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ORIGINAL ARTICLE
‘Watching an artist at work’: aesthetic leadership in clinical nursing
workplaces
Judy Mannix, Lesley Wilkes and John Daly
Aims and objectives. To explore how clinical leaders enact aesthetic leadership in
clinical nursing workplaces.
Background. Clinical leadership is heralded as vital for safe and effective nursing.
Different leadership styles have been applied to the clinical nursing workplace over
recent years. Many of these styles lack an explicit moral dimension, instead focusing
on leader qualities and developing leader competence around team building, quality
and safety. Aesthetic leadership, with its explicit moral dimension, could enhance
clinical leadership effectiveness and improve nursing workplaces. How aesthetic
leadership is enacted in clinical nursing settings requires exploration.
Design. A qualitative design, employing conversation-style interviews with experi-
enced registered nurses and written responses gathered from an online descriptive
survey.
Methods. Narrative data were gathered from interviews with 12 registered nurses
and written accounts from 31 nurses who responded to an online survey. Together,
transcribed interview data and the written accounts were subject to thematic analysis.
Results. Three main themes emerged: Leading by example: ‘be seen in the clinical
area’; Leading with composure: ‘a sense of calm in a hideous shift’; and Leading
through nursing values: ‘create an environment just by your being’.
Conclusions. Aesthetic leadership was shown to enhance clinical leadership activi-
ties in the nursing workplace. The capacity for clinical leaders to be self-reflective
can positively influence the nursing workplace. It was apparent that clinical leader
effectiveness can be enhanced with nursing values underpinning leadership activi-
ties and by being a visible, composed role model in the clinical workplace.
Relevance to clinical practice. Aesthetic leadership can enhance clinical nursing
workplaces with its explicit moral purpose and strong link to nursing values.
Clinical leaders who incorporate these attributes with being a visible, composed
role model have the capacity to improve the working lives of nurses across a
range of clinical settings.
Key words: aesthetic leadership, clinical leadership, nursing, qualitative design
What does this paper contribute
to the wider global clinical
community?
• Reveals how clinical leaders can positively affect outcomes in clin- ical settings through their leader- ship skills and knowledge.
• Supports aesthetic leadership as a suitable style of leadership for clinical leaders to incorporate into their leadership practice.
• Contributes to an enhanced understanding of the importance of being visible and composed as clinical leaders.
• Reinforces the importance of nursing values in the day-to-day activities of clinical leaders.
Accepted for publication: 21 June 2015
Authors: Judy Mannix, RN, MN, Senior Lecturer, Director of Aca-
demic Programs – Postgraduate, School of Nursing & Midwifery,
University of Western Sydney, Sydney; Lesley Wilkes, PhD, RN,
Professor of Nursing, School of Nursing & Midwifery, University
of Western Sydney/Nepean Blue Mountains Local Health District,
Penrith, NSW; John Daly, PhD, FACN, FAAN, Professor & Dean,
Faculty of Health, University of Technology, Sydney, NSW, Aus-
tralia
Correspondence: Judy Mannix, Senior Lecturer, School of Nursing
& Midwifery, University of Western Sydney, Locked Bag 1797,
Penrith, NSW 2751 Australia. Telephone: +61 2 46203760.
E-mail: [email protected]
© 2015 John Wiley & Sons Ltd
Journal of Clinical Nursing, 24, 3511–3518, doi: 10.1111/jocn.12956 3511
Introduction and background
Health care systems across the world increasingly are required
to provide quality health care services with seemingly fewer
resources. The responsibility for providing quality health care
in this environment can be collectively shared across the health
workforce. However, the burden of responsibility for ensuring
that quality care is produced and delivered consistently in clin-
ical settings settle on the shoulders of clinical leaders and man-
agers. These expectations occur in clinical workplaces that
have been described metaphorically as perfect storms due to
workforce shortages, staff skill mix problems, patient
demands and diminishing resources (Mannix et al. 2013).
Effective clinical leadership has been put forward by profes-
sional nursing organisations and government-sponsored
enquiries as the remedy for the ills of the nursing workplace
(Mannix et al. 2013) and has been identified as a way to
increase job satisfaction among nurses (Kaddourah et al.
