Authentic Leadership—A Concept Analysis

ABSTRACT

Aim

To report an analysis of the concept of authentic leadership.

Design

Concept analysis.

Data Sources

Data sources included core databases: CINAHL, PubMed, Embase, ProQuest, APA PsycINFO, ERIC, ABI/Inform and Tomlinson's Nursing Core Collection (2010).

Methods

Walker and Avant's method was used to identify descriptions, antecedents, consequences and empirical referents of the concept. Model, related and contrary cases were developed.

Results

Defining attributes were identified as self‐awareness, transparency, balanced processing, internalised moral perspective, caring, shared decision making and moral/ethical courage. Antecedents were authenticity, positive psychological capacities, life experiences, leadership development programme, supportive organisational climate and an ethical climate. Consequences are employee well‐being and satisfaction, positive work environment and enhanced performance and safety.

Conclusion

While authentic leadership is an emerging and popular leadership approach, there are gaps in relation to agreed definitions. Moreover, core textbooks within the subject area also fail to provide these definitions. This concept analysis represents the first comprehensive and robust analysis of the concept of authentic leadership that will serve to reliably inform research, education and practice.

Implications for the Profession and/or Patient Care

This analysis reveals that authentic leadership can have a positive effect on staff well‐being and satisfaction, their work environment, performance and ultimately safety. This has potential for a positive impact on patient care and patient outcomes by fostering an ethical and supportive work environment.

Impact

This study revealed a new comprehensive understanding of authentic leadership that provides conceptual clarity that will guide research and practice in the field, which refines the existing understanding, highlighting essential attributes and their relevance in nursing practice.

Patient or Public Contribution

No patient or public contribution.

1. Introduction

The professionalisation of nursing has been an ongoing process over the past century (Glasper 2020). Initially focusing on standardising core nursing competencies and professional regulation, and culminating in university‐based education, greater autonomy and recognition and advancement of nursing roles (Gilliss et al. 2021). One area that has received increasing attention during this journey of professionalisation is the need for advancing the scholarship and practice of leadership in nursing (Kim, Lee, and Lee 2022). As the profession has grown and developed, so too has the volume of research and publication across many domains, but especially in relation to leadership (Scully 2015). At the same time, despite the recognised importance of leadership development at all levels in nursing practice, and a considerable amount of published material that addresses this issue (Scully 2015), research that explores the impact of different approaches to leadership is very sparse in nursing (Ystaas et al. 2023). Overall, there has been a heavy reliance on proposing theories of leadership for nursing practice, but limited evidence of the effectiveness of these.

At the same time, transformational leadership is one of the most popular recommended approaches (Ystaas et al. 2023). Included, for example, as a recommended approach within Magnet hospital status (Moon, Van Dam, and Kitsos 2019). However, its implementation has focused very much on being recommended as useful in practice, rather than emanating from a strong empirical basis. Moreover, the literature is replete with studies, such as Moon, Van Dam, and Kitsos (2019) that describe the attributes of transformational leadership among leaders, without any substantive exploration of its impact in practice. Moreover, systematic reviews that explore the impact of transformational leadership, while highlighting supportive elements for nurses and the healthcare environment, do not demonstrate any significant overall benefit to excellence in healthcare or patient outcomes nursing (Ystaas et al. 2023). Consequently, the significant gaps that exist in the context of the overall impact of transformational leadership in nursing lead authors to conclude that significant gaps in leadership still exist, and particular attention is needed to enhance nursing leadership so that it improves patient safety and healthcare cultures (Ystaas et al. 2023).

Certainly from a nurse's perspective, the reality and experience is that a task‐focused, authoritarian leadership style still exists, despite the widespread advocation of transformational leadership (Poels et al. 2020; de Vries and Curtis 2018). Thus, transformational leadership emerges as an aspirational rather than a tangible approach to leadership for nursing. Panczyk et al. (2019, 694) attribute this failure in transformational leadership to the focus of this leader on vision and purpose, rather than the more personalised and ‘deep sense of self [and] expression of a position’ that describes the authentic leader. In general, leadership theories proposed for nursing practice over the past decades have had this broad focus on creating a singular vision for others to follow (Kok et al. 2023). Moreover, nurse leaders confirm their experience of learning about leadership as mostly theoretical and aspirational:

‘current educational methods of nursing leadership are largely theoretical and remote from practical nursing’ (Kim, Lee, and Lee 2022, 2222)

This may be because leadership advice was aimed at senior managers who have less close contact with practice, and thus perhaps a more philosophical rather than practical approach was useful (Al‐Dossary 2017). This failure of transformational leadership to have the planned effect resonates throughout the literature. Indeed, the Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing as far back as 2011 (2011, 222) proposed ‘a new style of leadership’ to address nursing and healthcare in this increasingly complex age. Filling this vacuum and indeed gaining increased popularity over recent decades is the concept of authentic leadership (Panczyk et al. 2019). It is thought that this style of leadership is particularly apt when healthcare organisations are confronting increasing challenges in managing their workforce due to political instability, staff shortages and financial restrictions (Panczyk et al. 2019).

Certainly, a number of different definitions of leader authenticity or authentic leadership have been developed (Gardner et al. 2011), drawing from disciplines such as psychology (Avolio and Gardner 2005). However, no single agreed‐upon definition of authentic leadership emerged among these scholars (Northouse 2018). Moreover, existent definitions lack conceptual depth that negates robust empirical investigation. Walumbwa et al. (2008), for example, whose team developed an instrument to measure authentic leadership, the Authentic Leadership Questionnaire (ALQ), provided only a brief definition. Thus, authentic leadership is described as a pattern of leader behaviours that draws upon and promotes both positive psychological capacities and a positive ethical climate to foster greater self‐awareness, an internalised moral perspective, balanced processing of information and relational transparency on the part of leaders working with followers, fostering positive self‐development (Walumbwa et al. 2008). In similar terms, Barbosa (2018) described authentic leadership as a leadership behaviour that cultivates positivity, optimism, hope and trust. Read and Laschinger (2015) suggested that authentic leadership is characterised by four core behaviours: balanced processing, relational transparency, an internalised moral perspective and self‐awareness. Srivastava and Dhar (2019) further defined authentic leadership as the leader's ability to influence followers' attitudes through commendable behaviours such as transparency in relationships, displaying behaviour that aligns with the leader's own beliefs and values and rendering fair decisions. However, none of these definitions provided any greater conceptual depth beyond simply a definition. This lack of conceptual clarity affects the understanding and application of authenticity and importantly hampers robust research in the field.

Thus, the impetus for considering a concept analysis of authentic leadership relates to the growing interest in the importance of authentic leadership and yet the lack of consensus in existing definitions, and overall limited conceptual understanding. Moreover, having an empirical basis for the implementation of a successful leadership approach in nursing requires attention to ongoing research in the field. This research would be strengthened using consistent definitions as a reference point. Moreover, conceptual analysis of the topic provides a more detailed and nuanced understanding of the topic, beyond simply definitions. This helps researchers in the field but can also serve to support a more robust approach to education and practice in the field.

