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Alexandra Thomson

Evolution of Leadership Theory


The “Great Man” theory of leadership is one of the first theories to describe how a leader comes to be (Grossman & Valiga, 2012). This theory postulates that someone is born a natural leader who is destined to lead; some children inherit leadership attributes and are born into the “right” family to influence them into becoming stronger leaders (Grossman & Valiga, 2012). This theory is related to the public’s desire to label certain personality traits as being well suited for leadership. From the idea of instinctive abilities and unique qualities of a leader in the “Great Man” theory, more nuanced personal trait theories have evolved (Grossman & Valiga, 2012). The focus of these theories is to identify universal characteristics of leadership (Grossman & Valiga, 2012). Subsequently, theorists began to shift the focus on experiential learning and how context matters for someone to thrive as a leader (Grossman & Valiga, 2012). Theories that recognize the relationship between effectiveness of leadership and situational circumstances are known as situational theories (Grossman & Valiga, 2012).


Much of the leadership literature, notably regarding nursing leadership, primarily discussed internal factors; up until the 1990s, most of the literature on this topic covered the purpose of leadership, leadership styles, leadership characteristics, and leadership development (Antrobus & Kitson, 1999). Stated another way, the importance of external influences such as socio-political factors and health policy were not stressed (Antrobus & Kitson, 1999). In the late 90s, these external influences on leadership started to receive attention (Antrobus & Kitson, 1999). The significance of understanding external factors and contemporary issues that alter the direction of nursing care gave rise to a new style of leadership know as renaissance leadership (Antrobus & Kitson, 1999). In healthcare, renaissance leaders emphasize that political forces and external agendas greatly impact professional planning (Antrobus & Kitson, 1999). Antrobus and Kitson (1999) stated “The ideology and language used by nurses differs from that used in policy and by policy-makers.” They describe how this creates a policy-practice divide and forces nurse leaders to interpret and communicate these ideological and policy concerns (Antrobus & Kitson, 1999).

Two of the most influential leadership models are known as transactional leadership and transformational leadership, highlighted in Video 1 (Scully, 2015; Train in a Day, 2015). Transactional leadership involves a mutually beneficial relationship between the leader and the follower; the leader gets the job done and the follower receives a benefit such as money or a promotion (Scully, 2015). Simply put, there is a participation reward at the end of the transaction (Scully, 2015). Transformational leadership asks followers to share the leader’s vision and be motivated to exceed expectations (Scully, 2015). The benefit for a follower in this case may be empowerment and being an agent for positive change (Scully, 2015). Leaders using the transformational leadership style believe that their follower’s potential can be elevated to achieve excellence with the right inspiration (Scully, 2015). This leadership style plays to a worker’s sense of morality and teamwork to evoke change (Scully, 2015).

Video 1. Transactional Versus Transformational Leaders (Train in a Day, 2015)


Most of the literature regarding leadership in healthcare focuses on transformational leadership. Future research should also consider other theoretical perspectives including:

a) Emotional intelligence leadership theory (Akerjordet & Severinsson, 2010).

b) Leader-member exchange theory (Katrinli et al., 2008)

c) Authentic leadership theory (Wong & Giallonardo, 2013)

d) Servant leadership theory (Nagel & Andenoro, 2012)


Although transformational leadership is the most prominent style used in a healthcare setting, an increasingly popular style known as connective leadership is seen as more appropriate in certain situations due to the nature of the interdisciplinary teams (Scully, 2015; Sahoo & Das, 2012). Any healthcare worker can demonstrate leadership skills; a position of authority is not necessary to be a leader and they are not confined by their perceived rank within the larger system (Grossman & Valiga, 2012). The connective leadership style asserts that leadership should be shared or distributed amongst team members (Sahoo & Das, 2012). Sahoo and Das (2012) argue, “Connective leaders can perceive common ground and possibilities where some more traditional leaders see division and difference.” A collaborative approach is used in modern practice throughout the healthcare system (Scully, 2015). Therefore, connective leadership is a welcomed paradigm shift in an interdependent setting (Scully, 2015).




Akerjordet, K. & Severinsson, E. (2010). The state of the science of emotional intelligence related to nursing leadership: An integrative review. Journal of Nursing Management, 18(4), 363-82.

Antrobus, S. & Kitson, A. (1999). Nursing leadership: Influencing and shaping health policy and nursing practice. Journal of Advanced Nursing, 29(3), 746-753.

Grossman, S. & Valiga, T. (2012). The new leadership challenge: Creating the future of nursing (4th ed.). Philadelphia: FA Davis Company.

Katrinli, A., Atabay, G., Gunay, G. & Guneri, B. (2008). Leader-member exchange, organizational

identification and the mediating role of job involvement for nurses. Journal of Advanced Nursing, 64(4), 354-362.

Nagel, C. & Andenoro, A.C. (2012). Healing leadership: The serving leader’s impact on patient outcomes in a clinical environment. Journal of Healthcare Leadership, 4, 25-31.

Sahoo, C. & Das, S. (2012). Women entrepreneurship and connective leadership: Achieving success. European Journal of Business Management, 4(3), 115-122. Scully, N.J. (2015). Leadership in nursing: The importance of recognising inherent values and attributes to secure a positive future for the profession. Collegian, 22: 439-444.

Train in a Day [Train in a Day]. (2015, July 23). Leadership styles: Which type of leader are you?

Wong, C.A. & Giallonardo, L.M. (2013). Authentic leadership and nurse-assessed adverse patient outcomes. Journal of Nursing Management, 21(5), 740-752.

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