2013).
While transformational leadership is the dominant leader-
ship style in nursing in recent decades (Cummings et al.
2010), it is not a style of leadership with specific application
to clinical leadership (Stanley 2008). Other relational-ori-
ented and task-oriented leadership styles have been used to a
lesser extent in nursing (Cummings 2012). Of these styles,
congruent leadership, proposed in recent years by Stanley
(2008) is unique in that it has explicit application to clinical
leadership in nursing. Many of the current leadership styles,
including transformational and congruent leadership focus
on leader characteristics in the leader/follower dyad (Stanley
2006, Hutchinson & Jackson 2013). In the current health
care climate, it may be timely to consider a style of leadership
style with a follower-centric focus to complement and over-
come shortcomings in these leader-focused styles (Mannix
et al. 2015a). Aesthetic leadership is one style with a follower
focus (Dinh et al. 2014), described as leadership with an
explicit moral dimension, and a reliance on tacit knowledge
gained from largely indescribable know-how derived from
sensory, emotional and somatic awareness (Mannix et al.
2015a). As well, this style of leadership sits well with nursing
because nurses have for many years acknowledged the valid-
ity of aesthetics to their knowledge and practice (Finfgeld-
Connett 2008). However, the ways in which aesthetic leader-
ship is enacted in the clinical nursing workplace is essentially
unknown. This paper addresses that gap.
Methods
Following approval for the study from the Institutional
Human Research Ethics Committee, this part of a larger,
mixed-methods study took a qualitative approach to col-
lect narrative data from two sources. Using convenience
sampling, the first source of data involved online recruit-
ment of nurses via e-learning platforms and online social
networks to complete an online descriptive survey, details
of which are reported elsewhere (Mannix et al. 2014).
The online survey included an invitation to respondents
to provide a written account of an experience of aesthetic
leadership from a clinical leader in their clinical nursing
world. Using purposive sampling, the second source of
narrative data were drawn from individual, in-depth con-
versation-style interviews with experienced registered
nurses employed in clinical leadership positions in nurs-
ing.
In all, 31 nurses who completed the online survey pro-
vided a written account of their experiences of aesthetic
leadership. Twelve clinical leaders participated in a
digitally recorded interview with one member of the
research team. The semi-structured interviews focused on
participants’ views of effective clinical leadership and the
influence of aesthetics on the clinical setting. The
duration of the interviews ranged between 30–60 minutes.
As reported elsewhere (Mannix et al. 2015b), involving
this number of participants was established when data
saturation occurred. The study’s rigour was enhanced by
having only one member of the research team conduct
the interviews.
The written accounts from the survey respondents [R]
and the transcribed data from interviewees [I] were
subsequently combined and together were analysed fol-
lowing thematic analysis principles. Initially, narrative
data were read by a research team member to get a
sense of meaning (Borbasi & Jackson 2012), followed by
an inductive approach to uncover and expound themes
(Vaismoradi et al. 2013). To assess trustworthiness and
credibility of the three emergent themes, another
researcher reviewed the findings to confirm that the
intended meaning was represented truly (Graneheim &
Lundman 2004).
Findings
From analysis of the narrative data, three main themes
emerged to reveal how aesthetic leadership is enacted by
clinical leaders in the workplace:
• Leading by example: ‘be seen in the clinical area’
• Leading with composure: ‘a sense of calm in a hideous
shift’
• Leading through nursing values: ‘create an environment
just by your being’
© 2015 John Wiley & Sons Ltd
3512 Journal of Clinical Nursing, 24, 3511–3518
J Mannix et al.
