Concept analysis of TFL in nursing


A substantial gap can be filled by the concept analysis of TFL in nursing. It is essential to be very clear in the conceptual meaning for further development and research. In the results of performance measures, TFL is strongly related to patient outcomes some of which are nursing satisfaction, retention, patient satisfaction and workgroup effectiveness. Leading the healthcare teams is an important factor for a positive patient outcome. Patient safety processes and positive leadership skills have been linked. Such as two patient outcomes that are perceived as negative which are patient restraints and immobility complications are inversely proportional to the level of leadership and nurse managers’ experience in working. Most research provide suggestions that improving patient outcomes can be linked to how well does leadership is doing in nursing stations. Future research to test linkages between patient outcomes and leadership is expected but the first logical step may very well be the concept analysis of TFL (Thomas, 2016).

Concept analysis of TFL in nursing


James McGregor Burns 1978, he defined it as “engage with others in such a way that leaders and followers raise one another to higher levels of motivation and morality.”

The transformational leader needs to have excellent and polished skills, which can vary from being able to work in collaboration, encouraging nurse colleagues to come forward and take part in decision making, the ability to put theory into practice and make the practice evident, being able to critically analyze the situation, effective problem solving skills and keen in decision making (Thompson, 2012).

Concept analysis of TFL in nursing

Literature Review

According to Bass 1999 leadership that involves a creation of an idea through communication. Transformative leaders motivate individuals to move beyond their self-interest along with the organization. Transformational leadership as a resource management that enhances human capital persuading them to perform with the best efficiency exceeding their own limits (Hutchinson & Jackson, 2013)

Studies have reported that nurses working with managers with leadership skills tend to have better work performances and a development of self-awareness, transparency and work ethic can be very advantageous for organizations (Bamford, Wong, & Laschinger, 2013).

Concept analysis of TFL in nursing

The health care is a speedy progressing stream with constant influx of changes environments which requires prompt responses to handle such abrupt changes. Transformational nurse leaders can grab the opportunity to prove themselves in this changing reform. Optimization of the traditional role of the nurse while adding value to families of the patients along with playing the part of care coordination is an essentiality to prove themselves. Since care coordination is still a working progress nurses can participate in such ventures to improve their professionalism as well as preserve it. Through transformative leadership nurses can create workspace that is comfortable and satisfyingly meeting all needs of patients and demands of the organization (Steaban, 2016).

  1. Wang (2011) says that it has been over a decade that research is being carried out on studies to verify the codependence of transformational leadership and team work. A study by (Chi & Huang, 2014) proves that transformational leadership predicts positive group affective tone which in turn positively influences team performance but also has the ability to induce negative team performances with negative group affective tone hence giving us clear description of how leader behavior can affect team work (Chi & Huang, 2014).

A review study on transformational leadership linkages and patient outcomes showed that there is a positive relativity between leadership and a variety of patient outcomes. Most organizations that adapt transformational leadership skills tend to have better strategic implementations to patient outcomes (Wong, Cummings, & Ducharme, 2013).

There are studies present suggesting that transformational leadership works perfectly when applied by head nurses enhancing nurse performance in safety compliances exerting significant positive impacts whatsoever (Lievens & Vlerick, 2014).

Concept analysis of TFL in nursing


There are number of transformational leadership attributes which are presented below (Fischer, 2016):

  • The nurse leader paves the way for fellow nurses to follow for unlocking their potential
  • A good nurse leaders inspires and is visionary in his activities during the service course to influence subordinates for moving forward as a team
  • The nurse leader builds the capacity of his team members to act more responsibly and promotes decision making power

Concept analysis of TFL in nursing

It is clear from the above statements that the leader (in this case nurse) builds trust and confidence in the followers through personal association, develops a collective sense of values and missions, coaches team members individually and helpfully and then encourages innovative techniques through critical examination and analysis (Fischer, 2016).

Concept analysis of TFL in nursing


Fischer (2016) stresses that transformational leaders is a huge factor on which the success of the organization depends on. Such leaders are capable of steering the organization through adaptations in the constant change. Leaders who have experienced issues in job security and promotions are needed to provoke and encourage employees. Transformational leaders have the capacity to formulate a group of people under one philosophy in organization. Achievement of implementation of problem solving solutions in an organization is the key role of a transformative leader. Leaders learn from their experiences differently and evolve due to those varying experiences as well. However the evolving of transformational leadership is yet to be understood. Here the query arises, how does the quality of transformational leadership cultured in one’s personality?

Concept analysis of TFL in nursing

Levels of studies on the development of mentoring procedures have risen in the past years. Mentors can be defined as individual experienced enough to give suggestions and impact other people’s careers positively (Fischer, 2016).

Concept analysis of TFL in nursing

Vast studies are present regarding the advantages apprentices receive from their mentors focusing on two features of the mentoring process. At first guideline to career development is proceeded with and next strategies to cope with the psychosocial pressures of organizational life are contributed by the mentor. Though it may seem these two are not very separate but the mentor usually provides a perspective that is easy to see for the protégé (Fischer, 2016).