2. Background

2.1. The Requirement for Authentic Leadership

Contemporary healthcare settings are increasingly complex and fraught with problems such as staff shortages and burnout (AONL 2023). This requires a more dynamic and responsive leader. These occurrences are well documented (AONL 2023) and beginning to encourage nurses and scholars alike to call for a more responsive, ethical and authentic relational style of leadership. Indeed, the American Organisation for Nursing Leadership (AONL 2023) recent survey of more than 2500 nurse leaders across the United States has found that nurses' well‐being is a top priority for leaders. Moreover, leaders recognise that significant challenges exist, and indeed lie ahead. Qualitative data from this study indicated that leadership for nursing was a considerable challenge, notably how to effectively support nurses during these challenging times (AONL 2023). They also noted that participants held concerns about staffing and developing an optimal organisational culture (AONL 2023). Specific concerns included:

‘concerns prevail about workplace violence, health equity, social determinants of health’ (AONL 2023, 13)

In this context, the notion of an authentic leadership assumes a high value:

‘When employees perceive that the leader is authentic, leads sincerely and openly, and emphasizes the transparency of the working relationship with employees, this will make them feel the presence of a natural leader and direct them to positive behaviors’ (Indrayanti and Ulfia 2022, 12)

Another important point to add to this perception of transparency and openness, when considering leadership styles that are suited to the future of healthcare, is the contemporary focus on ensuring equity across healthcare (AONL 2023). An analysis of traditional leadership models for nursing finds them inadequate in fully enabling the addressing of equity issues (Nikpour et al. 2022).

‘While there are a variety of frameworks available to guide leaders in examining their leadership knowledge, skills, and competencies few of these frameworks emphasize the inner self of the leader and the tremendous influence of culture and context on the development of leaders in nursing’ (Nikpour et al. 2022, s11)

Moreover, given ongoing concerns about ensuring optimal patient care in the context of staff shortages and other constraints and growing concerns about equity and dignity in healthcare, staff are increasingly drawn towards a leader with ethical outlook (Ystaas et al. 2023), something that is a central focus of authentic leadership. Although ethical competencies are an essential requirement for nurses, there has not been a central focus on ethics as an essential prerequisite for nurse leaders. Kok et al. (2023, 7) note the desire of leaders with

‘intrinsic motivation to provide good care gives them the courage to challenge fixed structures and vested ideas by experimenting how things can be changed or by proposing new ideas’.

Similarly, nurses in Kim, Lee, and Lee's (2022) study expressed the desire for relational skills and ethical leaders. This notion of an ethical leader is important. An analysis of patterns and trends of leadership in one nursing journal (Timmins 2020) revealed, for example, that publications on nursing leadership often focused heavily on describing approaches to leadership, the ‘how to’, with little emerging advice on the effect of this. Moreover, key elements of the role of nurse leaders such as ethical decision making, policy, innovation and conflict management (Weberg et al. 2018) were almost completely overlooked (Timmins 2020). Indeed ‘courageous, robust and moral nursing leadership has come to increased prominence as a means of addressing many of the problems faced by health services’ described by these authors as ‘intractable problems’ (Hutchinson et al. 2015, p. 3022). Indeed:

‘the time has come for a more comprehensive and contemporary interpretation of nursing leadership—one taking into account the modern complexities and environment in which nurses function’ (Scully 2015, 442)

Authentic leadership has a lot to offer in this regard (Indrayanti and Ulfia 2022; Zhang et al. 2022). Authentic leadership has important contributions to contemporary nursing due to its potential to address challenges by fostering a positive work environment and promoting quality care (Fallatah and Laschinger 2016).

2.2. Benefits of Authentic Leadership

Described as an ‘emerging approach in nursing’ (Best 2022, 4), authentic leadership appears to have potential for positive impact on quality care and patient satisfaction (Tate et al. 2023; Wong and Giallonardo 2013), nurses' perceptions of safety (Dirik and Seren Intepeler 2017), safety actions (Labrague, Sulaiman Dawood Al, et al. 2021), adverse patient outcomes (Wong and Giallonardo 2013) and social capital (Kida, Yumoto, and Ogata 2023; Read and Laschinger 2015). A recent review found positive benefits in nurses' job satisfaction, work engagement, work commitment, well‐being and patient outcomes (Maziero et al. 2020). While there has been limited attention to impact on interprofessional working, older studies demonstrate positive effects (Regan, Laschinger, and Wong 2016). Other studies have similarly found a positive effect on work engagement (Lv et al. 2022; Bamford, Wong, and Laschinger 2013).

Importantly, the relational aspect of this style is foremost, and influential, with an ‘unmistakeable focus’ on relational aspects of leadership (Wong and Cummings 2009, 534). Authentic leadership is promising in terms of delivering on relational and ethical aspects of leadership, making it particularly relevant in the context of modern healthcare environments where nurses' well‐being is crucial. First introduced as a general leadership concept by Avolio et al. (2004) (Maziero et al. 2020), authentic leadership in nursing was popularised through the seminal work of Wong, Laschinger, and Cummings (2010). Indeed, Wong (2008) in her original PhD thesis describes the genesis of this work, and how the work of Avolio et al. (2004), who described and measured authentic leadership, was explored for use in nursing leadership and practice. It is now recommended as the foremost and most promising approach to leadership that has potential for long‐term positive benefits on individual nurses and the healthcare environment (Doherty and Hunter Revell 2020).

Zhang et al.'s (2022) meta‐analytic review found that authentic leadership has a positive effect on many elements of importance for nursing practice: organisational commitment, psychological empowerment, work engagement, psychological capital, psychological safety, job autonomy, thriving, job satisfaction and workplace trust. Kinnear and Dryden‐Palmer (2014) found in their 5‐year improvement plan that authentic leadership reduced turnover and improved staffing levels. Staff engagement, which had previously been below what was expected, also improved with this implementation project. These authors also found substantive improvements in practice, notably a 30% reduction in cancelled surgeries and a huge improvement in deferrals, which were almost down to zero.

2.3. Definitions of Authentic Leadership

The concept of authentic leadership emerged in the early 2000s, driven by the increasing recognition of ethics and integrity in leadership. Two seminal works laid the foundation: Luthans and Avolio (2003) and George (2003). Luthans and Avolio (2003) defined authentic leadership as a process drawing from positive psychological capacities and a developed organisational context, resulting in greater self‐awareness and self‐regulated positive behaviours. George (2003) described authentic leaders as those with a deep sense of purpose, solid values and a focus on empowering others. As the concept gained traction, various definitions and conceptualisations emerged. Walumbwa et al. (2008) defined authentic leadership as promoting positive psychological capacities and an ethical climate to foster self‐awareness, an internalised moral perspective, balanced processing of information and relational transparency. While there was general consensus on core elements like self‐awareness and moral perspective, debates arose regarding the precise definition, measurement and operationalisation of authentic leadership.

Key debates included whether authentic leadership should be treated as a higher‐order construct encompassing its components or as a pattern of distinct dimensions (Avolio and Gardner 2005). The role of positive psychological capacities and organisational contexts was also debated (Luthans and Avolio 2003). Additionally, questions about the developmental nature of authentic leadership and whether it could be learned or not was an innate trait that emerged (Avolio and Walumbwa 2014). Despite these debates, gaps clearly remain regarding aspects of the nursing leaders' role that are yet unexplored.

Despite calls for the development and advancement of authentic leadership, and the availability of several measurement instruments (Panczyk et al. 2019), there is little clear focus on conceptual definitions of this topic in the nursing literature. Moreover, exact definitions are illusive. Both Walumbwa et al. (2008) and Wong and Laschinger (2013) are key researchers in the field. Certainly, a number of different definitions of leader authenticity or authentic leadership have been developed (Gardner et al. 2011), drawing from disciplines like humanistic psychology and positive psychology (Avolio and Gardner 2005). However, no single agreed‐upon definition of authentic leadership has emerged among these scholars (Northouse 2018).

