Foundation

What Is a Nursing Leadership Essay?

Core Definition

A nursing leadership essay is an academic document in which a nursing student or registered nurse critically examines one or more leadership theories, applies that theory to specific clinical or organizational contexts, and reflects on the implications for their own professional leadership development. When centred on transformational leadership, the essay explores how nurse leaders inspire, motivate, and intellectually develop their teams in ways that produce measurable improvements in staff engagement, patient outcomes, and organisational culture.

Ask any experienced nurse educator what assignment nursing students most consistently struggle with, and a version of this answer will come up repeatedly: the leadership essay. Not because the content is too complex — nurses manage genuinely complex clinical situations every day — but because the leadership essay asks for something that clinical training does not always develop. It asks you to step back from the practice itself and analyse the thinking and behaviour that makes excellent nursing practice possible in the first place.

That is what leadership theory is for. It gives you a structured, evidence-based language for understanding why some nursing units feel energised and high-functioning while others feel depleted and fragmented. It explains why some charge nurses seem to draw the best out of every staff member while others preside over units with chronic turnover and poor morale. And when that theory is transformational leadership — arguably the most studied and most influential framework in nursing leadership research over the past forty years — it gives you a framework that is both academically robust and deeply clinically relevant.

This guide walks you through everything you need to write an outstanding nursing leadership essay using transformational leadership theory. You will find a thorough explanation of the theory and its key components, a clear structure for your essay, full example essays at BSN, MSN, and DNP levels, a critical analysis section that will elevate your work beyond summary into genuine scholarly engagement, and the common errors that cost students marks — along with exactly how to fix them.

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BSN Leadership Essay

Focuses on understanding the theory, applying it to one clinical experience, and initial personal leadership reflection.

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MSN Leadership Paper

Requires deeper critical analysis, evidence synthesis, and application to organisational or unit-level leadership challenges.

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DNP Leadership Project

Demands systems-level thinking, policy application, implementation evidence, and scholarly critique of the theory itself.

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RN Professional Portfolio

Uses transformational leadership as a reflective lens on practice, demonstrating leadership competency for career advancement.

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Nursing Leadership Essay vs. Reflective Practice Essay — What’s the Difference?

These two assignment types are related but distinct. A nursing leadership essay is primarily theoretical and analytical: it examines a leadership framework, tests it against evidence, and applies it to practice. A reflective practice essay (often using Gibbs’ or Driscoll’s model) is primarily experiential: it begins with a personal clinical event and works outward to theory. Many nursing programs blend both — asking you to describe a leadership experience and then analyse it through a theoretical lens. If your assignment brief asks for reflection, your transformational leadership analysis should be grounded in a specific personal or clinical example, not treated as a purely abstract exercise.

Theoretical Foundations

Transformational Leadership Theory: Origins, Development, and Core Principles

To write an authoritative nursing leadership essay on transformational leadership, you need to understand not just what the theory says but where it came from, how it developed, and why it resonated so powerfully in healthcare contexts. A superficial treatment — “Burns developed the theory in 1978, and Bass extended it” — will earn surface marks. Understanding the intellectual trajectory of the theory is what allows you to engage with it critically rather than simply describe it.

1978

Burns: The Original Distinction

James MacGregor Burns introduced the foundational distinction between transactional and transforming leadership in his landmark work Leadership. For Burns, transactional leadership was an exchange relationship — performance for reward — while transforming leadership elevated both the leader and the follower toward higher moral purpose. Burns saw these as mutually exclusive styles.

1985

Bass: The Empirical Extension

Bernard Bass adapted and operationalised Burns’ concept in Leadership and Performance Beyond Expectations, identifying the specific behaviours that constitute transformational leadership and developing the Multifactor Leadership Questionnaire (MLQ) to measure them. Crucially, Bass argued that transformational and transactional leadership were not mutually exclusive but could coexist — effective leaders used both.

1994

Bass & Avolio: The Full Range Leadership Model

Bass and Avolio formalised the Full Range Leadership Model, which positioned transformational leadership behaviours (the Four I’s), transactional leadership behaviours (contingent reward, management-by-exception), and laissez-faire leadership on a continuum of effectiveness. This model became the dominant framework for leadership research in healthcare.

1990s–2000s

Nursing Leadership Research Explosion

Researchers including Tim Porter-O’Grady, Kathleen Malloch, and Bernadette Melnyk began applying transformational leadership specifically to nursing practice. Studies linked transformational nursing leadership to reduced nurse turnover, improved patient satisfaction scores, lower medication error rates, and stronger safety cultures — establishing the framework as the dominant lens in nursing leadership scholarship.

2008–Present

Magnet Recognition and Organisational Adoption

The American Nurses Credentialing Center (ANCC) embedded transformational leadership as a core component of Magnet Recognition — the gold standard of nursing excellence — requiring Magnet-designated hospitals to demonstrate transformational leadership practices at every organisational level. This institutionalised the framework and made it a practical, not just academic, standard in nursing leadership.

Transformational leaders do not merely manage the work of nursing. They change the meaning of the work itself — for their teams, their patients, and ultimately for the profession.

— Adapted from Bass & Avolio, Full Range Leadership Development (1994)

What makes transformational leadership particularly powerful as a framework for nursing is the alignment between its core mechanisms and the intrinsic motivations that draw most people to nursing in the first place. Nurses do not typically choose their profession for the pay or the schedule — they choose it for meaning, for human connection, for the sense of contributing to something that matters. Transformational leadership works precisely by tapping into those existing intrinsic motivations and amplifying them. A charge nurse who understands transformational leadership does not need to manage compliance; she creates conditions in which excellence is the natural expression of a shared sense of purpose.

For students writing essays about transformational leadership in nursing, two external sources are particularly valuable. The American Nurses Credentialing Center’s Magnet Recognition Programme documentation explicitly articulates how transformational leadership is operationalised in nursing organisations, providing evidence-based standards that are directly citable in academic essays. For the foundational theoretical framework, Bass and Avolio’s original MLQ manual and the associated research in the Journal of Nursing Management and Journal of Advanced Nursing remain the primary scholarly anchors for any rigorous treatment of the subject.

Framework

The Four I’s: A Deep-Dive Into Each Component

The four behavioural components of transformational leadership — collectively known as the Four I’s — are not simply a list of desirable qualities. They represent a theoretically coherent model of how leaders shift followers from transactional compliance to transformational commitment. Understanding each component at a level of clinical specificity is what separates a strong nursing leadership essay from a generic one.