Concept analysis of TFL in nursing


Transformational leadership has shown various impacts on followers, organizations and leaders too. The most obvious ones are on the followers keeping them persuaded and motivated to develop and grow and to perform at their best possible behaviour. As a result of which they feel more valuable hence making their performances very proficient and efficient. Leaders themselves appreciate loyalty and commitment by the followers, in turn creating a very positive ambience with significant results in job performances and turnovers, improving the organization’s reputation in the market (Fischer, 2016).

Concept analysis of TFL in nursing

Empirical Referent

A number of referents are available to measure TFL. Out of which the most common is the Multifactor Leadership Questionnaire (MLQ) by Bass and Avolio. It consists of a questionnaire measuring a variety of leadership behaviours having the 12 subscales of different attributes, both transactional and non-interventional and also including some general attributes too. This has widely been used the health care reform (Edwards et al. 2012). Other lesser known measures for TFL include the Leadership Practices Inventory and the Global Transformational Leadership Scale all of which have been criticised heavily for their high correlations (Hutchinson & Jackson 2013).

Concept analysis of TFL in nursing

Model Case

Taking an Example of Jenny, as she entered her new job into a health clinic facility as a master prepared nurse, which was previously disorganized and scattered. She due to her advanced education and potential soon gathered the attention of facility administration and was appointed as a nurse leader who aligned the schedules and guided nurses in better provision of care. During this period she utilized her outstanding characteristics of emotional intelligence, visionary, communication and enthusiasm and no later than a couple of weeks the nurse were filled with new energy and motivation to provide care to the patients.

Concept analysis of TFL in nursing

Borderline Case

Aesthetic leadership can be an example of borderline case (Mannix et al. 2015). Similar to TFL this leadership model is contrastingly different from it due to the actions of the follower instead of the leader. Another leadership model is a congruent leadership which involves adaptation according to a group without driving the leader or the followers (Mannix et al. 2015).

Concept analysis of TFL in nursing

Contrary cases

The explanation of borderline and other relative cases also brings in contrasting cases such as transactional leadership and Laissez-faire leadership, as well as with trait theory and pseudo-transformational leadership (Fischer, 2016).

Concept analysis of TFL in nursing

Transactional leadership is considered too be and exerted, negative and a conditional reward base management system, against the TFL approach which is very opposite. Contingent reward system drives the follower towards a specific aim. Many studies are in favour of such systems but some are also critical explaining that these type of systems bring about minor changes only. On the other hand TFL is very much a favourite in the nursing context for the encouragement and motivation of the followers in the organization (Fischer, 2016).

Effective leaders can have both transformational and transactional leadership qualities. Some people may be in favour of a dictator like management, while others have divided the tasks for leaders and followers to be accomplished by them individually considered very effective at practice. TFL can in no way be an alternative for transactional leadership, but can be used as a complement instead (Fischer, 2016).

Concept analysis of TFL in nursing

Theoretical implications

A critical theoretical implication arising from the concept may be the validity of the very commonly used definition of the word ‘transformational leadership.’ TFL is defined by Bass and Avolio (2004) as ‘a type of leadership style that leads to positive changes in those who follow.’ Leaders who use this style ‘are generally energetic, enthusiastic and passionate [as well as] . . . concerned and involved in the process [and] focused on helping every member of the group succeed as well’ (p. 25). The problem here is that transformational leadership here is telling what it does expect what it is. To gain the full perception of the terminology; a definition consisting of the leader qualities instead of explaining the effect on the followers (Fischer, 2016).

Concept analysis of TFL in nursing


The study has provided an insight about the transformational leadership style and it as a nursing concept. This approach is necessary to receive fruitful results in the healthcare system. For testing and further developments a clear concept needs to be formulated. There is still no transformational leadership prevalence usage in nursing has been published, expect a few, there is a lack of such articles. The current study shall be fulfilling this gap laying foundations of TFL in the nursing reform introducing necessary competencies for TFL.


Bamford, M., Wong, C. A., & Laschinger, H. (2013). The influence of authentic leadership and areas of worklife on work engagement of registered nurses. Journal of nursing management, 21(3), 529-540.

Chi, N.-W., & Huang, J.-C. (2014). Mechanisms linking transformational leadership and team performance: The mediating roles of team goal orientation and group affective tone. Group & Organization Management, 39(3), 300-325.

Fischer, S. A. (2016). Transformational leadership in nursing: a concept analysis. Journal of advanced nursing72(11), 2644-2653.

Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a more critical interpretation. Nursing inquiry, 20(1), 11-22.

Lievens, I., & Vlerick, P. (2014). Transformational leadership and safety performance among nurses: The mediating role of knowledge‐related job characteristics. Journal of advanced nursing, 70(3), 651-661.

Steaban, R. L. (2016). Health care reform, care coordination, and transformational leadership. Nursing administration quarterly, 40(2), 153-163.

Thomas, C. D. (2016). Transformational Leadership as a Means of Improving Patient Care and Nursing Retention.

Thompson J. (2012). Transformational leadership can improve workforce competencies. Nursing Management 18(10), 21–24.

Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: a systematic review update. Journal of nursing management, 21(5), 709-724.


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