authentic leadership in nursing essay

• Cancer Nursing Practice
• Emergency Nurse
• Evidence-Based Nursing
• Learning Disability Practice
• Mental Health Practice
• Nurse Researcher
• Nursing Children and Young People
• Nursing Management
• Nursing Older People
• Nursing Standard
• Primary Health Care
• RCN Nursing Awards
• Nursing Live
• Nursing Careers and Job Fairs
• CPD webinars on-demand
• --> Advanced -->

• Clinical articles
• CPD articles
• CPD Quizzes
• Expert advice
• Clinical placements
• Study skills
• Clinical skills
• University life
• Person-centred care
• Career advice
• Revalidation

Evidence and practice    

Exploring the role of authentic leadership in nursing, catherine best practice educator, saint catherine’s hospice, scarborough, england.

• To refresh your knowledge of various leadership styles that are commonly used in healthcare

• To learn about the principles and characteristics of authentic leadership

• To recognise the benefits and challenges of nurses adopting authentic leadership

Authentic leadership is a relatively new concept in nursing, with limited studies undertaken into its application in healthcare. Authentic leadership emphasises the importance of the leader being true to their personal core values and developing honest relationships with team members, valuing their contributions, and behaving ethically and transparently. Trust is a central tenet of authentic leadership that aims to lead to increased staff engagement, and enhanced individual and team performance. This article explores the principles, benefits and challenges of authentic leadership, as well as examining its potential role in nursing.

Nursing Standard . doi: 10.7748/ns.2022.e11927

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

[email protected]

None declared

Best C (2022) Exploring the role of authentic leadership in nursing. Nursing Standard. doi: 10.7748/ns.2022.e11927

Published online: 19 April 2022

clinical leadership - leadership - leadership frameworks - leadership models - leadership skills - professional - transformational leadership

User not found

Want to read more?

Already have access log in, 3-month trial offer for £5.25/month.

• Unlimited access to all 10 RCNi Journals
• RCNi Learning featuring over 175 modules to easily earn CPD time
• NMC-compliant RCNi Revalidation Portfolio to stay on track with your progress
• Personalised newsletters tailored to your interests
• A customisable dashboard with over 200 topics

Alternatively, you can purchase access to this article for the next seven days. Buy now

Are you a student? Our student subscription has content especially for you. Find out more

05 June 2024 / Vol 39 issue 6

TABLE OF CONTENTS

DIGITAL EDITION

• LATEST ISSUE
• SIGN UP FOR E-ALERT
• WRITE FOR US
• PERMISSIONS

Share article: Exploring the role of authentic leadership in nursing

We use cookies on this site to enhance your user experience.

By clicking any link on this page you are giving your consent for us to set cookies.

Authentic Leadership

Catherine Best (@CBest_23) is a public health nurse and an Honorary Visiting Lecturer in Nursing at the University of Bradford, whose research focuses on health inequality.  She is a member of the Phi Mu chapter of Sigma Theta Tau , and organisation that works to develop nurse leaders to improve healthcare everywhere. Catherine has written for us before, take a look at her blog co-authored with Parveen Ali (parveenazamali) about safe staffing .

Within the last decade concerns have been highlighted regarding the unethical behaviours of senior staff employed within a number of high-profile organisations (Gifford et al, 2019). This is supported by Crawford et al, (2020, p.115) who argue that poor and unethical decision making by some of the foremost ‘political, societal and organisational leaders’ has created a global challenge for many modern-day thinkers.

Healthcare has not escaped this criticism, with the behaviour of nurses and nurse leaders having been implicated in such scandals as Winterbourne (DoH, 2012), Mid Staffordshire NHS Foundation Trust (Francis, 2013) and Morecombe Bay (Kirkup, 2015). These scandals ultimately leading to a demand for increased corporate responsibility and a need for significant change in how healthcare services are delivered.

Such behaviours have amplified the call for a new type of genuine and values-based leadership; that of authentic leadership (Gardner et al, 2011). Characteristics of which argue Gill and Caza, (2018) include:

• Self-awareness • Internalised moral perspective • Relational transparency • Balanced decision making

Within the literature, leadership theories endorse the importance of the leader ‘serving, motivating, and empowering others’ (Browning, 2018, p.14). Leadership is a process argues Ng, (2017) that begins with the concept of self-leadership. A strong advocate for self-leadership is Daskal (2017), who, through her research, has created a set of guided principles of leadership development. These principles it could be argued, formulating the skillset of authentic leaders.

A core premise of the work of Hirst et al, (2016) is that authentic leaders play a crucial role in encouraging supportive behaviours in others, whilst demonstrating the value of openly sharing information. Such qualities assert Raso, (2019) being conducive to building trusting and productive relationships. Crucial elements of effective teams.

Having the ability to develop healthy workplace environments, however is reliant upon contextual factors, such as organisational culture, politics, and structure (Shirey, 2017), which can either promote or disrupt its development.

Until recently healthcare organisations have been dragged down by unrelenting bureaucracy, (Segel, 2017), a quintessentially command and control leadership regime and toxic cultures (West, 2019).

It could be argued however, that the impact of Covid-19 has witnessed a sea change in the way in which services are delivered, for we have witnessed first-hand how quickly systems, processes and laws can be put into place to protect the NHS, as evidenced with the establishing of the Nightingale Hospitals (NHS, 2020) and new legislation for example, – The Health Protection, (Coronavirus, Restrictions (England) Regulations 2020 (SI 2020/350). Although, has all this been managed simply by using a command and control approach to leadership?

It is likely that in time a plethora of research will emerge that will testify how healthcare leaders, including nurse leaders effectively managed this situation. Whether this research will identify new styles of leadership not yet considered, or simply regurgitate what we already have, remains to be seen. What is important however, is how we move forward.

Perhaps what will emerge is the need for individuals to find their way in the world. Is it possible for example that self-leadership will become ingrained within the fabric of the nursing workforce, or that the command and control style of healthcare leadership will soon be consigned to the annals of NHS leadership history? We can only wait and see.

Resilience, the current buzzword, will take on a new meaning as we emerge from the crisis, perhaps to a very different world than before. A nursing workforce that should above all else value its worth, will no longer be satisfied with excuses that limits the professions ability to grow. Nurses know the sacrifices they have made at a time of greatest need and will in time begin to demand opportunities that enable aspirational growth, which in turn has the potential to see new leaders emerge; ones with very different skillsets.

How we manage this as a collective remains to be seen. For ultimately, only time will tell.

Browning, M. (2018) Self-Leadership: Why it Matters? International Journal of Business and Social Science, 9 (2) February, pp. 14-18

Crawford, J.A. Dawkins, S. Martin, A. and Lewis, G. (2020) Putting the leader back into authentic leadership: Reconceptualising and rethinking leaders Australian Journal of Management, 45 (1) April, pp.114-133

Daskal, L. (2017). The Leadership Gap: What Gets Between You and Greatness. New York: Penguin Random House.

Department of Health (2012) Transforming Care A national response to Winterbourne View Hospital. Department of Health Review: Final Report. London: DoH

Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. TSO: London.

Gardner, W. Cogliser, C Davis, K. and Dickens, M.P. (2011) Authentic leadership: A review of the literature and research agenda. Leadership Quarterly, 22 August, pp. 1120–1145.

