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. 2022 Mar 26;30(7):2216–2226. doi: 10.1111/jonm.13596

Nursing leaders' perceptions of the state of nursing leadership and the need for nursing leadership education reform: A qualitative content analysis from South Korea

Hae‐Ok Kim 1, Insook Lee 2,✉, Byoung‐Sook Lee 3
PMCID: PMC10078751  PMID: 35301786

Abstract

Aim

This study aimed to clarify nursing leaders' perceptions of nursing leadership education and practice.

Background

Leadership is an essential competency that is required in nursing practice. It is also necessary to pay more attention to the development of nurses' leadership to improve patient safety and outcomes.

Methods

Participants were 15 nursing leaders. We adopted qualitative content analysis for data collected through individual and/or focus group interviews and analysed using the process of coding, condensing and categorizing.

Results

The results revealed the following five major themes with categories: (1) nursing leadership—commitment to nurses, the nursing profession and the organisation; (2) nursing leadership abilities—competency and compatibility, personality and traits; (3) importance of nursing leadership education to enhance educational efficiency and to nurture next‐generation nursing leaders; (4) difficulties in nursing leadership education: lack of perception and difficulty of implementation; and (5) strategies for nursing leadership education: contents and methods.

Conclusions

Nursing leaders' perception of nursing leadership was extended to nurses, organisations and nursing professions. Competency, capability, innate personality and traits are required nursing abilities that are acquired through education.

Implications for Nursing Management

Experience and theoretical‐based nursing leadership education should be introduced gradually and systematically from the beginning of nurses' careers.

Keywords: education, leadership, nursing, qualitative research

1. BACKGROUND

Nurses play an important role in transforming health care; therefore, effective nurse leadership is required (Page et al., 2021). Rising medical costs, increased competition among medical institutions and high demand for quality medical services are particularly calling for the efficient management of medical institutions, subsequently increasing the demand for nurses with management and leadership skills (Berez et al., 2015). Due to the nature of their duties in collaboration with patients, medical personnel and multidisciplinary experts, nurses are expected to demonstrate leadership skills in various contexts. Furthermore, the National Academy of Medicine (NAM) in the United States emphasized that nurses should develop their leadership capabilities throughout their careers (NAM, 2011). A 2016 NAM report highlighted the need to improve nurses' leadership development to promote patients' safety and health outcomes (National Academies of Sciences, Engineering, and Medicine, 2016). However, nurses may not be afforded the opportunity to undertake leadership education to develop the skills and behaviours to effectively manage themselves, their patients and other health care team members (Page et al., 2021).

Leadership is defined as the process and ability of a leader to positively impact the achievement of an organisation's goals and to bring about changes in its members' behaviour (J. S. Kim, Kim, Jang, et al., 2015; Roussel et al., 2006). Within nursing contexts, leadership creates an environment that both influences nurses to improve the quality of nursing care and motivates and empowers them through a clear vision (Cook, 2001; Finkelman, 2012; Y. M. Kim, Kim, Kim, et al., 2015). It is a skill that improves the performance of the nursing organisation (J. S. Kim, Kim, Jang, et al., 2015). Effective leadership from management inspires positive behaviours in staff, such as organisational citizenship behaviours, further job satisfaction and organisational commitment (Cummings et al., 2018).

Education is necessary to continuously improve nursing leadership abilities (Cope & Murray, 2017). Moreover, nurses can effectively incorporate their leadership education into their nursing practices and enhance nursing organisations' performance, while advancing the profession by providing leadership opportunities (Curtis, de Vries, & Sheerin, 2011; Curtis, Sheerin, & de Vries, 2011). Accordingly, it is necessary to provide more systematic education to develop the leadership required in nursing practice. However, it is necessary to ensure that this systematic education specifically highlights nursing leadership, its relevant abilities and the corresponding strategies required to disseminate nursing leadership education from experts, to promote the leadership crucial to the practice. In particular, understanding the perceptions of nursing leaders who work in nursing administration and education is meaningful in that they can influence nursing leadership education.

