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• To enhance your understanding of the characteristics and benefits of transformational leadership
• To reflect on how you could apply the principles of transformational leadership to your practice
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• To contribute towards your professional development and local registration renewal requirements (non-UK readers)
Learning disability nurses work across a variety of settings in roles that often require leadership skills. In learning disability services there is an emphasis on providing high-quality care, ensuring the safety of service users and reducing restrictive practices, with effective leadership considered vital to achieving these. Therefore, it is important that nurses adopt a leadership style which can galvanise their teams and colleagues and bring about change. One such style of leadership is transformational leadership, which uses emotional intelligence, open communication, role modelling and empowerment to motivate team members to ‘rally around’ a shared vision. This article explains how nurses can apply transformational leadership to their practice and encourage team members and colleagues to aim towards improved outcomes for people with learning disabilities and their carers.
Learning Disability Practice. doi: 10.7748/ldp.2024.e2254
Peer reviewThis article has been subject to external double-blind peer review and checked for plagiarism using automated software
Correspondence Conflict of interestNone declared
King J, King J (2024) Promoting transformational leadership in learning disability nursing. Learning Disability Practice. doi: 10.7748/ldp.2024.e2254
Published online: 16 September 2024
This article aims to assist nurses working in learning disability settings to identify the characteristics required for effective leadership and provide guidance on how they can develop transformational leadership skills. After reading this article and completing the time out activities you should be able to:
• Describe how transformational leadership can apply to learning disability nursing practice.
• Identify the transformational leadership skills you can use to bring about change and enhance the quality of care for service users.
• Implement crucial components of transformational leadership to empower team members to work together towards a shared vision.
• Reflect on your leadership journey and set goals that will guide your development as a transformational leader.
Learning disability nursing has had to react to a rapidly changing healthcare environment in which ongoing budget constraints coexist with an ageing population and an increased complexity of presentations and support needs. In such an environment, consistent and imaginative leadership is necessary for the delivery of high-quality services (Forrester-Jones et al 2021).
Many changes have occurred in learning disability policy and practice, particularly in terms of ensuring safety and reducing restrictions for service users. Services have shifted towards inclusive practice in community settings and away from restrictive hospital-based care (NHS England 2015). However, care failings in learning disability services such as those at Winterbourne View in South Gloucestershire and Whorlton Hall in County Durham, England, where lack of leadership was identified as a contributory factor, provide a reminder that there is still much to be done to ensure safe, inclusive and high-quality care for people with learning disabilities (Willis 2020). If nurses are to develop their skills in providing inclusive care and challenge preconceptions about what such care involves, strong and effective leadership will be required (Royal College of Nursing (RCN) 2021, Northway and Hopes 2022).
Learning disability nurses work in a wide variety of clinical, social care, educational and research settings (RCN 2021) and the need for them to develop leadership skills is emphasised throughout their pre-registration training (Doody et al 2022). The Nursing and Midwifery Council (NMC) (2018a) states that any nurse must have the ability to lead and manage care by being an effective communicator. Also, because people with learning disabilities continue to experience inequalities in health outcomes, nurse leadership that maximises the abilities of services to address these inequalities is paramount (RCN 2021).
There are a number of approaches to leadership and management in healthcare, many of which focus on the interpersonal relationships between leader and team members (Stanley 2023). One such approach is transformational leadership, whereby leaders seek to galvanise and inspire their team by demonstrating interpersonal characteristics that are often not required in traditional leadership approaches, which tend to be characterised by transactional relationships (Bass 1985, Avolio and Bass 2001). Whereas transactional leadership relies on contractual obligations and rewards to persuade employees to undertake their duties, transformational leadership encourages team members to ‘buy into’ a shared vision, generating an emotional connection to the team’s work and thereby improving performance (Ystaas et al 2023).
The topic of leadership is broad and challenging to define (Barr and Dowding 2019). Definitions of leadership often focus on the process of how individuals can work together as a group to achieve a common goal (Northouse 2021). Common to the many definitions and models of leadership is an understanding that effective leaders are knowledgeable, can communicate well and are able to problem-solve (Fischer 2017).
In nursing, leadership is recognised as being important across managerial and clinical roles (Marshall and Broome 2017). However, nurse leaders may not necessarily be managers in the typical sense; rather, leadership can be exercised at varying levels of seniority, with different nurses acting as leaders at different times, depending on the context (Jonas et al 2017). Learning disability nurses rely on their leadership skills when advocating for service users regardless of their position in the team or service.
Many healthcare organisations have sought to define a leadership structure; for example, the Healthcare Leadership Model describes nine dimensions of leadership (Box 1) (NHS Leadership Academy 2013).