Gifford, J. Green, M. Barends, E. Janssen, B. Capezio, A. and Nguyen, P. (2019) Rotten apples, bad barrels and sticky situations. An evidence review of unethical workplace behaviour. London: CIPD.

Gill, C. and Caza, A. (2018) An investigation of authentic leadership’s individual and group influences on follower responses. Journal of Management, 44 (2) February, pp. 530-554.

Hirst, G. Walumbwa, F. Aryee, S. Butarbutar, I. and Chen, C.J.H. (2016). A multi-level investigation of authentic leadership as an antecedent of helping behavior. Journal of Business Ethics, 139 (3) December, pp. 485-499

Kirkup, B. (2015) The Report of the Morecambe Bay Investigation. London: TSO.

NHS (2020) News: NHS to build more Nightingale Hospitals, as London set for opening. https://www.england.nhs.uk/2020/04/nhs-to-build-more-nightingale-hospitals-as-london-set-for-opening/

Ng, J. (2017). Unleashing the Greatness in You: The Power of Self-Leadership. London: WS Professional

Raso, R. (2019) Be you! Authentic leadership. Nursing Management, 50 (5) May, pp. 18-25

Segel K (2017) Bureaucracy Is Keeping Health Care from Getting Better. [Online]. Available from: https://hbr.org/2017/10/bureaucracy-is-keeping-health-care-from-getting-better Accessed 01 May 2020

Shirey, M.R. (2017) Leadership practices for healthy work environments. Nurse Management, 48 (5) May, pp. 42-50

The Health Protection, (Coronavirus, Restrictions (England) Regulations (2020) SI 2020/350. London: TSO.

West, (2019) The NHS crisis of caring for staff: what do we need to do? [Online]. Available from: https://www.kingsfund.org.uk/blog/2019/03/nhs-crisis-caring Accessed 01 May 2020.

Comment and Opinion | Open Debate

The views and opinions expressed on this site are solely those of the original authors. They do not necessarily represent the views of BMJ and should not be used to replace medical advice. Please see our full website terms and conditions .

All BMJ blog posts are posted under a CC-BY-NC licence

BMJ Journals

Authentic Leadership

Add to Collection

Added to Collection

A good leader sets the tone for the unit. AACN’s research shows that healthy work environments are much more likely to have nurse leaders who fully embrace the six HWE standards, creating a culture of compassionate care for team members and patients. Authentic leadership also equips nurses with the skills and encouragement they need to grow in their practice. The result is a more knowledgeable, cohesive unit that consistently elevates patient care.

Standard Definition

Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement.

Critical Elements

For organizations.

• The health care organization provides support for and access to education and coaching to ensure that nurse leaders develop and enhance knowledge and abilities in authentic leadership, skilled communication, effective decision making, true collaboration, meaningful recognition, and appropriate staffing.
• The health care organization ensures that nurse leaders are appropriately positioned in their pivotal role in creating and sustaining healthy work environments. This role includes participation in key decision making forums, access to essential information, and the authority to make necessary decisions.
• The health care organization facilitates the efforts of nurse leaders to create and sustain a healthy work environment by providing the necessary time and financial and human resources.
• The health care organization makes a formal mentoring program available for all nurse leaders. Nurse leaders actively engage in the mentoring of nurses in all roles and levels of experience.
• The health care organization includes the individual’s influence on creating and sustaining a healthy work environment as a criterion in each nurse leader’s performance appraisal.
• Nurse leaders demonstrate leadership in creating and sustaining healthy work environments in order to achieve professional advancement.
• The health care organization ensures progress toward creating and sustaining a healthy work environment is evaluated at regular intervals using tools designed for that purpose.

For Individuals

• Nurse leaders demonstrate an understanding of the requirements and dynamics at the point of care and within this context successfully translate the vision of a healthy work environment.
• Nurse leaders excel at generating visible enthusiasm for achieving the standards that create and sustain healthy work environments.
• Nurse leaders ensure the design of systems necessary to effectively implement and sustain standards for health work environments.
• Nurse leaders role model skilled communication, true collaboration, effective decision making, meaningful recognition, and authentic leadership.
• Nurse leaders and team members mutually and objectively evaluate the impact of leadership processes and decisions on the organization’s progress toward creating and sustaining a healthy work environment.

More on Authentic Leadership

• Authentic Leadership: Pearls of Wisdom
• Understanding & Advocating Against Workplace Violence
• Being a Confident Leader, Even When You Are New to the Role
• Nurse Managers Leading the Way: Reenvisioning Stress to Maintain Healthy Work Environments
• The Emerging Nurse Leader Blog Series
• Leadership at Its Best: Supporting Staff Nurses in a Pandemic
• Thought leadership: Propelling nursing forward
• Leading Within Your Unit: Q&A on Strategies for Success
• Clinical Leadership: Growing Nurses, Elevating Practice
• Fundamental Skills for Nurse Managers eLearning Program
• Lead from Wherever You Are
• The New Leadership Challenge: Creating the Future of Nursing
• The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success

Recommended

Pioneering “The Pause”- Improvements Through Initiatives

Authentic Leadership to Support Nurses: Educate, Empower, Elevate and Enjoy

Nurse Story

Becoming an Advocate for HWE

Authentic Leadership: How Does it Differ from Transformational Leadership

Online Course

Fundamental Skills for Nurse Managers

Igniting the Passion in Our Profession Using the AACN Healthy Work Environment Standards

Enhance your self-awareness to be an authentic leader

In 2013 alone, U.S. organizations spent more than $15 billion on leadership development activities. Although much of these expenses focus on external programming, including face-to-face workshops, webinars, and e-learning, fewer resources target the internal development of leaders. To maximize sustainable leadership development, emphasis must be given to both external programming and individual improvement.

Experts in the field argue that organizations can more effectively redeploy billions of training resources by focusing on helping leaders mine their regularly scheduled lives for deep insights, feedback, strategies, and solutions. By investing in self-awareness and reflective practices, individuals have a better chance to grow as emotionally capable leaders. This article discusses self-awareness as a means to boost authentic leadership, an emotionally capable positive leadership style, and provides suggestions for enhancing self-awareness.

Self-awareness in authentic leadership

Authentic leadership is a pattern of leader behavior that draws upon and promotes both positive psychological capacities and a positive ethical climate. Elements of this definition are incorporated in the Authentic Leadership Questionnaire (ALQ) developed in 2007 and considered the definitive valid and reliable instrument to measure individual-level authentic leadership.

The ALQ uses four scales to evaluate key components of AL: self-awareness, relational transparency, balanced processing, and internalized moral perspective. (See Components of the ALQ, based on Walumbwa and colleagues .)

Self-awareness, the focus of this article, refers to an individual’s capacity to show an understanding of personal strengths, weaknesses, and impact on others. In addition to being a core element of authentic leadership, self-awareness is a key component of emotional intelligence that contributes to self-regulation and leader effectiveness.

Enhancing self-awareness

Authentic leadership can be developed. To become an authentic leader, however, requires that individuals pursue a journey of self-discovery, self-improvement, reflection, and renewal. The following recommendations offer direction for building self-awareness in your authentic leadership development journey.

Explore personal strengths and fatal flaws.

Understanding personal strengths helps to maximize potential. Although it’s your strengths that likely got you noticed as a leader, it may not be your strengths that will keep you on track. For this reason, it’s important to also recognize your major weaknesses or fatal flaws so you can minimize these and prevent them from derailing your leadership.