Previous studies focusing on clinical nurses' nursing leadership have identified various types of nursing leadership: self‐leadership, transformational leadership and authentic leadership (Choi & Ahn, 2016; Lee & Kim, 2012; Miles & Scott, 2019). Additionally, quantitative studies have also examined the impact of nursing managers' leadership style on nurses' job satisfaction and organisational commitment (Choi & Ahn, 2016; Cope & Murray, 2017). Although some studies have conducted concept analyses of nursing leadership (S. M. Kim et al., 2019) and clinical nurses' leadership experiences (Lee et al., 2015), studies concerning nursing leaders' perceptions of nursing leadership and nursing leadership education are sparse.

Research should be conducted to examine nursing leaders' awareness of nursing leadership and nursing leadership education to develop systematic and effective strategies for nursing leadership education. This study aimed to clarify the perspectives of nursing leaders who have abundant experience as leaders in nursing management and education, regarding nursing leadership and nursing leadership education. This study provides useful information for constructing more effective and systematic nursing leadership education strategies by identifying nursing leaders' perceptions of nursing leadership and nursing leadership education.

1.1. Research purpose

This study aimed to clarify nursing leaders' perceptions of nursing leadership and its education. This study focused on the following questions selected through a literature review and expert group discussion: What is nursing leadership? What are the abilities required for nursing leadership? What is the importance of nursing leadership education? What are the difficulties in nursing leadership education? What are the strategies required for nursing leadership education?

2. METHODS

2.1. Study design

This study conducted a qualitative content analysis using the inductive approach of Elo and Kyngäs (2008) to understand nursing leaders' perception of nursing leadership. Qualitative content analyses provides a comprehensive understanding of the external and intrinsic meaning of given data and identifies the themes and categories through a systemic classification method (Choi et al., 2016).

2.2. Participants

According to Bandura's social learning theory (Grusec, 1992), learning occurs by interacting with others. Most nursing professors are performing the roles of leaders and teaching leadership in various fields of the nursing. They also have a profound impact on future nurses, that is, nursing students. Therefore, this study included nursing professors as nursing leaders. Participants in this study included a group of experienced nursing leaders who are qualified to discuss the topic. The following inclusion criteria were implemented for participant recruitment: (1) more than 20 years of clinical field experience as a nurse and (2) clinical nursing leader (director of nursing or team manager) or nursing professor with at least 10 years of relevant job experience.

We recruited participants using the snowball sampling method. Participants were nursing professionals, including nursing administrators, working in hospitals, faculty members of departments/colleges of nursing in universities, leaders of nursing professional organisations and nurses working in public institutions. Fifteen participants were recruited, with 12 (80%) having served as executive directors of nursing organisations, such as the Korean Nursing Association. Of these, seven (46.7%) nursing professor participants had clinical experience as nurses at tertiary university hospitals, while eight (53.3%) clinical nursing leaders were managers at secondary hospitals with over 500 beds. No primary hospital‐level nursing leaders were included.

2.3. Data collection

We conducted independent individual and focus group interviews (FGIs) with participants. We made the results more reliable by asking open‐ended questions to get the participants' unfiltered views on their lived experiences. A total of 10 face‐to‐face individual interviews were conducted spanning 1.5–2 h each. More details information that required explanation after the interview was obtained by individually contacting participants via telephone or email. A total of 17 follow‐up interviews were conducted; each participant was interviewed one to three times. The FGI was conducted with a group of five participants and lasted for 2 h and 20 min. Similar to the individual interviews, more details information that required explanation was obtained by individually contacting participants via telephone or email after the FGI.

The individual interview focused on the perceptions of nursing leadership and nursing leadership education, while the FGI focused on identifying the importance and problems of nursing leadership education and practical strategies and methods for implementing nursing leadership education. The FGI was employed to understand the perception of nursing leadership education to promote active discussions among participants through group interviews and obtain more diverse data on nursing leadership education.

Participants were informed of the study purpose and aim to ensure smooth interviews. We also informed them about the topics we wanted to explore and sent them the interview questions ahead of time by email or phone to give them the opportunity to consider their responses in advance and participate more fully.

We recorded participants' statements during the interviews and noted their main contents, thoughts and feelings. The FGI included six participants and lasted 2 h and 20 min. Data were collected between 28 November 2019 and 10 February 2020. We discontinued participant sampling when our interview data reached a saturation point where no new data were generated. All participants were women. On average, they were 52.33 years old (±6.33), had worked in nursing‐related jobs for 27.89 years (±6.47) and had been nursing leaders for 13.97 years (±3.77) (Table 1).

