National Association of Neonatal Nurses logo.


NANNP Corner

The Influence of Leadership

Bobby Bellflower, DNSC NNP-BC
NANNP Council Chair

Have you ever thought about the influence of leadership on your professional or personal life? If not, now might be the perfect time to think about it. As you know, there are countless books and articles on leadership, so many that it can be confusing. Is a good leader a person who knows exactly what to do in any situation and tells you what to do? Or is a good leader one who says, "you can only learn by sinking or swimming, so get in there and do it now"? In your opinion, what makes a good leader? There may be as many opinions on leadership as there are books and articles on the topic.

All nurses and Advanced Practice Registered Nurses (APRNs), especially in the Neonatal Intensive Care Unit (NICU), are leaders. Nurses and APRNs provide care and management for some of the most fragile patients and their families. In doing so, they demonstrate elements of leadership including integrity, initiative, insight, innovation, interest, inspiration, intensity, and information (Firehouse, 2003). Out of all the books and articles published on leadership, I believe the article "8 Essential Elements of Effective Leadership," published 17 years ago by a forum for firefighters, clearly states the leadership elements that most closely pertain to nurses and APRNs. Neonatal nurses exercise all of these elements every day (or night or 24 hours) in the NICU while caring for and managing babies and their families. The old saying about giving a nurse a roll of tape and repairing anything is real. What about the Neonatal Nurse Practitioner (NNP) that says there has to be a better way and devises a quality improvement (QI) project that clearly shows there is one? NNPs may not be in leadership positions, but they are leaders. The most crucial element of leadership may be integrity. What profession has been selected by the public as the profession with the most honesty and ethics? In the annual Gallup Poll, Americans have chosen nursing as the most honest and ethical profession for the past 18 years running (Reinhart, 2020).

Although there are numerous books on leadership and some disagreement in the literature on the best type of leadership education, there are two types of leaders that may profoundly influence nurses and APRNs: toxic and servant leaders. We have all dealt with toxic leaders who exercise the command-and-control method of leadership. They make life miserable; you cannot do anything right no matter how hard you try. They issue commands and make sure you know the consequences if you do not function as they tell you. They influence people in negative ways. Some characteristics of toxic leaders are

  • ridiculing others and telling them they are incompetent
  • being inconsiderate of followers' commitments outside of work
  • controlling how followers complete their tasks
  • making all decisions within a team whether they are important or not
  • believing they are more capable than others
  • denying responsibility for mistakes and accepting credit for successes of others
  • having explosive outbursts and varying in their degree of approachability
  • pitting others against one another (Hinshaw, 2020; Schmidt, 2008).

According to Hinshaw (2020), toxic leaders are more concerned with their ego, power, and prestige than making sure their followers have everything they need to do their jobs well. Research indicates that people who follow toxic leaders are unhappy in their jobs and are more likely to experience stress, develop physical and emotional illnesses, and participate in unproductive workplace behaviors (Hinshaw, 2020). Have you been in these situations in your personal or professional life? If so, although you may have loved your job, you may have thought about leaving because you were so miserable.

A servant leader is an opposite leadership style and provides opportunities for followers to grow and develop in their profession. Servant leaders desire to serve others and view leadership as a way to serve on a larger scale. Their influence is positive, and their followers are healthier (mentally and physically) and often develop the desire to serve others (Hinshaw, 2020). Some characteristics of a servant leader include

  • being honest, trustworthy, authentic, and humble
  • leading in a way that allows followers to grow
  • expressing care and concern for followers
  • listening deeply and honestly to understand
  • valuing and encouraging collaboration
  • creating and articulating a shared connection
  • utilizing systems-thinking to connect systems with ethical issues and challenges
  • leading with moral authority and ethical bounds (Hinshaw, 2020; Sipe & Frick, 2015).

Servant leaders emphasize serving people first by listening with empathy, collaborating, communicating, encouraging systems thinking, and using power judicially and ethically (Tanner & Banner, 2018). By doing these things, servant leaders increase teamwork and improve outcomes. Servant leaders have much better results when leading an organization through change than toxic leaders. Interestingly, servant leaders often move up the career ladder and are usually healthier than those who are command-and-control leaders (Tanner & Banner, 2018).

What type of leader are you? Learning to be a servant leader may improve your health and will undoubtedly help vulnerable babies and their families as well as your colleagues. And if you have a toxic leader or manager, encourage them to do some reading on servant leadership!


  1. Firehouse. (2003). 8 Essential Elements of Effective Leadership. Available at:
  2. Reinhart, R.J. (2020). Nurses Continue to Rate Highest in Honesty, Ethics. Gallup. Available at:
  3. Hinshaw, S. (2020). Learning about the True Power of Leadership by Comparing Servant Leadership to Toxic Leadership. Faculty Focus. Available at:
  4. Schmidt, A.A. (2008). Development and Validation of the Toxic Leadership Scale [Master's thesis, University of Maryland]. Digital Repository at the University of Maryland. Available at
  5. Sipe, J.W., & Frick, D.M. (2015). Seven Pillars of Servant Leadership: Practicing the Wisdom of Leading by Serving. Paulist Press.
  6. Tanno, J.P., & Banner, D.K. (2018). Servant leaders as change agents. Journal of Social Change, 10(1). 

Learn more about NANNP

Our Sponsor

pediatrix mednax