Completing the Strengths Finder instrument and reading about Goldsmith’s identified fatal flaws can help emphasize personal strengths without ignoring major weaknesses. Goldsmith defines fatal flaws as bad behaviors and cites examples of career derailing behaviors such as making destructive comments, withholding information, and claiming undeserved credit.

Understand your limitations and seek others to complement you and the team .

Self-awareness includes understanding personal limitations and acknowledging what still needs to be learned. Self-awareness also involves recognizing the strengths and fatal flaws in others to build a high performing team where all members complement each other and maximize the whole.

Examine emotional intelligence .

Emotional intelligence (EI) refers to people’s ability to recognize and understand their emotions and those of others. With EI, individuals can use their emotional awareness to manage personal behavior and relationships. EI has four distinctive components that need development: self-awareness, self-management, social awareness, and relationship management.

To better understand where you rate on the various EI scales, complete the simple and inexpensive Emotional Intelligence 2.0 instrument. Taking into account results of the assessment as well as suggestions for improvement can guide a personal AL development plan to develop EI.

Observe yourself and engage an observational partner .

Taking the time to record your major decisions along with the rationale for those decisions provides for personal analysis. In looking at the outcomes of decisions, you can establish a personal feedback loop that reveals what went well, what could be done better, and what patterns of behavior may be fruitful or counterproductive.

Including a trusted colleague or coach as an observational partner can offer just-in-time advice or retrospective validation with constructive direction. When leaders ask for input, it’s most beneficial for them to listen to feedback without justifying their actions or retaliating against the invited messenger.

Create down time for daily reflection .

Taking planned down time in the course of a busy schedule helps clear the mind and provide balanced perspective. This activity can involve taking a daily walk, engaging in mindfulness meditation, or reading daily scripture. Reflective down time is needed to enhance self-awareness and to cultivate authenticity.

Dig deep to gain insight .

It’s important for current and aspiring leaders to be able to ask and answer important questions such as: Who am I? What are my values? What is my purpose? What drives me? Are my actions consistent with what I value? How do others see me and is this consistent with how I wish to be seen?

Digging deep to honestly explore these questions requires time, dedication, and possibly validation from others. This type of deep reflection represents the inner work of leadership development that someone else cannot do for you.

Keep a reflective journal .

Keeping a journal helps to record personal thoughts that can lead to a higher degree of self-awareness and enhance both writing and emotional fluency. In recording daily reflections, this can help to recognize desirable as well as undesirable patterns of emotions and behavior that could either be repeated or modified for self-improvement.

A reflective journal also helps you begin to compose your individual life story, which can shed light on where you have come from, how you have learned from experiences, and provide direction for the future you wish to pursue.

Incorporate time for personal renewal and celebrate milestones .

Taking time to celebrate milestones is important for closure as well as for personal renewal. Pausing at regular intervals can be both inspiring and energizing for yourself and the team you lead.

Authentic leadership journey

Authentic leadership begins with self-awareness. Growing in self-awareness, however, entails individual responsibility, hard work, and devotion to reflective practices. You can use the suggestions in this article to build self-awareness that in turn enhances a personal authentic leadership development journey.

Selected references  

Bradberry T, Greaves J. Emotional Intelligence 2.0 . San Diego, CA: Talent Smart; 2009.

Giulioni JW. Developing leaders: Turning life into learning . September 11, 2014. http://smartblogs.com/leadership/2014/09/11/developing-leaders-turning-into-learning/?utm_source=brief .

Goldsmith M. What Got You Here Won’t Get You There . New York, NY: Hyperion; 2007.

Rath T. Strengths Finder 2.0 . New York, NY: Gallup Press; 2007

Walumbwa F, Avolio B, Gardner W, et al. Authentic leadership development and validation of a theory-based measure. Management Department Faculty Publications. Paper 24. 2008.

Maria R. Shirey is a professor and assistant dean for clinical and global partnerships at the University of Alabama at Birmingham School of Nursing.

1 Comment .

As an RN who is interested in ways to improve my practice, I found this article was relevant and timely to all nurses seeking to cultivate the leadership skills needed in our profession. I am writing you because I wanted to personally thank you for printing a useful article to foster both the growth of our colleagues and myself. I felt this article resonated with personal and professional values we share in nursing. The content that Shirey conveys provides practical application of self-awareness through multiple tools. She gives tips to assist nurses at every level to evaluate their decisions. All of these tips enable the nurse to learn the implementation of quality leadership. I appreciate that the publication included introspection and self-care for the nurse, along with the “permission” to acknowledge our limitations while seeking team members with needed skills to fill in those gaps. I feel that nurses will evolve using the skills encouraged by the author.

Further research on this topic and personal experience confirmed the insight that Shirey submitted regarding the facets of self-awareness and leadership in nursing. Starting with the professional nursing associations, both the NLN and AACN promote that leadership is a defining attribute of nursing. According to the NLN in 2012, being a leader with critical thinking skills is a characteristic of being a Baccalaureate-educated nurse. The AACN in 2008 also acknowledges roles that a nurse will fill—“leadership and scholarship in improving care, synthesis of theories and clinical experience, evaluator of outcomes, and communication skills across disciplines. Knowing that leadership is a key part of nursing, it is a professional responsibility to develop those traits.

Reviewing literature, I found two studies that echoed Shirey’s article. One was on nursing students developing leadership skills, and another focused on listening skills and nursing leadership. In the 2015 study, Waite affirmed that “self-awareness develops leadership capacity.” Waite focused on understanding one’s psychologically “preferred and non-preferred styles” to direct strengthening of non-preferred style and take advantage of strengths in the preferred style. Ms. Debbie Fitzgerald of Regent University, in 2009, wrote a dissertation documenting the positive effects of listening skills and communication in nursing leadership.

At work, I knew a manager who embodied the attributes of a self-aware leader. She had identified her strengths and capitalized on them. She was dynamic and creative while following sound clinical practice. Using skills and talents of motivation, support, and teaching; she directed those around her in an organized fashion. She was personable and approachable; always finding and encouraging the best traits in others to promote cohesive teamwork. She had educated herself and learned the clinical role well, continually improving her practice. Knowing and observing this manager gave me a positive model to reflect on.

Nurses are leaders of health– promoting positive change for individuals and groups. This positive change often begins with oneself, then flows to the people surrounding the initiator of change. Shirey’s article of being self-aware provides a clear path to growth of the professional nurse as a leader. The additional research and experience I provided confirm the assertions. By assessing oneself, acknowledging and addressing feedback, listening, following good role models, implementing theory and evidence (including those provided by Shirey), and evaluating the outcomes; nurses will be confident in the approach to grow continually in their careers.

Thank you for the inspiration to become a better leader.

Sincerely, Melissa Stephenson, RN

Comments are closed.

NurseLine Newsletter

• First Name *
• Last Name *
• Hidden Referrer

*By submitting your e-mail, you are opting in to receiving information from Healthcom Media and Affiliates. The details, including your email address/mobile number, may be used to keep you informed about future products and services.

Test Your Knowledge

Recent posts.