TABLE 1.

Participants characteristics (N = 15)

ID Interview type Professional position Highest education level Age (years) Affiliated institution Total nursing career (years) Nurse leader career (years) Leadership experience in a nursing professional organisation
01 FGD Professor Ph.D. 47 University 25.4 10.0 Yes
02 FGD Professor Ph.D. 53 University 21.0 10.0 Yes
03 II Team manager Masters 43 University and secondary hospital 20.4 10.0 Yes
04 II Director of nursing Masters 61 University and secondary hospital 39.1 20.8 Yes
05 II Director of nursing Masters 48 University and secondary hospital 25.5 12.0 Yes
06 II Team manager Ph.D. 50 Secondary hospital 28.0 15.0 Yes
07 II Professor Ph.D. 63 University 40.0 15.0 Yes
08 II School commissioner Ph.D. 60 Education office 28.0 20.0 Yes
09 II Professor Ph.D. 53 University and tertiary hospital 23.2 13.2 Yes
10 II Professor Ph.D. 52 University and tertiary hospital 30.0 16.0 Yes
11 II Director of nursing Masters 56 Secondary hospital 32.8 13.0 Yes
12 II Team manager Masters 52 University and tertiary hospital 28.0 12.6 No
13 FGD/II Unit manager Masters 43 Secondary hospital 20.0 10.2 No
14 FGD Professor Ph.D. 46 University 22.0 11.8 Yes
15 FGD Professor Ph.D. 58 University 35.0 20.0 No
M ± SD 52.33 ± 6.33 27.89 ± 6.47 13.97 ± 3.77
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Abbreviations: FGD, focus group discussion; II, individual in‐depth interview; M, mean; SD, standard deviation.

2.4. Data analysis

Data analysis was conducted in three stages: reading the transcribed data, gaining an overall understanding of the original data and then performing qualitative content analysis (Graneheim & Lundman, 2004). We coded key statements from the transcribed interviews after describing them as words or phrases that best expressed their content. Second, we condensed these words or phrases to be more abstract after grouping words or phrases created in the coding stage into concepts or phrases with higher abstractions and naming them with a code. Third, we created subcategories within the data according to the research themes and then reclustered them into more comprehensive and mutually exclusive categories.

2.5. Securing the validity of research results

We secured the validity of the results by considering their reliability, suitability, auditability and verifiability as presented by Lincoln and Guba (1985). The first analysis was shown to one of the two participants along with the original data, and by checking whether the results of the analysis reflected the interview, the reliability of the data analysis was secured. We validated the results by receiving and reaffirming feedback on it from the participants. We secured the validity of our results by selecting participants with extensive and meaningful experience as nursing leaders and collecting data until we reached a saturation point. Our data collection and analysis processes were described in detail in the event of an audit by two nursing scholars with extensive experience in conducting qualitative research. We quoted participants' statements directly below so that readers can verify our interpretations and analyses.

2.6. Ethical considerations

We obtained ethical approval from Kyungnam University's institutional review board (IRB; Approved No. 1040460‐A‐019‐055). Participants were made aware of the study's purpose and provided their informed oral and written consent before participating. Interview data were recorded with participants' permission, and the anonymity of transcribed interviews was guaranteed by assigning participants a number rather than their name.

3. RESULTS

We derived 11 categories and 25 subcategories from our analysis. They are also described in Table 2.

TABLE 2.

Perception of nursing leadership and leadership education among participants (N = 15)

Themes Categories Subcategories
Perceptions of nursing leadership Commitment to nursing Invigorating energy (Korean term Gi)
Establishing the environment for showing one's ability
Commitment to the nursing profession Practicing the basics of nursing
Becoming a bridge for the development of nursing professions
Commitment to the organisation Creating organisational performance
Directing members of the organisation
Abilities for nursing leadership Competency and capability Problem‐solving ability
Interpersonal relationship and communication skills
Organisational management skills
Personality and traits Human‐centred values
Self‐reflective mindset
Professional ethics and morals/ethics and morality as a professional
Mission for nursing
Importance of nursing leadership education To enhance educational efficiency To reduce trial and error
To improve the effectiveness of leadership competency
To nurture next‐generation nursing leaders To produce proactive nurses
To propose a nursing leadership model
Difficulties in nursing leadership education Lack of perception Lack of awareness about nursing leadership education
Barriers to nursing leadership
Difficulty of implementation Lack of organisational support and rewards a
Difficulties for narrowing the generation gap
Characteristics of strategies for nursing leadership education Contents Content inspiring dreams as a leader
Multidisciplinary and integrated content
Methods Cooperative experience‐driven education
Continuous and gradual education
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a

Clinical nurses.

