing the conflicts that occur between the different elements that constitute it often prove impossible. However, nurse leaders and managers demonstrate courage without necessarily being reckless as well as caution without being considered cowards (Coonan, 2007). This skill is closely tied to their ability to think beyond the present and to know what to do in any given circumstance. It helps them to show courage and determination when necessary and takes well-timed precautionary steps when certain measures prove to be counterproductive. This ability is invaluable to the continuous quality improvement process and patient satisfaction because they do require not only bold people but also diligent individuals who can detect and alter counterproductive measures (Kerridge, 2012).

Having examined some of the key similarities between nurse leaders and managers, it is important to note that they also exhibit some notable differences as discussed below. The first key difference between nurse leaders and managers is that while the leaders are concerned with affirming the values that are consistent with the nursing profession and challenging those that are not, nurse managers focus on upholding established organizational values (Coonan, 2007). Consequently, in circumstances where organizational values are inconsistent with the situation on the ground, the nurse leader can make the necessary adjustment as opposed to the nurse manager. Therefore, a nurse leader is in a better position to move with changing trends. This attribute places them in a position of advantage insofar as continuous quality improvement and patient satisfaction are concerned.

The second major difference is that the nurse leader is in a better position to achieve workable unity among nurses as opposed to the nurse manager (Coonan, 2007). The nurse leader banks on earned trust to build cohesion and mutual tolerance while simultaneously controlling emergent conflicts. The nurse manager, on the other hand, strictly focuses on ensuring that the assigned duties are discharged as required. Unity, cohesion, and trust may not be of much importance to a nurse manager as long as there is obedience. Consequently, the nurse leader is in a better position to facilitate continuous quality improvement and patient satisfaction than a nurse manager due to a better understanding of what goes on among unit members.

Personal Position and Rationale

Several other instances of differences between the two categories of nurse leadership exist, but the two discussed examples will suffice for this essay. A point worth noting, however, is that after examining these similarities and differences, it becomes apparent that each of the leadership approaches has its merits and demerits insofar as continuous quality improvement and patient satisfaction are concerned. However, although nurse leaders lack delegated authority, their style of leadership is preferable. They are in a position to achieve their agenda without formal authority. This ability is advantageous because Stanley (2006) asserts that people prefer to be led rather than to be managed. Consequently, they may resist and resent the nurse manager, especially when the manager is high-handed. Therefore, as a nurse leader, it is possible to bring positive change to the nursing profession in a shorter time compared to a nurse manager as long as bureaucracy does not stand in the way.


In conclusion, leadership is necessary for every setting that calls for the combined effort of many people. It is even more important for the nursing profession because nurses have become indispensable to the healthcare system, and leadership ensures that they remain committed to providing quality, safe, and reliable care. As such, the best leadership approach should be adopted when leading nurses.


Coonan, P. R. (2007). A Practical Guide to Leadership Development: Skills for Nurse Managers. Danvers, MA: HCPro Incorporated.

Heyrani, A., Maleki, M., Marnani, A. B., Ravaghi, H., Sedaghat, M., Jabbari, M., & Abdi, Z. (2012). Clinical governance implementation in a selected teaching emergency department: A systems approach. Implementation Science, 7(1), 84.

Kerridge, J. (2012). Why management skills are a priority for nurses. Nursing Times, 109(9), 16-17.

Stanley, D. (2006). Role conflict: leaders and managers. Nursing Management, 13(5), 31-37.

Swansburg, R. J. (2002). Introduction to management and leadership for nurse managers (1st ed.). Sudbury, MA: Jones and Bartlett Publishers.