According to Walumbwa et al. (2008, p. 90), whose team developed an instrument to measure authentic leadership, the ALQ, which is a pattern of leader behaviours that draws upon and promotes both positive psychological capacities and a positive ethical climate to foster greater self‐awareness, an internalised moral perspective, balanced processing of information and relational transparency on the part of leaders working with followers, fostering positive self‐development. In similar terms, Barbosa (2018) describes authentic leadership as the leadership behaviour that cultivates positivity, optimism, hope and trust. Similarly, Read and Laschinger (2015) suggest that authentic leadership is characterised by four core behaviours: balanced processing, relational transparency, an internalised moral perspective and self‐awareness. Srivastava and Dhar (2019) further define authentic leadership as the leader's ability to influence followers' attitudes through commendable behaviours such as transparency in relationships, displaying behaviour that aligns with the leader's own beliefs and values and rendering fair decisions. These definitions, while explicit, are varied with little consensus emerging.

While measurement and examination of authentic leadership is current and ongoing, recent studies such as Tate et al. (2023) while finding a positive impact of authentic leadership on quality care and patient satisfaction, did not provide an operational definition of authentic leadership to guide the study. These authors did; however, utilise the ALQ devised by Walumbwa et al. (2008), whose definition appears earlier, and perhaps it is this that guided the study. However, it is concerning that research and measurement are ongoing in the absence of a clearly agreed definition, especially as definitions provided are quite nebulous, diverse and inconsistent. Wong & Laschinger (2013, p. 947) also utilised the ALQ, citing an operational definition as follows: ‘leaders who are more authentic draw on their life experiences, psychological capacities (i.e., hope, optimism, resilience, and self‐efficacy), a sound moral perspective, and a supporting organizational climate to produce greater self‐awareness and self‐regulated positive behaviours’. Certainly, the construct of authentic leadership is widely recognised as one that is personal, relationally focused, genuine and value based.

A lack of clear and consistent conceptual definition presents a barrier to interpreting the current research findings, advancing research in the field and developing such leaders in practice. Therefore, this concept analysis aimed to provide consistency and clarity through conceptual analysis, by exploring the antecedents, attributes and consequences of authentic leadership. Thus, in order to guide both understanding in practice and robust examinations of the concept through research, a concept analysis is required to provide conceptual clarity (McKenna and Jeske 2021).

3. Methods

This concept analysis seeks to clarify the concept of authentic leadership and provide a comprehensive overview of authentic leadership by searching, assessing, evaluating and synthesising current research. The objective is to clarify and understand the meaning of the authentic leadership concept to unravel its complex and multifaceted nature through concept analysis.

Utilising a concept analysis can lead to a deeper comprehension of the concept of authentic leadership and a thorough overview of the body of literature about this concept. This utilisation can facilitate the synthesis of the most recent studies that provide a broad understanding of the selected concept in the field of nursing and help identify any gaps in the knowledge base.

According to Walker & Avant (2019, p. 69), a concept analysis in nursing is defined as ‘the process of examining concepts in nursing for the purpose of clarification and defining their attributes, relationships, and structure’. Walker and Avant (2019) presented a systematic process for concept analysis, providing nursing academics with a framework to investigate and define concepts in the field. Table 1 outlines the steps taken using Walker & Avant's method to inform this concept analysis. The process began with the use of electronic search engines to determine if a concept analysis of authentic leadership was previously conducted.

TABLE 1.

Walker and Avant's method of concept analysis (Walker and Avant 2019).

Step	Action
1	Selecting a concept
2	Determining the aims of the analysis
3	Identifying all possible uses of the concept in nursing
4	Defining concept attributes
5	Constructing a model case
6	Constructing borderline, related and contrary cases
7	Identifying antecedents and consequences of the concept
8	Defining empirical referents of the model

To ensure a comprehensive exploration of the concept of authentic leadership, three distinct search strategies were implemented, integrating both traditional and electronic sources. The first strategy involved a comprehensive exploration of foundational knowledge from nursing textbooks, while the second strategy focused on gathering up‐to‐date perspectives from electronic sources, including online databases and electronic journals by a consensus approach to defining the key search terms, supported by a subject‐specific university librarian. A third strategy, a search of English and nursing dictionaries, was not fully utilised as it yielded no results.

3.1. Search Strategy Implemented for Nursing Textbooks

The first search strategy involved examining nursing textbooks with the aim of determining the extent to which the concept of authentic leadership is addressed in key nursing textbooks guiding the discipline of nursing. This was accomplished by identifying whether these textbooks included and defined terms related to authentic leadership. The search strategy included two distinct phases. Firstly, a comprehensive review of relevant chapters and sections in books identified in Tomlinson's Nursing Core Collection (Tomlinsons 2010). Tomlinson's Nursing Core Collection is a robust collection of nursing textbooks used by libraries globally to stock books within this discipline. All textbooks from the Core Collection (Tomlinsons 2010) related to nursing management (within the Nursing Management Section) (n = 24) were considered for inclusion. In all cases, the most up‐to‐date version of the textbook was sought to ensure recent content. The table of contents and index of relevant textbooks within the nursing management section were searched using the key terms ‘authenticity’, ‘authentic leader’, ‘authentic leadership’, ‘ethical leadership’ and ‘true leadership’ to determine relevant content related to authentic leadership.

Secondly, to further identify additional and recent nursing textbooks that could enrich the literature review on authentic leadership, an inquiry was made to five of the world's top nursing schools. These universities were selected based on the QS World University Rankings by Subject for the year (QS world university rankings by subject, 2022). These schools, well‐known for their nursing departments, were contacted via email. Finally, recommendations on textbooks were also sought from experts in the fields of authentic leadership and nursing leadership. This was done to obtain a list of recommended textbooks that could offer a more in‐depth understanding of the concept of authentic leadership within the context of nursing and to identify whether these textbooks included and defined authentic leadership. The recommended books were also analysed in the same way as Tomlinson's collection (Tomlinsons 2010) to determine whether they defined and discussed authentic leadership.

3.2. Search Strategy Implemented for Electronic Database

The second search strategy was executed across the following electronic databases: CINAHL, PubMed, Embase, ProQuest, APA PsycINFO, ERIC and ABI Inform. The search terms used were ‘authentic,’ ‘leadership,’ and ‘nursing’. These terms were combined by using the Boolean operators ‘AND’ and ‘OR’, as suggested by Jansen and Spink (2006), to yield relevant results. Three sets of keywords were utilised in this analysis: (Authentic * OR Genuine OR Transparent) AND (lead* OR Manage*) AND (nurs*). The included studies had to be in English and available in full text, with no restrictions on publication year or research methodology. Selected articles needed to address at least two of these questions: What is authentic leadership? How is it measured? What are its attributes? What are its antecedents? What are its consequences? The search strategy is outlined in Table 2.

TABLE 2.

Keywords used to search the related works.

	First key words	Second key words/synonyms attached with OR
Component 1	Authentic	Authentic * OR Genuine OR Transparent
Component 2	Leadership	lead* OR Manage*
Component 3	Nursing	Nurs*

Note: Search results from Keywords 1, 2 and 3 should be combined with ‘AND’.

3.3. Search Strategy Implemented for English and Nursing Dictionaries

A search of English and nursing dictionaries was also performed to inform concept analysis. However, the term authentic leadership does not appear in contemporary dictionaries, for example, the Oxford English Dictionary (2024). An attempt to examine both concepts individually (i.e., authentic and leadership) did not yield valid material that was informative to the aim of the analysis.