3.1. Perceptions of nursing leadership

Perceptions of nursing leadership comprised three categories—commitment to nurses, commitment to the nursing profession and commitment to the organisation—and six subcategories.

3.1.1. Commitment to nurses

This category included ‘invigorating energy (Korean term Gi)’ and ‘establishing the environment for showing one's ability’. The former not only encourages nurses to endure complex nursing practice but also motivates nurses by giving precedence to their difficulties and taking care of them when they feel incompetent and confront problems in nursing practice. When new or junior nurses who lack nursing experience perform their work, ‘invigorating energy’ involves considering the expected difficulties in advance so that they can adapt well to the nursing practice and feel supported, thereby preventing them from leaving the job. The latter refers to the need to distribute work tasks correctly and fairly, have nurses help one another grow and develop as nursing professionals and provide them with various opportunities to demonstrate their abilities. ‘Establishing the environment for showing one's ability’ is about providing a better working environment for junior nurses and allowing them opportunities for professional development.

The new nurses are here, rather than just letting them go and saying, ‘Do it!’ Say, ‘What does he feel uncomfortable about?’ Like a mother taking care of a child … I think we should leave a happy nursing environment/nursing practice for our juniors. (Participant 13)

3.1.2. Commitment to the nursing profession

This category includes ‘practicing the basics of nursing’ and ‘becoming a bridge for the development of nursing professions’. The former refers to maintaining the basics of nursing practice by demonstrating their professional knowledge and skills as a fundamental principle of nursing and a bastion of patients' life and safety. It refers to creating a nursing‐friendly environment in order that nurses can work with pride without forgetting the essence of nursing as a profession. The latter refers to becoming a nursing leader and being dedicated to the nursing profession, preventing it from falling behind in the changing health and medical environment and creating harmony between different professions, interest groups and generations of practitioners. Participants recognized that nursing leadership encompasses multiple generations by conveying lessons learned from senior nurses and conveying junior nurses' opinions to senior nurses:

I think it is also important to instill a sense of duty about the importance of nurse work to do nursing well. This makes nurses focus on nursing practice. For good results for the patient, nurses should be guided in the right direction. (Participant 13)

3.1.3. Commitment to the organisation

This category includes ‘creating organisational performance’ and ‘directing members of the organisation’. The former refers to organising and leading organisational capabilities to understand and achieve organisational goals through problem‐solving strategies and enhancing organisational performance. The latter refers to presenting visions and goals to members of nursing organisations, sympathizing and moving forward, sharing values and experiencing achievements/results together to attain shared values. This prevents organisation members from getting lost in their work by presenting a clear vision and goals of the organisation. It can improve their work efficiency and induce high work performance:

If there is not leadership, the organization is like a ship floating in the open sea without a destination. A leader should present a vision of the organization's future, improve organizational engagement and satisfaction, improve the quality of care, lead to patient satisfaction, and ultimately improve the organization's performance. (Participant 4)

3.2. Abilities for nursing leadership

Abilities for nursing leadership comprised two categories—competency and capability and personality and trait—and seven subcategories.

3.2.1. Competency and capability

This category includes ‘problem‐solving ability’, ‘interpersonal relationship and communication skills’ and ‘organisational management skills’. The first includes nursing practice and expertise related to management: the various political, socio‐economic and environmental factors that affect nursing practice and the ability to leverage this expertise to think logically and critically, solve problems from a holistic perspective and present creative alternatives. The second refers to the ability to establish smooth interpersonal relationships between nurses and various other supportive professionals based on the ability to empathize and cooperate to ensure a win–win situation by maintaining this relationship. It also includes having the ability to use one's voice concerning nursing practice and to advocate for junior nurses and having sufficient energy/competence to be self‐assertive and to communicate and persuade others. The third refers to the ability to collaborate with, motivate and influence members of a given organisation through example. It also refers to the ability to read the flow of internal and external changes surrounding the organisation and to manage and wield these flows in a way that achieves the organisation's goals and changes arising from challenges:

As a leader, it is important to see the bigger picture and have comprehensive problem‐solving abilities that encompasses the whole. In other words, not only on a personal level, but as a nursing professional, you should be aware of all nursing and administration practices. Leading [a] ward is never easy. (Participant 11)

3.2.2. Personality and traits

This category includes ‘human‐centred values’, a ‘self‐reflective mindset’, ‘professional ethics and morals/ethics and morality as a professional’ and ‘a sense of a mission for nursing’. The first refers to the dignity of being a person who responds with sensitivity and empathizes with others based on an understanding of humankind and who faces, respects and cares for others with a warm heart and language. The second refers to having an honest and sincere heart, being humble enough to admit to your own mistakes and reflecting on and changing yourself to continue growing. It reflects a wide range of direct and indirect experiences and in‐depth contemplation. The third refers to building trust and taking responsibility for patients, fellow nurses and other medical professionals to promote patient safety. The fourth describes persistence, dedication and passion toward one's nursing work:

As a nursing leader, we need to be more error‐free than any other leader, more precise, and more detailed. I have to be passionate about nursing, take care of myself, and have the ability to do better ethically and morally. That's how you develop a high sense of duty as a nursing leader and with other like minded leaders, develop the nursing profession. (Participant 13)

3.3. Importance of nursing leadership education

Importance of nursing leadership education comprised two categories—to enhance educational efficiency and to nurture next‐generation nursing leaders—and four subcategories.

3.3.1. To enhance educational efficiency

This category contains ‘to reduce trial and error’ and ‘to improve the effectiveness and competency of leadership’. The first refers to the importance of inculcating leadership competency in nurses early on in their education from the preceptor curriculum to both prevent errors and shorten the period of nursing leadership competency development. The second refers to the importance of improving nursing staff's overall leadership levels by providing opportunities for nurses to develop their leadership competencies in a safe and supportive educational environment. Nursing leadership education is an opportunity for nurses to strengthen their nursing leadership capabilities and to adequately demonstrate the necessary leadership in the right places according to the situation:

The leadership course needs to develop leadership from the time preceptors educate new nurses. New nurses or preceptor nurses may still think that they are far from leadership and not leaders yet. It is necessary to instill such awareness as: ‘You are a leader!’ or ‘You are a leader during this practice!’ (Participant 12)

3.3.2. To nurture next‐generation nursing leaders

This category contains ‘to produce proactive nurses’ and ‘to propose a nursing leadership model’. The first refers to the need to train leaders who speak out in the nursing field and produce nurses who have a sense of duty for nursing. Participants said that improved nursing leadership education would allow them to develop creative problem‐solving approaches and coping skills that cannot be solved using knowledge only and, by extension, foster effective, influential and assertive nursing leaders. The second refers to the need to develop a new nursing leadership role model and study focused on inculcating leadership within nursing disciplines. Participants not only highlighted the importance of nursing leadership education for developing a sustainable flow of nursing leaders and role models and for fostering the next generation but also suggested that research is required to improve nursing leadership education and eventually propose a systematic model for it:

I think nursing leadership education is vital for the creation of a role model that I want to resemble in nursing leadership. I think we need leadership that reflects nursing characteristics; in this sense, we have used nursing leadership research in the fields of business administration and so on. However, it is also a unique aspect of nursing itself and requires the creation of a leadership model. (Participant 15)

3.4. Difficulties in nursing leadership education

Difficulties in nursing leadership education comprised two categories—lack of perception and difficulty of implementation—and four subcategories.

3.4.1. Lack of perception

This category includes ‘lack of awareness about nursing leadership education’ and ‘barriers to nursing leadership’. The first refers to the perception that there is no systematic form of nursing leadership education because the current educational methods of nursing leadership are largely theoretical and remote from practical nursing. The second refers to the reality that there are cultural or institutional barriers to cultivating leadership within the nursing profession even if nurses want to exercise nursing leadership—that managers and institutions prefer obedient and compliant nurses rather than leaders. In particular, these realities are reflected in nursing education:

These days in the industry, ‘Listen to me carefully!’ ‘Be a yes man!’ ‘Do not look like you are standing out!’ ‘If I stand out, I am the target!’ ‘Adapt well to the hospital situation!’ and say, ‘Yes, I understand’, and tell them to ‘Do well for the hospital without showing your personality’. In my opinion, this organizational culture is designed to prevent nurses' leadership (Participant 2)