I

Idealized Influence

The leader as a role model of professional values

Idealized Influence — sometimes called charisma in earlier literature — describes the leader’s capacity to be admired, respected, and trusted because of their demonstrated ethical conduct, consistent professional values, and genuine commitment to the shared mission. In nursing, this means the nurse leader who never cuts corners on patient safety even when the unit is short-staffed; who speaks up in a physician-dominated meeting when a care plan isn’t in the patient’s best interest; who stays visible on the floor during a difficult shift rather than retreating to the office. Idealized influence is not about personality magnetism — it is about behavioural consistency that earns moral authority over time. It is the foundation on which all other transformational behaviours rest, because followers who do not trust their leader will not be inspired by their vision, stimulated by their challenges, or supported by their coaching.
I

Inspirational Motivation

Communicating a compelling vision with enthusiasm

Inspirational Motivation refers to the leader’s ability to articulate a vision that gives work meaning beyond the immediate task — to communicate that what the team is doing together is significant, that the standard of care they provide matters, and that their collective effort is moving toward something worth reaching. In a nursing context, this is the unit manager who opens every shift huddle not with staffing ratios but with a brief story about a patient outcome the team made possible last week. It is the CNO who frames a new evidence-based practice protocol not as a compliance requirement but as an expression of the team’s commitment to the patients who trust them. Inspirational motivation does not require oratory — it requires genuine belief in the team’s mission, communicated consistently and specifically. Research consistently shows that this component is most directly associated with staff discretionary effort — the difference between doing the minimum required and doing everything possible.
I

Intellectual Stimulation

Challenging assumptions and fostering creative thinking

Intellectual Stimulation describes the leader’s practice of challenging staff to question existing assumptions, approach problems from new angles, and engage their critical thinking rather than defer to authority or habit. In clinical nursing, the intellectual status quo is genuinely dangerous — “we’ve always done it this way” is one of the most reliable predictors of preventable patient harm. A transformational nurse leader who exercises intellectual stimulation asks new graduates why they think a procedure is done a particular way; invites experienced staff to challenge a care pathway that produces inconsistent outcomes; creates psychologically safe environments where raising a concern is valued rather than penalised. This component is directly associated with cultures of continuous improvement, the implementation of evidence-based practice, and the development of clinical leadership in staff nurses. It is also, not coincidentally, the component most foreign to hierarchical clinical environments — and therefore the one that requires the most deliberate cultivation.
I

Individualized Consideration

Attending to each team member’s developmental needs

Individualized Consideration refers to the leader’s attention to the unique professional development needs, personal circumstances, and intrinsic motivators of each team member. The transformational nurse leader does not manage people as interchangeable units of labour — they know that the new graduate needs a different kind of support than the experienced nurse who is considering specialisation, and that the nurse returning from extended leave needs something different again. Individualised consideration involves active listening, personalised feedback, mentoring relationships, and the structural creation of growth opportunities — project assignments, unit committees, preceptorship roles, conference attendance — that align with each nurse’s developmental goals. This component is the one most directly associated with nurse retention. Study after study in the nursing management literature links managers who demonstrate individualised consideration to significantly lower unit-level turnover rates — which is, in itself, one of the most powerful contributors to patient safety and care quality.
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How to Use the Four I’s in Your Essay

When writing a nursing leadership essay, don’t just define each component — apply each one to a specific clinical or organisational scenario with a named example. The essay that earns top marks does not say “Individualized Consideration means attending to each staff member’s needs.” It says: “On a busy surgical ward with a 27% annual nurse turnover rate, a charge nurse who implements individualised consideration might begin with a structured one-to-one conversation with each team member to identify professional development goals — a practice that Boamah et al. (2018) found significantly associated with reduced intention to leave in a sample of 500 Canadian nurses.” Theory plus evidence plus specific application is the formula for distinction-level nursing leadership writing.

Clinical Context

Applying Transformational Leadership to Clinical Nursing Practice

The theoretical framework is the scaffold. What gives a nursing leadership essay its clinical credibility — and what separates the work of a nursing student from the work of a generic management student — is the ability to translate abstract leadership principles into the specific, textured reality of clinical nursing environments. The applications below demonstrate what each transformational leadership behaviour looks like when it is actually practised in the settings where nurses work.

Transformational Leadership in Acute Care Settings

The acute care environment — medical-surgical floors, step-down units, emergency departments, critical care — is characterised by high acuity, time pressure, interprofessional complexity, and the constant risk that the human cost of system failure is measured in patient lives rather than balance sheet losses. In this context, transformational leadership is not a luxury or a cultural preference — it is a patient safety strategy.

Consider the charge nurse who, on a unit with a recent cluster of medication near-misses, convenes a post-incident analysis that does not seek to assign blame but to understand the system conditions that created the error opportunities — an exercise in intellectual stimulation. Or the nurse manager who, in response to survey data showing declining staff morale, schedules one-to-one meetings with every team member over a four-week period specifically to understand individual concerns and development aspirations — an exercise in individualised consideration. Or the CNO who, launching a new falls prevention initiative, begins not with a policy memo but with a unit-wide presentation connecting the initiative to a specific patient outcome story that the team already cares about — an exercise in inspirational motivation.

Each of these behaviours has a corresponding evidence base. Boamah et al.’s (2018) landmark study in Worldviews on Evidence-Based Nursing found that transformational leadership by nurse managers predicted nurse-reported patient safety culture, which in turn predicted adverse event rates. Wong and Cummings’ (2007) systematic review in the Journal of Nursing Management identified a consistent positive relationship between transformational leadership practices and patient satisfaction scores across multiple care settings. The evidence is not peripheral — it is central to the clinical argument for transformational leadership in nursing.

Transformational Leadership in Long-Term and Community Care

In long-term care and community nursing settings, the leadership challenges shift significantly. Staff-to-patient ratios are often more stretched. Care relationships are longer and more intimate. The risk of compassion fatigue and emotional exhaustion is particularly high. And the proximity to institutional authority — medical directors, facility managers, regulatory inspectors — is often more immediate and more fraught than in hospital settings.

In these environments, idealized influence takes on particular importance. Community nurses and residential care staff frequently report that the single most influential factor in their professional satisfaction is whether their direct manager demonstrates the same values they themselves hold about dignity, respect, and quality of care. A manager who consistently models person-centred care — who refers to residents by name in every meeting, who challenges shortcuts that compromise dignity even when they would save time, who advocates for resource allocations that improve quality of life rather than just safety metrics — earns a form of moral authority that no policy manual can manufacture.