4. Findings

The concept of authentic leadership, despite its significance in the field of nursing and midwifery, was not widely referenced in relevant text books identified within the Tomlinsons Nursing Core Collection (Tomlinsons 2010). Of the total number of relevant books reviewed (n = 16), less than half (n = 8) provided some explanation about authentic leadership. These explanations generally revolved briefly around the qualities of an authentic leader (Bishop 2009; Harris, Roussel, and Thomas 2015; Johns 2015), within standards of a healthy work environment (Sullivan 2012) and among other aspects (Marquis and Huston 2014; Weiss, Tappen, and Grimley 2015; Yoder‐Wise 2014). Interestingly, while the concept of authentic leadership was frequently mentioned, a precise definition was often lacking, underscoring the evolving nature of this leadership style in the field of nursing.

Textbooks recommended by the top five nursing schools that responded (n = 2) were analysed to determine whether they defined and discussed authentic leadership. These were arguably more recent than that of the core collection (Tomlinsons 2010). One university recommended a predominant book published in 2021. This book discusses the qualities of an authentic leader, the importance of authentic leadership in various contexts and the underpinning theoretical framework of the concept. Another recommended six books, one of which refined ideas and frameworks about leadership by providing a comprehensive guide for leaders. It discusses cultivating authentic leadership. Two further textbooks were suggested by experts in the fields of nursing and authentic nursing leadership. One provided a comprehensive guide for nursing professionals on nursing leadership and management, involving how to become an authentic leader. The other provided a definition and discussion on the role of authenticity in leadership.

A detailed analysis of these textbooks revealed that the concept of ‘authentic leadership’ was more predominant in those published in the last 12–15 years. This recency emphasises the growing importance of authentic leadership in contemporary organisational contexts. These current books also highlight the emerging emphasis on human behaviours and attention to human aspects of people in organisations, accentuating the function of leaders and illustrating that leaders need to be adaptable, true to themselves and others and self‐aware. Indeed, an important consideration is the timing of the introduction of the concept of authentic leadership within the nursing field. Authentic leadership was not clearly defined until it was suggested by Luthans and Avolio (2003). Furthermore, the theory of authentic leadership was not fully developed until Bill George created it in the same year (George 2003).

With regard to the database search Table 2 identifies that the words ‘authentic’ and its synonyms along with ‘leadership’ and its meanings were the dominant words in the search process. Also, the word ‘nursing’ is included to ensure that the selected articles are in the required field of study. A total of 3733 publications were retrieved. After removing duplicates, 1979 studies remained. Following a review of titles and abstracts, 170 papers remained to examine the inclusion criteria. The literature that resulted was screened for eligibility criteria, reducing the number of included papers to 110, as shown in Figure 1.

FIGURE 1.

Prisma diagram outlining the process of manuscript selection.

5. Identifying and Defining the Attributes of Authentic Leadership

Research studies about authentic leadership span various disciplines, including nursing. This cross‐disciplinary exploration leads to identifying common themes and elements that can deepen the understanding of authentic leadership practices in nursing. Initially, the focus was on four attributes: self‐awareness, transparency, balanced processing and internalised moral perspective. However, further analysis has identified three additional attributes that can be integrated within this understanding, caring, shared decision making and ethical courage (Figure 2). Figure 2 illustrates the antecedents, attributes and consequences of authentic leadership.

FIGURE 2.

Authentic leadership antecedents, attributes and consequences.

Ultimately seven attributes of authentic leadership emerged: self‐awareness, transparency, internalised moral perspective, balanced processing, caring, shared decision making and moral/ethical courage (Table 3).

TABLE 3.

Attributes of authentic leadership and sources discussing these attributes.

Attribute	Sources
Self‐awareness	Wong and Walsh 2020; Wong and Giallonardo 2013; Wong and Laschinger 2013; Wong et al. 2020; Laschinger, Wong, and Grau 2012; Shapira‐Lishchinsky 2014; Sahraei Beiranvand et al. 2021; Regan, Laschinger, and Wong 2016; Puni and Hilton 2020; Perry 2018; Panczyk et al. 2019; Mrayyan et al. 2022; Mortier, Vlerick, and Clays 2016; Maziero et al. 2022; Marsango and Sharma 2023; Malila, Lunkka, and Suhonen 2017; Laschinger, Wong, and Grau 2013; Laschinger and Fida 2014
Transparency	Labrague, Al Sabei et al. 2021; Kida, Yumoto, and Ogata 2023; Jaworski et al. 2022; Huan‐Fang, Hui‐Ying, and Hui‐Ting 2019; Gotlib et al. 2018; Giordano‐Mulligan 2017; Fernandes Carvalho et al. 2016; Fallatah, Laschinger, and Read 2017; Fallatah and Laschinger 2016; Ellis and Bostain 2019; Dirik and Seren Intepeler 2017; Davidson and Mitchell 2017; Cottingham 2022; Bryan and Vitello‐Cicciu 2022; Blackstock et al. 2023; Bannay and Hadi 2021; Bakari et al. 2019; Baek, Han, and Ryu 2019; Alkaabi and Wong 2020; Alilyyani et al. 2022; Alilyyani 2022
Internalised moral perspective	Alexander and Lopez 2018; Yemi‐Sofumade 2012; Wong and Cummings 2009; Valle et al. 2021; Tate et al. 2023; Shirey, White‐Williams, and Hites 2019; Raso 2019; Özer et al. 2019; Murphy 2015; Murphy 2012; Mondini et al. 2020; Meng et al. 2022; Malik and Dhar 2017; Malik, Dhar, and Handa 2016; Laschinger et al. 2015; Giallonardo, Wong, and Iwasiw 2010; Filipova 2018; Farnese et al. 2019; Chevalier et al. 2021; Chapman III and Miller 2016; Barbosa 2018; Bamford, Wong, and Laschinger 2013
Balanced processing	Wong and Walsh 2020; Wong and Giallonardo 2013; Wong and Laschinger 2013; Wong et al. 2020; Laschinger, Wong, and Grau 2012; Shapira‐Lishchinsky 2014; Sahraei Beiranvand et al. 2021; Regan, Laschinger, and Wong 2016; Puni and Hilton 2020; Perry 2018; Panczyk et al. 2019; Mrayyan et al. 2022; Mortier, Vlerick, and Clays 2016; Maziero et al. 2022; Marsango and Sharma 2023; Malila, Lunkka, and Suhonen 2017; Laschinger, Wong, and Grau 2013; Laschinger and Fida 2014; Labrague, Al Sabei, et al. 2021; Kida, Yumoto, and Ogata 2023; Jaworski et al. 2022; Huan‐Fang, Hui‐Ying, and Hui‐Ting 2019; Gotlib et al. 2018; Giordano‐Mulligan 2017; Fernandes Carvalho et al. 2016; Fallatah, Laschinger, and Read 2017; Fallatah and Laschinger 2016; Ellis and Bostain 2019; Dirik and Seren Intepeler 2017; Davidson and Mitchell 2017; Cottingham 2022; Bryan and Vitello‐Cicciu 2022; Blackstock et al. 2023; Bannay and Hadi 2021; Bakari et al. 2019; Baek, Han, and Ryu 2019; Alkaabi and Wong 2020; Alilyyani et al. 2022; Alilyyani 2022; Alexander and Lopez 2018; Yemi‐Sofumade 2012; Wong and Cummings 2009; Valle et al. 2021; Tate et al. 2023; Shirey, White‐Williams, and Hites 2019; Raso 2019; Özer et al. 2019; Murphy 2015; Murphy 2012; Mondini et al. 2020; Meng et al. 2022; Malik and Dhar 2017; Malik, Dhar, and Handa 2016; Laschinger et al. 2015; Giallonardo, Wong, and Iwasiw 2010; Filipova 2018; Farnese et al. 2019; Chevalier et al. 2021; Chapman III and Miller 2016; Barbosa 2018; Bamford, Wong, and Laschinger 2013; Raso, Fitzpatrick, and Masick 2020; Luger and Fitzpatrick 2022; Stone 2021; Raso et al. 2021; Giordano‐Mulligan 2017; Giordano‐Mulligan, Moran‐Peters, and Eckardt 2023; Giordano‐Mulligan and Eckardt 2019
Caring	Raso, Fitzpatrick, and Masick 2020; Luger and Fitzpatrick 2022; Stone 2021; Raso et al. 2021; Giordano‐Mulligan 2017; Giordano‐Mulligan, Moran‐Peters, and Eckardt 2023; Giordano‐Mulligan and Eckardt 2019
Shared decision making	Raso, Fitzpatrick, and Masick 2020; Luger and Fitzpatrick 2022; Stone 2021; Raso et al. 2021; Giordano‐Mulligan 2017; Giordano‐Mulligan, Moran‐Peters, and Eckardt 2023; Giordano‐Mulligan and Eckardt 2019
Moral–ethical courage	Raso, Fitzpatrick, and Masick 2020; Luger and Fitzpatrick 2022; Stone 2021; Raso et al. 2021; Giordano‐Mulligan 2017; Giordano‐Mulligan, Moran‐Peters, and Eckardt 2023; Giordano‐Mulligan and Eckardt 2019

