Strategic Leadership in Nursing

Abstract

Managing the complex healthcare facility in a lower middle-income country (LMIC) such as Ghana can be challenging and demands management principles that would enable the leader to be conscious of the significant role of the environment. Nurses and midwives constitute majority of the health workforce, play pivotal role in healthcare delivery, consuming most of the resources in managing patient care, and promote the corporate image of the facility. Nurse leaders should exhibit practical leadership skills that would enable effective utilization of the capabilities of staff to achieve organizational goals and prominence in the environment. Long-term viability and competitiveness of the healthcare system demands cost-effective strategies using organizational competencies to take advantage of the opportunities within the environment. Leadership, therefore, becomes essential by initiating a vision that harnesses the potential of staff and stakeholders to this commitment. To withstand time and change, strategic leadership principles such as setting high standards of excellence, demonstrating exceptional performance, and constantly delivering value are imminent. Strategic leadership in nursing ensures provision of leadership strategies that would enhance effective teams and mitigate existing challenges confronting the health system. The paper finds that nursing as a profession is incessantly evolving and, hence, requires strong and dynamic leadership.

1. Introduction

Managing the health needs of the populace in a lower middle-income country (LMIC) such as Ghana is an enigma, due to the many challenges confronting the health system, particularly, the varied professional groups, increased cost of delivering care, increased workload, and the continuous diminishing numbers of staff. Being the largest group of healthcare professionals, nurses and midwives are pivotal to these issues. Thus, nurse leaders are constantly searching for the “best” approach to facilitate both staff and patients’ outcomes amid these challenges [1]. Encountering these challenges and other related healthcare issues, nurse leaders should exhibit practical leadership skills that would enable effective utilization of the capabilities of staff to achieve organizational goals and prominence in their environment.

To ensure the long-term viability and competitiveness of the healthcare system, nurse leaders need a set of guiding principles or search for strategies cost-effectively using organizational competencies taking advantage of the opportunities within the environment whilst avoiding environmental threats. Leadership, therefore, becomes very essential in this approach by initiating a vision that harnesses the potential of staff and stakeholders to this commitment. For an organization to withstand time and change, strategic leadership principles such as setting high standards of excellence, demonstrating exceptional performance, and constantly delivering value.

The administration of nursing staff thus becomes crucial to any healthcare system due to their numbers and essential roles [2]. The phrase “nursing administration” is used to denote a broad range of nursing professionals who are well-versed in the principles of effective leadership in the healthcare industry. It is the art and science of planning, organizing, leading, coordinating, controlling, policy-making and motivating human resources towards the achievement of organizational goals. Nursing administration promotes commitment, cohesiveness, coherence, and direction to the provision of nursing services by encouraging efficiency and comprehensiveness in accomplishing the purposes and goals of nursing. Strategic leadership is sensitive to taking advantage of the core competencies of nursing staff to deliver quality incomparable healthcare.

In today’s healthcare market, nurse administrators can highly impact the need for lower prices and better treatment that becomes a daily headline through leading and dealing with a wide range of concerns, such as policy, administration, finances, culture, and human resources. Nurse administrators are multi-faceted professionals who establish objectives and strategies for the departments of nursing and maintain organizational structure and culture to achieve the objectives by the maintenance of stable staffing patterns, selecting and assigning nursing personnel and formulating policies that are indispensable aspects of nursing administration. Additionally, they maintain proper nursing records for clinical and administrative purposes as well as constantly evaluate and improving nursing care of patients with the established nursing standard.

2. Principles of nursing administration

Nursing departments uphold the cooperate values and promote the image and services of the healthcare system. Nursing staff are guided by the principles of excellence in service, excellence in practice and excellence in leadership in promoting competitive advantage within the confines of their immediate environment and beyond. Patients, regardless of their circumstances, have intrinsic value and should be treated with dignity and respect, according to the principles of excellence in service. Patients’ rights to privacy and confidentiality must always be respected in the pursuit of high-quality comprehensive care that is affordable and based on cutting-edge technology. Thus, every interaction with patients and their families should be marked by empathy and consideration for the wellbeing of those being served.