Transformational Leadership and the Magnet Recognition Programme

The most direct institutional expression of transformational leadership in nursing is the American Nurses Credentialing Center’s Magnet Recognition Programme. Magnet hospitals are required to demonstrate that nursing leadership at all organisational levels operates according to transformational principles — not as a aspiration but as a measurable, documented practice standard. The Five Magnet Model Components include Transformational Leadership as the first and foundational component, explicitly requiring that nurse leaders “transform the vision, mission, and values of the organization and lead the nursing staff through change.”

For nursing students writing leadership essays, the Magnet framework offers a powerful bridge between academic theory and real-world organisational practice. Magnet-designated facilities are publicly identifiable, their leadership structures are documented in the nursing literature, and research comparing Magnet and non-Magnet facilities provides an extensive evidence base for the outcomes associated with transformational nursing leadership at scale.

Clinical SettingKey Leadership ChallengeTransformational BehaviourEvidence-Based Outcome
Emergency Department High-acuity, high-turnover, emotional exhaustion Individualized Consideration — regular developmental conversations; Idealized Influence — visible role modelling of calm under pressure Improved nurse resilience and reduced burnout (Lavoie-Tremblay et al., 2015)
Medical-Surgical Unit Medication errors, falls, hospital-acquired infections Intellectual Stimulation — safety huddles with root cause dialogue; Inspirational Motivation — connecting compliance to patient outcomes Reduced adverse events and improved patient safety culture (Boamah et al., 2018)
ICU / Critical Care Moral distress, complex end-of-life decisions, interprofessional conflict Idealized Influence — modelling ethical advocacy; Inspirational Motivation — sustaining meaning in high-death environments Lower moral distress, higher team cohesion (Wendler et al., 2016)
Community / District Nursing Autonomous practice, isolation, high caseloads, compassion fatigue Individualized Consideration — frequent supportive supervision; Intellectual Stimulation — case-based peer learning Reduced intention to leave, improved practice confidence (Cummings et al., 2010)
Long-Term / Residential Care Low status, limited resources, high emotional labour, regulatory pressure Idealized Influence — consistent person-centred modelling; Inspirational Motivation — dignity-of-care framing Improved resident satisfaction and staff retention (Castle & Decker, 2011)
Writing Strategy

How to Structure Your Nursing Leadership Essay Step by Step

Structure is not decoration — it is argument. A nursing leadership essay that jumps between description, application, and personal reflection without a clear logical architecture will feel fragmented regardless of how good the individual paragraphs are. The structure below represents the most widely taught and most consistently effective approach for nursing leadership essays centred on transformational leadership theory, calibrated to the level of academic depth your program expects.

1

Introduction — Frame the Argument, Define the Scope

Begin with a sentence that establishes the significance of leadership in nursing — not as a generic statement but as a specific claim grounded in the current professional landscape. Follow with a brief definition of transformational leadership, citing either Burns (1978) or Bass and Avolio (1994) as your theoretical anchor. Then clearly state your essay’s argument or focus: what aspects of transformational leadership will you examine, in what clinical context, and to what end? Close the introduction with a signpost sentence that tells the reader exactly what is coming. Introductions should be 150–200 words. Do not summarise your entire essay in the introduction — introduce the argument, not the conclusion.

2

Theoretical Overview — Explain the Framework With Academic Precision

This section provides a scholarly account of transformational leadership theory — its origins with Burns (1978), its operationalisation by Bass (1985), and the development of the Full Range Leadership Model by Bass and Avolio (1994). Explain the Four I’s with definitions drawn from primary theoretical sources. At graduate level, this section should also briefly contrast transformational leadership with transactional leadership and laissez-faire leadership to demonstrate your understanding of the broader theoretical landscape. This section is not your opinion — it is your command of the scholarship. Every claim should be cited. This section typically runs 300–400 words at BSN level and 400–600 words at MSN/DNP level.

3

Application to Practice — Connect Theory to Clinical Reality

This is often the most important section of the nursing leadership essay, and the one most frequently done poorly. You must move beyond restating what transformational leadership is and demonstrate what it looks like — specifically, concretely, and evidentially — in actual clinical nursing environments. Use a scenario, a case study, a published example, or your own clinical experience (depending on your assignment brief) to illustrate each of the Four I’s in action. Support every applied claim with peer-reviewed evidence showing the outcome that this leadership behaviour produces. Avoid generic application (“a transformational nurse leader would be compassionate”) in favour of specific application (“a transformational charge nurse implementing individualized consideration might schedule monthly structured one-to-one career development conversations, a practice associated with a 23% reduction in turnover intention in Wong and Cummings’ 2007 systematic review”). This section typically runs 600–800 words.

4

Critical Analysis — Evaluate the Theory, Don’t Just Describe It

The difference between a good nursing leadership essay and an excellent one is almost always in the critical analysis section. Description says what the theory is; critical analysis asks whether it is adequate. What are the limitations of transformational leadership theory in nursing contexts? Where does the evidence base have gaps? Are there clinical environments or populations for which the model is poorly suited? What critiques have scholars levelled at it — questions of gender, power, context-dependence, measurement validity? A strong critical analysis does not mean you argue against the theory — it means you engage with it as a living scholarly debate rather than an unquestioned truth. This section is what graduate marking rubrics mean when they specify “critical engagement” or “analytical depth.” It typically runs 300–500 words at BSN level and 500–700 words at MSN/DNP level.

5

Personal Reflection — Connect the Theory to Your Own Leadership Identity

Many nursing leadership essay assignments require a personal reflection component — an honest self-assessment of where you currently are in your leadership development relative to the transformational model, which components represent strengths and which represent development areas, and how this essay has shaped your understanding of the kind of nurse leader you want to become. This section should use the first person (unlike the rest of the essay, which is typically third person) and should demonstrate the genuine self-awareness that nursing educators are looking for. Avoid both false modesty (“I have no leadership skills yet”) and self-promotional assertion (“I naturally demonstrate all four components”). The most effective reflections identify one or two specific developmental areas with specific development plans — supervised practice, mentorship, further reading — that are realistic and professional.

