Leadership is the process of influencing people to work willingly toward shared goals. Management is the process of planning, organizing, staffing, directing, and controlling resources to reach organizational goals. Leading (directing) is the management function in which leadership is exercised: motivating, communicating, delegating, and handling conflict.

A charge nurse, a chief nurse, a public health nurse in a rural health unit (RHU), and a staff nurse coordinating a team can all be leaders. Leadership does not require a formal position; management does.

The ideal nurse manager combines both: a manager who also leads.

Power is the capacity to influence others. French and Raven's bases of power are commonly tested:

Expert and referent power are personal and last longest; legitimate, reward, and coercive power depend on position.

1. Trait (great man) theories

• Leaders are born with qualities such as intelligence, self-confidence, integrity, and drive.
• Weakness: they do not explain why the same person leads well in one situation and poorly in another, and they imply leadership cannot be learned.

2. Behavioral (style) theories — Lewin's three styles

Blake and Mouton's Managerial Grid plots concern for production (task, horizontal axis) against concern for people (vertical axis), each 1 to 9:

• (1,1) impoverished — little concern for either
• (9,1) authority-compliance — high task, low people
• (1,9) country club — high people, low task
• (5,5) middle-of-the-road — balanced compromise
• (9,9) team management — high task and high people; considered the most effective

The Ohio State and Michigan studies similarly separated initiating structure (task behavior) from consideration (relationship behavior).

3. Situational and contingency theories — there is no single best style; the effective style depends on the situation.

• Fiedler's contingency model: the leader's style (measured by the least preferred co-worker, LPC, scale) is fairly fixed. Task-oriented leaders do best when the situation is very favorable or very unfavorable; relationship-oriented leaders do best in moderately favorable situations. Favorability depends on leader–member relations, task structure, and position power.
• Hersey and Blanchard's situational leadership: the leader adapts to the follower's readiness (ability and willingness).

• House's path–goal theory (based on expectancy theory): the leader clears the path to goals. Directive leadership suits inexperienced staff or unclear tasks; supportive suits stressful or repetitive work; participative suits staff who want involvement; achievement-oriented sets challenging goals for capable staff.

4. Contemporary theories

Transformational leadership is linked with staff retention, satisfaction, and a culture of safety, and is a core component of Magnet-type excellence models. Contingent reward belongs to transactional leadership, not transformational.

• Match style to situation. During a cardiac arrest the team leader gives direct, closed-loop orders (autocratic). When revising the ward's fall-prevention protocol, the head nurse invites staff input (democratic). With an experienced clinical instructor group, the manager gives broad goals and trusts them (delegating or laissez-faire).
• Match style to readiness. A newly hired nurse in the first week of orientation needs telling; the same nurse at six months, competent but discouraged, needs participating.
• Use personal power. Nurses without formal titles lead through expert and referent power — being clinically excellent, consistent, and fair.
• Community setting. A public health nurse leading a barangay health campaign often uses participative and transformational approaches, because barangay health workers (BHWs) are volunteers who respond to shared purpose more than to authority.
• Develop leaders. Hospitals build leadership through mentoring, charge-nurse rotation, and continuing professional development.

• Every registered nurse leads the care of assigned clients: setting priorities, directing auxiliary staff, coordinating with the health team, and advocating for the client.
• The nurse manager sets direction, creates a positive work environment, develops staff, and models ethical behavior.
• The Philippine Nursing Act of 2002 (RA 9173) Section 28 lists, within the scope of nursing, coordination with the health team, linkage with community resources, supervision of nursing students, and administration of nursing services in varied settings — leadership is part of the legal scope of practice, not an optional extra.
• Section 29 sets qualifications for nursing service administrators: a supervisory or managerial nurse must be a registered nurse with a bachelor's degree in nursing, at least two years of experience in general nursing service administration, at least nine units of graduate courses in management and administration, and membership in good standing in the accredited professional organization of nurses. The chief nurse or director of nursing also needs at least five years in a supervisory or managerial position and a master's degree in nursing; the Act sets lower requirements for chief nurses of primary hospitals.
• Leaders remain accountable for decisions made under their authority, including those they delegate.

• The Code of Ethics for Registered Nurses (PRC Board of Nursing Resolution No. 220, series of 2004) guides the nurse's relationships with people, practice, co-workers, society, and the profession. Violations may lead to suspension or revocation of the certificate of registration.
• Leaders must use power ethically: coercive power used to intimidate, favoritism, or retaliation against staff who report safety concerns are ethical violations and damage safety culture.
• Autocratic direction is justified by an emergency, not by convenience. Directing staff to perform acts outside their competence or legal scope is never justified by style.
• Confidentiality of staff and client information applies to leaders (Data Privacy Act of 2012, RA 10173).

Case 1. A fire alarm sounds in the pediatric ward at night. The charge nurse assigns each staff member a specific task and route. Which style is appropriate?

Answer: Autocratic. In an emergency, quick, clear, centralized decisions protect life. Group discussion would waste critical time.

Case 2. A head nurse wants to reduce medication errors. She forms a group of staff nurses, shares error data, and asks them to design the new double-check process. Which style and why?

Answer: Democratic (participative), with transformational elements (shared vision, intellectual stimulation). Staff who design the process are more likely to follow it.

Case 3. A skilled ICU nurse with ten years of experience has recently become withdrawn and unmotivated after a staffing dispute. Using Hersey and Blanchard, what style fits?

Answer: Participating (supporting) — high relationship, low task. She is able but currently unwilling; she needs support and involvement, not instruction.

Case 4. A nurse supervisor rewards units that meet their monthly hand-hygiene audit targets with extra training slots and addresses only deviations from standards. Which theory?

Answer: Transactional — contingent reward and management by exception.

• Choosing "democratic" as the best style in every question. In emergencies or with a new, untrained team, the autocratic or telling style is correct.
• Confusing laissez-faire with delegating. Laissez-faire is a general absence of direction; the delegating style is a deliberate choice for able and willing followers.
• Placing contingent reward under transformational leadership — it is transactional.
• Treating Fiedler's theory as "the leader adapts." In Fiedler's model the style is fixed; the situation is changed or the leader is matched to it. In Hersey and Blanchard, the leader adapts.
• Reading (9,1) as people-centered. The first number is concern for production (task).
• Assuming only people with titles lead. Staff nurses lead client care every shift.

• Management = position and processes; leadership = influence; the best nurse manager does both.
• Autocratic for emergencies and untrained staff; democratic for stable teams and commitment; laissez-faire only for highly skilled, self-directed experts.
• Managerial Grid: (9,9) team management is most effective; (9,1) is task-centered, (1,9) people-centered.
• Hersey and Blanchard: telling → selling → participating → delegating as readiness rises.
• Fiedler: style is fixed; favorable or unfavorable situations favor task-oriented leaders.
• Path–goal: directive for unclear tasks and inexperienced staff; supportive for stressful routine work.
• Transformational: idealized influence, inspirational motivation, intellectual stimulation, individualized consideration.
• Transactional: contingent reward and management by exception.
• Servant leaders serve first; authentic leaders act from self-awareness and transparency.
• Expert and referent power are personal and most durable.
• RA 9173 Section 28 places health-team coordination and nursing service administration within nursing scope; Section 29 sets administrator qualifications.