Leadership styles in nursing: Which approach should you use?

Estimated reading time: 10 minutes

Most nursing leaders are already intensely familiar with the different types of nursing leadership styles. But just as no two days on the floor are ever alike, sticking to a single leadership approach day in and day out can be a recipe for inefficiency, staff attrition and missed opportunities. 

Knowing which style to use – and when to use it – is the true game changer in nursing leadership. Along with insights from nurses in the Sermo community, this article provides a practical decision framework for matching leadership approaches to immediate clinical demands. Join the community to take advantage of their knowledge and share your own. 

Why leadership style matters in nursing

Selecting the wrong leadership style is not just an administrative misstep; it is a driver of staff attrition, which can be expensive. The national turnover rate was 17.6% in 2025, and replacing a single staff RN costs an average of $60,090. Multiply that expense across a department, and the financial drain can become staggering. Attrition can also lead to burnout for the staff that remain, which often affects patient safety and outcomes.

Smart approaches to leadership, on the other hand, can go a long way toward preventing attrition. Research consistently identifies leadership quality as one of the strongest predictors of nurse retention, and 77% of healthcare workers report higher job satisfaction under leaders with high emotional intelligence. 

A general nurse and medical director shared this insight on Sermo: “Clinical quality and safety are always number one, but burnout and well-being [are] a close second. If our nurses are overworked and under-rested, then clinical care will suffer.”

The 7 leadership styles nurse leaders need to know

Most leaders can already define and discuss nursing leadership approaches quite well. It’s knowing when and how to use them that is the differentiating factor. Here’s an easy-to-reference rundown of the main leadership styles in nursing. 

Transformational leadership

Leaders using this style inspire teams through shared vision, mentorship and professional development to achieve outcomes beyond expectations. 

This is the default style for most nurse leaders and has the strongest evidence for reducing staff turnover and improving patient outcomes. An example might be a nurse leader who notices rising patient fall rates, reviews evidence-based prevention strategies with their team, invites staff input on the matter and mentors newer nurses during implementation of the strategies. When leaders skillfully execute this style, they can have an overwhelmingly positive effect on their staff. “A nurse who is able to go to their manager, feel heard and see the change makes a nurse feel safe at work!” says one Sermo member and LPN. 

• Best suited for: Stable units focused on culture building, Magnet designation preparation and long-term staff development.
• Less effective when: Rapid decisions are needed (as in codes and emergencies), when the team needs structure and accountability more than inspiration or when new staff require more direct guidance.

Servant leadership

Servant nurse leaders prioritize staff well-being and development above their leader status; they lead by serving rather than directing. 

This style of leadership is best for environments where staff emotions can be on edge. Research shows that it can have positive effects on workplace stressors, as well as decrease burnout and improve staff satisfaction – two things that are on team members’ minds these days. In a recent small-sample Sermo poll, many members said that burnout and well-being are two things that nurse leaders should focus most on right now. 

• Best suited for: Long-term care and hospice settings; fractured teams with high turnover; teams with a lack of trust after leadership failures. Also effective in supporting staff after organizational change.
• Less effective when: Performance accountability is needed, as this style can be interpreted as permissiveness by underperforming staff. Should also be avoided during crises that require quick top-down decisions.

Democratic leadership

This leadership style drives team buy-in through collaboration, shared decision-making and collective input on policies and processes.

For example, democratic leadership can be used during team meetings where nurses voice concerns and contribute to the development of new protocols. 

• Best suited for: Protocol development, quality improvement initiatives and experienced teams where staff input genuinely improves decisions. 
• Less effective when: Urgent situations require fast, unilateral decisions. Also less effective with very large teams where consensus-building becomes unwieldy, or with new staff who lack the experience to make meaningful contributions and need more direction.

Transactional leadership

Transactional nurse leaders use clear expectations, structured rewards and defined consequences to maintain performance standards.

• Best suited for: Onboarding periods, establishing baseline accountability and in settings where compliance with specific protocols is non-negotiable (medication administration, infection control, documentation standards). It’s also useful for new teams that need structure before they can benefit from more collaborative approaches.
• Less effective when: Teams are experienced and self-directed (since it can feel like micromanaging), and when innovation or creative problem-solving is needed. Should generally not be used as the sole leadership style over the long term, since it doesn’t inspire growth beyond compliance.

Autocratic leadership

Leaders using this style concentrate decision-making authority with the leader, issuing directives with little or no team input. Autocratic leadership techniques are quick, decisive and non-collaborative – by design.

• Best suited for: Codes, mass-casualty events, rapid-response situations and clinical emergencies where delay costs lives. Essential when a clear chain of command is the difference between organized response and chaos. 
• Less effective when: Used as a default style in non-emergency situations. When applied to routine unit management, it can be corrosive to staff morale, trust and retention. A nurse leader who defaults to autocratic management in daily operations may drive experienced nurses to transfer or leave.

Laissez-faire leadership

The laissez-faire nurse leadership style is characterized by maximum staff autonomy and minimal direct supervision; much trust is placed in the team to self-manage.

Leaders using laissez-faire approaches should still remain available to provide direction, should uncertainty or gaps arise. Some research finds laissez-faire leadership to be associated with staff turnover.

• Best suited for: Highly experienced, self-directed specialty teams (such as seasoned ICU nurses and experienced OR teams), where team members have deep expertise and intrinsic motivation. 
• Less effective when: Teams include new graduates or mixed experience levels, when clear accountability structures are needed, or when patient safety requires active oversight. This leadership style can create dangerous accountability gaps with inexperienced staff who interpret hands-off leadership as absent leadership.

