Internal and External Factors That Affect the Leadership Role

The description of the healthcare setting

This paper aims to show how the role of nurses has evolved over the last years. In particular, it is necessary to focus on the leadership styles, used by these medical workers. In addition to that, I would like to discuss those internal and external factors that affect the leadership role of nurses. I work in such an organization as Saint Francis Memorial Hospital; this institution is a member of Catholic Healthcare West. It provides a wide range of services and programs to both in-patients and out-patients, for example, cancer care programs, palliative care, spiritual care services, HIV care, and so forth. This hospital serves both the poor and the affluent neighborhoods of Nob Hill.

It is a private non-profit organization. The mission of this institution is formulated in this way, “to dedicate our resources to delivering compassionate, high-quality, affordable health services for our sisters and brothers who are poor and disenfranchised; and partnering with others in the community to improve the quality of life” (Saint Francis Memorial Hospital, 2010, unpaged). The fulfillment of this mission is impossible without the active involvement of nurses and providing them with the position of leadership.

On the whole, Saint Francis Memorial Hospital can be called a flat or inclusive organization which means that there are only a few layers of management between the front line personnel and the chief executive officer. There are only four levels in this hierarchy: staff nurse, unit director, vice-president and president. Scholars argue that the absence of this many-layered hierarchy contributes to better teamwork and, more importantly, gives nurses a higher degree of autonomy and leadership (Henderson & Winch, 2008, p 94). Work empowerment is believed to be the critical factor that increases nurses’ motivation and subsequently enhances their performance (Germain & Cunnings, 2010). Therefore, I may say that the organizational structure of Saint Francis Memorial Hospital promotes nurse autonomy and leadership skills.

Nevertheless, one should bear in mind that this new role of nurses also set sets higher standards of performance for them. Many researchers claim that modern nurses face such a problem as “role overload” which means that they have to meet multiple demands, made by the staff, colleagues, patients, and their families (McCallin & Frankson, 2010, p 323). The key issue is that the scope of their duties is often unspecified. Hospital administrators should not underestimate the seriousness of this role overload: it makes the person feel that he/she is responsible for everything, and this leads to anxiety, stress, and frustration (McCallin & Frankson, 2010, p 323). Fortunately, this is not the case with Saint Francis Memorial Hospital mostly because the administration provides continuous training to the personnel and encourages teamwork.

Nurse leadership style

As far as a leadership style is concerned, I should say that the nurse manager, I work with, adopts such approach as transformational leadership. It’s a major advantage is that such a method provides both stimulus and opportunity for the development of one’s professional and interpersonal skills (O’Brien et al, 2010). In part, the choice of this leadership strategy can be explained by the fact that nurses, who are over-supervised, are usually reluctant to take any initiative. Moreover, they usually feel dissatisfied with their work (O’Brien et al, 2010, p 142). To some extent, transformational leadership is based on mentoring when a more experienced and knowledgeable employee-partners with a less experienced one.

This is a form of so-called on-the-job training. The nurse managers and physicians at Saint Francis Memorial Hospital avoid being too authoritative or autocratic. More likely, they view the relations of nurses and physicians as partnerships in which both sides respect one another. Yet, there are several obstacles to forming these partnerships, namely: time pressure and different scope of duties. However, these obstacles are not insurmountable especially if hospital administration genuinely makes everything to empower nurse practitioners.

Internal and external factors, affecting leadership

Several internal and external factors can affect nurse leadership in medical institutions. One of them is the availability of training. Those hospitals that provide on-the-job training to the medical personnel, usually achieve two purposes: improve the quality and patient care and empower nurses who feel that they are valued by the organization (Adams-Wendling & Lee, 2005). Nonetheless, the training capacity of the hospital depends on the budget of the organization. To some degree, nurse leadership is often dependent on the staffing policies of the organization. For instance, if the hospital has a very high turnover rate, there is very little likelihood that the nurses will be able to acquire or improve leadership skills (Adams-Wendling & Lee, 2005).

Those organizations that gain and lose employees very quickly fail to promote teamwork and leadership. The problem is that a nurse who does not intend to work in the same hospital for a long time, is less willing to demonstrate any leadership qualities. As it has been noted before, the organizational structure also impacts nurse leadership. A flat or inclusive structure is usually more conducive to no nurse leadership whereas a many-layered hierarchy stifles leadership qualities and deprives medical workers of any autonomy (Henderson & Winch).

The external environment of the organization can also be a driving force in promoting leadership. One of them is the licensing standards set by the state. Such organizations as JCAHO (Joint Commission on Accreditation of Healthcare Organizations) define the competencies which nurses must possess and one of them is leadership (Whelan, 2006). They focus on such aspects of leadership as critical thinking, risk management, problem recognition and so forth (Whelan, 2006, p 200). Those medical institutions, where nurses fail to meet these standards, may not receive accreditation. Thus, it is quite possible to argue that for a healthcare organization nurse leadership is a necessity rather than a luxury. Shortly, the performance standards, set for these medical workers, may be raised even higher, and as a result, they will have to acquire and elaborate new leadership skills.

However, when speaking about the external environment of the medical institution, one should not speak only about the policies, imposed by the federal government. The thing is that medical practitioners and scholars have long realized that a nurse cannot be regarded as someone has does only menial jobs. This healthcare professional must obtain a higher degree of independence; otherwise, the quality of patient care may never improve. As a matter of fact, patients’ expectations are one of the forces affecting the role of nurses and leadership in medical institutions. One should take it consideration that modern hospitals are usually competitive, and patients can choose from a wide range of healthcare providers.


Therefore, to remain competitive hospitals have to promote nurse leadership which may enhance patients’ satisfaction. Saint Francis Memorial Hospital is one of those organizations that have long embraced this philosophy. In my opinion, it is driven primarily by customers’ expectations and demands rather than governmentally-imposed standards and this is an indispensable condition for the successful performance of nurses as well as other healthcare professionals.

Reference List

Adams-Wendling L, & Lee R. (2005). Quality Improvement in Nursing Facilities: A NURSING LEADERSHIP PERSPECTIVE. Journal of Gerontological Nursing, 31(11), 36-41.

McCallin A & Frankson C. (2010). The role of the charge nurse manager: a descriptive exploratory study. Journal of Nursing Management, 18, p 319- 325.

Germain P. & Cummings G. (2010). The influence of nursing leadership on nurse performance: a systematic literature review. Journal of Nursing Management, 18, p 425-439.

Henderson A. & Winch S. (2008). Commentary. Managing the clinical setting for best nursing practice: a brief overview of contemporary initiatives. Journal of Nursing Management. 16, pp 92-95.

O’Brien J. Martin D. Heyworth J. & Meyer N. (2008). Negotiating transformational leadership: A key to effective collaboration. Nursing and Health Sciences. 10, p 137-143.

Saint Francis Memorial Hospital. (2010). Web.

Whelan. L. (2006) Competency assessment of nursing staff. Orthopaedic Nursing, 25(3), p 198-202.