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nloaded from https://onlinelibrary.w
iley.com /doi/10.1111/jocn.12956 by Southern C
ross U niversity, W
iley O nline L
ibrary on [05/04/2023]. See the T erm
s and C onditions (https://onlinelibrary.w
iley.com /term
s-and-conditions) on W iley O
nline L ibrary for rules of use; O
A articles are governed by the applicable C
reative C om
m ons L
icense
Leading by example: ‘be seen in the clinical area’
It was evident from both the conversations and the written
accounts that for clinical leaders to be effective, they
needed to show leadership through being involved in day-
to-day activities in clinical settings. This required clinical
leaders to have a physical presence in the clinical area,
whether it involved, as one interviewee stated, a ‘walk
through every ward’ [I3], being ‘a resource person’ [I6] or
as one respondent wrote, ‘jump in and help do whatever
she can to help me get back on track’ [R12]. The view that
a clinical leader has ‘to be seen in the clinical area’ [I6] and
be seen ‘relating to other staff’ [I9] enables them to provide
support to colleagues in various situations, either to individ-
ual colleagues or collectively in the clinical workplace. In
some cases, it involved supporting colleagues who was
‘doing something new that they’ve never done before’ [I8],
while in other situations, it involved clinical leaders encour-
aging staff in the workplace. For example, providing sup-
port to less experienced colleagues can have a positive
effect on the nursing workplace, as one interviewee
recounted:
. . .[you] build up their confidence and hopefully that then encour-
ages them to be creative because we go through hard times in the
health system. Once you get staff who are confident and feeling
happy in their environment, supported in their environment, they
feel valued and all that sort of thing. [I5]
Creating positive workplaces required clinical leaders to
be visible and involved in activities in clinical settings. As
part of this visible presence was the capacity to effectively
communicate with colleagues, whether it involved ‘trying to
be collaborative, to see what they think, listen to them, lis-
ten to their concerns, because a lot of the staff have differ-
ent skill levels’ [I8] or around nonclinical workplace issues,
such as an incident of bullying reported by one respondent:
. . .the victim felt like she could not continue in her work in the
positive way she had always performed. This clinical leader sup-
ported her by communicating, listening, debriefing and discussing
moving forward with her work in a new and positive light, and
enabled strength in the person who previously felt disabled in prac-
tice. [R31]
Clinical leaders also needed to have sufficient knowledge
and skills to enhance workplace relations among colleagues.
As interviewees remarked, ‘they [colleagues] need to have
faith in you; they need to see you as a model . . . someone
to look up to, that kind of model’ [I6] and ‘if you’ve got a
goal or something you want to achieve, having the ability
to sort of bring that across to other staff so that they also
want to aspire to the same goal’ [I8]. At the same time, it
requires clinical leaders to respect their positional power
they may have and to recognise their limitations, as one
interviewee commented:
I think a good leader isn’t scared of power. They welcome differ-
ence of opinion. They welcome other ideas because a leader has
got to be able to say I don’t know all the answers and sometimes I
need to see outside the box. [I5]
It was also apparent that clinical leaders saw the impor-
tance of empowering colleagues and fostering teamwork in
the clinical workplace. Different strategies were employed
by clinical leaders to achieve this, including ‘following up
with the staff, making sure that they feel safe, empowering
the more junior staff, encouraging them to ask questions’
[I8], and producing a video involving staff, ‘to recognise
and acknowledge the great work done as individuals and as
a team’ [R4]. The importance of being involved with col-
leagues in the clinical setting was noted by a respondent
who wrote:
My clinical leader used aesthetic leadership skills to engage his staff
in frontline management work. The staff were asked what they
were passionate about, what drove them crazy every day? The clin-
ical leader them empowered the staff to improve these processes
and correct issues. [R17]
Leading with composure: ‘a sense of calm in a hideous
shift’
There was an awareness of the impact effective clinical
leadership had on the clinical environment, especially the
effect on staff demeanour. A number of interviewees spoke
of a ‘sense of calmness’ [I11] as an indication of effective
clinical leadership. This was summed up by one interviewee
who commented:
I think it [good clinical leadership] has a very calming effect. You
can walk on to a shift that is well led and you can also see the staff
breathe a sigh of relief because the modern clinical era – in public
hospitals now, the patients are so sick and there is so much that
the nurses are expected to do, that if a shift is a bit out of kilter
it’s just hell. [I7]
Composure from a clinical leader resulted in positive feel-
ings from staff with reports that clinical areas, although