Situational leadership 

Rather than applying a single style to their entire team, a nurse leader who applies situational leadership adapts their approach for each team member based on the member’s skill set and commitment level to a given task. 

Generally, there are four modes used within situational leadership: directing (helping new staff learn procedures), coaching (developing nurses who need guidance and encouragement), supporting (encouraging competent nurses who need confidence) and delegating (to experienced, self-directed nurses).

• Best suited for: Any setting where team members have varying experience levels, which is most nursing units. Particularly effective for charge nurses and preceptors managing mixed-experience teams on the same shift. 
• Less effective when: The leader doesn’t invest the time to assess each team member’s development level, leading to a mismatch (directing an expert feels condescending; delegating to a novice feels negligent). It’s also difficult to sustain during extreme staffing shortages, when there’s no time for individualized assessment.

How to develop style flexibility as a nurse leader

Knowing how to switch leadership styles when needed is a skill that separates competent nurse leaders from great ones. But developing this flexibility takes practice.

1. Start by identifying your default style through an honest self-assessment. (This is probably the style you feel most comfortable carrying out.)
2. Identify the style you have the most trouble executing, and practice it in low-stakes situations – for example, try a laissez-faire approach when things are slow, and you know you have some skilled nurses on the floor.
3. Seek out mentorship from another nurse leader who tends to use a different style. Connecting with the nursing community on Sermo can be a great way to do this!
4. Attend leadership development programs that include scenario-based practice activities, such as AONL review courses.

How to match your leadership style to your team and setting

Choosing the correct leadership style is more of an art than a science – it doesn’t always go as planned, and mistakes are likely. But these guardrails can make success easier.

The right leadership style is determined by two factors: your team’s abilities and the needs of your clinical environment. You must consider both to adapt your leadership style to different situations.

Assess your team’s competency level

• A team made of new or mostly new staff will generally need transactional leadership, which provides more structure; adding in transformational techniques can help engage staff and make them feel more comfortable.
• An experienced, stable team can benefit from servant or democratic leadership, which drives ownership.
• For teams with mixed experience levels, consider situational leadership, which allows leaders to adapt their approach to each staff member.

Assess your clinical environment

• For fast-paced, high-acuity environments, like the ICU or ED, use autocratic leadership during critical situations like codes, using short, to-the-point directives (“Get the crash cart,” “Start an IV”). Then, transition back to transformational leadership when the crisis has passed. At this time, a staff debrief via open-ended questions (“What did we do well? What could we have done better?”) can help rebuild psychological safety after a stressful, emotional experience. 
• In environments where staff development is critical, like primary care or an outpatient-focused setup, use democratic or transformational leadership.
• After a leadership failure, servant leadership techniques can be effective in rebuilding team morale, which is a critical piece of the care puzzle. 
• In teams where quality improvement or protocol updates are needed, democratic leadership can help maximize staff buy-in to the changes. It can also make nurses feel valued. “I prefer the democratic style of leadership,” says a nurse on Sermo.

Common leadership style mistakes to watch out for

Even the most skilled nurse manager can run into snags when adopting leadership styles. Here are a few potential missteps to watch out for.

• Using the autocratic style by default. While handing down orders can be the easiest way to get things done, it often doesn’t foster goodwill among your staff.
• Letting laissez-faire dominate in a newbie team. A staff made of inexperienced nurses, or a mixed-level team, may not yet have the skills to figure things out on their own, potentially resulting in patient safety risks.
• Dismissing democratic leadership as indecisive. For the right type of team, it can be an effective leadership style, and doesn’t mean that you’re passing off authority to someone else.
• Sticking with one leadership style all the time. Honing the ability to flex between styles as needed can increase staff satisfaction and patient safety.
• Leaping to transformational leadership too soon. While this is the style to strive for in an ideal situation, implementing it for teams that haven’t yet developed basic operational structure can be frustrating – for both you and your team.
• Failing to adjust your style for individual staff members. Team members can have wildly different responses to a given leadership style, because of generational factors, specialty, or just personal preference. Get to know your staff and figure out what works best for them.

Learning how to apply leadership principles can be difficult, but the effort is worth it. As one specialist nurse shared on Sermo: “Nursing leadership is very challenging; I do it because I love my team and believe they deserve a place where they love to work. This, however, isn’t without sacrifice. I am always available for issues, which means not being truly off. It is not the stance taken by many, but I believe it’s what my team deserves.”

The bottom line

Leadership styles should be thought of as skills to hone and carry out, rather than chosen based on personal preference or personality traits. The most effective nursing leaders apply the styles based on staff competency and clinical needs. Subpar style execution can result in nurse burnout, reduced team well-being and less-than-optimal patient outcomes. This means that it’s not a nice-to-have soft skill for great nurse leaders; it’s an operational necessity.

Key Takeaways

• The national RN turnover rate rose to 17.6% in 2025, and the cost of replacing a single staff RN is $60,090. Leadership style is one of the most documented drivers of nurse retention – and attrition.
• Transformational leadership is the most evidence-backed style for reducing nursing turnover and improving patient outcomes in stable teams, while servant leadership can be most effective on stressed or high-turnover teams. Democratic leadership is most useful for new protocol buy-in, and autocratic leadership can save lives in crisis situations.
• 77% of healthcare workers say they are more satisfied with their jobs when their leaders demonstrate high emotional intelligence.
• The most effective nurse leaders use transformational techniques by default, adjusting as the situation demands. The choice of leadership style should be influenced by two critical factors: The competency of the team and the needs of the clinical environment.