The nursing profession is viewed as both a science and an art, with the core values of nurturing and care. The practice of nursing evolves around knowledge (science) which is modelled in practice (art). Compassion and care are fundamental to the profession’s principal responsibility: in restoring and maintaining patients’ health. Patients’ health needs are managed holistically by nurses and other healthcare team members utilizing the models of nursing care. For instance, nurses monitor and evaluate nursing practice through auditing to improve patient-centered care and health education. Continuing education, membership in a professional association, and research are all ways in which nurses can ensure that clients’ needs are met, and nursing practice remains competitive.

Nurses, according to the principles of excellence in leadership, should foster a progressive work environment that utilizes current technologies while exercising fiscal prudence to enable the greatest possible standard of healthcare. The health system should be a learning organization that engages research to enhance evidence-based practice. The role of the nurse is to promote and facilitate group decision-making. It is critical that nurses become sensitive to the unique requirements of each patient and promote, commend, recognize, and encourage professional and personal development to enhance the quality and differentiation of service. Suggestions and criticisms should be considered as challenges for improvement and innovations thus, giving room for flexibility and creativity. Equity, fairness and engagement should be employed in all performance and personnel policies to promote confidence, competence and commitment.

Nursing administration through effective communication eliminates misconceptions, misinterpretations and create shared vision, direction, and understanding among staff. Subsequently, it is essential to establish effective control. Control is an aspect of nursing administration that comprises of ongoing monitoring and evaluation of the execution of the plan. Supportive supervision via standard-setting, comparing performance with standards and making necessary corrections to ensure achievement of organizational goals. Effective communication enhances control in the nursing environment. Objectives are effectively communicated, roles and responsibilities as well as resources are distributed to accomplish all activities without any misunderstanding and confusion among staff.

3. Nuances of leadership and management

Leadership and management actions can be initiated with “the goal in mind,” that is, outcomes that justify the existence of the organization [3]. Nurse managers at all levels of the health system should strive to improve the well-being of the patients. The nurse manager should integrate the department’s vision to the hospital’s strategic objectives or vision and focus time on activities that converge energy to the results. Leaders must have the ability to motivate and inspire others to work with a passion for common objectives [4]. When it comes to leadership in healthcare, it is the capacity to get people to work together toward a common objective [5, 6]. Good leaders must help others to overcome obstacles and achieve goals, even when the situation is difficult. Hence, nursing leaders should create a workplace climate that fosters good working conditions to enhance patient and staff outcomes. Organizational goals can only be achieved through management’s use of people and available resources.

Management sets plans and budgets whereas leadership creates vision and strategy. Managing practices involve planning, organizing, implementing, monitoring and evaluation, whereas leading practices include scanning, focusing, aligning/mobilizing, and inspiring. Both tasks are accomplished in concert. Leaders in the nursing profession utilize a wide range of leadership and management techniques. Strong organizational capacity enhances healthcare services and long-term improvements in people’s health care through continuous implementation of the eight practices.

Nurse managers should adhere to the eight leading and management practices to become better leaders and managers. The practices can be employed in a wide variety of scenarios to increase organizational performance and to maintain performance over time. For operational strategies and reporting systems to reflect organizational priorities, nurse managers should follow best management practices and adhere to these guidelines. Being well-versed in the usage of management systems and processes and being able to meet those expectations are two key characteristics of successful nurse managers. Supportive supervision and monitoring and evaluation mechanisms that provide timely, reliable information are significant in the provision of feedback on performance.

To run the department effectively, nurse managers should be vigilant on the provision of nursing services to ensure effectiveness (the right services), efficiency (services are delivered in the right way), and consistently high quality to meet patients’ satisfaction. Successful managers must accomplish these three objectives first. During the planning phase, the nurse leader conducts a thorough investigation of the environment to obtain relevant information. Strategies are then developed for goal achievement through delegating responsibilities to team members while ensuring that members are held accountable for timely completion of tasks and within budget. Nurse leaders also ensure that the plan is implemented by putting systems in place and assigning tasks to the right people, as well as monitoring and evaluating progress to achieve the intended outcomes.

