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Review Article - (2021) Volume 6, Issue 2

Leadership and Teamwork in Nursing

Lambrini Kourkouta1, Aysegul Yıldırım Kaptanoglu2, Konstantinos Koukourikos1, Christos Iliadis3*, Petros Ouzounakis4 and Areti Tsaloglidou1

1Department of Nursing, International Hellenic University, Thessaloniki, Greece

2Department of Health Science School/ Health Management, Beykent University, Istanbul, Turkey

3Department of Nursing, Private Therapeutic Center of Thessaloniki, Thessaloniki, Greece

4Department of Nursing, University Hospital of Alexandroupoli, Alexandroupoli, Greece

*Corresponding Author:
Christos Iliadis
Department of Nursing
Private Therapeutic Center of Thessaloniki

Received Date: February 10, 2021; Accepted Date: February 25, 2021; Published Date: March 04, 2021

Citation: Kourkouta L, Kaptanoglu AY, Koukourikos K, Iliadis C, Ouzounakis P, et al. (2021) Leadership and Teamwork in Nursing. J Heaflfth Commun Vol.6 No.2:2.

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Introduction: Leadership is defined as the influencing process of thought, feelings, attitudes, and behaviors of a small or large, formal, or informal group of people by an individual leader.

Purpose: The present review study focuses on the nursing team and its characteristics, on the nursing administration and it analyses the way the leadership influences the nursing team.

Methods: The material of the study consisted of articles on the subject found in Greek and international databases such as: Google Scholar, Mednet, Pubmed, Medline and the Association of Greek Academic Libraries (HEAL-Link). The exclusion criterion for the articles was the language, except of Greek and English. Only articles and studies accessible to authors were mostly used.

Results: The nursing team at the hospital environment is a classic functional group headed by the head nurse of the department, who is designed by the hospital management. The leadership of nurses is linked to decision-making, creating the appropriate atmosphere, adequate assignments, resolving conflicts, the integrity of actions and the effective development of team members through collaboration, and guidance. A good and successful leader will seek to develop the staff during his leadership.

Conclusion: The heads therefore serve as role models for nurses and gain the respect of their staff by setting a good example and clear goals.


Leader; Nursing leadership; Head nurse; Teamwork


It has been known since antiquity that the successful provision of care and treatment services, such as that provided by therapeutic institutions called "Asclepieia", was based on the partnership and the involvement of more people and often various disciplines, in order to ultimately be effective. Their structure is a complex function of management, because it is mainly based on interpersonal relationships [1,2].

In Byzantium, the hospital care provided by the Byzantine institutions reached its peak. Through the Typical, ie the written regulations of the monasteries, which survived until today, valuable information about the organization of hospitals and the activities of their staff is drawn [3,4].

Nowadays, the modern health facilities require high quality work by every employed member. Their operational needs and requirements, which are constantly becoming complex, cannot be met if all employees do not perform quantitatively and qualitatively for the same common goals. Especially those who lead in various fields in modern hospitals should be aware that human resource management is a critical parameter for the overall progress and development of each institution [5,6].

Leadership is defined as the process of influencing the thinking, emotions, attitudes, and behaviors of a small or large, formal or informal group of people by an individual/leader. The process of influencing is implemented in such a way that people voluntary and willingly, with the appropriate cooperation, give their best to achieve effective goals resulting from the mission of the group and its ambition for progress or a better future [7].

The team is not just a group of people exchanging views. It should be noted that people, from the first years of life, belong to groups through which they socialize and learn to cooperate and coexist with other people [8].

Nurses, moreover, in their daily routine of the hospital environment, work primarily in groups, either as members of an interdisciplinary team or as members of nursing groups [9].

Regarding the nursing team, its proper functioning is associated with the provision of safe and quality care and with the emergence of positive health results of patients. The nursing leadership, the behavior of which guides, encourages, inspires and supports nurses, is an important factor in the success of the nursing team [10].

The effectiveness of nursing team is closely linked to leadership. The effectiveness of the care provided by the nursing team and the positive impact on patient health is largely related to the behavior of the leadership [11].

The purpose of this review study is to investigate the characteristics of the nursing team in exercising nursing administration and to analyse the way leadership affects the nursing team.

Literature Review

The study material consisted of articles on the subject found in Greek and international databases such as: Google Scholar, Mednet, Pubmed, Medline and the Hellenic Academic Libraries Association (HEAL-Link), using the following keywords: leader, nursing leadership, head nurse, teamwork. The exclusion criterion for the articles was the language, except for Greek and English. Only articles and studies accessible to authors were used.

Talking about nursing team

In the area of the hospital, especially the hospital clinics, the nursing team consists of members who are not similar to each other, as the nursing staff working in these departments include primarily people of different educational backgrounds, such as [8].

• Graduate nurses of higher education

• Secondary education assistants

• Auxiliary nursing staff, such as ward assistants and stretcherbearers

These categories of nursing staff collaborate in the various departments of the hospital to provide health care to patients under the supervision of nurses and the guidance of the head nurse [9].

The nursing team should be a mix of older and younger nurses, because the older ones have extensive clinical experience, while the Youngers are full of hope, enthusiasm and fresh ideas. In addition, the employment of a greater number of registered nurses is associated with a lower error rate to patients [10,11]. In the Greek reality, due to the great shortage of registered nurses, assistant nurses are invited to replace nurses, which often lead to conflicts [12].

