Not all managers are leaders, but they should be. Many leaders don’t manage and that means there are corporations and public entities everywhere that are struggling with the grey area between administering formal operational needs which allow entities to function, inspire creative employees to be independent and innovative change agents.
In nursing, or healthcare in general, there seems to be more managers than leaders. Healthcare is highly regulated, needs to be extra cautious, analyze risk, and do all it can to “do no harm.” Because of the hierarchical culture, need for policy and procedure to protect the public as well as its staff, those who prefer to manage, who are task and goal oriented, enjoy a position of power. They tend to be attracted to the hierarchical roles of management in healthcare.

Leaders can be found on every floor and staff position in healthcare settings. They may not have formal titles, but you can spot them even without a badge that says “leader”. These staff are change agents. They enjoy their work. They are people oriented and service driven. They engage others with their goals for empowerment and bettering the system, the process, or simply the unit they work on.

Managers dictate rules already made by powers greater than their staff. They do not require input, only compliance.
Leaders invite feedback, group input, interpersonal relationships. Leaders care about people. Managers care about process and algorithmic outcomes. They may be inspirational leaders while still juggling the rigors of planning, implementing, analyzing, assessing both processes and people. It takes a special person to do so, one more inspired to work with and for their subordinates and patients, vs someone who goes into management to delegate the workload because they have the power to do so. Delegation is a tool. The skill to delegate and negotiate tasks can take time. It usually feels uncomfortable to new managers that are true leaders. Those that delegate heavily
prior to management usually have less inspiring leadership skills than leaders who become managers because they want to help the work of the “people.” The reason many leaders become managers is to care for the employees in new and different ways. Many times delegating more work to those same people feels counter intuitive. There is a standard of delegation to help with this skill set. It includes:
The five rights of delegation
Right Task
Right Circumstance
Right Person
Right Direction/Comminication
Right Supervision/evaluation
When considering delegation, the above “rights” can help to organize the tasks and people needed to complete them.

There are many different leadership styles. Authoritative-leader and subordinate, no room for discussion, strong control, Democratic-goals discusses by group, cooperative between leader and subordinates, Laissez Faire-not involved, lack of real personal leadership, Situational-dependent on situation or need,places value on accomplishment and relationship, charismatic-an emotional tie exists between leader and followers and a strong sense of commitment and loyalty, transactional-leadership is a traditional manager/staff model. Uses incentive and reward as a way to get staff to do extra or means of control, transformational-emphasizes importance of interpersonal relationships serves as a role model, inspires change, encourages growth, caring leadership- an extension of transformational as it believes managing is about people not manipulation, quantum-creative, flexible, encouraging, servant leadership-serve first by helping the helpers and those they serve.

Effective leadership must be genuine and heartfelt. One must manage tasks but lead people. People can manage themselves, in fact they must for there to be proactive qualitative change and growth. People are inspired when their strengths are allowed to flourish and their weakness are not under a microscope. Leading people allows the (micro) management of their daily lives to fall away so that time and task can be spent on giving employees tools to do their best, the space and trust to have innovative ideas that can in turn be used for a greater good for others.

Humans are pack animals. We are social, especially in a healthcare setting. Leaders must be able to manage in healthcare in a fluid nature as situations change quickly. In times of crisis, authoritative styles are needed and appreciated (codes, transfers to higher level of care, escalating violence from families or patients.) Other times, a democratic model works best.(We need a resource nurse. What times are you the most
busy and when could you need the
most help?) Transformational leadership is the highest level of leadership/management style
as it encourages and inspires employees to engage in their work, make personal connection, and want to thrive.

It takes a tenacious person to lead in healthcare. The
ones that value the personhood of their staff, their work, who trusts their employees, listens to needs, provides resources and tools, acts as a resource vs micromanaging or shaming, has the ability to change as the need presents, and can share their humanity with their staff-those are the qualities of a manager that is also a leader. Someone who values the people who make up the organization, manages up, surrounds themselves with strong, supportive, intelligent people who share the same values. That is my ideal manager, and one I have not had in many years. This is why nurse burn out rates are high, and we will continue to lose nurses at an alarming speed.  Managers who lead. Healthcare needs them.

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