Increasing diversity in nursing with support from Nurses on Boards Coalition

Adventures in lifelong learning

The power of language

Making peace with imperfection

When laws and nursing ethics collide

Taking on health disparities

Oncology nursing: Clinical assistant onboarding

Medication safety and pediatric health

Confidence is in

Tailored falls prevention plans

Men in nursing

Chylothorax: A stepwise approach to care

Aortic dissection

FAQs: AI and prompt engineering

Caring for adults with autism spectrum disorder

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Wiley Open Access Collection

A caring leadership model in nursing: A grounded theory approach

Fengjian zhang.

1 Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China

2 School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China

Chunyan Guan

Hongwei chang, associated data.

The data in our study are available for academic use.

This study aimed to develop a theoretical model of caring leadership in nursing.

Nurse leader's role plays an integral part in complex health care institutions. As a common feature of leaders, leaders' caring leadership can positively influence the stakeholders in health care institutions. Still, little is known about caring leadership in nursing, especially in the Chinese cultural background.

Grounded theory was used to develop the theoretical model of caring leadership. Both semi‐structured interviews and open‐ended questionnaire surveys were used to collect data for constructing the theory model. Ten nurse leaders and 11 nurse staff were recruited for an interview, and 168 nurse leaders and 286 nurses were recruited for an open‐ended questionnaire survey.

A theoretical model of caring leadership was developed using five core attributions: benevolent to others, appreciate the uniqueness, facilitate self‐actualization, maintain mutual benefit and motivate with charisma. Caring leadership in nurse leaders works through the caring and leading process, resulting in nurses' well‐being, patients' healing and organisational excellence.

A caring leadership model was developed through grounded theory, revealing Chinese nurses' perspectives on caring leadership in Chinese cultural background. According to the model, the concept of caring leadership has been further explained, and it makes contributions to the measurement and leaders' practice in health care institutions.

Implications for Nursing Management

This caring leadership model developed in our study provides a new perspective and understanding of caring and leadership for nurse leaders. Nurse leaders need to strengthen their responsibilities and personal qualities while caring for nurse staff to improve leadership efficacy based on the theoretical model. And caring leadership can help nurse leaders to balance the interests of stakeholders, leading to positive consequences for nurse staff, patients and health care organisations.

1. BACKGROUND

Management in the health care system is becoming much more complicated as the health care system develops and transforms. It is constantly confronted with challenges such as limited budgets, nurse shortages and increasing patient care needs. Nurse leaders play crucial roles in balancing the health care system, nurse staff and the patient, sustaining high reliability in patient care service and leading the organisation into excellence (Arakelian et al.,  2019 ; Bondas,  2003 ; Cummings et al.,  2021 ). Developing nurse leaders has been regarded as an essential strategy to transform health care because effective leaders can instill nurse self‐efficacy and their practice behaviours (Cummings et al.,  2021 ).

While some popular leadership types, such as transformational leadership (Fischer,  2016 ), ethical leadership (Barkhordari‐Sharifabad et al.,  2018 ) and authentic leadership (Alilyyani et al.,  2018 ), are currently being studied by nursing researchers. However, some researchers point out that nursing leadership is a human‐to‐human interaction rooted in complex micro and macro systems based on disciplinary and clinical practice characteristics, which should be valued and developed to advance nursing theory and practice (Leclerc et al.,  2021 ; Watson et al.,  2018 ).

Caring is regarded as the essence and core of nursing, and it is rooted in fundamental issues of human life and existence (Bergbom et al.,  2021 ; Nasman,  2020 ). In clinical practice, caring is also required to alleviate patient suffering, promote healing and care for patients suffering from abortion and mental illness (Nasman,  2020 ). Bondas ( 2003 ) argued that without a caring perspective in patient care, the patient's suffering would not be alleviated, and the patient would be denied assistance. Furthermore, in recent years, caring has been emphasized in leadership and education (Gabriel,  2014 ; Li et al.,  2020 ). Caring is also a common feature of many followers' praises for their leader. A caring leader has romantic characteristics such as compassion, kindness, trust and supportive behaviours towards followers (Abreu Pederzini,  2019 ; Williams et al.,  2011 ). Leaders' caring creates an affection bonding that encourages the leader and follower to grow by forming interpersonal connections based on mutual respect and love. Caring takes place in two ways during this process: leaders ‘leaping in’ to assume responsibility for a current situation (Tomkins & Simpson,  2015 ). The second one is leaders ‘leaping ahead’ to show the possibility of the future (Tomkins & Simpson,  2015 ). In previous studies, the description of caring leaders and leaders' caring present the human‐centred altruistic values and behaviours to their followers, which helps to ensure their well‐being and flourish.

In China, leaders' caring is always mentioned by researchers when discussing leadership in an organisation. Traditional Chinese culture is centred on Confucianism, including benevolence, righteousness, propriety, wisdom and trustworthiness, embodying moral principles, values and behaviours of individuals within the Chinese cultural context (Chen et al.,  2011 , 2017 ; Zhang et al.,  2012 ). With the deep‐rooted Confucius values, hierarchy, relationalism and morality were emphasized among leaders and followers. Hierarchy refers to leaders' authority and responsibility; relationalism refers to close interpersonal relationships; morality indicates leaders' characters and ethical behaviours. In China, leaders' caring embodies a close relationship among leaders and followers, which is essential in making effective leadership by helping to form an emotional bonding and a reciprocal relationship to enhance the role behaviours (Chen et al.,  2017 ; Zhang et al.,  2012 ). Hence, the individuals with the higher position are expected to close relationships with their followers and show kindness. Specifically, excellent leaders need to demonstrate an individualized and holistic concern for the well‐being of individuals and their families, indicating caring for the followers.

Caring has become a more prominent topic in organisational life in recent years. And leaders' caring has been linked to organisational commitment, anxiety reduction at work, increased workplace self‐esteem and, more tentatively, organisational performance and productivity (Kostich et al.,  2020 ; Olender,  2017 ; Tomkins & Simpson,  2015 ). Furthermore, previous empirical studies have revealed that nursing leaders' caring behaviour positively influences staff nurses and patients (Kostich,  2020 ; Salinas et al.,  2020 ), indicating the importance of caring leadership in clinical practice.

Caring leadership comes naturally from characteristics, evidenced by a supportive leader–follower relationship, which is critical to achieving the Institute of Healthcare's vision of nurses as full partners with other health care professionals (Peng et al.,  2015 ). Eriksson's Caritative theory illustrated caring through relationships that involve love, mercy and compassion; the motive of caring is to alleviate suffering and protect well‐being (Bergbom et al.,  2021 ). In Eriksson's theory, caring is a natural process deeply connected with human suffering and helps to understand the essence of caring. Based on Eriksson's Caritative theory, Bondas ( 2003 ) described caring leadership in health care institutions as related to motivation, human love and mercy, which consists of encompassing nurse management and patient caring, emphasizing guidance, direction, respect, and human love and compassion for employees, as well as a ministration of patients. The aim of Bondas's caring leadership focuses on patient service, contributing to creating a caring environment in health care settings. Watson's caring theory also offers a philosophical viewpoint on caring leadership. As the basis of this theory, the transpersonal caring relationship in Watson's theory conveys a concern for human life and embodies the 10 Caritatas Process, which addresses the essence of caring (Watson,  2008 ). Moreover, the core concepts in the 10 Caritatas Process like loving‐kindness, inspiring, trusting, nurturing, forgiving, deepening, balancing, co‐creating, ministering and opening provide principles for the leading process. Based on Watson's theory, Williams et al. ( 2011 ) developed a caring leadership model by incorporating the 10 Caritas Process and Kouzes and Posner's leadership theory, demonstrating supportive leader–follower relationships using core concepts. Their research looked into the core elements of caring leadership in health care settings, highlighting the value and significance of caring leadership in nursing care.