6

Conclusion — Synthesise the Argument, Don’t Summarise It

A conclusion is not a summary. It does not repeat what you have already said. It draws the logical implications of your argument: given everything you have established about transformational leadership theory, its clinical application, and its limitations, what does this mean for nursing practice, leadership development, or the profession? It may also gesture toward future research directions or outstanding questions. Close with a strong final sentence that articulates the central claim of the essay at its highest level of generality. Conclusions should be 150–200 words — brief, precise, and forward-looking.

Marking Rubric Breakdown: What Examiners Are Actually Assessing

Knowledge & Understanding
  • Accurate definition and history of the theory
  • Correct identification of all Four I’s
  • Understanding of broader theoretical context (transactional vs. transformational)
  • Knowledge of Magnet framework and AONL standards
Critical Analysis
  • Evaluation of theory strengths and limitations
  • Engagement with scholarly critiques
  • Comparison to alternative leadership models
  • Independent scholarly judgement demonstrated
Application to Practice
  • Specific, clinically grounded examples
  • Theory-practice connections are explicit
  • Evidence supports each applied claim
  • Demonstrates clinical contextual awareness
Evidence & Referencing
  • Primary theoretical sources cited (Burns, Bass, Avolio)
  • Peer-reviewed nursing leadership research used
  • Sources within 5–7 years (except foundational texts)
  • Correct APA 7th / Harvard / Vancouver format
Reflection
  • Genuine self-assessment, not performance
  • Specific developmental areas identified
  • Realistic development plan articulated
  • Links personal practice to professional standards
Writing Quality
  • Academic register maintained throughout
  • Clear, logical argument structure
  • Appropriate use of signpost sentences
  • Word count adhered to precisely
Full Examples

Complete Nursing Leadership Essay Examples

The following essays are complete, fully written examples at different program levels. Each demonstrates the structural principles outlined above, with theory, clinical application, critical analysis, and personal reflection integrated into a coherent academic argument. They are written to model excellent academic writing in nursing leadership — read them for their structure, their use of evidence, and the way they move between theory and practice. Do not submit them as your own work.

Example 1: BSN — Transformational Leadership in a Medical-Surgical Setting

BSN / ~1,000 words

Introduction

The quality of nursing leadership is one of the most powerful determinants of nurse satisfaction, staff retention, and patient safety outcomes in any clinical setting (Wong & Cummings, 2007). As nursing faces a persistent global workforce shortage and increasing demands for complex, high-quality care, the question of how nurse leaders motivate and develop their teams has never carried greater professional urgency. Transformational leadership — a model first articulated by Burns (1978) and operationalised for nursing practice by Bass and Avolio (1994) — offers a theoretically robust and empirically supported framework for understanding how nurse leaders can move their teams from minimum compliance to genuine professional commitment. This essay examines the four core components of transformational leadership, applies them to a medical-surgical nursing context, and reflects on the implications for the author’s own leadership development.

Transformational Leadership: Theoretical Framework

Transformational leadership was introduced by Burns (1978), who distinguished between transactional leadership — an exchange of performance for reward — and transforming leadership, which elevates both leader and follower toward higher moral and professional purpose. Bass (1985) extended Burns’ framework empirically, developing the Multifactor Leadership Questionnaire (MLQ) to measure specific transformational behaviours, and Bass and Avolio (1994) subsequently formalised the Full Range Leadership Model, which places transformational, transactional, and laissez-faire leadership behaviours on a continuum from most to least effective.

Bass and Avolio (1994) identified four distinct transformational leadership behaviours, collectively referred to as the Four I’s. Idealised Influence describes the leader who earns trust and admiration through ethical conduct and consistent professional values. Inspirational Motivation refers to the leader’s ability to articulate a shared vision that gives work a sense of collective purpose and meaning. Intellectual Stimulation describes the practice of challenging team members to question assumptions and engage their critical thinking. Individualized Consideration refers to the leader’s attentiveness to each team member’s unique developmental needs, operating as a coach and mentor rather than simply a manager.

Application to Medical-Surgical Nursing Practice

In a busy medical-surgical unit, where nurses manage high patient loads across complex, heterogeneous conditions, transformational leadership practices have direct implications for both staff wellbeing and patient safety. Boamah et al. (2018) found in a study of 378 nurses across multiple Canadian hospitals that transformational nursing management was a significant predictor of patient safety culture, which in turn was associated with fewer adverse events. Each of the Four I’s maps onto specific, actionable management behaviours in this setting.

A charge nurse demonstrating idealised influence is one who, when facing a short-staffed night shift, does not simply delegate and observe but visibly participates in direct patient care alongside the team. This consistency between espoused values (“we prioritise patient safety”) and enacted behaviour (taking a patient assignment when the unit is unsafe) builds the moral authority that allows the leader’s vision and expectations to carry weight beyond formal positional power. A nurse manager demonstrating inspirational motivation opens unit meetings not with performance metrics but with patient outcome stories that connect daily clinical work to its larger human significance. A leader who stimulates intellectual engagement creates structured forums — safety huddles, journal clubs, case reviews — in which questioning existing practice is not only permitted but expected and rewarded. And a manager exercising individualised consideration knows which staff members are considering advanced training, which are experiencing compassion fatigue, and which are ready to take on new clinical leadership responsibilities — and responds to each accordingly.

Critical Reflection on the Theory

While the evidence base for transformational leadership in nursing is substantial, it is not without limitations. A notable critique is the theory’s assumption of a relatively stable, bounded team over which a single leader exerts consistent influence — an assumption that sits uneasily with the shift-based, multi-manager reality of most acute care nursing environments. When a nurse works across multiple charge nurses with varying leadership styles, the unit-level impact of any single leader’s transformational behaviour is diffused. Yukl (2010) also argues that the Four I’s framework lacks sufficient specificity to guide practical leadership development, since behaviours like “inspirational motivation” resist operationalisation into concrete daily practices without additional scaffolding. These limitations do not invalidate the framework but suggest it should be applied in conjunction with context-sensitive leadership development programmes rather than treated as a universal prescription.

Personal Reflection and Leadership Development

Reflecting on my own emerging leadership practice, I recognise that individualised consideration is the component I most need to intentionally develop. As a nursing student rotating across clinical placements, I have not yet had sustained responsibility for a team, and my experience of attending to individual professional needs has been limited to peer interactions rather than mentorship or coaching relationships. I intend to address this development area by seeking out a formal mentorship relationship with a senior charge nurse during my final placement, specifically to observe and participate in the one-to-one conversations through which individualised consideration is operationalised in practice. Engaging with this aspect of transformational leadership at an early career stage will, I believe, establish the relational habits that are significantly harder to develop retrospectively.