While management systems are fundamental for dependable operations, management alone cannot ensure success. Nurse managers who implement new tools and systems frequently achieve similar results, unless they successfully train others to use them, change them regularly to suit client demands, and manage the organizational framework in which they operate using innovative methods. Effective nurse managers adapt to any volatile setting and inspire others to do the same. These adaptive abilities enable individuals to succeed in the face of difficult circumstances and limited resources. Nurse managers are well-informed about opportunities and dangers, and their direction is transparent to nurses and other staff. Commitment ensues when people and resources are focused on a common shared vision, and workgroups delivered on the promises made by nurse managers. To lead effectively, nurse managers must direct their workgroup’s attention toward attaining achievements that meet the requirements and preferences of clients while also responding to the interests of key stakeholders. With complete assistance, nurses who work on the front lines of healthcare can learn to identify their barriers to service quality, begin improvements, and give excellent service to their clients. To maintain support, the nurse manager may also need to secure top management commitment. Below are the eight leading and managing practices that nurse managers can practice:

• Scanning: identifying internal and external conditions that influence desired results

• Focusing: directing attention to priority challenges and actions

• Aligning and mobilizing: motivating internal and external stakeholders to support desired results

• Inspiring: creating commitment and a climate of continuous improvement

• Planning: preparing a set of activities, timeline, and accountabilities to meet goals

• Organizing: developing structures, systems, and processes to support the plan of action

• Implementing: carrying out and adapting the plan of action while coordinating related activities

• Monitoring and evaluating: observing, examining, and assessing progress.

4. Leadership and strategy

Nurse managers have 24-h responsibility for managing nurses, nursing units, and patients and serve as a bridge between the operational and management levels of the facility [7]. They are responsible for creating a safe and healthy work environment for the healthcare staff as well as ensuring that members of the multidisciplinary teams continue to grow professionally and offer high-quality treatment, foster a supportive and encouraging work environment [7]. The nurse manager position is significant thus, requires effective and efficient leadership that is conceptual, technical, and humane.

To understand strategic leadership, it is important to separate the two words, leadership, and strategy. Leadership is a process whereby people are influenced by an individual to work toward the attainment of a mutually agreed goal willingly and enthusiastically [8]. On the other hand, management is defined as “the pursuit of organizational goals efficiently and effectively by integrating the work of people through planning, organizing, leading, and controlling the organization’s resources” [9]. Strategy is a matter of doing things differently or doing the same things in a new way, making a deliberate decision to do something different from your competitors, and developing a system of operations that is distinct from those of competitors. To cut costs and improve on-time performance, one needs a system that sets apart us from the competition.

The nurse manager in maintaining her unique position in the healthcare facility needs both leadership and strategy to coordinate the affairs of colleagues and stakeholders to uphold the values and integrity of the facility. Leadership is needed for developing and sharing a sound vision whereas strategy is needed to achieve the vision and position the facility within the environment with an incomparable competitive advantage.

5. Strategic leadership defined

Strategic leadership is the ability to anticipate, imagine, maintain flexibility, and empower others to accomplish strategic change as needed. Organizational development, or the process of delivering leadership and inspiration, is what it’s all about. The multifunctional work requires managing via others, managing an entire organization rather than a functional subdivision, coping with change, attracting, and managing people (and intellectual) resources, and being able to actively influence others.

The art and science of strategic leadership go hand in hand. Having an open mind, looking at things from a different perspective and being willing to consider the ‘what if possibilities,’ as well as the bravery to analyze and weigh the various options, are all part of the art of problem-solving. To be a strategic leader, one must have the confidence to make decisions, implement policies, and convince others to share your vision and work together to accomplish it. Thus, focus your thoughts and take action to bring your goal to fruition.

Strategic leadership, therefore, is the interaction of acting, thinking, and doing or influencing the capability of leaders. Strategic leaders are in all levels of the organization as individuals and teams. Nurse leaders are found in all levels of the health system playing formidable roles for the achievement of organizational objectives. Thus, it is essential to develop them to acquire this role orientation to become strategic leaders to achieve organizational prominence.

6. Characteristics of strategic leadership

Strategic leaders’ tasks and responsibilities include leading and managing change and making use of the organization’s unique resources to ensure the organization’s successful evolution. To be effective, a strategic leader must provide direction to the organization in a way that everyone can comprehend and appreciate [10]. Long-term and often major organizational changes are part of the work of strategic leaders, who have a wide range of responsibilities. Strategic leadership is a learning process that uses a combination of thinking, acting, and persuading skills to move an organization in the direction of long-term success. In other words, strategic leaders are excellent managers and leaders who are continually looking for ways to improve.