Both Eriksson and Watson's theories provided perspectives to understand leader's caring in health care settings; the related caring leadership model also provides frameworks for leading practice. However, these studies on caring leadership are primarily based on the critical thinking of the theory, lacking leader–follower perspectives, and were not tested with empirical studies. Furthermore, the caring theory and caring leadership model are derived from western cultural backgrounds, following the views and contributions of Chinese in a multicultural context. Thus, with a deep understanding of related theories, this study proposes to use a grounded theory method to develop a theoretical model of caring leadership with a Chinese cultural background, thereby contributing to the development and measurement of caring leadership and its application in health care practice.

2.1. Grounded theory methodology

Corbin and Strauss's ( 1990 ) grounded theory, which is based on a pragmatic philosophical perspective, offers a methodology for researchers to better understand and explain leadership. Based on the participants' beliefs and experiences, this study employs grounded theory to determine the connotation and denotation of caring leadership in nursing. Meanwhile, the interaction process and potential consequences of caring leadership will be discussed and interpreted.

2.2. Data collection and sampling

2.2.1. semi‐structured interview.

From 3 November to 28 December 2020, nurse leaders and staff at a teaching hospital in Wuhan, China, were recruited using purposive and theoretical sampling. The following criteria were used to select nurse leaders: (1) at least 3 years of nursing management experience; (2) an intermediate title or higher; and (3) involvement in front‐line nursing management. Nurse leaders who had not been involved in front‐line nursing management for at least 6 months were excluded. The following were the inclusion criteria for nurse staff: (1) engaged in front‐line nursing service and (2) worked in the department for at least 2 years. The following are the exclusion criteria for nurse staff: (1) rotating nurses or training nurses and (2) not working in the clinical department for more than 6 months. According to the interviewee's preference, a semi‐structured interview was applied to collect data through face‐to‐face, telephone and online video interviews. The interview was held in a relaxed and comfortable setting, such as the interviewees' office.

In‐depth interviews were conducted with participants, who were asked the following questions: (1) What behaviours of a leader make you think she/he is a caring leader? (2) What characteristics or traits do you think a caring leader should have? (3) What kind of influence can a caring leader have? (4) How can caring leader improve their leadership effectiveness? (5) Is there anything else you had like to say? The interviews lasted 40–70 min and were filled with open‐ended questions; the interview outline was not strictly followed to obtain more information.

The interviewer was a male registered nurse and was a PhD candidate during this study. Before this study, he received systematic training in qualitative research, and he had rich experiences of conducting interviews, such as focus group interviews with nursing students.

The data were collected anonymously to protect interviewees' privacy. Each interviewee was assigned a unique number, such as L01 or N01 (L for nurse leaders; N for nurse staff). The first author transcribed the audio recordings within 24 h after the interview for further analysis.

2.2.2. Open‐ended questionnaire survey

An open‐ended questionnaire survey was conducted as an additional data source to provide an in‐depth understanding of a caring leader, providing mutual confirmation and ensuring the reliability and credibility of this study. The questionnaire included an introduction of this study with a brief description of caring leadership, a self‐designed demographic information questionnaire and two open‐ended questions, as follows: (1) What characteristics of a nurse leader do you believe would lead you to believe she is a caring leader? (2) What qualities do you believe a caring leader should possess? In the introduction, caring leadership described those nurse leaders concerned about the employee's well‐being and flourishing and demonstrating caring to the employees. Respondents were asked to provide at least three different descriptions for each question.

The participants were recruited through purposeful and convenient sampling in six teaching hospitals in Xiangyang and Wuhan, China. The participants, including nurse leaders and nurse staff, were able to complete it via an online platform named Wenjuanxing ( https://www.wjx.cn/ ). The online survey link was sent to every unit via nurses Wechat groups (Wechat: an instant chat tool widely used in the workplace) with the help of nursing administrators from the six teaching hospitals. Individuals can choose whether or not to participate in this study without any obligation before completing the questionnaire. Informed consent forms are presented and must be signed by the participants. All questions are mandatory; the questionnaire cannot be submitted if any questions are left unanswered. The questionnaire was launched on 30 December 2020, 0:00, and closed on 31 December 2020, 24:00. The descriptions were given a number, such as O01.

2.3. Data analysis

According to Corbin and Strauss's ( 1990 ) theory, the transcripts from the interview and descriptions from the questionnaire were analysed based on the following coding procedures: (1) open coding, (2) axial coding and (3) selective coding. Figure  1 presents the data collection and analysis process.

Data collection and analysis process

As soon as the first bit of data was collected, the data from the interview were coded. At the open coding stage, the transcripts were conceptualized and then clustered into subcategories during the coding stage. Researchers analysed the subcategories and explored the relationship to develop main categories at the axial coding stage. And at the selective coding stage, the interrelationship among main categories had been further interpreted to form the core categories. To ensure that the core categories can explain all of the main categories, they should be closely related (Corbin & Strauss,  1990 ; Kempster & Parry,  2011 ). To avoid bias and achieve greater precision during the coding process, constant comparisons were used while analysing the data.

To improve trustworthiness and credibility, the survey data were coded and constantly compared with the data from the interview after homogeneous categorization. Furthermore, before coding the survey descriptions, they were screened against the following criteria: (1) The descriptions were clear; (2) the leaders' behaviours or traits were demonstrated; and (3) the descriptions were pertinent to the topic. The first and second authors completed this process and integrated similar descriptions for further analysis. Microsoft Excel 2021 software was used to screen and integrate the original descriptions from questionnaires.

Researchers repeatedly read the transcripts and descriptions to ensure their familiarity and sensitivity to the data in case of missing important information. The first and second authors encode the original transcripts and descriptions separately during the coding stage and then compare the results until the codes are consistent. If there were coding disagreements, seek assistance from the corresponding author to make a final decision. QSR NVivo 11.0 software was used to analyse the transcripts and integrated descriptions.

2.4. Theoretical saturation

Theoretical saturation is essential for verifying the perfection of the theoretical model. Expert interview and expert verification were used for theoretical saturation test to ensure the integrity and reliability of the results. First, three experts related to this topic were interviewed and then coded the transcripts. After that, no new codes emerged when compared with previous codes. Second, the original data, codes and results were submitted to three experts for review, and the theoretical model was considered saturated without any objections from the experts.

2.5. Ethical consideration

Before starting this study, ethical approval was obtained from the researchers' affiliated university's ethical committee (Approval Number S137). Meanwhile, the interviewees were informed of the information of this study, and written or oral consent was obtained from participants before the formal interview. The person who completed the questionnaire was considered to have agreed to participate in this study about the open‐ended questionnaire survey.

3. FINDINGS

Ten nurse leaders and 11 nurse staff with a mean age of 38.14 were recruited for the interview; the management experience of nurse leaders ranged from 3 to 26 years. The range of work experience of nurse leaders was 14–36 years, and the nurse staff was 3–15 years. Table  1 presents the detailed characteristics of participants. And a total of 454 participants were recruited in the open‐ended questionnaire survey, including 168 nurse leaders and 286 nurses. Table  2 depicts the detailed characteristics of participants. A total of 3005 descriptions were collected during the online survey. After screening and homogeneous categorizing, 123 descriptions were retained for further analysis.