Conclusion

Transformational leadership offers nursing students and registered nurses alike a theoretically grounded, empirically supported framework for understanding what effective clinical leadership looks like and why it matters. Its four behavioural components — idealised influence, inspirational motivation, intellectual stimulation, and individualised consideration — are not abstract ideals but actionable practices that directly shape the cultures in which nurses work and patients receive care. While the theory carries important limitations in the context of shift-based, multi-leader environments, its central insight — that the nurse leader’s role is to develop people, not just manage tasks — remains one of the most important contributions that leadership scholarship has made to nursing practice.

Example 2: MSN — Transformational Leadership and Nurse Retention in the Post-Pandemic ICU

MSN / ~1,400 words

Introduction

The global nursing workforce crisis, dramatically accelerated by the COVID-19 pandemic, has elevated nurse retention from a perennial organisational concern to an acute patient safety emergency. In critical care settings specifically — environments where clinical complexity is highest, emotional labour most extreme, and the consequences of understaffing most immediately life-threatening — the retention question is inseparable from the leadership question. How nurse managers lead their intensive care teams has a measurable, documented impact on nurses’ decisions to stay or leave (Lavoie-Tremblay et al., 2015). This essay argues that transformational leadership, operationalised through Bass and Avolio’s (1994) Four I’s framework, represents the most evidence-supported approach available to ICU nurse managers seeking to improve staff retention in the current workforce environment. It examines the theoretical basis of this claim, applies it to post-pandemic ICU realities, critically evaluates its limitations, and proposes a leadership development agenda grounded in both the evidence and the author’s clinical experience.

Theoretical Foundation

Burns’ (1978) foundational distinction between transactional and transformational leadership is particularly instructive in the ICU context. Transactional leadership — the exchange of performance compliance for pay, scheduling preferences, or career advancement — may sustain minimum function in stable conditions, but it offers little resistance to the forces driving nurses out of critical care in the post-pandemic period: moral residue from pandemic-era triage decisions, chronic compassion fatigue, perceived organisational betrayal, and a labour market that now offers critical care nurses multiple alternative options for their skills. Transformational leadership, by contrast, addresses the psychological and professional conditions that make sustained commitment to a demanding clinical role possible.

Bass and Avolio’s (1994) operationalisation of transformational leadership through the Four I’s provides the specific behavioural levers through which this commitment is built. The theoretical mechanism is what Bass (1985) termed “motivation beyond expectation” — the leader creates conditions in which staff invest discretionary effort not because of formal incentives but because of a genuine sense of shared professional purpose and personal growth. In the context of nurse retention, this mechanism operates through the well-documented relationships between transformational leadership and the psychological outcomes — job satisfaction, professional engagement, reduced burnout, perceived organisational support — that predict stay-or-leave decisions.

Application to Post-Pandemic ICU Leadership

The intensive care unit in the post-pandemic period presents a distinctive leadership landscape. Many ICU nurses carry what moral distress researchers describe as “moral residue” — the accumulated weight of ethical compromises made under crisis conditions (Rushton, 2017). Others are experiencing a form of post-traumatic growth that has reconfigured their professional identity and raised their threshold for what they are willing to accept from their work environment. Traditional transactional management strategies — the annual pay review, the occasional recognition award — are insufficient to the psychological and professional complexity of this moment.

In this context, idealised influence demands that nurse managers acknowledge the extraordinary nature of what their teams endured without minimising it or rushing to a narrative of recovery. The transformational ICU manager who says, in a unit meeting, “I know what the past two years cost many of you, and I want this team to be a place where that cost is acknowledged rather than managed away” is not being soft — they are building the moral authority without which no other transformational behaviour can take root. Inspirational motivation in the post-pandemic ICU does not mean pretending the crisis never happened — it means articulating, with honesty and specificity, what this team is building together now: the standards of care, the culture of psychological safety, the professional community that gives the work meaning beyond the suffering it involves.

Intellectual stimulation in the ICU recovery period might take the form of structured ethical debriefing sessions — not simply clinical case review but genuine critical dialogue about the ethical dimensions of care under resource constraint. Caseload analysis suggests that ICU nurses who are given structured forums to process and learn from ethically difficult cases demonstrate significantly lower compassion fatigue scores and higher professional engagement than those who are not (Wendler et al., 2016). Individualised consideration requires that the nurse manager know which staff members have been most affected by the pandemic experience and offer differentiated responses — not the same resilience workshop for everyone, but genuinely personalised support: some staff need a reduced caseload, others need advanced professional development opportunities that restore their sense of growth, and others need the specific kind of validation that comes from being trusted with a new leadership responsibility.

Critical Evaluation

The evidence base for transformational leadership in nursing is substantial, but it carries methodological limitations that a rigorous MSN-level essay must acknowledge. The majority of studies in this literature rely on self-reported data from nurses about their managers’ leadership behaviours — a methodology that introduces the possibility of same-source bias, in which nurses who report higher job satisfaction also report their manager as more transformational, without it being possible to determine the causal direction of this relationship (Cummings et al., 2010). Experimental or quasi-experimental designs testing the actual implementation of transformational leadership interventions are relatively rare in the nursing literature, making the direction of causality harder to establish than the strength of association would suggest.

A second limitation is the theory’s relative insensitivity to structural constraints. A nurse manager who understands and is committed to transformational leadership practices may still be operating in an organisational context — inadequate staffing ratios, unsupportive senior management, a culture of blame rather than learning — that actively undermines their ability to practise individualised consideration or intellectual stimulation. This suggests that transformational leadership development in nursing must be embedded in organisational change rather than treating individual manager development as sufficient. A leader cannot inspire a team toward shared purpose while the organisation simultaneously communicates through its resource allocation decisions that those purposes are not worth supporting.

Implications for Leadership Development and Practice

For the author, currently working as a registered nurse in a tertiary ICU and pursuing this MSN programme with an intended transition into clinical leadership, this analysis has sharpened a specific development agenda. The component of transformational leadership that most clearly requires intentional development in my own practice is intellectual stimulation — specifically, the creation of structured forums for critical clinical and ethical dialogue in a team culture that currently manages difficult experiences through stoic endurance rather than reflective processing. I intend to propose a monthly ethical debriefing session format to my current unit manager, both as a development opportunity for myself in facilitation and as a direct application of the evidence reviewed in this essay. I will use Rushton’s (2017) framework for moral distress and resilience as a theoretical foundation for the session design, drawing on the growing evidence base for structured moral distress interventions in critical care nursing.