Strategic leadership is a continuous process and a cycle. ‘It is not enough just to ‘think,’ ‘plan,’ and ‘reflect’, people expect to see things happen. This cycle involves (1) assessing where we are. The nurse leader conducts environmental analysis in the facility, or department to know where they are. The environmental analysis involves both internal and external analysis. The internal analysis includes identifying the strengths and capabilities of staff, resources, vision, mission, policies, objectives, activities accomplished previously, etc. The weakness of the organization should also be identified such as staff and resource inefficiencies, etc. the external analysis will help you to identify the opportunities and threats within the environment. The data gathered from this analysis will then be analyzed. (2) Understanding where we are and want to be – Mission, vision. The nurse leader analyses all the data gathered in step (1) to understand the current situation. (3) Learning how to get there —Planning and using strategies that will continue to define us. This involves critical analysis of the data gathered, studying other successful organizations, and using benchmarks to develop plans and strategies. Again, organization of resources as well as alignment and mobilization of staff. (4) Making journey—Implementing tactics. Implementation starts with monitoring and evaluation together with inspiration. The nurse leader monitors all activities being implemented to ensure the right things are done or take corrective actions where necessary. Nurses are inspired throughout the process to maintain the momentum of implementation thus, encouraging creativity and innovation to enhance core competencies. (5) Checking progress—Current performance. The nurse leader continuously checks all the activities been accomplished to sustain enthusiasm by motivation through acknowledgement and praise. Thus, the strategic organization is all about continually becoming. Strategic leadership involves discovery more than determination and is not reserved for those at the top only.

Essential for nurse managers are the provision of direction, application of strategic thinking for policymaking, a clear plan of action, balance long and short-term goals; develop ownership; build partnerships; leading by example and a succession plan for the future of the organization. This creates a balance between short-term and long-term goals, strategic leadership in oneself and others, making words into action (making the journey), monitoring the progress, and changing course if necessary are all significant for nurse managers. They need to be able to think, act, and have an impact. A nurse manager’s strategic strategy is nothing more than that. The judgments and choices that an organization makes when they implement or fail to implement the plan constitute a real strategy.

Everyone, not only the CEO or nurse leader, has a role to play in strategic leadership. A collection of processes cannot adequately describe this never-ending cycle of personal, group, and organizational growth. It aims at helping senior executives and future leaders build and maintain a focus on the ‘essential few’ factors that have been determined to be most critical to the long-term success and competitiveness of the organization. All these aspects are necessary for organizations to be long-term winners in the face of change and uncertainty and to continually give value to all of their main stakeholders—including society—no matter how challenging the environment. The ‘roadmap’ is the executive blueprint for moving the organization to the next level of performance and competitiveness. These important performance components should be included.

To be effective, a strategic leader must have transformative powers, act morally and politically when appropriate, prioritize the relationship between the organization and its environment, and possess strong managerial skills. Successful strategic leaders, according to Cousins [11], have specific cognitive and conceptual abilities. According to him, they are analytical, creative thinkers who can thrive in a dynamic and complicated environment because of their analytical, creative, innovative, reflective, and proactive thinking abilities [11]. As a healthcare organization, nursing necessitates leaders who possess these traits to achieve and maintain a competitive edge.

7. Components of strategic leadership

When it comes to effective strategic leadership, there are five key components: (1) Creating an inspiring mission statement and sharing it with colleagues, (2) Developing high-level cognitive activity because developing strategies is hard mental work, (3) Gathering multiple inputs, that is strategy formulation which is democratic, (4) Anticipating and creating a future that involves the invention of a new world, and (5) Revolutionary thinking and action to get things accomplished.

The critical performance components of strategic leadership include the (1) Organization’s Business Model which must be designed and driven by the leadership team, who must focus relentlessly on ‘doing the right things for the business – not just ‘doing things right’. (2) Organizational culture, particularly, the values or beliefs can either be the greatest enabler or inhibitor of organizational performance. (3) An organization’s core shared purpose which becomes the ‘anchor’ that keeps the organization from ‘drifting’ into danger in the sea of turbulence. (4) Renewal that is the seamless integration of adaptability, innovation, and continuous learning, which is the secret ingredient that sustains the organization’s ‘vitality’, its ‘relevance’ through time so its ‘business model’ never becomes outmoded. (5) Organization’s vision, which is the destination the organization wants to reach. The organization is on a journey, and it is the responsibility of the leader to ensure that it ends up at the desired destination. (6) Principles of engagement which cover how the organization presents itself to society including such topics as corporate governance, corporate social responsibility, sustainability or environmental programs, ethical practices and more. Over time these principles define and either strengthen or weaken the organization’s image and even the strength of the brand. They cannot be minimized or trivialized. (7) Investing in the growth of the organization’s human resources. When an organization aligns itself around a goal or vision, it can harness all of the organization’s resources to achieve that goal. For the achievement of the vision, it is necessary to include the following elements: critical success factors, performance drivers, key business objectives (KBOs), and the strategies that assist in achieving these KBOs, all of which must be implemented perfectly to achieve the desired outcomes.