Demographic data ( N  = 21 participants)

Demographic characteristics ( N  = 454 participants)

The framework of the caring leadership model emerged as a result of multiple levels of coding and constant comparison. The coding process is shown in Table  3 . The model represented the core attributes of caring leadership, how caring leadership works and the possible influence of caring leadership, presented in Figure  2 .

Coding process of caring leadership model

Caring leadership model

3.1. The attributions of caring leadership

3.1.1. benevolent to others.

Benevolence to others means nurse leaders treat nurse staff with love and kindness, keep authentic and inclusive, maintain their dignity proactively and are willing to provide support beyond working affairs to help nurse staff maintain a work–life balance and promote their physical health and psychological well‐being. In Chinese culture, leaders are often expected to play a paternalistic role; the benevolence of nurses embodies the leaders' concern for nurses' life and dignity so that nurses' non‐work needs can be met to some extent. Conversely, while there is an emphasis on the leader's authority in traditional leadership, in which staff needs to demonstrate absolute obedience to the leader, leaders' benevolence enables nurse staff to maintain a relatively close psychological distance from the leader, resulting in nurses' better work experience. During this process, a positive interpersonal relationship is built between nurse leaders and nurse staff, laying the foundation for leadership effectiveness.

A nurse said: ‘The head nurse has a genuine concern for us, she is always considerate of us in our daily lives, and we are not so nervous when we are with her … she helps us find a doctor or gives us a rest when we are not feeling well.’

3.1.2. Appreciate the uniqueness

Both nurse leaders and nurse staff believe that there are differences among nurse staff; thus, the diversity of individuals should be considered. Nursing leaders respect nurse staff's personalities and values, identify and develop nurse staff's strengths, fully trust and empower them, and recognize and appreciate their work and achievements. The appreciation of individuals' uniqueness contributes to an inclusive organisational climate, encouraging staff to be creative in their work and providing the conditions for innovation and organisational transformation.

A nurse leader shared: ‘It is important to develop the potential of the nurses, and then let them work on their own so that they can develop their own niche areas of interest … when a nurse wins a competition, I publicly praise them in the group and sometimes give them a small extra reward.’

3.1.3. Facilitate self‐actualization

Professional development is essential for the majority of the nursing staff. Nurses who are stuck in their professional development can experience burnout and lose enthusiasm for their work. By guiding the direction of nurse staff's professional development and providing assistance within their capacity, nurses' professional competence and work enthusiasm will improve. During this process, nurse staff will achieve professional growth and development, thus contributing to patient care quality. Moreover, the nurse's identification with the organisation will also be further strengthened.

A nurse leader said: ‘I held an offline meeting for nurses in 5 years, I first gave them a 5‐year plan and did a career planning motivation session … the nurses are allowed to further training and academic conferences.’

3.1.4. Maintain mutual benefits

Maintaining mutual benefits means the nurse leaders keep impartial, concerned about nurse staff's welfare, deal with interpersonal conflicts, strengthen cooperation and create a positive organisational environment, providing a holistic perspective on leaders' caring. The caring leader emphasizes the significance of developing positive interpersonal relationships with followers, which are not unique but universal. Those leaders should keep equality while treating the followers, and this impartiality helps in protecting the interests of all followers. Taking concern about the rights and interests of followers is an essential requirement of leaders' caring; the ignorance of followers' rights and interests leads to uncaring feelings. Promoting teamwork, resolving conflicts within the organisation and shaping a positive organisational working environment provide a managerial perspective on leaders' caring behaviours for the followers. All individuals in the organisation, other than the nurses, will benefit from these caring behaviours. On the one hand, nurses must collaborate with others at work. Promoting teamwork and resolving interpersonal conflicts contribute to collaboration, which results in high work efficiency. Conversely, improving the working environment is beneficial to the nurses' work experience and contributes to all individuals within the organisation. These elements demonstrate leaders' efforts to maintain the benefits of all individuals while considering nurses' interests. Leaders must also ensure that mutual benefits are maintained from an organisational perspective. Maintaining mutual benefits improves the cohesion between nurse staff, promoting the collaboration of nurse staff to achieve the organisation's goal.

A nurse said: ‘She must be concerned about the rights and welfare of nurses, and sometimes we want her to deal with the conflicts with others without favoring … she organizes some team activities to promote the collaboration.’

3.1.5. Motivate with charisma

Leaders' charisma refers to leaders' characters and competencies while accomplishing organisational goals and leading the organisation to excellence. Leaders' characters embody the followers' moral expectations, such as devotion, selflessness and modelling. Leaders competencies are related to the organisational existence and development, such as vision and creation. With the characters and competencies, leaders will set a model for followers while achieving organisational goals. During this process, followers will strengthen their inner identity and follow the leader to create a bright future. From the followers' perspective, the leader's good character and competencies satisfy their expectations of the leader's image, motivating them to follow the leader and reinforcing their positive work behaviours. Furthermore, a leader who neglects the characters and competencies requirement means their neglect of leaders' responsibilities, making it difficult to form an identity with the followers. The caring for the followers will remain superficial because of their inability to address the difficulties faced by followers, which is not conducive to the long‐term development of the organisation and the continuous caring of the followers. As a result, charming personalities and competencies of nurse leaders ensure the leadership process and the achievement of the organisation's goals, motivating nursing staff to strengthen their role behaviours and excellent performance.

A nurse leader shared: ‘The leader must set an example for everyone, so that they will trust you … and as a leader, you should lead ahead to reach a high goal, requiring you to be strategic and innovative.’

3.2. Work of caring leadership

Caring and leading are two ways that caring leadership works, and they are mutually reinforcing and cannot be separated. During the leadership process, nurse leaders should show respect, provide support, build mutual‐trust relationships with their staff, promote cooperation and meet future challenges. At the same time, nurse leaders must accept the responsibility and mission of being a leader in caring for their employees by guiding the direction of the organisation and the nursing staff, setting a good example for them and finally leading them to a bright future. When a leader focuses on caring while neglecting his or her responsibilities, the organisation's principles are violated, resulting in a loss of motivation and an inability to achieve the set goals. On the other hand, if a leader focuses on the organisation's tasks while neglecting to care for the staff, the staff will be unable to form a sense of belonging and will lose their creativity. Long term, it will jeopardize the organisation's development and excellence and the care for nursing staff.

A nurse leader shared: ‘Caring for nurses is very important, but the leading of nurses is also critical, the responsibility of leader requires the leader to be able to have long term goals that will bring the staff to further future.’

3.3. The consequences of caring leadership

3.3.1. nurse well‐being.

Nurse well‐being can be viewed as a direct result of caring leadership, implying that nurses have a positive working experience. With caring leadership, nurses will feel supported in achieving work–life balance and dealing with workplace challenges, increasing their job satisfaction. Moreover, nurses will also feel respected and trusted to maintain dignity and empowerment, enhancing their work performance, and they can realize self‐worth during this process.

A nurse said: ‘When I feel the concern of the head nurse, I feel warm and want to do a better job.’

3.3.2. Patient healing

Patient healing is one of the possible outcomes of caring leadership. Nurses who are caring will provide care to patients, which improves the patients' experience of nursing care. Furthermore, caring leadership influences the working behaviours of nurses, such as work engagement, which helps to improve the quality of patient care.