Conclusion

The post-pandemic nursing workforce crisis is, at its root, a leadership crisis — not a failure of individual nurse managers but a systemic inadequacy in the organisational conditions, leadership development infrastructure, and professional support structures that make sustainable nursing practice possible. Transformational leadership, applied through the Four I’s framework in contextually sensitive and evidence-informed ways, offers the most promising available response to the retention challenges facing ICU nursing specifically and healthcare systems broadly. Its limitations — methodological, structural, and contextual — are real and must be acknowledged, but they point toward the conditions under which the theory can be most effectively applied rather than toward its fundamental inadequacy. The nurse leader who understands this framework deeply, applies it with contextual intelligence, and commits to their own ongoing development within it is precisely the kind of leader the profession needs more of.

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Key Sources to Cite in Your Transformational Leadership Essay

  • Burns, J.M. (1978). Leadership. Harper & Row — foundational theoretical source, always cite for the transactional/transformational distinction
  • Bass, B.M. (1985). Leadership and Performance Beyond Expectations. Free Press — the empirical operationalisation of the theory
  • Bass, B.M. & Avolio, B.J. (1994). Improving Organizational Effectiveness Through Transformational Leadership. Sage — the Four I’s and Full Range Leadership Model
  • Wong, C.A. & Cummings, G.G. (2007). Systematic review of transformational leadership and patient outcomes in the Journal of Nursing Management
  • Boamah, S.A. et al. (2018). Transformational leadership → patient safety culture → adverse events, Worldviews on Evidence-Based Nursing
  • Cummings, G.G. et al. (2010). Leadership styles and outcomes in nursing: a systematic review, International Journal of Nursing Studies
Scholarly Critique

Critical Analysis: Strengths, Limitations, and Scholarly Debates

Critical analysis is the component that most separates good nursing leadership essays from excellent ones. Description tells the reader what transformational leadership is. Critical analysis asks whether the theory is adequate, complete, and appropriately applied — and answers that question with evidence and scholarly argument rather than opinion. The following section models the kind of critical engagement that earns top marks at undergraduate and postgraduate level.

Strengths of Transformational Leadership Theory in Nursing

The empirical support for transformational leadership in nursing is broader and more consistent than for virtually any other leadership framework applied in healthcare settings. Cummings et al.’s (2010) systematic review of 53 studies examining leadership styles and outcomes in nursing found that transformational and relationally focused leadership approaches were associated with higher nurse job satisfaction, greater productivity, lower rates of absenteeism, and better patient satisfaction scores compared to transactional or task-focused approaches. The breadth of this evidence base — spanning multiple countries, care settings, and nursing specialties — gives transformational leadership theory a clinical validity that more recently developed or less extensively studied frameworks cannot yet claim.

The integration of transformational leadership into the Magnet Recognition Programme has further strengthened the theory’s practical relevance in nursing. Because Magnet-designated facilities are required to demonstrate transformational leadership practices at all levels, and because extensive comparative research documents the outcomes differences between Magnet and non-Magnet facilities, the theory has moved from a scholarly framework into an operational standard with direct, measurable implications for nursing practice quality.

Limitations and Critical Perspectives

Despite its empirical strength, transformational leadership theory attracts several substantive scholarly critiques that nursing leadership essays should engage with rather than avoid.

The first concerns gender and power dynamics. Several feminist nursing scholars — including Kanter (1977) in earlier work and more recently Hader (2011) — have argued that transformational leadership’s emphasis on vision, inspiration, and charisma implicitly valorises leadership behaviours more commonly socialised in men, while the “individualized consideration” component — the relational, supportive, developmental role — aligns with caregiving behaviours that women in nursing are already expected to perform without recognition or reward. This critique does not invalidate the framework but calls for careful attention to whether transformational leadership models are applied in ways that distribute both the benefits and the burdens of leadership development equitably across gendered lines.

The second critique concerns context sensitivity. Transformational leadership theory, as originally formulated, makes relatively weak claims about the conditions under which it is most and least effective. In nursing, leadership environments vary enormously: a transformational leadership approach that is highly effective in a stable, well-resourced Magnet facility may be significantly less effective in a chronically understaffed, high-turnover community nursing context where the structural conditions for inspirational motivation — meaningful work, supported professional development, psychological safety — are themselves absent. Hersey and Blanchard’s (1969) situational leadership model offers a useful complementary perspective here, suggesting that effective leaders adapt their style to the developmental readiness of their followers rather than applying a single model universally.

A third, methodological critique concerns the direction of causality in the evidence base. Because most studies of transformational leadership in nursing use cross-sectional designs and self-report measures, it is difficult to determine whether transformational leadership causes improved nurse satisfaction and patient outcomes, or whether nurses who are already highly satisfied and engaged in high-functioning units are simply more likely to rate their managers as transformational. Prospective, longitudinal, and experimental studies are relatively rare in this literature, which limits the confidence with which causal claims can be made.

✓ Strong Critical Analysis Reads Like This
“While Boamah et al.’s (2018) finding that transformational leadership predicts patient safety culture is compelling, the cross-sectional design prevents causal inference. It is possible that units with stronger safety cultures attract or develop more transformational managers, reversing the implied direction of effect. Future research using longitudinal designs with baseline leadership measurement would significantly strengthen the evidentiary basis for the causal claim.”
✗ Weak Critical Analysis Reads Like This
“Transformational leadership is a very good theory that has many strengths. Some people might argue it has limitations but overall I believe it is the best approach for nursing leadership and the evidence clearly supports this view in most situations.”
Theoretical Landscape

Comparing Transformational Leadership to Other Nursing Leadership Theories

A nursing leadership essay that discusses transformational leadership in isolation — as if it were the only framework available — loses marks because it fails to demonstrate the theoretical breadth that graduate-level nursing education expects. Showing that you understand where transformational leadership sits in the broader landscape of leadership theory, and why you have selected it over alternatives, significantly strengthens your academic argument.