when chaotic and busy there was a sense of a ‘harmonious
place’ [I8], of ‘organised chaos’ [I3], and ‘even if they’ve
got two MET [Medical Emergency Team] calls going at the
same time it still seems controlled’ [I7]. Also evident in
these busy clinical settings was a ‘sense of achievement’
© 2015 John Wiley & Sons Ltd
Journal of Clinical Nursing, 24, 3511–3518 3513
Original article Aesthetic leadership in clinical nursing
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nloaded from https://onlinelibrary.w
iley.com /doi/10.1111/jocn.12956 by Southern C
ross U niversity, W
iley O nline L
ibrary on [05/04/2023]. See the T erm
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iley.com /term
s-and-conditions) on W iley O
nline L ibrary for rules of use; O
A articles are governed by the applicable C
reative C om
m ons L
icense
[I7], getting ‘a very good feeling just by walking around
and seeing how people are interacting without them saying
anything to you’ [I3], and observing nursing staff ‘with
smiles on their faces’ [I9]. These attitudes and behaviours
tended to have a flow-on effect to how the clinical setting
functioned, as one interviewee noted:
it [ward] just runs, it ticks over, the staff are stable, they don’t
have the huge turnovers, in fact, sometimes there’s waiting lists to
get in because they are such a good cohesive team and some of
these wards you know, no matter what sort of day they have they
pull together, you know like it doesn’t matter if that’s not my buz-
zer or I’m sitting near this phone so I’ll answer it. [I3]
This type of composed leadership also resulted in a
heightened level of confidence among staff in the manage-
ment of clinical situations. As one interviewee com-
mented, the confidence shown by a clinical leader ‘gives
me confidence just to go out and do what I’ve been doing
but with even more confidence’ [I11]. Effective and com-
posed clinical leaders were able to instil confidence in col-
leagues and ‘foster relationships, respect and credibility’
[R10] among staff, as described in the following written
account:
Clinical leader delineated hierarchy and professional divides to cre-
ate an integrated clinic rehab service, brought clinicians, support
and admin staff together regularly and encouraged innovation to
redesign the service and support new pathways. [R23].
Similarly, leader composure was required to facilitate
positive attitudes among staff in a clinical area experiencing
change. In this situation:
. . .a number of colleagues were distressed by the challenges existing
services directed at them, to justify what they were doing and why.
. . .established reflective practice groups to enable active discussion
and feedback from each other regarding the implementation issues.
In facilitating the group I provided home baked goodies, and good
coffee, to enable staff to relax and enjoy the sessions as ‘separate’
to the daily demands of the job. [R6]
For those in clinical leadership roles, it was evident
that they recognised the effect they could have on a clini-
cal setting and that they needed to ‘have insight’ [I10],
‘be self-aware of their weaknesses and strengths’ [I5], and
realise their influence. Clinical leaders can provide stabil-
ity to a nursing team through their advanced knowledge
and skills and are able to ‘put out the little fires before
they become a big fire’ [I6]. This level of insight and
self-reflection was encapsulated by one interviewee who
remarked:
I’m maturing as a nurse leader, I’m learning to not take other peo-
ple’s negativity or criticisms personally, and recognising stress and
burnout in other people, and also trying to recognise it in myself,
but not taking other people’s negativity on. I think a positive out-
look is really important . . . to keep focused on what we’re trying
to achieve and just bringing it back to why are we actually all here
– working together and all those kind of things. [I9]
Leading through nursing values: ‘create an environment
just by your being’
The narrative accounts revealed that nursing values
around caring, professionalism and collegiality were
important elements in how clinical leaders demonstrated
aesthetic qualities in their day-to-day practice. As was
remarked, as a clinical leader ‘you should look profes-
sional, you’re a leader, people look to you’ [I10], and
‘the environment has a huge impact on their [patient/
staff] sense of well-being’ [I9]. Aspects of professionalism
evident among clinical leaders were reflected in a number
of areas, including expectations of how the clinical set-
ting presents and how one feels when in the area. As
one interviewee commented, ‘the ward looks neat, clean,
tidy, calm’ [I7] when a professional stance is taken by a
clinical leader. A clinical environment that presents in
this way can be reassuring to those entering the area, as
one interviewee remarked, ‘if things look organised, then
I know that someone’s on the ball’ [I9]. It can also foster
professionalism among those working in the area, as one
comment reflected:
I think when the environment’s right they [nursing staff] are
believed in and nurtured, I think pride in their appearance and the
ward’s appearance, and the aesthetic qualities follow . . . I think we
need to look at our appearance on the ward. What can we do?