A nurse leader shared: ‘Nurse will take the responsibility to care for the patients and help them, which is more beneficial to patients' recovery and healing.’

3.3.3. Organisation excellence

Organisational excellence is viewed as the consequence of caring leadership as well. The collaboration of nurse staff can improve work efficiency, which helps decrease running costs and enhance health care quality. Furthermore, nurse staff will be positively motivated by the caring leadership of nurse leaders and will devote themselves to nursing care service, which is critical for organisational excellence.

A nurse said: ‘Nurse leaders with caring leadership will develop a good reputation of the organization so that individuals will want to work here and the hospital will develop well.’

4. DISCUSSION

This study used interviews and open‐ended questionnaires among nurse leaders and staff to develop a caring leadership model, making the results more reliable. The data integration resulted in three domains for the caring leadership model: (1) the core attributions, (2) the work way and (3) the consequence. It reveals nurses' perception of caring leadership in China, how caring leadership works in health care organisations and the possible consequences of caring leadership. According to this model, leaders establish a positive interpersonal relationship with nurse staff through caring and leading nurses with personal charms. Compared with previous studies, the caring leadership model in this study is developed through grounded theory rather than conceptual exploration (Bondas,  2003 ; Williams et al.,  2011 ), it provides a view of caring leadership in Chinese culture and it reveals the working way and consequence of caring leadership in the leading process, helping to give rational thinking to nursing leaders.

Caring leadership focused on individuals' needs, existence and values and emphasized treating others with love and kindness to maintain an individual's dignity. For example, Bondas's ( 2003 ) study explored five elements of caring in nursing administration, such as valuing human dignity, recognizing employees' uniqueness and potential and organising with the caritas motive. Williams et al. ( 2011 ) described caring leadership model with the core values like always leading with kindness, compassion and equality, generating hope and faith through co‐create, embodying an environment of caring–helping–trusting for self and others, which are consistent with the core attributions like benevolent to others, appreciate the uniqueness and facilitate self‐actualization in our study. This level of consistency reflects the universality and understanding of the philosophy and ethics of care. However, the present research reveals two new attributions of maintaining mutual benefits and motivation with charisma; these two dimensions complement the requirements for effective caring leadership in organisations, emphasizing the importance of leaders in maintaining long‐term organisational stability and leading nurse staff to organisational excellence. Furthermore, in Chinese culture, leaders' responsibilities and morality were emphasized; these emerging two dimensions embody the Chinese nurses' unique understanding of caring leadership. The emphasis on caring for employees in health care organisations should not overshadow the leaders' responsibility and value (Levay & Andersson Bäck,  2021 ). When caring for nursing staff, leaders should maintain the mutual benefits of all stakeholders and motivate them with unique personal charisma, forming an excellent organisational culture and order. Caring leadership can achieve employee‐driven and organisational goals indefinitely under this condition.

Some popular leadership models currently include reference to leaders' caring and concern to individuals, such as individualized consideration in transformational leadership (Fischer,  2016 ) and benevolent leadership in paternalistic leadership (Chen et al.,  2015 ). In China, nursing leadership also embodies caring human philosophy, highlighting nurse leaders' individual‐oriented caring to nursing staff in management. Relevant studies reveal that leaders' caring is essential in leadership, but the development and measurement of caring leadership were briefly discussed. In our study, the caring leadership model is developed as a specialized leadership, and caring leadership is expanded. For example, individualized consideration and benevolent leadership focus on caring for individuals' work and life (Chen et al.,  2015 ; Fischer,  2016 ); our study reveals that a caring leader also pays attention to individuals' values, self‐actualization, benefits and family, reflecting the different understanding of caring in different cultural backgrounds. Furthermore, during the leadership process, leaders' duties and characteristics are emphasized, which aids in developing the individual's recognition of the leaders. As a result, leaders can influence and motivate individuals to help the organisation achieve its goals. Caring and leading are two essential processes of caring leadership in action. Previous research has primarily focused on the ethics and philosophy of caring, emphasizing caring for individuals without a leading process. In our study, the importance of leading is emphasized, for caring leadership, caring embodies the respect, love and kindness for employees, focusing on the existence of human beings, leading highlights the responsibility for employees, focusing on the version and future of all stakeholders, both of which are indispensable. For a caring leader, it is essential to be concerned with the mission of the organisation and the individuals (Levay & Andersson Bäck,  2021 ); the leading process helps develop a shared version and motivates the individuals to devote themselves.

In terms of the outcomes of caring leadership, this study is broadly consistent with previous research (Bondas,  2003 ; Brewer et al.,  2020 ; Kostich et al.,  2020 ). Caring leadership of nurse leaders improves nurses' experiences by reinforcing positive work behaviours, which contributes to the quality of patient care and the excellence of health care organisations. Meanwhile, the positive impact of patients and organisations positively impacts nurses. However, the results of this effect must be validated further through empirical studies.

5. LIMITATIONS

This study provides a framework for nurse leaders in Chinese health care institutions to understand caring leadership. To ensure reliability, researchers used a combination of methods to collect data. Because the caring leadership model is based on their perceptions and experiences, it has limited generalizability in other cultures, even Chinese culture has considerable influence in East Asia. Conversely, this study is a theoretical construct devoid of empirical evidence, requiring continuous revision and refinement with quantitative study design in future studies.

6. CONCLUSION

The present research provides a theoretical model of caring leadership in Chinese cultural background. The attributions reveal Chinese nurses' perspectives on caring leadership. The work of caring leadership indicates how to improve leadership efficiency, and the consequences present the influence of caring leadership in health care institutions. The results obtained from this study confirm the importance of caring leadership in health care institutions, which should be emphasized for nurse leaders. According to the study, caring leadership is further illustrated, and it provides a framework for future studies on measurement and leading practice.

7. IMPLICATION FOR NURSING MANAGEMENT

This caring leadership model developed in our study offers a new perspective and understanding of caring and leadership for nurse leaders. Nurse leaders need to strengthen their responsibilities and personal qualities while caring for nurse staff to improve leadership efficacy based on the theoretical model. Caring leadership can also assist nurse leaders in balancing the interests of all stakeholders, resulting in a positive outcome for nurse staff, patients and health care organisations.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

ETHICS STATEMENT

The study was reviewed and approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (No. S137).

ACKNOWLEDGEMENTS

The authors thank all the leaders and nurses who participated in the study. This study was funded by 2020 scientific research project of Chinese Nursing Association (Project No. ZHKY202006).

