Purpose and scope
The purpose of this best practice guideline is to assist nurses and others performing both formal and informal nursing leadership roles from the point-of-care to the board room, across a variety of practice domains and settings. It identifies evidence-based leadership behaviour that nurses can implement individually and collectively to benefit patients, health-care team members, organizations, systems and health-care policy, research and education. Leadership practices that help create a healthy work environment can ultimately improve patient and client experiences and outcomes. Even point-of-care nurses, who may not see themselves as leaders, can adopt these practices in their informal leadership role and significantly improve their work environment and in turn, patient outcomes.
The guideline is relevant to nurses in:
- all roles including point-of-care nurses, administrators, educators, researchers and those engaged in policy work, and also to nursing students,
- all domains of nursing (clinical practice, administration, education, research and policy), and
- all practice settings.
The guideline will also be helpful for:
- inter-professional team members,
- non-nursing administrators at the unit, organizational and system level,
- policy makers and governments,
- professional organizations, employers and labour groups, and
- federal, provincial and territorial standard-setting bodies.
Registered Nurses’ Association of Ontario (2013). Developing and Sustaining Nursing Leadership, (2nd ed.). Toronto, ON: Registered Nurses’ Association of Ontario.
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Developing and Sustaining Nursing Leadership.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1.0: Nurse leaders use transformational leadership practices to create and sustain healthy work environments.
Recommendation 1.1: Nurse leaders build relationships and trust.
Recommendation 1.2: Nurse leaders create or contribute to an empowering work environment.
Recommendation 1.3: Nurse leaders create or contribute to an environment that supports knowledge integration.
Recommendation 1.4: Nurse leaders lead, support and sustain change.
Recommendation 1.5: Nurse leaders balance the complexities of the system, identifying and managing competing values and priorities.
Recommendation 2.0: Nurse leaders continually develop their personal resources for effective leadership.
Recommendation 2.1: Nurse leaders exhibit a strong professional nursing identity.
Recommendation 2.2: Nurse leaders reflect on and take responsibility for the growth and development of their own leadership expertise.
Recommendation 2.3: Nurse leaders act as coaches and mentors to develop leadership expertise in others and further develop their own professional skills.
Recommendation 2.4: Nurse leaders cultivate professional and personal social supports.
Recommendation 2.5: Nurse leaders exhibit a strong professional nursing identity.
Recommendation 2.6: Nurse leaders reflect on and take responsibility for the growth and development of their own leadership expertise.
Recommendation 3.0: Educational programs provide formal and point-of care opportunities for leadership development for nurses.
Recommendation 3.1: Nursing leadership programs incorporate evidence-informed models and theories.
Recommendation 3.2: Nursing leadership programs offered through undergraduate, graduate and continuing education include formal and point-of care opportunities for leadership.
Recommendation 4.0: Health-service organizations provide supports for effective nursing leadership
Recommendation 4.1: Health-service organizations demonstrate respect for nurses as professionals and their contribution to care.
Recommendation 4.2: Health-service organizations respect nurses as individuals.
Recommendation 4.3: Health-service organizations plan and provide opportunities for growth, advancement and leadership development, not only for nurses in formal leadership positions but also for nurses at the point-of-care.
Recommendation 4.4: Health-service organizations support empowerment, enabling nurses to be responsible and accountable for their professional practice.
Recommendation 4.5: Health-service organizations provide timely access to information, decision-support systems and the resources necessary for care.
Recommendation 4.6: Health-service organizations promote and support teams, collaborations and partnerships.
Recommendation 4.7: Health-service organizations support leaders to assist and facilitate change.
Recommendation 4.8: Health-service organizations give managers spans of control that enable effective nursing leadership.
Recommendation 4.9: Health-service organizations invest in training and succession planning to develop future leaders
Recommendation 5.0: Governments develop policies and provide resources that support effective leadership.
Recommendation 5.1: Governments in all provinces and territories establish a senior nurse leader as a policy advisor.
Recommendation 5.2: Governments in all provinces and territories provide links among these nurse leaders.
Recommendation 5.3: Governments in all provinces and territories establish a nursing advisory council.
Recommendation 5.4: Governments in all provinces and territories establish, fund and maintain programs for nursing leadership development.
Recommendation 5.5: Governments in all provinces and territories establish, fund and maintain programs of nursing leadership research.
Recommendation 6.0: Researchers partner with governments and educational and health-service organizations to conduct nursing leadership research.
Recommendation 6.1: Researchers study the impact of nursing leadership on nurses, patients/clients, organizations and systems.
Recommendation 6.2: Researchers develop, implement and evaluate a leadership intervention based on the Conceptual Model for Developing and Sustaining Nursing Leadership.
Recommendation 6.3: Researchers conduct research on health human resources planning for nursing leadership roles.
Recommendation 6.4: Researchers conduct research on nursing leadership education and development.
Recommendation 7.0: Health-service and educational accreditation bodies incorporate into their standards this guideline’s organizational support recommendations for formal and informal leaders.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.