Leader vs Follower

In terms of personal experience, I have found remarkable similarities between the roles of nursing leadership and following.  More exactly, and as will be discussed, the complementary nature of the leader/follower relationship seems to me to be, in nursing, both essential and reflective of alternating characteristics and behaviors.  In any leadership, of course, the circumstances demand reciprocity between the participants, as there can be no effective leader without a following committed to an appreciable extent.  In nursing, however, the profession itself sets all of this into sharper focus, and the interactive properties of the relationship are consequently amplified.  I would add that this emphasis is due, in my estimation, on the inherently volatile and vitally important nature of nursing itself.  In other organizations, lapses between leaders and followers may easily be excused, or not even perceived; in nursing, no such disconnect may exist because the work is too intrinsically valuable.

The difference in nursing acknowledged, it is nonetheless true that certain key attributes of all leadership are necessary for the nursing leader.  While each attribute contains within it other elements, central to leadership are intelligence, self-confidence, determination, integrity, caring, trustworthiness, and flexibility (Kelly, 2011,  p. 9).  Nursing itself, however, adds meaning to each component, as I believe that nursing leadership demands an exercise of these qualities in what may be termed a heightened form.  For example, it is essential that any true leader evince authentic integrity, no matter the field.  In nursing, that integrity is based on the nurse leader’s commitment to the welfare of patients and the proper administration of all services going to that welfare, and this reinforces the integrity itself.  Nursing is, ultimately, a humane profession, so integrity here takes on a more humane aspect.  Similarly, the quality of caring alters when applied to the nursing leader.  More exactly, it must be caring that extends beyond more ordinary expressions of it from leaders in other fields because, again, the occupation is more vital to human interests.  This caring is also more complex, for the nurse leader must balance the emotional component with the realities of administration.

It is inescapable that leadership in nursing presents challenges beyond those of other forms, simply because the changes in the health care arena require creative leadership.  Health care environments evolve to meet the community needs, as well as budget restraints and a host of other variables.  Then, organizational shifts frequently occur as hospitals restructure to address new staff circumstances, patient diversity, and a moving away from formal leadership to self-managed teams (Clark, 2008,  p. 5).  Creative then translates to both complex and highly active, for the nurse leader is unable to rely on leadership structures and formulas as such.  A single day’s influx of an unexpected number of patients in a hospital, for example, calls for a leadership response immediately and effectively taking into account the new circumstances, and adjusting staff to best meet the altered priorities.  As noted, the nursing leader must incorporate integrity, trustworthiness, and all the other elements of leadership, but this is a leader who must also engage in a higher state of flexibility in order to meet the unique challenges of the role and the field.

In regard to the nurse as follower, it is interesting to see how the necessary qualities do indeed mirror those of the leader.  This is by no means coincidental.  As with virtually all leadership scenarios, the nursing leadership itself is only as effective as the relationship in place between the two components.  The goal is engagement, and this may only occur when the leader comprehends and appeals to the values and motivations of the followers (Barker, 1990, p. 43).  This, then, may only occur when those values and motivations echo those of the leader, and a reciprocity of interests then creates the effective group scenario under the leadership.  No matter the actual goal of the group, the nursing leadership/follower relationship is profoundly interactive, as each part actually and exponentially promotes the strength of the other.

Consequently, the skills and qualities most important within nursing followers are commitment, willingness to follow instruction, actual skill and education, a sense of the needs of the group as a whole, flexibility, and integrity.  It is natural that the last two qualities are also required for nursing leadership, even as they evince somewhat different aspects in followers.  Integrity in the nursing follower, for example, equates to a sense of honor and responsibility in fulfilling the expectations made by the leader.  Similarly, flexibility here even more strongly echoes the attribute as present in the leader; as the nursing leader relies on the follower’s ability and willingness to adapt to the unforeseen, so too is the follower’s exercise of flexibility an acceptance of the greater need as perceived by the leader.

Pragmatic considerations also greatly influence the behavior of followers in nursing.  In plain terms, nursing leaders are typically empowered to have impacts on the daily and long-term careers of their followers.  Nursing leaders, for example, often schedule staff, and the followers then perceive a reward system built into the relationship (Klainberg, Dirschel, 2010,  p. 67).  This goes to follower motivation, as any such system must affect the responses of the followers.  With the nursing follower, however, the inherent reciprocity of the relationship also serves to add dimension to the reward.  More exactly, the follower is more committed to perform better for the leader in order to gain the reward, which translates to greater attention their duties.

Lastly, regarding the role of follower, it is critical that the nurse not perceive this as a passive function.  The best followers are self-directed, active participants in every facet of the health care experience (Kelly, 2011,  p. 3).  This is something the nursing leader relies on, and for very tangible reasons.  All nurses are famously on the “front lines,” and are in a position to receive important information constantly.  Such information, regarding a particular patient or concerned with another development in the environment, must then be of great import to the leader.  Consequently, the nurse follower is empowered with a responsibility unlike other followers, in assisting the leader through the conveying of vital information.  This model of facilitation alone goes to reinforcing how, in nursing, the leader/follower relationship is not at all one of separate interests, but more a symbiotic process.



Barker, A. M. (1990).  Transformational Nursing Leadership: A Vision for the Future.  Sudbury: Jones & Bartlett Learning.

Clark, C.  (2008).  Creative Nursing Leadership and Management.  Sudbury: Jones & Bartlett      Learning.

Kelly, P.  (2011).  Nursing Leadership & Management.  Belmont: Cengage Learning.

Klainberg, M., & Dirschel, A.  (2010).  Today’s Nursing Leader: Managing, Succeeding, Excelling.  Sudbury: Jones & Bartlett Learning.