Self‐awareness is the foundation of authentic leadership, and the ability of leaders to understand their strengths, weaknesses and values. This attribute allows leaders to reflect on their actions and decisions, fostering a meaningful relationship with their followers that enables leaders to be genuine and transparent, enhancing trust within the team (Wong and Laschinger 2013; Wong and Walsh 2020). Self‐awareness, for instance, can increase transparency by enabling leaders to communicate openly and honestly about their thoughts and motivations, thereby nurturing followers' trust.

Another attribute is transparency, it involves open and honest communication, fostering trust and mutual respect among team members (Labrague, Al Sabei, et al. 2021).

Internalised moral perspective involves acting in accordance with one's values and beliefs, rather than acting to please others or succumbing to external influences such as organisational pressures (Walumbwa et al. 2008). This ethical orientation not only guides their actions but also sets a moral standard for their followers (Wong and Walsh 2020).

Balanced processing forms another key attribute, referring to the objective analysis of relevant data before making decisions (Wong and Walsh 2020). Authentic leaders consider all perspectives, including dissenting viewpoints, leading to improved decision making and problem solving (Laschinger, Wong, and Grau 2012). This attribute ensures that leaders make informed and fair decisions that are in the best interest of the team and organisation (Wong and Laschinger 2013).

Caring is demonstrated by leaders who show concern for the well‐being of their followers, integrating work and home life to create a cohesive and supportive environment (Giordano‐Mulligan 2017).

Shared decision making involves involving team members in the decision‐making process, valuing their contributions and ensuring fairness (Luger and Fitzpatrick 2022).

Moral ethical courage is the ability to adhere to ethical principles even in the face of adversity (Giordano‐Mulligan 2017; Luger and Fitzpatrick 2022). Leaders with this attribute advocate for what is right, promoting a culture of integrity and ethical behaviour.

Thus, in healthcare, nursing leaders who are self‐aware, transparent and have moral and ethical courage are able to promote a positive work environment that promotes the performance of individuals and the organisation as a whole. As a result, professional growth and nurse satisfaction are encouraged, which in turn leads to improved patient outcomes (Alexander and Lopez 2018).

5.1. Antecedents of Authentic Leadership

Antecedents are factors that contribute to the emergence or development of a concept (Walker and Avant 2019). In the context of nursing, several authentic leadership antecedents have been identified. These are authenticity, positive psychological capacities, life experiences, leadership development programme, supportive organisational climate and an ethical climate (Table 4).

TABLE 4.

Antecedents of authentic leadership.

Antecedents	Sources
Personal antecedents
Authenticity	Yemi‐Sofumade 2012; Raso, Fitzpatrick, and Masick 2020; Raso 2019; Murphy 2015; Kerfoot 2006; Davidson and Mitchell 2017; Chapman III and Miller 2016; Barbosa 2018; Bannay and Hadi 2021; Bamford, Wong, and Laschinger 2013; Anwar, Abid, and Waqas 2019
Positive psychological capacities	Alilyyani 2022; Wong and Giallonardo 2013; Giallonardo, Wong, and Iwasiw 2010; Flores et al. 2022; Wong and Laschinger 2013; Wong and Cummings 2009; Bryan and Vitello‐Cicciu 2022; Bannay and Hadi 2021; Doherty and Hunter Revell 2020; Marques‐Quinteiro et al. 2021
Life experience	Wong and Laschinger 2013; Wong and Cummings 2009; Bryan and Vitello‐Cicciu 2022; Bannay and Hadi 2021; Doherty and Hunter Revell 2020; Shirey 2006a; Shirey 2006b; Stone 2021
Organisational antecedents
Supportive organisational culture	Alilyyani, Wong, and Cummings 2018; Doherty and Hunter Revell 2020
Ethical climate	Alilyyani 2022
Leadership development programme	Fallatah, Laschinger, and Read 2017; Huan‐Fang, Hui‐Ying, and Hui‐Ting 2019; Hwang, Song, and Ko 2022; Laschinger, Wong, and Grau 2013; Meng et al. 2022; Stone 2021; Wong and Walsh 2020

These antecedents can originate from both personal and organisational sources (Table 4). Personal antecedents are individual characteristics and experiences that contribute to the development of authentic leadership. Organisational antecedents refer to factors within the organisational environment that promote the development of authentic leadership. In relation to personal antecedents, authenticity is the congruence of a leader's interior values, beliefs and actions, and is the basis of authentic leadership. This fundamental concept has been developed through research and may be considered as both the beginning and the result of other antecedents (Kerfoot 2006; Murphy 2012) (Table 4).

Positive psychological capacities, such as confidence, optimism and resilience, are fundamental personal antecedents and components that contribute to the development of authentic leadership. These capacities enhance a leader's self‐awareness and self‐regulation, enabling them to remain genuine to their own identity and beliefs, especially when faced with difficult (Shirey 2006a; Wong and Cummings 2009; Wong and Laschinger 2013). Life experiences, encompassing personal history and consequential occurrences, play a vital role in shaping a leader's values, self‐identity and moral outlook. These experiences, combined with positive psychological capacities, contribute to the authenticity of leaders by fostering self‐awareness and self‐regulation (Bannay and Hadi 2021; Bryan and Vitello‐Cicciu 2022; Doherty and Hunter Revell 2020; Shirey 2006b; Wong and Cummings 2009) (Table 4).

Organisational antecedents refer to factors within the organisational environment that promote the development of authentic leadership. Within the organisational context, a supportive organisational climate includes a positive organisational environment that encourages transparency, high moral standards and ethical behaviour (Table 4). This environment helps leaders follow their internal moral standards and act honestly (Alilyyani 2022). An ethical climate is a significant contextual factor that enhances the development of authentic leadership (Alilyyani 2022). When leaders operate in an ethical climate, they engage in practices that foster mutual cooperation and trust with their employees. Ethical climates promote high levels of transparency and moral standards, helping leaders maintain their authenticity (Gardner, Avolio, and Walumbwa 2005). Leadership development programmes are crucial for nurturing authentic leaders who can inspire and guide teams effectively. Providing employees with the resources, support and opportunities they need to perform their roles effectively can foster an environment conducive to the development and expression of authentic leadership (Alilyyani, Wong, and Cummings 2018; Doherty and Hunter Revell 2020).