You put it in such a way to get them to own it. [I5]
The way a clinical area presents can also have positive
effects on staff, as one respondent recounted a situation
where a clinical leader emphasised the importance of the
aesthetics on staff and patient comfort. As the respondent
commented, the new environment ‘increased the morale of
the staff and has improved patient care by both leaders and
staff being positive about their surroundings’ [R8]. In the
absence of a professional approach from clinical leaders, it
can be ‘visually assaulting just to walk in to the ward, with
so much ‘stuff’ on the walls, so many old notices and pos-
ters’ [I2] and give the appearance of being ‘very cold and
impersonal, just very untidy and overcrowded, a bit fac-
tory-like’ [I9].
© 2015 John Wiley & Sons Ltd
3514 Journal of Clinical Nursing, 24, 3511–3518
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ross U niversity, W
iley O nline L
ibrary on [05/04/2023]. See the T erm
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iley.com /term
s-and-conditions) on W iley O
nline L ibrary for rules of use; O
A articles are governed by the applicable C
reative C om
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icense
It was evident that the physical appearance of any clini-
cal setting was regarded as an important aspect to how
patient care was delivered and that a professional approach
from clinical leaders enhanced the patient and staff experi-
ences. It was also evident that such positive experiences can
stay with nurses and shape how they behave as clinical
leaders. An early nursing career experience with a dying
patient was recounted by one interviewee:
I just remember the room. There was aromatherapy burning. There
were low lights, flowers, family were there, music playing and it
was just a very peaceful, serene environment and it was just so dif-
ferent from anything in the acute hospitals that I’d experienced
before. We washed this lady and she was so fragile but just so
lovely. The nurse was very gentle and I thought: oh, this is really
nice. I thought: wow, what a privilege. How privileged was I that
the family let me come in at such an important time and it just
really struck me. [I9]
For clinical leaders, the importance of reflective practice
was evident in the way it affected their day-to-day clinical
practice, especially in relation to the delivery of patient
care. One interviewee reflected on how an earlier experi-
ence of observing a clinical leader affected how they
approached subsequent clinical situations:
. . . you walk into the patient’s room and it’s as though it’s their
space now and I think you’ve got the ability as a nurse to create an
environment just by your being, your presence and the way it’s not
about you and you can shove all that out the back and be that per-
son for the patient. I think if when I’ve observed people doing that,
I think that’s what I want to be like. That’s what I want to do,
you know. [I11]
Embracing nursing values around trust, equality and
advocacy by clinical leaders fostered collegiality in the clini-
cal workplace. One respondent remarked that in addition
to ‘being an advocate for staff and patients’ [R10], clinical
leaders can be a ‘link between them and administration’
[R10]. The importance of clinical leaders valuing colleagues
and acknowledging their contributions were also reflected
in the narratives. As was commented, good leaders were
those nurses ‘who mentored, who valued the juniors and
valued education and valued the patient, and are able to
transfer that information’ [I5], and acknowledge that ‘we’re
all equal, we work as a team’ [I10]. An example of how
clinical leaders can value colleagues was evident when a
clinical leader ‘acknowledged the positive difference having
music in the outpatient day setting had on the environment
and the mood in the department’ [R7]. Establishing trusting
relationships with colleagues and patients was also an
important value for clinical leaders to possess, as one inter-
viewee commented, ‘If people don’t like you or don’t trust
you, they’re not going to have a bar of what you’re going
to say or what you’re trying to bring across’ [I8]. Similarly,
the importance of trust was emphasised by another intervie-
wee who remarked, ‘If you lose trust, you’ve lost every-
thing, I think, as a clinical leader’ [I6].