• Inspiring shared purposed
• Leading with care
• Evaluating information
• Connecting the service
• Sharing the vision
• Engaging the team
• Holding to account
• Developing capability
• Influencing for results
(Adapted from NHS Leadership Academy 2013)
• Challenges in learning disability nursing practice about staff retention and service redesign demonstrate the need to adopt a leadership approach that promotes a shared vision of high-quality care
• Transformational leadership encourages staff to ‘buy into’ a shared vision, generating an emotional connection to the team’s work and thereby improving performance
• The four core components of transformational leadership are idealised influence, inspirational motivation, intellectual stimulation and individual consideration
• Learning disability nurse leaders should seek to improve their leadership skills through collaboration with others, continuous professional development, supervision and reflection on practice
Read more about the nine dimensions of the Healthcare Leadership Model on the NHS Leadership Academy website: www.leadershipacademy.nhs.uk/healthcare-leadership-model/explore-the-healthcare-leadership-model Are all nine dimensions important in learning disability nursing? If so, why?
The concept of transformational leadership was popularised by Bass (1985), who developed earlier work by Downton (1973) and Burns (1978) and described how a leader might use skills in communication and emotional intelligence to ‘rally’ a team around a shared vision and foster a sense of purpose. Avolio and Bass (2001) later argued that by empowering staff and appealing to their values, a leader could improve team performance over and above what could be achieved by a typical transactional leadership style. According to Avolio and Bass (2001), a leader who can inspire commitment to a shared goal through role modelling and collaboration can motivate team members more effectively than a leader who subscribes to a ‘tell and do’ model of leadership in which staff members are motivated by contractual obligation or reward.
Evidence suggests that transformational leadership can be particularly beneficial in nursing. A review by Ystaas et al (2023) identified benefits of transformational leadership such as increased job satisfaction and feelings of empowerment among nurses in a variety of settings, while Alanazi et al (2023) identified links between transformational leadership and improved quality of patient care. Conroy et al (2023) and Gebreheat et al (2023) noted benefits such as improved job satisfaction and greater retention when a transformational leadership approach was employed instead of other leadership styles. Fischer (2017) argued that transformational leadership could improve team cohesion when new staff join a nursing team, while McFadden et al (2009) suggested that transformational leadership could have a positive effect on patient safety.
Spano-Szekely et al (2016) found that effective transformational leadership correlated positively with the presence of emotional intelligence in nurse managers. Emotional intelligence can be demonstrated by attempting to recognise and manage one’s reactions to a situation and avoid acting on impulse, which can contribute to a breakdown in communication and leave colleagues feeling that they have not been heard. It is important that transformational leaders process information and respond in a calm and measured way.
When considering learning disability nursing practice specifically, ongoing challenges about staff retention and service redesign – notably the challenge of shifting care from institutional to community settings (NHS England 2015) – show that there is a need to adopt a consistent transformational leadership approach to promote a shared vision of high-quality care delivery.
Think about a colleague who has shown leadership in supporting you to overcome adversity. It could be a current or former manager, a senior colleague or a nurse educator. What leadership qualities can you identify in their approach? Select one or two of their leadership qualities that you would like to demonstrate in your practice and reflect on how you might develop them
Bass (1985) and Avolio and Bass (2001) suggested that there are four core components of transformational leadership:
• Idealised influence.
• Inspirational motivation.
• Intellectual stimulation.
• Individual consideration.
This component of transformational leadership relates to the positive influence that the leader is able to have on their team, inspiring colleagues to demonstrate behaviours that contribute to the team’s shared vision. The leader may influence team members through role modelling and/or charisma, and by using language that encourages and empowers them. Such language should be inclusive, positive, energetic and enthusiastic about the team’s shared goal (Wong et al 2013, Asif et al 2019).
A central element of idealised influence is the development of trust between leader and team members. The leader may foster trust by showing passion and enthusiasm for their work and by demonstrating a level of authenticity and integrity which others will want to emulate. In this way, the leader embodies the idea of a highly competent and dynamic practitioner and exemplifies the standards of the nursing profession (Ilies et al 2013).
Inspirational motivation refers to the idea that a transformational leader who can effectively communicate shared values is likely to inspire staff and encourage them to ‘buy into’ a shared vision (Fischer 2017). This component of transformational leadership relates to how a leader instils enthusiasm in a group of staff by encouraging all members to contribute to the best of their abilities. This is achieved by reinforcing objectives, emphasising the shared mission and fostering a ‘can-do’ attitude.
If the whole team buys into the leader’s vision, the theory is that they will endeavour to achieve it (Avolio and Bass 2001). It is hoped that the shared vision cultivated by the leader will inspire creative thought processes and expand the capabilities of the team, enabling them to overcome challenges; for example, when a service for people with learning disabilities needs to extend its operating hours or introduce a new care pathway despite limited resources (Ryan and Danaher 2019).