3.4.2. Difficulty of implementation

This category includes ‘lack of organisational support and rewards’ and ‘difficulties in narrowing the generation gap’. The former refers to the lack of institutional support and adequate compensation for nursing leadership education efforts. Participants cited a lack of financial support to properly perform nursing leadership education and institutional support, such as recognizing individual performance based on leadership education. The latter refers to the fact that it is difficult to narrow the generational gap between nursing managers and junior nurses. The generational and cultural differences between nursing leaders and junior nurses make nursing leadership education more difficult:

I think there is a generational gap each year. Now, students are getting much information from videos on their smartphones, and our older generation, professors, were taught the concepts a long time ago, so it does not make sense. That is why leadership education is increasingly difficult. (Participant 2)

3.5. Characteristics of strategies for nursing leadership education

Characteristics of strategies for nursing leadership education comprised two categories—contents and methods—and four subcategories.

3.5.1. Contents

This category includes ‘content inspiring dreams as a leader’ and ‘multidisciplinary and integrated content’. The former refers to exploring a vision of the future, a view of the whole and a model of nursing leadership. Nursing leadership education intends to instil dreams and hopes in juniors by including the future nursing vision and nursing leadership's role models. The latter refers to a pedagogical approach of linking and converging nursing education with other disciplines to engage alternative ideas and perspectives:

Leadership education should be understood as an integrated concept, and such a curriculum is needed. This kind of networking will be good, not with nursing students, but with engineering students or design students. That way, students' vision will not only be buried in nursing only and they will be able to expand their vision. (Participant 14)

3.5.2. Methods

This category includes ‘cooperative experience‐driven education’ and ‘continuous and gradual education’. The former refers to a pedagogical approach of learning collaboratively and actively in actual situations; taking the initiative to problem‐solve; and working by sharing activities with colleagues, seniors, juniors and people in other disciplines via group activity. The latter refers to the need to begin nursing leadership education as early as possible in nursing college. Participants noted that they should implement nursing leadership education continuously and in a step‐by‐step manner:

Mentoring, tutoring, and team tasks are also used as part of leadership education. The most important thing is to show leadership in the confronted situations with support. (Participant 10)

4. DISCUSSION

Our participants recognized nursing leadership as a multidimensional and wide‐ranging concept that applies to all nurses' and organisations' practice, performance and professional development. Participants possessed a much broader understanding or perception of nursing leadership compared with previous studies' participants, who defined nursing leadership as directly participating in clinical care and influencing others to improve the quality of care or creating an environment to motivate and empower employees with a clear vision (Cook, 2001). This might be because these previous studies interviewed clinical nurses, rather than leaders in the profession as our study did. We suggest that experienced leaders have a broader view of leadership. Although some other studies defined leadership through an organisational lens by focusing on leadership vis‐à‐vis problem‐solving, professional duty and development (Lee et al., 2015), our findings show that nursing leaders' perceptions of nursing leadership consider both organisational performance and professional development and are focused largely on improving these aspects of nursing.

Our findings also suggest that our participants prized a particular kind of cooperation, communication and relationship building between nurses and medical support professionals based on empathy. Participants highlighted the importance of making their voices heard—a result that is unique to our study. These results indicated that our participants prized particular personality traits that help foster strong interpersonal relationships as a key leadership quality. The competency and capability of nursing leaders represent the minimum qualifications that a nursing leadership should possess.

These results are largely corroborated by previous studies, which have found that beyond clinical expertise, problem‐solving and so on, nursing leaders' interpersonal and relationship‐building skills are key markers of their effectiveness (Curtis, de Vries, & Sheerin, 2011; Finkelman, 2012; J. S. Kim, Kim, Jang, et al., 2015; Y. M. Kim, Kim, Kim, et al., 2015; Patrick et al., 2011). Leaders' ability to build relationships and foster effective communication with other professional departments has also been identified as an important indicator of their effectiveness. In particular, it should be noted that the most cited competencies for nursing managers' leadership capabilities in scoping reviews are communication and financial management (González‐García et al., 2021). Nursing leaders should be charged with overseeing the operations of the organisation (budgets, facilities and human resources), sustaining the organisation's missions and representing the department of nursing within the greater hospital.

