Relational Leadership in a Transactional World

By Rose O. Sherman, EdD, RN, NEA-BC

There is significant research evidence that a relationship leadership style (authentic, servant, and human-centered leadership) is linked to more effective recruitment and retention and quality patient outcomes. However, nurse leaders increasingly tell me staying relational is more complicated in a transactional healthcare environment. Consider the thoughts of a nurse manager:

I have always prided myself on a relational leadership style, but given the many demands of my time, I find this more challenging. My executive team keeps loading more non-clinical administrative responsibilities on my plate as other departments back off because of shortages. At the same time, I am being pressured to round on patients and families to improve my patient experience scores. Then, I am expected to pull data to look at my performance metrics and develop a performance plan if they fall. Whatever free time I have left is consumed by meetings. All this takes away from the time I spend in relationships with staff. At the same time, my staff is also more transactional with scheduling demands, complaints about pay, and negativity about their workload. I cannot remember when anyone asked me how I was doing.

Like many nurse leaders I have spoken with recently, the nurse manager above acknowledged she felt very burned out and was on what she described as a hamster wheel with no apparent way off. What is important is that she is reflective enough to see the change in her behavior—a default to being task-oriented as the stress accumulates.

Her fellow managers offered good support and guidance as we discussed her dilemma. One leader said, “You see relational leadership as an all-or-nothing approach where I see it as what I aspire to do but don’t do it 100% of the time. Sometimes, you need to be transactional, and the situation demands that. Other times, you need to be relational and will have to work to ensure you do that. Will you always be successful – no, you won’t.” 

This leader makes a strong point about choosing an approach. Nurse managers struggle to be everything to everyone today, and many feel like they are failing miserably. It is okay not to get it right every time, and sometimes, you will need to apologize because you have not used the right approach. Learning to flex your leadership style is an important skill you develop over time. Give yourself grace as you work valiantly to lead in this turbulent healthcare environment.

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