A transformational leader should be able to encourage innovation and creativity in problem-solving among team members (Fischer 2017). They should be able to inspire critical thinking and stimulate team members to develop new ideas. Intellectual stimulation involves the transformational leader challenging the status quo in practice and developing a team which is prepared for change by expanding the capacity of its members to adapt and giving them the confidence to ‘push the boundaries’ of their abilities (Avolio and Bass 2001).
The leader should be prepared to ask questions that encourage team members to respond creatively, support team members to come up with inventive solutions to challenges, and empower them to believe in their ability to bring about change (Broome and Marshall 2017).
This component of transformational leadership relates to the leader’s ability to focus on the needs of individual team members by responding to their unique experiences and facilitating their professional development (Northouse 2021). The leader should tailor the approach they use to meet the specific needs of individuals, nurture their growth and make them feel included (Collins et al 2019).
Individual consideration involves the transformational leader creating an environment in which individual team members feel valued and giving them the confidence to perform well and bring their ‘authentic self’ to their role. A transformational leader should be aware of their own level of emotional intelligence and how their communication style may be perceived by others; a lack of emotional intelligence may mean that they unconsciously undermine the efforts of colleagues or fail to recognise the emotional challenges a staff member is experiencing.
Using shared values and communication skills to influence teams towards a clear mission is crucial in transformational leadership. Take a moment to reflect on your workplace. Is there a defined mission? Do you know what your role is in achieving it? Has the mission been effectively explained to you and your team?
Learning disability nurses work across many different services, from dedicated learning disability units to inpatient hospital settings and GP practices. As such, they work with people with learning disabilities of all ages and with a variety of support needs. The principles of, and skills required for, transformational leadership, such as role modelling, empowerment and creative problem-solving, may be of benefit to learning disability nurses as they seek to motivate colleagues, promote best practice and involve people with learning disabilities in their own care. The development of leadership skills is considered essential, particularly in the post-registration period.
Role modelling is a fundamental aspect of transformational leadership for influencing staff behaviour and improving team performance (Avolio and Bass 2001). Through leading by example, learning disability nurse leaders can raise the performance of individual team members and encourage them to strive towards achieving a shared goal, such as delivering high-quality care for people with learning disabilities (Ryan and Danaher 2019). By challenging in a confident and professional manner any misconceptions colleagues or visitors may have about the care of people with learning disabilities – for example, negative views about the value of blood tests or vaccinations – learning disability nurse leaders can set a positive example and empower team members to act in the same way. Similarly, consistently adhering to standards of professional behaviour such as optimal timekeeping and politeness in interactions with colleagues will encourage team members to adopt similar behaviours (Boamah 2022).
Transformational leaders can use their communication skills, emotional intelligence and problem-solving abilities to motivate others and bring about change (Avolio and Bass 2001). They should be able to empower individuals and teams to take the necessary steps towards achieving the team’s shared vision. This is where the emotional intelligence and communication skills of learning disability nurse leaders are paramount (Ryan and Danaher 2019).
These personal traits can be complemented by the use of a carefully designed and implemented clinical and managerial supervision model (Wade 2023). Supervision offers an opportunity for learning disability nurse leaders (as supervisors) to discuss how they can support each team member (as supervisees) on an individual, humanistic level. The leader should seek an authentic connection with the individual team member based on shared values. Supervisor and supervisee can learn about each other’s vision for the learning disability service and how their visions may align (Launer 2018, Featherbe 2023).
Transformational leadership encourages open and honest communication. Applied to supervision, this enables the supervisee to learn, reflect and ultimately consider how they can contribute to the team’s shared goal. Learning disability nurse leaders should take an individualised approach to staff mentoring as part of the supervision process and discuss learning and development opportunities based on each team member’s needs and interests. This will enable team members to feel empowered to contribute to the team’s mission. It can also reduce the risk of burnout and have a positive effect on staff retention (Conroy et al 2023).
By encouraging creative problem-solving among team members, a transformational nurse leader can contribute to addressing some of the challenges involved in providing high-quality services for people with learning disabilities and their carers. One example of these challenges is the adaptation of the home environment to a service user’s sensory needs so that the need for moving elsewhere or admission to a care facility can be avoided where possible.
Adapting the home environment to a service user’s sensory needs could involve, for example, discussing with their carer the idea of ensuring access to a personalised ‘quiet space’. A transformational nurse leader should address any misconceptions and assumptions about the abilities and needs of people with learning disabilities while encouraging innovation and the individual talents of team members (Ystaas et al 2023).
