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• To enhance your understanding of the components of compassionate leadership
• To recognise how engaging in compassionate leadership might be beneficial for nurse leaders and teams
• To consider the steps you could take to implement compassionate leadership in your practice
Rationale and key points
This article explains how to implement compassionate leadership in nursing teams. Compassionate leadership is an approach that aims to empower and support staff through four main behavioural principles – attending, understanding, empathising and helping.
• Compassionate leadership can be practised by all nurses, irrespective of their role or position, and with individuals or groups.
• For the nurse, understanding and reflecting on their own leadership style is the starting point for compassionate leadership, after which nurses may consider leading others.
• Implementing compassionate leadership can empower teams, enhancing team members’ performance, motivation and well-being.
• Compassionate leadership can also support improved outcomes for patients, since motivated nurses are more likely to provide high-quality care.
Reflective activity
‘How to’ articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of:
• How this article might help you to introduce compassionate leadership into your nursing team.
• How you could use this article to educate nursing colleagues and students about the role of compassionate leadership in nursing teams.
Nursing Management. doi: 10.7748/nm.2024.e2133
Peer reviewThis article has been subject to external double-blind peer review and checked for plagiarism using automated software
Correspondence Conflict of interestNone declared
Collins E, Foo V, Hotchkiss M et al (2024) How to implement compassionate leadership in nursing teams. Nursing Management. doi: 10.7748/nm.2024.e2133
DisclaimerPlease note that information provided by How to articles is not sufficient to make the reader competent to perform the task. All clinical skills should be formally assessed according to policy and procedures. It is the nurse’s responsibility to ensure their practice remains up to date and reflects the latest evidence
Published online: 19 September 2024
THE NURSING profession is currently experiencing numerous challenges, including increased workload and caring for complex patients, due to factors such as a rise in the number of older patients with multiple morbidities, understaffing, high rates of staff sickness and issues with retention and recruitment (Collard et al 2020, Health Education England 2021). Given these circumstances, effective nurse leadership is particularly important. One approach is compassionate leadership, which nurses can use to empower, support and care for their colleagues. It may also underpin the fundamentals of care delivery because when staff are treated with compassion themselves, they are more able to direct their support and care to others, which can lead to higher quality care and increased patient satisfaction. In this way, compassionate leadership can assist nurse leaders to mitigate some of the challenges currently experienced by the profession (Pattison and Corser 2023).
While there are many definitions of compassionate leadership, Bailey and West (2022) cited its main principles as understanding, empathy, support and enabling others – qualities which are vital to staff feeling cared for, valued and respected. Similarly, Atkins and Parker (2012) stated that compassionate leadership involves four main behaviours: attending, understanding, empathising and helping. The procedure for implementing compassionate leadership detailed in this article is based on these four behaviours (Atkins and Parker 2012, West et al 2017). It is intended as a guide for nurses rather than as a step-by-step process.
• Ensure you have up-to-date knowledge and understanding of what comprises compassionate leadership, for example the main concepts, benefits and challenges of this approach. It is also important that you make sure you have sufficient workload capacity to deliver support to others effectively, remembering that demonstrating compassion can be time-consuming.
• Take some time to reflect on whether compassionate leadership is a suitable approach. Have you seen compassionate leadership in practice? What does it look like? Consider what effect compassionate leadership might have on colleagues and the wider team.
• Complete a self-assessment questionnaire to identify your capacity and preparedness to deliver compassionate leadership. This is important because each person’s view of what represents compassion may be different according to their spiritual views and moral code, for example. Some examples of useful self-assessment questions that aspiring compassionate nurse leaders might ask themselves can be found in the Compassion in the Workplace Model and include (Poorkavoos 2016):
• Do I show care and concern towards people in my team?
• Do people in my team feel safe in sharing their concerns?
• Do people in my team know that I will try to help them if they have a problem?
• Do people in my team feel safe in sharing their personal problems, issues and challenges with each other?
• Do people in my team feel they can openly express their emotional pain?
• Consider when and how you could practically demonstrate compassionate leadership, for example:
• Review and identify the communication channels available for staff in your workplace – are there regular staff meetings, handovers or ‘huddles’ where they can comfortably express their opinions?
• Consider operating an ‘open-door’ drop-in policy – for example, set aside time for staff to visit your office or a private area to discuss any issues they may have, or hold scheduled meetings to ensure that there is an open forum available for colleagues to address any concerns. Alternatively, if you are a nurse in charge of a shift, you could use handovers and huddles to provide an open forum for discussion.
• Consider a communication and comments book where staff can raise concerns.