5.2. Consequences of Authentic Leadership

Consequences refer to the outcomes or effects that result from the presence of a concept (Walker and Avant 2019). Authentic leadership has been linked with a wide range of positive consequences, not only in relation to employee well‐being and satisfaction but also in relation to a positive work environment (Table 5).

TABLE 5.

Consequences of authentic leadership.

Consequences	Sources
Employee well‐being and satisfaction
Employee retention	Yemi‐Sofumade 2012; Stone 2021; Laschinger, Wong, and Grau 2012; Nelson et al. 2014; Mrayyan et al. 2022; Malik 2018; Long 2020; Kida, Yumoto, and Ogata 2023; Kerfoot 2006; Flores et al. 2022; Chapman III and Miller 2016; Alexander and Lopez 2018; Long 2020; Flores et al. 2022
Decrease in turnover intentions	Yemi‐Sofumade 2012; Stone 2021; Raso 2019; Mortier, Vlerick, and Clays 2016; Hwanget al., 2022; Giordano‐Mulligan and Eckardt 2019; Fallatah, Laschinger, and Read 2017; Dwyer et al. 2019; Alilyyani 2022; Malila, Lunkka, and Suhonen 2017; Giordano‐Mulligan and Eckardt 2019; Fallatah, Laschinger, and Read 2017; Alilyyani et al. 2022
Lower levels of burnout	Woo and Han 2018; Valle et al. 2021; Long 2020; Raso et al. 2021; Raso 2019; Dwyer et al. 2019; Maziero et al. 2020; Lindsay and Mathieson 2022; Laschinger et al. 2015; Jaworski et al. 2022; Huan‐Fang, Hui‐Ying, and Hui‐Ting 2019
Employee well‐being	Long 2020; Raso 2019; Alkaabi and Wong 2020; Bannay and Hadi 2021; Marques‐Quinteiro et al. 2021; Malik and Dhar 2017; Laschinger, Wong, and Grau 2013; Jaworski et al. 2022
Job satisfaction	Wong et al. 2020; Wong and Cummings 2009; Valle et al. 2021; Tate et al. 2023; Laschinger, Wong, and Grau 2012; Regan, Laschinger, and Wong 2016; Read and Laschinger 2015; Mrayyan et al. 2022; Chapman III and Miller 2016; Long 2020; Flores et al. 2022; Raso et al. 2021; Raso 2019; Giordano‐Mulligan and Eckardt 2019; Dwyer et al. 2019; Alilyyani et al. 2022; Maziero et al. 2020; Lindsay and Mathieson 2022; Anwar, Abid, and Waqas 2019; Bakari et al. 2019; Barbosa 2018; Batista et al. 2021; Murphy 2015; Murphy 2012; Marsango and Sharma 2023; Marques‐Quinteiro et al. 2021; Malik and Dhar 2017; Laschinger and Smith 2013; Giordano‐Mulligan, Moran‐Peters, and Eckardt 2023; Chevalier et al. 2021; Fallatah and Laschinger 2016
Positive work environment
Engagement	Wong and Laschinger 2013; Wong and Cummings 2009; Valle et al. 2021; Tate et al. 2023; Laschinger, Wong, and Grau 2012; Regan, Laschinger, and Wong 2016; Mrayyan et al. 2022; Flores et al. 2022; Raso 2019; Giordano‐Mulligan and Eckardt 2019; Alilyyani et al. 2022; Lindsay and Mathieson 2022; Bamford, Wong, and Laschinger 2013; Barbosa 2018; Meng et al. 2022; Marsango and Sharma 2023; Laschinger, Wong, and Grau 2013; Laschinger et al. 2015; Labrague, Al Sabei, et al. 2021; Giordano‐Mulligan 2017
Positive work environments	Wong and Cummings 2009; Fallatah, Laschinger, and Read 2017; Marques‐Quinteiro et al. 2021; Bryan and Vitello‐Cicciu 2022
Reduction of coworkers' incivility	Malila, Lunkka, and Suhonen 2017; Alkaabi and Wong 2020; Blackstock et al. 2023
Healthy work environments (HWE)	Valle et al. 2021; Tate et al. 2023; Shirey 2006a; Flores et al. 2022; Lindsay and Mathieson 2022; Barbosa 2018; Puni and Hilton 2020; Murphy 2012; Maziero et al. 2022; Marsango and Sharma 2023; Laschinger and Fida 2014; Labrague, Al Sabei, et al. 2021; Giordano‐Mulligan, Moran‐Peters, and Eckardt 2023; Chevalier et al. 2021
Commitment	Wong and Laschinger 2013; Wong et al. 2020; Wong and Cummings 2009; Tate et al. 2023; Laschinger, Wong, and Grau 2012; Flores et al. 2022; Raso et al. 2021; Giordano‐Mulligan and Eckardt 2019; Lindsay and Mathieson 2022; Anwar, Abid, and Waqas 2019; Baek, Han, and Ryu 2019; Bakari et al. 2019; Puni and Hilton 2020; Malik and Dhar 2017; Labrague, Sulaiman Dawood Al, et al. 2021
Trust in the manager	Wong and Laschinger 2013; Wong and Giallonardo 2013; Giordano‐Mulligan and Eckardt 2019; Alilyyani 2022; Alkaabi and Wong 2020; Laschinger, Wong, and Grau 2013; Laschinger and Smith 2013
Group cohesiveness	Alshammari et al. 2020
Empowerment	Wong and Laschinger 2013; Wong and Giallonardo 2013; Valle et al. 2021; Sahraei Beiranvand et al. 2021; Malila, Lunkka, and Suhonen 2017; Raso et al. 2021; Raso 2019; Giordano‐Mulligan and Eckardt 2019; Baek, Han, and Ryu 2019; Barbosa 2018; Laschinger, Wong, and Grau 2013; Laschinger et al. 2015; Laschinger and Smith 2013
Enhance performance and safety
Reduce emotional exhaustion	Wong et al. 2020; Malila, Lunkka, and Suhonen 2017; Giordano‐Mulligan and Eckardt 2019
Creativity and citizenship behaviours	Malik, Dhar, and Handa 2016; Anwar, Abid, and Waqas 2019; Raso 2019; Laschinger, Wong, and Grau 2012; Puni and Hilton 2020; Wong and Laschinger 2013; Giordano‐Mulligan and Eckardt 2019; Fernandes Carvalho et al. 2016
Safety climate	Perry 2018; Mrayyan et al. 2022; Woo and Han 2018
Increasing productivity	Alshammari et al. 2020; Mrayyan et al. 2022; Mondini et al. 2020; Marques‐Quinteiro et al. 2021; Jaworski et al. 2022; Murphy 2015; Murphy 2012; Mondini et al. 2020; Marques‐Quinteiro et al. 2021; Gotlib et al. 2018
Student GPA	Eyong and Rathee 2017

Table 5 outlines the consequences of authentic leadership insofar as it can positively affect both the organisation and employees. The consequences of authentic leadership are multifaceted, encompassing both personal and organisational levels. Essentially, they relate to employee well‐being and satisfaction, positive work environment and enhanced performance and safety.

Authentic leadership positively affects employee well‐being and satisfaction on a personal level by encouraging job satisfaction, lowering level of burnout (Long 2020), engagement and lowering turnover intentions (Raso 2019). As a consequence of authentic leadership, employees experience job satisfaction, greater work engagement and commitment, which impact the organisation through improved employee retention. Additionally, a low level of burnout ensures positive work environments and high productivity. Furthermore, the safety climate is another consequence of authentic leadership.