The transformational leader of a learning disability nursing team will provide positive and constructive feedback on colleagues’ performance and encourage innovative problem-solving through the feedback process (Launer 2018). They will also recognise the individual emotions, communication style and needs of each team member. Where appropriate they will encourage team members to take on more complex roles and develop new skills; for example, by empowering social care colleagues to enhance the quality of life of people with learning disabilities by supporting these colleagues to teach life skills to service users and most importantly to coach service users to develop their own life skills in line with their likes, dislikes and goals (Savarimuthu 2020).
Think about the service or team you currently work in. What opportunities are there for people with learning disabilities and their carers to contribute to the service or team’s culture and practices? Consider how you might involve service users and their carers in developing the team’s mission
In learning disability nursing there is a focus on the potential for service users and their carers to be involved in service development, and empowering them to do so is considered a crucial nursing role (Northway and Hopes 2022). Empowering service users and their carers is a core component of the care provided by learning disability services (RCN 2021). Patient empowerment also features in The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates, primarily in standard 2.3 of the ‘prioritise people’ section, which states that nurses should ‘encourage and empower people to share in decisions about their treatment and care’ (NMC 2018b).
Learning disability nurses often act as advocates for service users and their carers, and are well-positioned to offer alternatives to harmful narratives and incorrect assumptions around learning disabilities; for example, the assumption that people with behavioural needs cannot live safely in the community or that people with complex disabilities cannot have a good quality of life (Doody et al 2019). Promoting inclusion by considering the lived experiences of people with learning disabilities often requires practical adaptations, such as closer involvement of carers in decision-making and the use of communication tools such as social stories. Ensuring that the voices of people with learning disabilities are heard and considered in service design and development can be challenging. Taking on that challenge is one way for learning disability nurses to demonstrate their leadership abilities (Jukes and Aspinall 2015, Doody et al 2019).
There should be opportunities for service users and their carers to contribute to leadership practices in a team or organisation. With the appropriate communication in place, people with learning disabilities can provide valuable insights into the overall environment and culture of a service (Martin and Hanley 2022). The transformational leader of a learning disability nursing team can use their communication, emotional intelligence and creative thinking skills to promote the inclusion of service users and their carers; for example, including their views in the development of a team’s shared mission statement or inviting them to provide feedback about proposed changes to the service. Incorporating the views and lived experiences of people with learning disabilities can have a galvanising effect on staff, who may be motivated to deliver high-quality care in response to feedback. It can also challenge nurse leaders to think critically about decisions affecting a learning disability service (Jukes and Aspinall 2015).
Imagine that a new initial assessment tool for people with learning disabilities is to be introduced in the service you lead. The tool is evidence-based and addresses shortcomings in the tool previously used in the service, but it takes longer to complete and requires staff to attend additional training. Some team members feel unhappy about the change. How would you use transformational leadership to support team members to transition to the new tool? What might the barriers be and how would you overcome them? How would you ensure that all the team’s concerns are listened to while also ensuring that the change occurs?
As detailed in the NMC (2018a) Standards of Proficiency for Registered Nurses, nurses are expected to take ‘responsibility for continuous self-reflection, seeking and responding to support and feedback to develop their professional knowledge and skills’.
Learning disability nurse leaders should seek to improve their leadership skills through working and collaborating with other leaders, engaging in continuous professional development and seeking clinical supervision sessions with leaders they admire (Donaldson and Sabin 2017, Northway and Hopes 2022).
Effective supervision is often a central component of the development of leadership skills, particularly early on in a nurse’s career (Donaldson and Sabin 2017). Reflection on practice is crucial for developing leadership skills, since it enables nurse leaders to consider the actions they and their team have taken and use any learning opportunities that may arise as a result (Jasper and Rosser 2013). Learning disability nurse leaders should regularly seek reflective opportunities with their supervisor, focusing on developing their confidence and capability to support their team members.
As part of nurse leaders’ reflective process, self-assessing their leadership skills and progress in developing them will be useful. Broome and Marshall (2017) suggested seeking feedback from an experienced leader who can act as a mentor, while also noting the need for nurse leaders to consider self-care, recognising the challenges to personal well-being created by the stress and workload of providing leadership.
Learning disability nurses are required to coordinate, lead and manage care in a diverse array of settings, and the development of leadership skills is considered essential, particularly in the post-registration period.
For any aspiring nurse leader, being able to identify their development needs and recognise their strengths and areas requiring improvement are core components of their role. By using a transformational leadership approach, learning disability nurses can bring about positive change by motivating team members and colleagues to improve services for people with learning disabilities and their carers. A transformational leadership approach can also assist nurse leaders to ensure that the voices of service users are heard and that colleagues are empowered to become leaders in their own right.
Undertaking this CPD article can be used as evidence for revalidation, or the equivalent in the country where you work. Now that you have completed the article, reflect on your practice in this area and consider writing a reflective account. Guidelines are available at rcni.com/reflective-account
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