(8) Creation and delivery of value to all key stakeholders including society. Values are defined as any of the tangible or intangible benefits that the customer or stakeholder perceives he or she receives from you and would not realize from any other provider. As such it represents an immediate source of differentiation and is also the foundation for building and maintaining exceptional stakeholder relationships. (9) Agility and resiliency; agility involves identifying, assessing, and acting on opportunities (or threats) faster and better than competition. Resiliency involves recovering from problem situations better and faster than a competitor – minimizing the potential ‘cost of lost opportunity’. (10) Relationship mastery; this is the capability to build and maintain exceptional and secure relationships with all key stakeholder groups including customers. In times of market turbulence nothing contributes more to the organization’s stability than well-defined and secure relationships with key stakeholders. (11) Competitiveness and growth; the ultimate outcome which is driven by the above. There must be also a sensing system or strategic information architecture to support all the above components including a hyper-decision-making capability.

8. Strategic leadership process

The healthcare industry has expanded its understanding of the significance and impact of strong leadership [12]. The healthcare system’s complexity necessitates the skills of a capable leader who can bring together medical and clinical practice while also recognizing the needs of patients and establishing a wide range of health services [13]. The primary goal of the healthcare sector is to provide preventive, rehabilitative, and palliative care to a community [14]. The strategic leadership process has four stages: competence, vision, communication, and service.

Step 1—The capacity to meet a specific demand, an honest appraisal of one’s skills, shortcomings, goals, and motivating factors, the development of a competency that others respect, and the competency must be recognized by the organization, are all components of competence. Developing exceptional competence requires 10–18 years, and early development of core competence should be prioritized through investment.

Step 2—To guide the organization in the right direction and create a vision that serves as a guidepost. This creates a motivational focus, giving employees a specific goal to work toward. The following are characteristics of a vision: To be imaginable is to have a vision of the future. Long-term interest appeals to stakeholders are desirable. Clear: able to serve as a compass for making decisions. Adaptable: allowing for a wide range of reactions and allowing for individual initiative. The term “communicable” refers to the ability to communicate effectively within five minutes.

Step 3—Included in the list of questions to inquire about the effectiveness of communication is: The vision statement will be communicated to whom? What are all the possible means of communication? We must consider how we can best convey the organization’s long-term strategy to our stakeholders. What are the best means of contacting you in the future? What measures can be used to assess whether or not the vision statement is known and understood by the target audience? A vision statement without proper communication is like hosting a party without sending out invitations.

Step 4—Empathy, healing, listening, awareness, foresight, persuasion, stewardship, dedication to the growth of people, developing community, and conceptualizing are among the 10 characteristics of servant leaders highlighted by Spears [15]. The leader-follower relationship should be built on open and reciprocal exchanges of information. Being able to listen and be open to what others have to say is a learned skill. Through good listening, servant leaders recognize and validate the thoughts of their subordinates. Servant leaders that are empathic show that they truly understand the thoughts and feelings of their subordinates. It’s all about the help a servant leader gives their followers to overcome their own personal struggles. Servants who are aware of their social, physical, and political surroundings are better able to respond to the needs of their organizations. Persuasion is the ability to communicate in a way that persuades others to change their minds. Focus on the person’s capacity to be a visionary for the organization by providing a rich sense of objectives and direction. Servant leadership requires foresight and accountability, while stewardship requires accountability for one’s leadership role. For those who want to learn more about servant leadership, these ten traits are an excellent starting point.

9. Relationship management

To complete all four elements of the Strategic Leadership Process, managing relationships is essential. As a strategic leader, you need to manage your connections with your colleagues, executives, and employees effectively. Listening and effective talking are two abilities that can help manage relationships.