At the organisational level, trust in management, structural empowerment (Wong and Laschinger 2013; Wong and Giallonardo 2013) and the promotion of quality care help to create a cohesive and productive work environment. Performance and productivity are also major consequences (Jaworski et al. 2022; Marques‐Quinteiro et al. 2021). While progressive organisational outcomes like leader effectiveness, creativity, resilience and group cohesion drive overall organisational success, increased trust, creativity and citizenship behaviours foster individual fulfilment (Anwar, Abid, and Waqas 2019; Malik and Dhar 2017; Raso 2019). Organisational effectiveness is further increased through the promotion of safety (Mrayyan et al. 2022; Perry 2018) and the decrease in emotional exhaustion (Malila, Lunkka, and Suhonen 2017; Wong et al. 2020).

Developing trust and relationships has both a personal and organisational benefit, demonstrating the crucial role that authentic leadership plays in developing ethical and transparent interactions. This comprehensive analysis of the results illustrates the significant contribution of authentic leadership to creating an ethical, successful workplace across all relevant realms of influence. Figure 2 illustrates the antecedents, attributes and consequences of authentic leadership.

5.3. Model Case, Borderline Case, Contrary Case and Related Concepts

5.3.1. Model Case

The nursing manager of a prominent hospital has dedicated significant effort towards cultivating personal authenticity and has undergone training in leadership development programmes that emphasise self‐awareness, transparency, balanced thinking and ethical decision making. The manager exhibits a strong sense of concern for both patients and staff, actively participating in collaborative decision‐making processes and displaying ethical fortitude. The implementation of this particular leadership style has resulted in notable improvements in the overall well‐being of nursing staff, the establishment of a work atmosphere characterised by positivity and support and advancements in both patient safety and the quality of care provided.

This model case includes the key antecedents of authentic leadership: leadership development programmes, a supportive organisational climate and an ethical climate. The attributes of authentic leadership such as self‐awareness, transparency, balanced processing and ethical courage are evident. The consequences include improvements in the overall well‐being of nursing staff, the establishment of a positive and supportive work atmosphere and advancements in both patient safety and the quality of care provided.

5.3.2. Borderline Case

The charge nurse in a small clinic has traits of transparency and compassion, yet has not been afforded the chance to partake in structured leadership training or cultivate a thoroughly supportive organisational environment. Although the aims of the nurse are respected by the staff, there are obstacles in the pursuit of a unified and empowering work environment. The overall levels of patient safety and satisfaction are generally satisfactory, while there are infrequent instances of performance breakdowns and concerns regarding staff well‐being. This case partially includes the antecedents of authentic leadership but lacks full support from leadership development programmes and a fully supportive organisational climate. The attributes of transparency and compassion are present, but other attributes like balanced processing and ethical courage are not fully developed. Consequently, mixed consequences are observed with satisfactory patient safety and satisfaction but occasional performance breakdowns and staff well‐being concerns.

5.3.3. Contrary Case

The nurse supervisor in a care facility demonstrates a lack of adherence to the values of authenticity, displays indifference towards the well‐being of both individuals under their care and the staff and operates without transparency or ethical decision making. As a result, the work environment exhibits signs of strain, staff members express discontentment and there are potential negative implications for patient safety and the overall quality of care provided. The absence of structural empowerment, work engagement and ethical climate leads to adverse consequences for both employees and patients. This is due to lacks of the key antecedents of a supportive organisational climate, leadership development programmes and an ethical climate. The essential attributes of authentic leadership such as self‐awareness, transparency and ethical courage are missing.

5.4. Related Concepts and Empirical Referents

5.4.1. Related Concepts

Authentic leadership concept overlaps with various concepts including ethical, transformational and servant leadership. Each concept possesses unique attributes but shares common elements with authentic leadership, such as positive influence. For instance, ethical leadership places significant emphasis on the process of making moral decisions and integrity, encompassing key characteristics of authentic leadership, including moral courage and the establishment of an ethical climate. However, it is worth noting that ethical leadership may not clearly encompass essential elements like self‐awareness or balanced processing, which are considered vital to authentic leadership (Yemi‐Sofumade 2012).

Also, like authentic leadership, transformational leadership places significant emphasis on the crucial role of inspiring and motivating followers through shared ideals, empathy and personal development. While transformational leadership primarily revolves around the ability to inspire and drive change and innovation, authentic leadership emphasises self‐awareness, fostering transparency and engaging in ethical decision making. This leadership style also emphasises authenticity (Blake 2020).

Servant leadership highlights the act of serving others, placing their needs as a priority and fostering a supportive and nurturing environment (Kaya and Karatepe 2020), aligning with the core authentic leadership values of compassion and collaborative decision making. However, it is important to note that this perspective may not fully encompass the wider scope of self‐awareness and balanced information processing. Gaining a comprehensive understanding of these interconnected concepts facilitates a more profound and intricate grasp of the influence of leadership on the formation of organisational culture, the provision of patient care and the welfare of staff members.

5.4.2. Empirical Referents

Empirical referents are tangible examples or metrics that can be employed to determine whether a concept is present or absent (Walker and Avant 2019). For authentic leadership, the empirical referent could be a scale or measurable variables that capture the essence of the concept, such as self‐awareness, relational transparency, balanced processing and internalised moral perspective. There are several scales, such as the ALQ designed by Walumbwa et al. (2008) and the Authentic Leadership Inventory by Roof (2014). These tools have been designed to measure authentic leadership and evaluate the fundamental characteristics of authentic leadership. Also, the Authentic Nurse Leadership Questionnaire designed by Giordano‐Mulligan (2017) is considered a dependable and effective instrument to quantity perceived authentic nursing. These are reliable instruments tailored to the nursing context, reflecting nursing values and measuring attributes like self‐awareness, moral ethical courage, relational integrity, shared decision making and caring. By employing these scales, researchers and practitioners can achieve a detailed understanding of authentic leadership across different settings, enabling the development of targeted interventions and training programmes to promote authentic leadership within organisations.

5.4.3. Emerging Definition

From this concept analysis, a proposed definition of authentic leadership is as follows. Authentic leadership comprises both personal and organisational characteristics. The authentic leader is one who is self‐aware, transparent, caring, has an internalised moral perspective, balanced processing and moral/ethical courage. The authentic leader shares decision making. Authentic leaders develop through the presence of their positive psychological capacities, life experience and authenticity. They require support within their organisations in order to manifest the necessary qualities of leadership. Essentially a supportive, ethical climate in addition to promotion of leadership development programmes is needed. Notably, there is a synergistic relationship within the personal characteristics, for example, having an internalised moral perspective enhances self‐awareness. In a similar way, the organisational environment serves to support and develop the necessary attributes of authentic leadership.

6. Discussion

Through a careful analysis of the concept of authentic leadership, using robust search methods and by integrating findings from various disciplines, this concept analysis refined and contextualised authentic leadership in a comprehensive way for the nursing field for the first time. This concept analysis built upon and expanded previous analyses related to understanding authentic leadership in healthcare (Alilyyani, Wong, and Cummings 2018), by maintaining a clear focus on application for the nursing profession and using comprehensive and advanced searching methods. A consistent and comprehensive definition of authentic leadership was not identified through this search, although it was observed that increased attention has been given to this concept in recent decades (Alilyyani, Wong, and Cummings 2018).