Leadership TheoryCore PremiseStrengths in NursingLimitations in NursingWhen to Reference It
Transformational Leadership (Bass & Avolio, 1994) Leaders inspire commitment through shared vision, intellectual growth, and individualised development Strongest evidence base; embedded in Magnet framework; associated with retention and patient safety outcomes Context-insensitive; methodological limitations in evidence; gender critique Your primary framework — this is the essay’s theoretical anchor
Transactional Leadership (Burns, 1978) Leadership as an exchange: performance for reward, deviation met with correction Useful in task-oriented, compliance-critical contexts (infection control, medication protocols) Produces compliance, not commitment; inadequate for complex professional motivation Use as contrast to strengthen the case for transformational approaches
Servant Leadership (Greenleaf, 1977) The leader’s primary role is to serve the needs of their followers and community Strong alignment with nursing values; associated with ethical climate and patient dignity outcomes Weaker evidence base in nursing than transformational; risk of role confusion and boundary issues Reference as a complementary framework with shared values but different emphasis
Situational Leadership (Hersey & Blanchard, 1969) Effective leaders adapt their style to the developmental readiness of each follower Practically useful for nurse managers with diverse teams; addresses context-sensitivity gap Less empirically supported in nursing than transformational; can feel formulaic in application Reference when discussing the limitations of a single-style approach to nursing leadership
Authentic Leadership (Avolio & Gardner, 2005) Effective leaders are self-aware, transparent, morally grounded, and internally consistent Directly addresses moral distress and ethical climate in nursing; growing evidence base Limited large-scale nursing studies; concept of “authenticity” is theoretically contested Reference in critical analysis as an emerging alternative to or complement of transformational approaches
Resonant Leadership (Boyatzis & McKee, 2005) Effective leaders maintain emotional connection with their teams through mindfulness, hope, and compassion Relevant to burnout prevention and compassion fatigue management; strong face validity in nursing Weaker empirical base in healthcare settings; limited psychometric measurement tools Reference in discussions of emotional intelligence in nursing leadership
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The “Why Transformational?” Move — Make It Explicit

One of the most effective ways to elevate your nursing leadership essay is to make your theoretical choice explicit rather than implicit. Don’t just begin applying the transformational framework without justifying it. Somewhere in your theoretical overview, write a brief paragraph explaining why transformational leadership is your analytical lens rather than servant leadership, situational leadership, or another available framework. The answer — strongest evidence base, embedded in Magnet standards, most extensively validated in nursing-specific contexts — demonstrates that your theoretical choice is deliberate and scholarly rather than arbitrary. This is what graduate-level “justification of theoretical framework” means in practice.

Quality Control

Common Errors in Nursing Leadership Essays and How to Fix Them

The most common errors in nursing leadership essays follow recognisable patterns. The table below identifies the errors that nursing faculty flag most consistently in marking feedback — along with the precise correction for each. Reviewing this list before submitting your essay will eliminate the most avoidable mark losses.

❌ Common ErrorWhy It Costs Marks✓ The Fix
Describing the theory without applying it to practice A leadership essay is not a theory textbook summary. Description without application demonstrates comprehension, not analytical ability After every theoretical claim, ask: “What does this look like in a clinical nursing setting, specifically?” Then write that. Theory → clinical scenario → evidence of outcome
Applying the theory uncritically — no limitations acknowledged Presenting any leadership theory as entirely adequate and unproblematic signals a lack of scholarly engagement and costs marks in “critical analysis” criteria Include a dedicated section evaluating limitations — methodological, contextual, and theoretical. Engage with at least one scholarly critique by name and source
Using only secondary or textbook sources Nursing leadership essays at BSN level and above require primary academic sources — peer-reviewed journal articles, not just nursing management textbooks Cite original theoretical sources (Burns, Bass, Avolio) and peer-reviewed nursing journals (Journal of Nursing Management, Journal of Advanced Nursing, Nursing Administration Quarterly)
Reflection section is generic self-praise “I am a natural leader who demonstrates transformational qualities” is not reflection — it is assertion. Marking rubrics reward honest, specific, evidence-linked self-assessment Identify a specific developmental area; link it to one of the Four I’s; propose a specific, realistic development plan with timeline and method
Using outdated sources without explanation Most nursing programs expect sources published within the last five to seven years, with exceptions for foundational theoretical works Use Burns (1978) and Bass and Avolio (1994) as foundational exceptions — note they are primary theoretical sources. Support all clinical applications with recent (post-2018) peer-reviewed evidence
Confusing transformational and transactional leadership A significant proportion of nursing leadership essays either conflate these two or fail to distinguish them with sufficient precision — immediately flagged by nursing faculty State the distinction explicitly in your theoretical overview, citing Burns (1978) for the original distinction and Bass (1985) for the argument that both styles coexist in effective leaders
Not addressing Magnet Recognition at MSN/DNP level At graduate level, failing to connect transformational leadership to the Magnet framework misses a major organisational and policy context that faculty expect you to know Include at least one paragraph connecting transformational leadership to the ANCC Magnet Recognition Programme — its five model components and the requirement for transformational leadership at all organisational levels
Introduction that begins with a generic opener “Leadership is very important in healthcare” — this sentence adds zero value and signals a lack of intellectual engagement from the first sentence Open with a specific claim supported by evidence: “Transformational nurse leadership is significantly associated with patient safety culture and adverse event rates (Boamah et al., 2018) — making the question of how nurses lead not merely a management concern but a clinical one.”
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Pre-Submission Nursing Leadership Essay Checklist

  • Introduction makes a specific, cited claim and clearly states the essay’s focus and structure
  • Theoretical overview cites primary sources: Burns (1978), Bass (1985), Bass & Avolio (1994)
  • All Four I’s are defined and each one is applied to a specific, named clinical nursing scenario
  • Every applied claim is supported by peer-reviewed nursing evidence
  • Critical analysis section identifies at least two limitations and engages with at least one named scholarly critique
  • Reflection section identifies a specific developmental area with a realistic development plan
  • Transformational leadership is contrasted with at least one alternative framework
  • At MSN/DNP level: Magnet Recognition Programme is referenced and connected to transformational leadership
  • All sources are peer-reviewed; foundational texts (Burns, Bass) plus at least 5 recent nursing-specific sources
  • Word count is within the specified range (not over; not more than 10% under)