Being a nurse administrator or leader necessitates a high level of listening skills. (1) Ignoring is a form of listening in which the listener does not pay attention to what the speaker is saying. (2) “Pretend listening” refers to the practice of paying scant attention to a speaker while doing other things. (3) Selective listening usually occurs in a group setting where one tunes in and out depending on the interest of the verbal cues. (4) Attentive listening is focusing on the speaker and not allowing external noise or potential distractions to interfere with the messages being conveyed. (5) Empathic listening is the most successful kind of listening because it allows you to put yourself in the other person’s shoes and fully comprehend what they are trying to say. Strategic leadership in the healthcare industry necessitates that the nurse leader is well-versed in all these types of listening styles to effectively engage colleagues and build trust.

Keys to the effective conversation are (1) Candor: setting up an agenda with one’s feelings, beliefs, or ideas. That is the act of being open and honest or frank. Conversations with colleagues should be straightforward and sensitive to their sentiments. (2) Clarity: verbal and non-verbal exchange of wants and needs should be the same and specific. (3) Commitment: agreement on next steps. Nurse leaders should learn to agree with colleagues on the next steps to adopt and be committed to them.

10. Effective strategic leadership

Nursing as a profession is incessantly evolving hence requires strong and dynamic leadership. The complex and dynamic nature of the nursing environment requires nurse executives to leverage the basic tenants of strategic leadership to promote nursing performance and service delivery [14]. It’s all about developing a feeling of purpose and direction, which are crucial enablers for interacting with key internal and external aspects in the organization’s environment [16]. Strategic leadership, according to Nwachukwu and Vu [17], is based on the ability of a leader to think strategically and see the future to improve the efficiency of the business. Strategic leadership is not only about having unique qualities that allow for the acquisition and learning of new knowledge and ideas but also having an adaptive capacity to effectively respond to the dynamism and complexity of the external environment. Hence, strategic leaders may respond to a changing environment by constantly and tactically adjusting their organization. The presence of strategic leadership is not enough to promote organizational effectiveness as other antecedents can be at play [16]. Effective strategic leadership is a crucial aspect of organizational effectiveness and has been associated with numerous organizational outcomes [18]. Effective strategic leadership can identify the moderation and mediating factors such as the internal and external environmental dynamics, taking advantage of the opportunities and overcoming the threats [19]. Organizational strategic flexibility and sustainability are facilitated by the strategic leadership. This means that a nursing organization’s long-term strategic planning hinges on its leadership, in which leaders adopt a common vision of what the organization will become [12].

To be an effective strategic leader, an organization should first determine its long-term goals, strike a balance between internal and external controls, efficiently manage its resources, maintain an effective organizational culture, and focus on ethical standards.

1. Choosing a course of action. Involves defining a long-term goal and a strategy for achieving goals. For the next 3–5 years, strategic direction is articulated in terms of the opportunities and dangers that exist. All organizations need to have a strong foundation of beliefs and a clear vision of what the future holds.

2. Organizational controls that are well-balanced. Strategic and financial controls must be developed and used effectively by strategic leaders. Controls define the parameters by which strategies are to be implemented and the actions that must be performed to change those strategies once they have been implemented. Financial and strategic controls must be balanced to succeed. For strategic executives, the Balance scorecard framework is a way to check that they have created both financial and strategic controls to measure organizational performance Premise is that when financial controls are prioritized above strategic controls, organizations put their future performance at risk. Organizations can use diverse views to attain higher levels of performance when strategic and financial controls are properly balanced. Financial perspective criteria involve cash flow, return on equity and return on assets. Customer perspectives criteria consist of the assessment of the ability to anticipate customers’ needs, the effectiveness of customer service practices, the percentage of repeat business, and the quality of communication with customers. Internal business processes perspective criteria include improvements in innovation ability, improvements in employee morale and changes in turnover rates. Learning and growth perspective criteria also include improvements in innovation ability, the number of new products compared to computers and increases in employees’ skills.

3. Effectively managing the organization’s resource portfolio. This includes financial, organizational (competencies and capabilities) and human capital. Organizations’ resources must be managed in a way that is consistent and supportive of the strategy. They also must be allocated as efficiently and effectively as possible so that each area of the firm has what it needs for strategy implementation. The changing strategy will likely call for the reallocation of resources and the movement of people and other resources from one area to another. Financial resources are managed through the budgeting and resource allocation process. Core competencies and competitive capabilities should be developed in a strategy supportive fashion. Organizations should build their strategy around things they are good at doing and/or become good at doing things that are supportive of strategy. A firm’s human capital, which refers to knowledge and skills of a firm’s entire workforce, should also fit its strategy. This can be accomplished by hiring people that fit the organization and its strategy, and an effective training and development program. Investments should be made to acquire and develop the firm’s human capital.