The stability, in respect of all nurses working in a particular department, has a huge impact on the team functioning and is related to the cohesion between the members and the development of effective working relationships. The instability of nursing staff undermines labor relations and contributes to increasing the stress of nurses and the absence from work [13].

In a department, in addition to the permanent nursing staff, there is also the auxiliary one, which works for a certain time (5 months, 1 year, etc). The stability of the groups contributes to the provision of high-quality nursing care [14].

Furthermore, the nursing composition of the group is not stable per shift, because it depends on the work schedule of the nursing staff. The nurses of the same nursing department work different days of the week and different shifts. The combination of shifts creates instability, because in each shift and every day the staff is called upon to work with different members of the team [15].

Another factor of instability is the rapid movement of patients, who come and go very the data regarding the work of the nursing groups are really volatile in terms of the members of the nursing team as well as to the patients who have to take care of [16].

Consistency among nursing staff is also important for patient satisfaction and team performance. The functioning of the nursing team relies on the ability of members to communicate, share responsibility for the performance of work and have a sense of "belonging". The cohesion degree can help maximize or reduce performance. The groups are considered to be cohesive when they have common values, goals and beliefs when working together e.g. in the same shift [17,18].

Talking about nursing administration

According to presidential decree 87/1986 "Single Frame of Hospital Organization” (Government Gazette 32 vol. A), which sets the framework for public hospitals in Greece, the hospital consists of three services [19].

• Medical

• Nursing

• Administrative

The levels of nursing administration are as follows:

The A hierarchical level, at the base of the pyramid of the nursing administration, corresponds to the Head of the Department, who leads the nursing staff of a specific department [20].

The B hierarchical level of nursing administration, in the middle of the pyramid, corresponds to the nursing subdivision, i.e. the head of the nursing sector, which has under his responsibility 4 to 8 nursing departments depending on the organization of each Hospital and the current legislation. The Head of Sector is in the intermediate level of administration and cooperates with the heads of level A and with the Director of the Nursing Service. When the director of the Nursing service is absent, he/she is replaced by one of the heads of the Nursing sectors [15,21].

The C hierarchical level of nursing administration, at the top of the pyramid, corresponds to the director of the nursing service, who leads the departments, the heads of the sectors and all the nursing staff [20].

Depending on the level of administration, the appropriate administrative and technical skills are required. The lower levels correspond to more techniques and less administrative skills and vice versa to the higher hierarchical levels. The main functions of the nursing administration, regardless of the level of administrative responsibility are: design-planning, organization, management-coordination and control [22].

According to the American Organization of Nurse Executives (AONE), nurses who are managers regardless of the position from which they exercise administration should have five skills [18]:

• Communication and relationship building

• Knowledge of the health care environment

• To have leadership skills

• To emit professionalism

• To have business skills and principles.

Other researchers believe that high quality leaders have clinical experience, administrative skills, adequate training, and business skills and understand leadership principles [19]. Thus, a trainee nurse is a leader in patients, a nurse staff is also leader in patients, and a manager is a leader in the entire group [20].

Talking about leadership in the nursing team

Leadership in the nursing team is linked to decision-making process, creation of suitable atmosphere, adequate assignments, conflict resolution, integrity of actions, and effective development of team members through collaboration and guidance [7].

The nurse leader provides to his followers with a clear vision, motivates and empowers them. He shows how things have to be done by guiding them [22]. Furthermore, he is a source of inspiration, admiration and a model of leadership for the followers. A leader who knows how to appreciate others is confident and is able to create effective teams [23].

The nurses, on the other hand, consider as effective leaders the ones who have a number of personal characteristics such as [24]:

• Personal and professional self-knowledge and clinical reliability

• Consistent behavior and promotion of justice and equality in the team

• Ensuring clarity for the team members regarding their role and responsibilities as well as the role of others in the team

• Communication and interpersonal skills

• Providing substantial and constructive feedback to the team

• Ability to cultivate commitment and optimism within the team

• Organization and coordination of work in a fair and honest manner.

It is well documented in the literature that nurses-leaders are not born, but developed through training, education and professional development. Nurse-leaders can learn leadership skills, such as creating a shared vision, establishing clear expectations, and ultimately building strong organizational commitment [20,25].

The leader, in his attempt to lead the team, adopts a set of behaviors called leadership style. The way he communicates with his subordinates, the atmosphere he creates at work, the use of power, the integrity of his character, the interest he displays as a representative of the nursing group are a series of behaviors that refer to the leadership style used. Successful leaders are flexible and do not follow a leadership style, but alternate the leadership style according to the occasion, in order to lead their subordinates to success [26,27].

Leadership has a significant impact on the work environment and organizational commitment of staff. The head nurse positively affects the work environment and strengthens the organizational commitment of nurses, achieves greater achievements at the departmental level. At the same time, it has a positive effect on patient safety, because it guides nurses' efforts to improve patient safety [28,29].

One of the most important factors regarding the team success is to create a positive atmosphere of cooperation. Leaders, who show respect for the ideas of the team members and interest in personal issues of members, are considered more effective. Leaders, who show a supportive attitude and create a positive atmosphere within the team, help their group members to perform in a better way [30].


The head nurses, therefore, should be properly trained to look for opportunities to help, encourage and reward the good performance of their nurses, while aiming at creating an atmosphere of cooperation within the nursing team. It is important for nurses to feel capable and supported by their heads. Support and guidance are leadership attitudes contributing to a healthy work environment and motivate nurses to perform in a better way and be more effective.