Nursing leadership education is required to foster these qualities, in particular, smooth cooperation experience and self‐assertion training requires further strengthening. These leadership goals are aligned with the current predominating concepts of transformational leadership (Afsar & Masood, 2018; Giddens, 2018) and authentic leadership (Alilyyani et al., 2018). Because all our participants were women, we believe that there is a gendered dimension to perceptions of leadership. Our participants prized warm and inclusive leadership styles that address the unique characteristics of the nursing profession. However, in reality, nursing leadership in South Korea is male dominated and does not have the same focus on cooperation and inclusivity.

Participants stated that nursing leadership education can contribute to the nursing organisation's effective performance by reducing the period of nursing leadership competency development and improving the overall leadership level of nursing staff. They also highlighted the need to groom next‐generation nursing leaders and role models who are both aware of the changing needs of the nursing profession today and can tailor their leadership education to nursing‐specific contexts. Participants did not explicitly refer to student leaders but said that it is important to educate nursing students about the role and implementation of leadership and provide them with opportunities to demonstrate this skill. Nurse managers play an important role, not only in ensuring their own leadership capabilities, but also in fostering the leadership capacity of the next generation of nurses (Page et al., 2021). Having an awareness of nursing leadership and nursing education is important in the field of clinical nursing. Nurse practice leaders can contribute to the clinical learning of nursing students and nurses by being responsible for educating them in clinical practice and becoming role models as nursing leaders.

These results are largely corroborated by previous studies, which suggest that all nurses—not just managers—should have leadership‐specific training (J. S. Kim, Kim, Jang, et al., 2015). Our participants' insistence on ‘making their voices heard’ as a means of improving nursing leadership education is mirrored in some studies that suggest that self‐leadership and communication are key competencies of high‐performing nurses (Im et al., 2012). Understanding what comprises a successful leadership programme would enhance leadership capacity building across the nursing profession (Page et al., 2021). We suggest that to improve nurses' sense of belonging to an organisation, strengthen their communication skills and build their self‐leadership skills, nurses require both educational initiatives and more comprehensive and active support from hospitals and nursing organisations.

The difficulties in nursing leadership education indicate that there is no systematic nursing leadership education, that such education is largely theoretical and remote from nursing practice and that practitioners observe various institutional barriers to making systemic changes. These results are largely corroborated by previous studies that maintain that nursing leadership education needs to be taught and updated continuously in university curricula and clinical institutions, and throughout nurses' careers, because nursing leadership is a journey that begins at nursing college (Curtis, Sheerin, & de Vries, 2011; Jefferies, 2018). Other studies have suggested that there is a lack of systematic nursing leadership education and nursing students lack practical nursing leadership in clinical practice, even if they become clinical nurses after graduation (Al‐Dossary, 2017). Therefore, nursing colleges' curricula and nursing professionals' continuing education should be amended to raise awareness of the importance of leadership, provide support for professional development initiatives and work to implement nursing leadership education.

The content of such educational efforts should inspire a new generation of leaders to work together; thus, a multidisciplinary approach emphasizing the need for practical knowledge and collaborative problem‐solving across multiple disciplines should be implemented throughout the curriculum. Such efforts should be sensitive to nurses' experience, field of specialty and the ever‐changing nature of medicine and should be conducted continuously, step by step and regularly, similar to ‘getting wet in the drizzle’. These findings are largely corroborated by studies in the literature that suggest that practical education is better at fostering nursing leadership (Curtis, de Vries, & Sheerin, 2011). According to the results of Alilyyani et al. (2018), nursing leadership development in undergraduate education should include a focus on authentic leadership to serve as a foundation for effective leadership by preparing students. The competencies of authentic leadership will enable them to become effective practitioners and potential future leaders. Given the centrality of nursing leadership to effective nursing practice, we suggest that nursing educators integrate continuous and practical leadership into nursing curricula. Some studies have suggested that a discussion‐based (J. Kim et al., 2011) or situated learning model (Ailey et al., 2015) could be helpful in this respect. Others have suggested that peer‐mentoring programmes can help nursing students experience leadership and develop their leadership skills (Bright, 2019). In general, both the literature and our participants suggest that traditional, lecture‐based education does not breed leadership or help students internalize what they have learned and make considerable behavioural changes.