1. Observe your team members and consider their well-being. Identify if any staff members (yourself included) appear to be struggling with clinical or personal challenges; for example, are they experiencing frequent sickness or absences from work, and/or changes in mood and demeanour around the workplace?
2. Create opportunities to discuss your concerns and gain staff feedback. This might involve relatively straightforward processes such as setting aside regular time to ‘check-in’ with individual colleagues or providing time at the end of the shift to ask staff ‘how the shift went’, discuss any concerns and ask for feedback.
3. Adopt a non-judgemental manner when listening to staff members and encourage them to talk about their issues and emotions, ensuring that you acknowledge their perspective.
4. Demonstrate that you are engaged with staff members by using verbal and non-verbal communication skills such as: active listening (for example, staying ‘present’ and focused on the person, using cues to demonstrate understanding and reflecting back information to ensure clarity); asking open and closed questions; and using minimal encouragers (brief responses designed to encourage people to continue to talk, for example ‘Tell me more about that’). Body language can also be useful when demonstrating compassionate leadership, for example nodding at appropriate times to demonstrate understanding and empathy, using encouraging body language such as leaning forward, maintaining eye contact, adopting open and encouraging facial expressions, and using touch if appropriate.
5. Try to understand what is causing issues for the individual colleague or team. This may be as simple as taking a moment to ask a staff member ‘Are you okay?’ or ‘What is bothering you?’. Similarly, you might observe staff members’ behaviour when interacting with patients or performing clinical skills to identify if they are experiencing undue levels of stress.
6. Demonstrate care and compassion for the individual and/or team by offering verbal and non-verbal empathy, with the aim of ‘putting yourself in their shoes’ to understand their perspective and challenges. An example of verbal empathy might involve finding a private moment to check-in with a colleague and using a simple supportive statement to let them know that you understand the challenges involved in their work: ‘We have a lot going on the unit and I can imagine it has been very difficult, but I can see that you’re still maintaining high standards of care’. Examples of non-verbal empathy can include leaning forward to express attentiveness during a conversation and the use of paralanguage (matching the loudness, inflection and pitch of the person’s voice), as well as maintaining eye contact and a positive facial expression.
7. Focus on reflection and problem-solving by considering barriers that may be preventing or discouraging staff members from performing effectively at work, for example challenging workloads or unsociable shift patterns. Ensure they have the required resources and equipment, as well as access to the relevant training required to support their role.
8. If you notice that a colleague is experiencing difficulties, ask them if there is anything you can do that might help, or if the wider team might be able to offer them support. For example, depending on the nature of their issue, this might include offering a quiet private space for them to discuss the issue, or more formal support such as counselling or referral to occupational health.
9. Recognise that it is not always possible to ‘solve’ the issues experienced by individual colleagues or the team; for example, you may have no control over shift patterns imposed by senior management or budget constraints. However, as a compassionate leader you can continue to be present, listen, acknowledge colleagues’ issues and empathise with them.
10. Remember the importance of role modelling, which can demonstrate integrity and appropriate leadership behaviours for others to aspire to. Modelling compassionate behaviour, as detailed above, can encourage the same behaviours in others.
11. Show appreciation by regularly thanking team members for sharing their concerns with you and for the work that they do.
12. There are no formal requirements for compassionate leadership. However, you may decide to record support sessions with staff depending on the nature of the issue and the possible outcome, for example if an incident is likely to be escalated for disciplinary reasons. You might also keep written notes of these sessions, with the permission of the parties involved, and formulate an action plan if required; for example, where a staff member wants to attend a series of skill updates to improve their confidence.
13. Remember that patient safety will always be a priority, and that adopting a compassionate leadership style does not mean that incidents such as medication errors can be ignored. However, any mistakes or clinical errors can still be managed with a compassionate approach.
Compassionate leadership is centred on the concepts of compassion and interpersonal relationships. As discussed previously, Atkins and Parker (2012) suggested that compassion consists of four main elements: attending, understanding, empathising and helping. West et al (2017) described these four behaviours as attending (being present and actively listening), understanding (appraisal where blame is withheld), empathising (feeling others’ distress without being overwhelmed) and helping (action using emotional intelligence).