The centrality of recipients of care shaped how clinical
leaders went about their day-to-day activities in clinical
areas. As one interviewee who worked in aged care com-
mented, ‘the residents should be the central point – that’s
what everything radiates out of, including the relatives and
the doctors’ [I2]. Patient-centred nursing care focusing on
comfort and hygiene was regarded as not only a reflection
of good nursing care but also of sound clinical leadership.
As evident from the narratives, when patients have their
hygiene needs attended to and the area around their bed
looking tidy, ‘they looked care for and that makes the
patient feel better’ [I1]. As a result of this, these ‘small
details humanise the patient into a person’ [R1], and these
values can be retained in an evidence-based environment.
One of the ways in which clinical leaders apply their
knowledge and skills to humanise patients while providing
care and comfort was recounted in a narrative describing a
situation where treatment was being withdrawn from a
brain dead patient in an intensive care setting. The way in
which the clinical leader expertly orchestrated the transition
from a highly clinical setting to a palliative care space so
the family could be with the patient when he died ‘was just
like watching an artist at work, . . . comb his hair and do
things so that he would resemble more like the person that
he really was’ [I11].
Discussion
The findings from the combined 12 interviews and 31 written
accounts reveal a rich narrative on how clinical leaders enact
aesthetic leadership in the clinical nursing world. It was
important for clinical leaders to be visible and accessible to
colleagues in the clinical setting and in doing so, practise with
a professionalism and competence reflective of nursing val-
ues. These findings support previous studies that have
reported the positive effect leader visibility has on the nursing
workplace (Cummings et al. 2008), as well as the preference
for clinical leaders to be accessible and approachable (Stanley
2014). Clinical leaders portrayed nursing values and a profes-
sional image through their actions and behaviours and in
doing so, influenced colleagues’ behaviours and shaped clini-
cal outcomes. This modelling of professionalism has flow-on
effects in clinical settings, especially for recipients of nursing
care. As Hatfield et al. (2013) report, patients have been
© 2015 John Wiley & Sons Ltd
Journal of Clinical Nursing, 24, 3511–3518 3515
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icense
shown to link nursing competence to a professional image,
including how they present and they interact with patients
and colleagues.
As would be expected in study involving participants from
a practice-based discipline, a number of the leadership attri-
butes to emerge from the findings had an obvious clinical
focus around clinical leader competence and also reflective
of the centrality of caring in nursing. Participants recounted
situations where the clinical skills and knowledge of the clin-
ical leader impacted positively on their own practice. It was
also apparent that for clinical leaders to be effective, they
were collegial and supportive in the workplace. Clinical lea-
der attributes focusing on clinical competence and collegial
support of followers have been reported previously (Stanley
2006, 2014, Mannix et al. 2013), but as Mannix et al. high-
light, most of the attributes previously reported are indica-
tive of the technical and practical skills and knowledge
required for clinical competence and leader effectiveness.
Technical and practical knowledge and skills have been
theorised by Habermas (1972) to be aspects of two of three
types of cognitive interests, empirical and interpretive
respectively, with critically oriented, emancipatory knowl-
edge and cognitive interests being the third. These emanci-
patory interests and knowledge facilitate the central notion
of self-reflection that enables an individual to critique exist-
ing systems and practices (Habermas 1972). In the current
study, attributes reflective of emancipatory knowledge and
interests are a feature in all three themes, especially where
nursing values and beliefs shape the practice of clinical
leaders. By practising self-reflection, clinical leaders have
demonstrated composure in their leadership activities that
instils confidence in colleagues and facilitates a positive
clinical workplace. This finding has not been previously
reported in the nursing literature.
The way in which aesthetic leadership is enacted by clini-
cal leaders as reported in this study revealed a number of
attributes. A comparison of extant leadership models
revealed some attributes common to other leadership mod-
els used in varying degrees in nursing (see Table 1).