Bloom's new classification method is a step‐by‐step approach to education that helps the capabilities of application, analysis, evaluation and creation beyond simple memory and understanding (Krautscheid, 2008). In other words, applying learning methods such as effective leadership analysis or demonstrating leadership through teamwork activities using situation‐oriented learning or action learning for effective nursing leadership education can help develop a higher level of application and analysis at Bloom's stage. Nurses will be able to identify and judge the changing patient's condition using logical reasoning and demonstrate necessary nursing leadership. Because the process of demonstrating nursing leadership is not just a level of memory or understanding, students should apply the practice or role play as an education method to identify important nursing problems and demonstrate the nursing leadership necessary to solve them through nursing scenarios. If students implement a nursing leadership education programme to demonstrate the necessary leadership through nursing cases, it will be effective as it will comprise the stages of application, analysis, evaluation and creation, which is the upper level of Bloom's new classification.

In summary, ‘invigorating energy’ and ‘establishing the environment for showing one's ability’ reflects the commitment of nursing leadership to educational strategies aligned with transformational leadership that comprises idealized influence, inspirational motivation, intellectual stimulation and individual consideration. Furthermore, ‘human‐centred values’, ‘self‐reflective mindset’, ‘professional ethics and morals’ and ‘a calling to nursing’ as part of nursing leaders' personalities and traits correspond to authentic leadership. Therefore, nursing leadership should pay attention to transformational leadership or authentic leadership among various nursing leadership types, and nursing leadership education at academic and clinical levels should be focused on to assist leaders to perform well.

4.1. Limitations

This study examined nursing leadership and effective measures of nursing leadership education based on Korean culture/sentiment. Hence, the perception of universal nursing leadership and suggestions for nursing leadership education may be limited. In future research, it is necessary to explore the universal perception of nursing leadership and effective methods of nursing leadership education through cross‐national research projects with different cultural backgrounds.

We suggest that although nursing education and leadership can be improved through educational reform, further research on nursing leadership needs to be conducted from a different perspective to establish the ideal content and format of nursing leadership education. We also suggest that future researchers develop and verify nursing leadership education programmes suitable for the ever‐changing nursing and medical environment and intergenerational study. This includes the use of virtual reality and other digital technology suitable for the fourth industrial revolution. Delphi and survey research on nursing leaders to develop effective leadership education strategies should be performed.

5. CONCLUSIONS

Nursing leaders view nursing leadership as a broad, multidimensional concept and are keenly aware of the importance of education in its improvement over the long term. They also realize that there are some institutional and practical obstacles to implementing effective nursing leadership education. During interviews, our participants suggested various pedagogical content and methodologies that should be gradually, steadily and repeatedly applied in any reform or intentional application of nursing leadership education. In general, our nursing leaders felt that effective leadership is essentially encouraging in character, and they recommended that steps be taken to improve and ensure encouraging, empathetic communication and relationship building between nurses, nursing professionals, hospitals and other organisations.

6. IMPLICATIONS FOR NURSING MANAGEMENT

This study contributes to the literature by making the first attempt to gather nursing leaders' opinions and perspectives on nursing leadership, the role of education in improving nursing leadership, and suggesting future directions for such education. These results can help develop a more practical nursing leadership education system to foster leadership behaviour. Experience‐based and theoretical nursing leadership education should be introduced gradually and systematically from the beginning of nurses' careers.

CONFLICT OF INTEREST

The authors report no actual or potential conflicts of interest.

ETHICAL APPROVAL

Ethical approval was obtained from a Kyungnam University's IRB (No. 1040460‐A‐019‐055). The researchers explained the study purpose to the participants, and all participants gave informed oral and written consent before participating. The study was carried out in accordance with the 1995 Helsinki Declaration and the ethical standards of National Research Committee.

ACKNOWLEDGEMENTS

We are grateful to all the nursing leaders who volunteered to participate in this study and thank the IRB, who approved the research. The authors received no specific funding for this work.

Kim, H.‐O. , Lee, I. , & Lee, B.‐S. (2022). Nursing leaders' perceptions of the state of nursing leadership and the need for nursing leadership education reform: A qualitative content analysis from South Korea. Journal of Nursing Management, 30(7), 2216–2226. 10.1111/jonm.13596

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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