Zhang, F. , Peng, X. , Huang, L. , Liu, Y. , Xu, J. , He, J. , Guan, C. , Chang, H. , & Chen, Y. (2022). A caring leadership model in nursing: A grounded theory approach . Journal of Nursing Management , 30 ( 4 ), 981–992. 10.1111/jonm.13600 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

Funding information Chinese Nursing Association, Grant/Award Number: ZHKY202006

DATA AVAILABILITY STATEMENT

• Abreu Pederzini, G. D. (2019). Realistic egocentrism: Caring leadership through an evolutionary lens . Culture and Organization , 26 ( 5–6 ), 372–387. 10.1080/14759551.2019.1637875 [ CrossRef ] [ Google Scholar ]
• Alilyyani, B. , Wong, C. A. , & Cummings, G. (2018). Antecedents, mediators, and outcomes of authentic leadership in healthcare: A systematic review . International Journal of Nursing Studies , 83 , 34–64. 10.1016/j.ijnurstu.2018.04.001 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Arakelian, E. , Rudolfsson, G. , Rask‐Andersen, A. , Runeson‐Broberg, R. , & Walinder, R. (2019). I stay—Swedish specialist nurses in the perioperative context and their reasons to stay at their workplace . Journal of Perianesthesia Nursing , 34 ( 3 ), 633–644. 10.1016/j.jopan.2018.06.095 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Barkhordari‐Sharifabad, M. , Ashktorab, T. , & Atashzadeh‐Shoorideh, F. (2018). Ethical leadership outcomes in nursing: A qualitative study . Nursing Ethics , 25 ( 8 ), 1051–1063. 10.1177/0969733016687157 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bergbom, I. , Nåden, D. , & Nyström, L. (2021). Katie Eriksson's caring theories. Part 1. The caritative caring theory, the multidimensional health theory and the theory of human suffering . Scandinavian Journal of Caring Sciences . 10.1111/scs.13036 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bondas, T. (2003). Caritative leadership: Ministering to the patients . Nursing Administration Quarterly , 27 ( 3 ), 249–253. 10.1097/00006216-200307000-00012 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brewer, B. B. , Anderson, J. , & Watson, J. (2020). Evaluating changes in caring behaviors of caritas coaches pre and post the caritas coach education program . Journal of Advanced Nursing , 50 ( 2 ), 85–89. 10.1097/NNA.0000000000000846 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chen, L. , Yang, B. , & Jing, R. (2015). Paternalistic leadership, team conflict, and TMT decision effectiveness: Interactions in the Chinese context . Management and Organization Review , 11 ( 4 ), 739–762. 10.1017/mor.2015.34 [ CrossRef ] [ Google Scholar ]
• Chen, T. , Li, F. , & Leung, K. (2017). Whipping into shape: Construct definition, measurement, and validation of directive‐achieving leadership in Chinese culture . Asia Pacific Journal of Management , 34 ( 3 ), 537–563. 10.1007/s10490-017-9511-6 [ CrossRef ] [ Google Scholar ]
• Chen, X.‐P. , Eberly, M. B. , Chiang, T.‐J. , Farh, J.‐L. , & Cheng, B.‐S. (2011). Affective trust in Chinese leaders . Journal of Management , 40 ( 3 ), 796–819. 10.1177/0149206311410604 [ CrossRef ] [ Google Scholar ]
• Corbin, J. M. , & Strauss, A. (1990). Grounded theory research: Procedures, canons, and evaluative criteria . Qualitative Sociology , 13 ( 1 ), 3–21. 10.1007/BF00988593 [ CrossRef ] [ Google Scholar ]
• Cummings, G. G. , Lee, S. , Tate, K. , Penconek, T. , Micaroni, S. P. M. , Paananen, T. , & Chatterjee, G. E. (2021). The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership . International Journal of Nursing Studies , 115 , 103842. 10.1016/j.ijnurstu.2020.103842 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fischer, S. A. (2016). Transformational leadership in nursing: A concept analysis . Journal of Advanced Nursing , 72 ( 11 ), 2644–2653. 10.1111/jan.13049 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gabriel, Y. (2014). The caring leader—What followers expect of their leaders and why? Leadership , 11 ( 3 ), 316–334. 10.1177/1742715014532482 [ CrossRef ] [ Google Scholar ]
• Kempster, S. , & Parry, K. W. (2011). Grounded theory and leadership research: A critical realist perspective . The Leadership Quarterly , 22 ( 1 ), 106–120. 10.1016/j.leaqua.2010.12.010 [ CrossRef ] [ Google Scholar ]
• Kostich, K. (2020). The relationship between staff nurses' perceptions of nurse manager caring behaviors and patient experience: A correlational study (Publication No. 28030480) [Ph.D., University of Missouri–Kansas City]. ProQuest Dissertations & Theses Global . https://www.proquest.com/docview/2434714591/3522EB520BF8460CPQ/1?accountid=11524
• Kostich, K. , Lasiter, S. , & Gorrell, R. (2020). Staff nurses' perceptions of nurse manager caring behaviors: A scoping study . Journal of Advanced Nursing , 50 ( 5 ), 293–299. 10.1097/NNA.0000000000000886 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Leclerc, L. , Kennedy, K. , & Campis, S. (2021). Human‐centred leadership in health care: A contemporary nursing leadership theory generated via constructivist grounded theory . Journal of Nursing Management , 29 ( 2 ), 294–306. 10.1111/jonm.13154 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Levay, C. , & Andersson Bäck, M. (2021). Caring leader identity between power and powerlessness . Organization Studies , 017084062110062. 10.1177/01708406211006245 [ CrossRef ] [ Google Scholar ]
• Li, Y. S. , Liu, C. F. , Yu, W. P. , Mills, M. E. C. , & Yang, B. H. (2020). Caring behaviours and stress perception among student nurses in different nursing programmes: A cross‐sectional study . Nurse Education in Practice , 48 , 102856. 10.1016/j.nepr.2020.102856 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nasman, Y. (2020). The theory of caritative caring: Katie Eriksson's theory of caritative caring presented from a human science point of view . Nursing Philosophy , 21 ( 4 ), e12321. 10.1111/nup.12321 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Olender, L. (2017). The relationship between and factors influencing staff nurses' perceptions of nurse manager caring and exposure to workplace bullying in multiple healthcare settings . Journal of Nursing Administration , 47 ( 10 ), 501–507. 10.1097/NNA.0000000000000522 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Peng, X. , Liu, Y. , & Zeng, Q. (2015). Caring behaviour perceptions from nurses of their first‐line nurse managers . Scandinavian Journal of Caring Sciences , 29 ( 4 ), 708–715. 10.1111/scs.12201 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Salinas, M. , Salinas, N. , Duffy, J. R. , & Davidson, J. (2020). Do caring behaviors in the quality caring model promote the human emotion of feeling cared for in hospitalized stroke patients and their families? Applied Nursing Research , 55 , 151299. 10.1016/j.apnr.2020.151299 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tomkins, L. , & Simpson, P. (2015). Caring leadership: A Heideggerian perspective . Organization Studies , 36 ( 8 ), 1013–1031. 10.1177/0170840615580008 [ CrossRef ] [ Google Scholar ]
• Watson, J. (2008). Nursing: The philosophy and science of caring (1st ed.). University Press of Colorado. [ Google Scholar ]
• Watson, J. , Porter‐O'Grady, T. , Horton‐Deutsch, S. , & Malloch, K. (2018). Quantum caring leadership: Integrating quantum leadership with caring science . Nursing Science Quarterly , 31 ( 3 ), 253–258. 10.1177/0894318418774893 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Williams, R. L. II , McDowell, J. B. , & Kautz, D. D. (2011). A caring leadership model for nursing's future . International Journal for Human Caring , 15 ( 1 ), 31–35. 10.20467/1091-5710.15.1.31 [ CrossRef ] [ Google Scholar ]
• Zhang, H. , Everett, A. M. , Elkin, G. , & Cone, M. H. (2012). Authentic leadership theory development: Theorizing on Chinese philosophy . Asia Pacific Business Review , 18 ( 4 ), 587–605. 10.1080/13602381.2012.690258 [ CrossRef ] [ Google Scholar ]