Nurses do not need to attend a specific course in compassionate leadership; however, it is useful for them to have an appreciation of the evidence base. There are also national leadership programmes available such as the self-guided online course An Introduction to Leading with Kindness and Compassion in Health and Social Care, which is provided by the King’s Fund: www.kingsfund.org.uk/leadership-development/courses/leading-kindness-compassion-health-social-care
Papadopoulos et al (2020) stated that acting with compassion is demanding and can be a cause of increased stress for managers and leaders. Compassionate leaders may also experience distress when supporting colleagues with concerns and issues, which may lead to them feeling overwhelmed and unable to support individual staff members (Vogel and Flint 2021). An international study by Papadopoulos et al (2021) examined nurse leaders’ views of compassionate leadership and concluded that stress was most commonly reported as an issue by UK nurses, with leaders often experiencing ‘compassion fatigue’ as a result of feeling unsupported. Potential causes of compassion fatigue include workload demands, time limitations, line management responsibilities and negative workplace cultures (Papadopoulos et al 2020). Additional contributing factors can include organisational pressures and caring for complex patients (de Zulueta 2016). The 2022 NHS Staff Survey reported that 45% of NHS staff felt unwell due to staff stress, while only 57% felt their organisation was taking positive action on staff health and well-being (NHS Employers 2023).
Another challenge in relation to compassionate leadership is the apparent inconsistencies in how it is delivered. Stepp (2019) and Papadopoulos et al (2020) acknowledged that a nurse’s cultural, spiritual and personal beliefs can influence their delivery of compassionate leadership, leading to inconsistencies in managerial approaches.
Effective communication from leaders has been shown to be an important factor in the well-being of employees and managers (Jonsdottir and Fridriksdottir 2020). An advantage of compassionate leadership is the active listening, empathy and emotional support it can provide for individuals who may be experiencing personal or professional challenges, and these elements are often expressed through non-verbal communication (Vogel and Flint 2021). It has been estimated that non-verbal communication constitutes between 70% and 93% of communication, indicating that it may be significantly more influential than the spoken word (Hull 2016, Mitchell and Hill 2020). For aspiring compassionate nurse leaders, it is important to be aware of non-verbal signals including facial expressions, which can indicate emotions that an individual might not be able to express verbally, and to employ active listening to enhance understanding and rapport (Jonsdottir and Fridriksdottir 2020, Mitchell and Hill 2020).
Implementing a compassionate leadership approach can have a positive effect on the well-being of managers and staff members. Increased heart rate, raised blood pressure and suboptimal mental health are all signs of stress (Royal College of Nursing 2015), with nursing identified as one of the most demanding professions (Boddy 2022). However, compassion has been reported to produce positive emotions that can strengthen immune systems and reduce an individual’s heart rate and blood pressure. In addition, compassionate leadership has been shown to reduce the risk of burnout and improve staff mental health (Gilbert 2013, Vogel and Flint 2021). Furthermore, improved staff well-being has the potential to positively affect team members’ engagement with their roles, which can lead to them feeling valued and more resilient and may subsequently improve retention and reduce sickness rates (West 2018).
Compassionate leadership can enhance nurses’ workplace motivation and work-life balance (Sullivan and Garland 2009, King’s Fund 2012). Additionally, a compassionate leadership style can foster closer teamworking and a nurturing environment that facilitates effective communication between team members. A compassionate leader will work inclusively with the team using shared problem-solving to address workplace challenges (Trueland 2022). Conversely, a working environment managed by leaders who do not value compassion can lead to a fearful and toxic culture with compromised staff professionalism, substandard care and low staff morale – all issues identified by the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013, de Zulueta 2016, NHS England 2022).
A compassionate leadership approach also promotes responsibility and accountability among team members, enabling them to have challenging conversations with each other and address issues (Shuck et al 2019, West 2021). An example might be if it is identified that a colleague’s behaviour is negatively affecting a team. In such a scenario, the nurse leader should consider challenging such behaviour while using compassionate leadership techniques such as empathy and active listening. In this way, the leader will ensure a supportive approach to managing staff performance (Odell 2021).
The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates (Nursing and Midwifery Council 2018) emphasises the importance of role modelling to demonstrate integrity and leadership, and the compassionate leader should encourage their colleagues to adopt a similar approach (Odell 2021). Staff can benefit from observing compassionate leadership behaviours such as acknowledging colleagues’ emotions and ideas, and which promote a move away from a culture of ‘fear’ towards a safe environment where errors are viewed as learning opportunities rather than punishable mistakes (de Zulueta 2016, Vogel and Flint 2021). For the nurse leader, role modelling compassionate behaviour is essential to encouraging staff to adopt similar behaviours, which can subsequently be beneficial when working in challenging environments, for example where nursing teams are short-staffed or caring for complex patients. When nurse leaders act compassionately, evidence suggests that staff appreciate the leader, feel happier and more satisfied in their work and may ‘go the extra mile’ to complete nursing tasks (Papadopoulos et al 2021).
Overall, implementing compassionate leadership encourages increased confidence in nurses and empowers them to take an active role in decisions about patient care and the organisation. The use of compassionate leadership is also advocated by NHS England (2024) as an inclusive practice that involves staff at all levels and supports ‘leadership of all, by all and for all’.
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