From this table of leadership models, it is not surprising
that aesthetic leadership shares a number of attributes with
other leadership models that focus on moral behaviours
and are values-oriented, such as authentic, ethical and ser-
vant leadership (Mumford & Fried 2014). However, it is
evident that there are no similarities with transactional
leadership and few similarities with transformational lead-
ership, the most common leadership model in the nursing
discourse (Cummings et al. 2010). The similarities with
congruent leadership, the only leadership model specific to
clinical leadership in nursing (Stanley 2006), support the T a b le
1 C li n ic a l le a d er
a tt ri b u te s ev id en t in
le a d er sh ip
m o d el s
L ea d er sh ip
m o d el
A tt ri b u te s
A cc es si b le
&
a p p ro a ch a b le
C o m p o su re
&
ca lm
n es s
C li n ic a ll y sk il fu l &
k n o w le d g ea b le
C o ll eg ia l &
fo st er s
te am
w o rk
C re a ti ve
&
v is io n ar y
E m b o d ie s
d is ci p li n e v a lu es
E x p li ci t m o ra l
d im
en si o n
In si g h tf u l &
se lf -r efl ec ti v e
V is ib le
ro le
m o d el
A es th et ic
A u th en ti c
C o n g ru en t
E th ic a l
S er v an
t
T ra n sa ct io n a l
T ra n sf o rm
a ti o n a l
T a b le
d is ti ll ed
fr o m : C le a ry
et al . (2 0 1 1 ), H u tc h in so n a n d Ja ck so n (2 0 1 3 ), Ja ck so n (2 0 0 8 ), K a ls h o v en
et al . (2 0 1 1 ), L a d k in
a n d T a y lo r (2 0 1 0 ), M a n n ix
et al . (2 0 1 5 a ), S ta n le y (2 0 0 6 ).
S h a d ed
ce ll s in d ic a te
a tt ri b u te
ev id en t in
le a d er sh ip
m o d el .
© 2015 John Wiley & Sons Ltd
3516 Journal of Clinical Nursing, 24, 3511–3518
J Mannix et al.
13652702, 2015, 23-24, D ow
nloaded from https://onlinelibrary.w
iley.com /doi/10.1111/jocn.12956 by Southern C
ross U niversity, W
iley O nline L
ibrary on [05/04/2023]. See the T erm
s and C onditions (https://onlinelibrary.w
iley.com /term
s-and-conditions) on W iley O
nline L ibrary for rules of use; O
A articles are governed by the applicable C
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appropriateness of aesthetic leadership to clinical settings.
As shown in the table, leading with composure and calm-
ness were the only attributes not identified in any other
leadership model. While these attributes are unique only to
the model of aesthetic leadership, it has been found by
Ennis et al. (2014) that when clinical leaders remain calm
in a crisis in mental health settings, it positively contributes
to clinical practice.
Strengths and limitations
One strength of this study is the number of participant narra-
tives available for thematic analysis. Together, they provided
a rich source of data on aesthetic leadership. As with other
qualitative approaches to research a limitation of the study is
that the findings are not generalisable. Nonetheless, the find-
ings of the study contribute to an understanding of how aes-
thetic leadership is enacted by clinical leaders in nursing.
Conclusion
The way in which aesthetic leadership was portrayed in the
43 narratives analysed for this study illuminates how
effective clinical leadership can be practised in the nursing
workplace. The capacity for clinical leaders to be self-reflec-
tive was shown to positively influence the nursing work-
place. It was apparent that clinical leader effectiveness can
be enhanced with nursing values underpinning leadership
activities and by being a visible, composed role model in
the clinical workplace. While some of the attributes to
emerge from this study are apparent in other leadership
models, leading with composure is an attribute for clinical
leaders to consider in their practice.
Relevance to clinical practice
Aesthetic leadership was shown as a leadership model to
enhance clinical nursing workplaces. With aesthetic leader-
ship’s explicit moral purpose and strong link to nursing val-
ues, clinical leaders who incorporate these attributes with
being a visible, composed role model have the capacity to
improve the working lives of nurses across a range of clini-
cal settings.
Contributions
Study design: JM, LW, JD; Data collection and analysis:
JM, LW; Manuscript preparation: JM, LW, JD.
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