4. Sustaining an effective organizational culture. This complex mix of basic beliefs, ideas and symbols that are shared throughout the organization, particularly among the employees, have a significant impact on the way business is done. It sets the stage for the organization’s strategy-making and implementation. Employees’ behavior is also regulated by this method. Organizational culture is made up of a wide range of factors, including its origins. Once established, an organization’s culture tends to survive because it hires people who share its values, socializes its employees, and systematically indoctrinates them with the culture’s norms and practices. The retelling of organizational folklore and ceremonies honoring personnel who exhibit cultural values. Cultural standards should be rewarded. The robustness of a company’s culture can vary depending on how deeply it is ingrained in everyday operations and customs. A company’s culture should reflect its strategy to help it become more strategically competitive and generate above-average returns. As difficult as it may be to change a company’s culture, with the right strategic leadership, it may be done.

5. Emphasizing ethical practices. Controlling employees’ judgment and behavior can be achieved through the application of ethical practices. When it comes to making decisions, they should be a key element of the culture of the firm. It is critical for strategic leaders to set and convey ethics-related goals; continually revise and disseminate the organization’s code of conduct; create an acceptable work environment; and utilize reward systems to recognize and promote ethical behavior. Ethical practices can be used to ensure that people are acting in a morally correct manner.

6. Developing policies and procedures. People’s behavior is governed by policies and procedures, which are sets of written and unwritten norms and styles of conduct. The standardization of work practices and the specification of the optimal methods for completing tasks can boost productivity. Provide direction from the top-down on how specific tasks should be completed. As a result of their efforts, important strategic actions are carried out consistently. The kinds and numbers of policies and procedures employed by various kinds of organizations vary widely. There must be a good synergy between an organization’s policies and procedures and its overall strategy.

7. Developing reward systems. Effective plan execution can only be achieved through employee commitment if they get incentives. Behavioral control can be achieved in part through the use of rewards. Those who achieve their goals should be rewarded abundantly, and those who don’t achieve their goals should not be rewarded. Strategy-based incentives and monetary compensation should be used to motivate employees to improve efficiency and find ways to save money. Distinguishers should recognize and reward those who are creative. Consequently, organizations must reward and encourage their employees in ways that complement the strategy and implementation of the business plan.

11. Strategic leadership and strategic management process

The strategic management process can only succeed if it is led by an effective strategic leader. Vision and mission are shaped by the strategic leadership of the organization, and the development and implementation of strategies are facilitated by the leadership of the organization.

Leadership plays a key role in terms of enforcing organizational strategies. Strategic leaders in an organization work with the strategic vision by formulating strategies, implementing, and evaluating those strategies to achieve the strategic goal [20]. This process is described as the strategic management process. Strategic management is a rapidly developing field of study that has emerged in response to increasing environmental diversities [21]. Strategic management seeks to manage all resources to create and sustain a competitive advantage for a successful future. The focus is to view the organization as a whole and examine the firm’s performance attempting to explain why others perform better under similar chaotic conditions. Strategic management emphasizes on decision making, which is a characteristic feature. These strategic decisions are long term and focus on the future of the organization. The distinguishing characteristics of strategic management are its emphasis on strategic decision-making with three key attributes: rare, consequential, and directive [22].

12. Strategic leadership models

All the leadership styles are significant in strategic leadership, particularly when to use each of the styles to realize its usefulness. However, transformational, laissez-faire and transactional leadership are the models used in bringing about strategic leadership. Knowing which styles to use as a nurse leader is important when dealing with a complex work environment such as the hospital where varied accomplished health professionals converge to manage the patient.

12.1 Transformational leadership

Transformational leadership devotes attention to charismatic and emotional elements of leadership which emphasize intrinsic inspiration and follower growth. This aligns with the needs of today’s workforce, who needs inspiration and empowerment to succeed. Working with teams to identify what changes are needed, building a shared vision to guide the change, and then implementing those changes together with dedicated members of the group are all steps in leadership. By changing roles and responsibilities, leaders motivate their teams to put the interests of the organization ahead of their own. It is a process that affects and transforms individuals under transformational leadership. Leaders can also have a unique and reflecting effect on their subordinates and subordinates. The values, norms, ethics, feelings, and long-term objectives of transformational leadership are at the heart of this approach. It also requires assessing the motivations of followers, meeting their needs, and treating them as individuals... Transactional leaders are responsible for the day-to-day operations of the company, whereas transformational leaders are responsible for bringing in new ideas and implementing them.