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Common Questions

FAQs: Nursing Leadership Essays and Transformational Leadership

What is transformational leadership in nursing?
Transformational leadership in nursing is a leadership style in which nurse managers and leaders inspire and motivate staff by articulating a compelling shared vision, modelling professional values and ethical conduct, fostering intellectual growth and critical thinking, and providing individualised developmental support to team members. Theorised by Burns (1978) and operationalised by Bass and Avolio (1994) through the Four I’s — Idealised Influence, Inspirational Motivation, Intellectual Stimulation, and Individualised Consideration — it has become the most extensively researched leadership framework in nursing. Studies consistently associate transformational nursing leadership with higher staff satisfaction, lower nurse turnover, stronger patient safety cultures, and better patient outcomes compared to transactional or laissez-faire leadership approaches.
How do I structure a nursing leadership essay on transformational leadership?
The recommended structure is: (1) Introduction — frame the significance of the topic, define transformational leadership, state your essay’s argument and scope; (2) Theoretical Overview — explain the origin and development of the theory with primary citations; (3) The Four I’s — define each component with supporting evidence; (4) Application to Clinical Practice — connect each component to specific nursing scenarios with outcome evidence; (5) Critical Analysis — evaluate strengths and limitations of the theory; (6) Personal Reflection — honest self-assessment of your own leadership development relative to the framework; (7) Conclusion — synthesise the argument and articulate implications. At BSN level, this typically produces an essay of 1,000–1,500 words; at MSN level, 1,500–2,500 words; at DNP level, 2,500–4,000 words or more depending on program requirements.
What are the Four I’s of transformational leadership?
Bass and Avolio’s (1994) Four I’s are: (1) Idealised Influence — the leader earns trust and moral authority by consistently modelling the professional values and ethical standards they ask of their team; (2) Inspirational Motivation — the leader articulates a compelling vision that gives the team’s work collective meaning and sustained purpose; (3) Intellectual Stimulation — the leader challenges staff to question assumptions, think creatively, and engage critically with their practice rather than deferring to habit or authority; and (4) Individualized Consideration — the leader attends to each team member’s unique professional development needs, acting as a coach and mentor rather than simply a supervisor. In nursing, each of these behaviours has specific, evidence-supported manifestations that directly affect staff wellbeing, team function, and patient outcomes.
What is the difference between transformational and transactional leadership in nursing?
Transactional leadership operates through explicit exchange: nurses who meet performance expectations receive rewards (scheduling preferences, pay increases, recognition); those who do not meet expectations receive correction. It produces compliance — nurses do what is required — but typically does not generate the discretionary effort, professional engagement, or intrinsic motivation that sustain high-quality care over time. Transformational leadership, by contrast, operates through shared purpose, intellectual growth, and genuine interpersonal development. It produces commitment — nurses invest beyond the minimum because they care about the work, the team, and the patients. Bass and Avolio (1994) argue that effective nurse leaders use both styles, but that transformational behaviours are the primary drivers of the outcomes nursing organisations most value: retention, safety culture, and professional engagement.
What sources should I use in a nursing leadership essay on transformational leadership?
Your essay needs three categories of sources. Primary theoretical sources: Burns (1978) Leadership; Bass (1985) Leadership and Performance Beyond Expectations; Bass and Avolio (1994) Improving Organizational Effectiveness Through Transformational Leadership. Nursing-specific leadership research: Wong and Cummings (2007) systematic review in the Journal of Nursing Management; Boamah et al. (2018) in Worldviews on Evidence-Based Nursing; Cummings et al. (2010) systematic review in the International Journal of Nursing Studies. Professional standards documents: the ANCC Magnet Recognition Programme documentation; the American Organization for Nursing Leadership (AONL) Nurse Manager Competencies. All clinical application evidence should come from peer-reviewed nursing journals published within the last five to seven years.
How do I write a critical analysis of transformational leadership theory?
A strong critical analysis does three things. First, it identifies specific, scholarly critiques rather than vague limitations — not “some people argue the theory isn’t perfect” but “Yukl (2010) argues that the Four I’s resist practical operationalisation because behaviours like inspirational motivation are defined at a level of abstraction that provides insufficient guidance for leadership development programmes.” Second, it engages with methodological limitations: most evidence for transformational leadership uses cross-sectional, self-report designs that prevent causal inference. Third, it considers context sensitivity: does transformational leadership work equally well in a short-staffed rural community nursing context as in a well-resourced Magnet hospital? The strongest analyses acknowledge that these limitations are real without using them to dismiss the framework — the goal is engagement with complexity, not the production of a simple verdict.
Is transformational leadership the best theory for a nursing leadership essay?
Transformational leadership has the strongest and most extensive evidence base of any leadership framework applied in nursing contexts, its integration into the Magnet Recognition Programme gives it direct practical relevance, and it has been studied across virtually every nursing specialty and care setting — which makes it the most defensible and most richly supported choice for most nursing leadership essay assignments. That said, the “best” choice depends on your specific assignment brief. If your brief asks you to apply leadership theory to a community mental health context, servant leadership or resonant leadership might offer a more specific fit. If you are asked to critically compare multiple frameworks, you will need to engage with transformational leadership as one of several. Always read your brief carefully before committing to a framework.
Can Smart Academic Writing help me with my nursing leadership essay?
Yes. Our team includes nursing academics, registered nurses with leadership experience, and specialist academic writers who provide professional nursing assignment help for leadership essays at every program level — BSN through DNP. We also support MSN assignment writing, DNP project assistance, nursing reflection papers, and program-specific support for Chamberlain University, Walden University, and Capella FlexPath students. Every essay is written from scratch to your specific brief, referenced in your required style, and reviewed for clinical accuracy, academic depth, and writing quality before delivery.
Conclusion

Transformational Leadership: A Framework Worth Mastering

A nursing leadership essay on transformational leadership is not simply an academic exercise. It is an invitation to think seriously about the professional environment you want to create — the kind of unit culture you want to build, the kind of leader you want to be, and the kind of nursing you want to make possible for the patients and colleagues who depend on your leadership. The Four I’s framework is not a checklist. It is a theoretically coherent description of how leaders transform the meaning of work itself — how they convert daily clinical tasks into expressions of shared purpose and how they develop individual nurses into professionals who lead from wherever they stand in the organisation.

Writing this essay well means doing more than summarising Bass and Avolio. It means applying their framework with clinical specificity, engaging with the evidence base with scholarly rigour, critiquing the theory with intellectual honesty, and reflecting on your own leadership development with genuine self-awareness. That combination — theoretical command, clinical application, critical analysis, and personal reflection — is what nursing educators are assessing, and it is also, not coincidentally, exactly the combination of capacities that excellent nursing leadership requires in practice.

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