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2.2: Management, Leadership, Followership, and Mentorship

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  • From the Field

    Understanding principles related to management, leadership, followership, and mentorship is important for student nurses, who will both observe and experience countless examples of these four concepts throughout their careers. For example:

    • Nurses working on a code team may need to learn how to be good followers and take direction.
    • A charge nurse needs to be able to follow hospital-wide protocols.
    • An experienced nurse orienting a new nurse to the unit may display good mentorship by setting good examples and working at a pace that helps the new team member learn.


    Management has traditionally consisted of five essential functions: planning, organizing, commanding, coordinating, and controlling. In the late 1930s, these five functions were modified and expanded to include seven elements known by the acronym POSDCORB (MacLeod, 2012). Planning refers to the action of determining goals for the future. Organizing requires the manager to design an efficient and effective workplace. Staffing refers to the manager’s responsibility for recruiting, hiring, training, and maintaining staff, while also directing or guiding the organization to meet specific objectives, and coordinating or synchronizing the activities and use of resources. Finally, the manager demonstrates success in achieving goals by reporting (communicating progress and results) and budgeting (using scarce resources wisely). Although critics consider POSDCORB to be an overly simplistic view of management, each of the seven elements continues to be evident within management practices.


    The responsibilities of managers and leaders within a group or organization are closely linked. Leadership is regarded by many as the ability to guide others into actions that meet the needs of the organization. MacPhee describes leadership as “the process of engaging and influencing others” (2015, p. 6). Health care leaders identify the needs of clients, establish what is required for health (for both individuals and organizations), and then encourage others to engage in actions that meet these needs. Porter-O’Grady and Malloch (2011) state that the health care leader does not have to be an expert in operations or problem solving, but rather must be a “good signpost reader.” In addition, the leader transmutes this “signpost” knowledge of the future into action for followers. Leaders are recognized as providing visions and strategies, while managers are responsible for operationalizing those visions and strategies (Pangman & Pangman, 2010).

    Leadership by individuals is evident throughout health care. Not all leaders are appointed to formal positions of leadership. Nurse leaders have the knowledge and skill sets required to assist individuals in leading healthy lives and to support health care organizations in building a quality health care system. Leaders communicate their vision for the future to others through a combination of words and actions. These health care leaders create and follow a vision for the future. Action is much louder than words alone. Leaders make a difference.

    The Canadian Nurses Association’s (CNA) Position Statement on Nursing Leadership (2009) states:

    Nursing leadership is about the competent and engaged practice of nurses, who provide exemplary care, think critically and independently, inform their practice with evidence, delegate and take charge appropriately, advocate for patients and communities, insist on practising to their full and legal scope and push the boundaries of practice to innovative new levels.


    Followership is frequently described as the “upward influence” of individuals on their leaders and their teams. The actions of followers have an important influence on staff performance and patient outcomes (Whitlock, 2013). Being an effective follower requires individuals to contribute to the team not only by doing as they are told, but also by being aware and raising relevant concerns. Effective followers realize that they can initiate change and disagree or challenge their leaders if they feel their organization or unit is failing to “promote wellness and deliver safe, value driven and compassionate care” (Spriggs, 2016, p. 637). Leaders who gain the trust and dedication of followers are more effective in their leadership role (Hibberd & Smith, 2006). Everybody has a voice and a responsibility to take ownership of the workplace culture, and good followership contributes to the establishment of high-functioning and safety-conscious teams (Whitlock, 2013).


    Experienced and thoughtful mentors play an important role in the development of nurse leaders. Mentorship is defined as “a formal supportive relationship between two or more health professionals that has the potential to result in professional growth and development for both mentors and mentees” (Ontario Ministry of Health and Long-Term Care, 2017, p. 1). It is a reciprocal relationship between an expert and a novice; the expert provides advice, feedback, and guidance, and the novice assists the mentor with projects while maintaining a relationship of respect, loyalty, and confidentiality (Evans, 2015).

    Mentors can provide emotional support and career guidance that advance new nurses and nurse managers to professional success. However, Porter-O’Grady and Malloch (2011) suggest that some mentorships are toxic. Toxic mentoring occurs when mentors perpetuate past practices that prevent necessary changes from happening, rather than encouraging growth and development. Toxic mentoring can also occur when the mentor fails to assist the mentee to develop his or her own identity and leadership style, so that when the mentor is no longer present, the mentee is unable to progress on his or her career path. Finally, the mentor may give unrealistic assignments to the mentee, which may remain unfulfilled, culminating in mentee failure. These examples of toxic mentoring illustrate the importance of mentees choosing their mentors carefully since this relationship requires trust and mutual positive regard.

    Essential Learning Activity 1.1.1

    For more information on the CNA’s position on nursing leadership, read their “Nursing Leadership Position Statement.”