According to Bass [23], transformational leadership is defined by the impact it has on the people it serves. Transformational leaders, according to Bass, inspire their people to trust, respect and admire them. Transformational leadership is judged mostly on the impact the leader has on his or her subordinates. Transformational leaders inspire loyalty, adoration, and respect in their followers because of the leader’s willingness to go above and beyond the call of duty. Due to the transformational leader’s ability to foster a sense of personal value in his or her followers, these results can be achieved. They provide adherents with a compelling mission and vision, as well as a sense of self-worth. It is via academic stimulation, idealized influence (charisma), and personal consideration that followers are transformed and motivated to action. Additionally, the leader encourages his or her subordinates to cultivate inventive and unique approaches to question the status quo and modify the environment to achieve success. Because leadership is a continuum from transformational to transactional to laissez-faire, Bass argued that leaders can simultaneously demonstrate both transformative and non-transformative leadership attributes.

12.2 Laissez-faire

Laissez-faire leadership style is when a leader does not provide leadership that allows followers to look after themselves. Subordinates end up with freedom in deciding which policies and methods to adopt. The leader develops the structure of the work and provides adequate resources for work and helps upon requests by coaching or answering questions or supplying information. However, the leader does not participate in workshop discussions or group tasks. The leader again does not provide comments on followers’ performance unless specifically requested. As a result of this, employees may become dissatisfied and fail to meet the goals they had set for themselves.

Negative repercussions are commonly linked to leadership, particularly in terms of follower satisfaction or leader effectiveness [24]. Female leaders are more likely to be transformational leaders, whereas male leaders are more likely to be laissez-faire leaders [25]. Those that have a proven track record of excellence or matured employees are most suited for this type of leadership. Using this strategy, more experienced employees become self-sufficient, productive, and impactful. As a result, the approach encourages team members to be creative and original, which in turn aids in the advancement of their careers. Members see a laissez-faire attitude as a vote of confidence in their talents, which gives them more room to grow into self-assured, devoted, competent, and successful individuals.

12.3 Transactional theory

The transactional leader directs attention to the use of conditional responses such as rewards and punishments to acquire compliance from followers. Transactional leaders attain goals by seeking to uphold the status quo, not aiming for advancement, whereas transformational leaders endeavor to transform the future by inspiring the followers. Transactional leadership styles result in increased job satisfaction as well as leader job performance. The leader gets the job done with no commitment from the followers. Because of its emphasis on short-term goals, transactional leadership is more like a management style than a true leadership one. Despite these drawbacks, it can be a useful tool in other settings, such as in the workplace.

As depicted in Figure 1, leadership is viewed as a continuum, ranging from transformational leadership, through transactional leadership to laissez-faire leadership. This implies while leaders may have a specific style this may not be fixed, as there are points/situations when leaders’ styles may depict traits of the other two. Transformational leaders bring a lot of energy and enthusiasm to the workplace, change and new ideas to management, thus more is achieved. Transactional leaders maintain the status quo and ensure goals are achieved through the routine accomplishment of roles and responsibilities with normal energy, whereas laissez-faire leaders normally lack energy and ideas and bring lethargy to the workplace killing at time enthusiasms. Nurse leaders, in being strategic ought to acknowledge this continuum, understand the peculiarities of a particular situation and know and practicalize the best-fitting approach.

Figure 1.

Leadership continuum.

13. Conclusion

The complex and dynamic nature of the nursing environment requires nurse executives to leverage the basic tenants of strategic leadership to promote nursing performance and service delivery. Leadership plays a key role in terms of making and enforcing organizational strategies. Leadership capabilities and strategies are essential for optimizing team-based nursing and patient outcomes. A visionary leadership approach motivates teamwork and seeks to reach the highest levels of performance possible within the boundaries of nursing practice.

Many studies support the transformational method since it encourages employees to work creatively, exhibit dedication, and meet expectations. Some research suggests combining the three styles in management because each situation necessitates a distinct style. Transformational and laissez-faire methods encourage employees’ independence and creativity. When a leader wants to develop new practices and implement them quickly, transactional approach works best.