However, outdated leadership approaches are commonly observed in nursing (Poels et al. 2020; de Vries and Curtis 2018) and can lead to several negative consequences, including neglect of psychosocial and compassionate care, increased stress and burnout among staff and poorer team dynamics, ultimately resulting in lower motivation and subpar patient outcomes (de Vries and Curtis 2018). In contrast, authentic leadership, which emphasises personal integrity, relational transparency and ethical behaviour, holds the potential to address these issues by fostering a positive work environment and enhancing quality care (Barbosa 2018).

Interviews with hospital nurses reveal that significant barriers to good leadership exist, including a lack of managerial experience, confidence, education, training and support from higher management and the wider multidisciplinary teams (de Vries and Curtis 2018). Most concerning is that nurses perceive the reality of leadership in healthcare as predominantly task oriented, transactional and outdated (Poels et al. 2020; de Vries and Curtis 2018) despite consistent advice over the past three decades towards the use of transformational leadership styles in healthcare. This discrepancy results in a leadership style that fails to meet the evolving needs of the nursing workforce and the healthcare system (de Vries and Curtis 2018). Thus, despite decades of rhetoric about the importance of nursing leadership and increasingly available education on the topic, good nursing leadership is often absent in healthcare settings (de Vries and Curtis 2018), this further highlights the need for a shift towards authentic leadership.

Panczyk et al. (2019), (p. 694) attribute this failure in transformational leadership as being due to the focus of this leader on vision and purpose, rather than the more personalised and ‘deep sense of self [and] expression of a position’ that describes the authentic leader. However, despite calls for the development and advancement of authentic leadership, and the availability of several measurement instruments (Panczyk et al. 2019), there has been little clear focus on conceptual definitions of this topic in the literature.

Indeed while measurement and examination of authentic leadership is current and ongoing, recent studies such as Tate et al. (2023), while finding a positive impact of authentic leadership on quality care and patient satisfaction, failed to provide an operational definition of authentic leadership to guide the study. These authors did; however, utilise the ALQ, devised by Walumbwa et al. (2008), whose definition appears earlier, and perhaps it is this that guided the study. However, it is concerning that research and measurement are ongoing in the absence of a clearly agreed definition, especially as definitions provided are brief, nebulous, diverse and inconsistent.

Overall, there is a lack of consensus on the specific dimensions or behaviours that constitute authentic leadership. Current definitions highlight consistencies in understanding with common themes emerging such as self‐awareness, ethical behaviour, transparency and balanced processing. However, the extent to which these individual attributes are included in definitions varies as does the labelling, description and quantification of these dimensions. Furthermore, current definitions provide a broad understanding of authentic leadership but lack specificity on how these behaviours are practically enacted in various contexts. As such, and in order to guide both understandings in practice and robust examinations of the concept through research, this concept analysis provides hitherto unavailable conceptual clarity regarding the attributes, antecedents and consequences of authentic leadership that could have far‐reaching positive influences on nursing and healthcare practice.

6.1. Attributes and Definition of Authentic Leadership

Defined as a ‘leadership approach based on faithfulness and guided by positive psychological capacities and ethical integrity’, a more holistic and comprehensive view of the attributes of authentic leadership has been developed. These attributes were identified as comprising self‐awareness, transparency, internalised moral perspective, balanced processing, caring, shared decision making and ethical courage. Hitherto the focus was on four main domains of authentic leadership that were described and used across many studies. These are self‐awareness, transparency, balanced processing and internalised moral perspective (Alilyyani, Wong, and Cummings 2018; Read and Laschinger 2015; Walumbwa et al. 2008). However, this concept analysis has identified and integrated three further additional attributes caring, shared decision making and ethical courage. Moreover, while previous authors focused on singular key aspects of this leadership style such as cultivating positivity through a focus on engendering optimism, hope and trust (Barbosa 2018) or transparency and authenticity (Best 2022), this concept analysis goes further than this to describe the multiple, deep‐seated and fundamental nature of the attributes that the leader must possess. Similarly, authors such as Srivastava and Dhar (2019) focused on authentic leadership as influence on others, through relational strengths such as transparency in relationships, displaying behaviour that aligns with the leader's own beliefs and values and rendering fair decisions. However, this concept analysis provides a more far‐reaching analysis that demonstrates that while relational aspects are important (in terms of self‐awareness and transparency), positive psychological experiences are more likely related to the antecedents, rather than being key attributes of authentic leadership behaviour per se. Within this analysis, there is also a strong focus on the moral and ethical aspects of leadership. Moreover, caring, as a key attribute, is identified for the first time, as a core component that is an essential contributory attribute.

6.2. Antecedents of Authentic Leadership

A comprehensive understanding of the antecedents of authentic leadership has not been hitherto demonstrated in the nursing literature. Alilyyani, Wong, and Cummings (2018) in their review of authentic leadership in healthcare identified a singular antecedent—structural empowerment. However, this aspect of authentic leadership did not emerge strongly in this concept analysis. Antecedents of authentic leadership are described in this concept analysis as either personal or organisation, and a combination of both is required. This is the first time that this has been demonstrated within the literature. Personal antecedents are authenticity, positive psychological capacities and life experiences, whereas organisational aspects comprise the availability of leadership development programmes, supportive organisational climate, and an ethical climate. While there has been a strong focus on personal traits that leaders must possess, in relation to all leadership styles, including authentic leadership, the contribution of the environment is an important finding of this concept analysis. It is unrealistic to place the full responsibility for leadership success entirely on a single leader or their leadership style. This concept analysis clearly outlines that for this leadership style to exist, it needs to have a supportive organisational culture that provides education and also supports the ethical behaviours of the authentic leader by having an ethical climate. Authentic leadership requires both personal traits and supportive organizational enviroment to succeed.

6.3. Consequences of Authentic Leadership

It appears from this concept analysis that there are far‐reaching consequences of authentic leadership that apply to employee well‐being and satisfaction, a positive work environment and overall may make a positive contribution to enhancing personal performance and patient safety. These positive contributions resonate throughout the literature (Ystaas et al. 2023; Maziero et al. 2020), and are reflected in the expansive literature base that informed these consequences as a component part of the development of this concept analysis. However, it is important to note that while associations were observed, causation was not conclusively established, and further longitudinal and experimental research is required to confirm its potential contribution (Ystaas et al. 2023). Notwithstanding this, authentic leadership has potentially an important contribution to nursing research and practice for the future.

6.4. Implications for Nursing

This concept analysis provides a useful framework for understanding authentic leadership that can inform researchers in the field of nursing leadership. Its potential key role in supporting employee well‐being and satisfaction is noteworthy given the current emphasis on the urgent need to improve the well‐being of nurses. This supports not only the nurses but ultimately impacts patient satisfaction. Nurses believe that leadership and a collegial environment are key to their well‐being at work (Utriainen et al. 2015). Both of which are fostered within the paradigm of authentic leadership. Moreover, the idea of leader fairness is something that emerges strongly from nurses (Utriainen et al. 2015; de Vries and Curtis 2018), and is central component of the ethical and moral aspects of authentic leadership. In addition to supporting nurses as individuals and in teams, the moral ethical courage and internalised moral perspective of authentic leaders are virtually essential in current healthcare environments where workforce issues abound, and difficult decisions need to be made in relation to care rationing. What is important, and has been exposed in this concept analysis, is the important role that the workplace environment has in supporting authentic leadership. This is perhaps why espoused leadership approaches in the past have met with only limited success. It is not about choosing or adopting a singular approach within an individual, but rather it is a group and organisation effort, that includes a supportive environment and, importantly, education to support effective leadership development.

6.5. Limitations and Future Directions

The most recent, and currently used, version of the Nursing and Midwifery Core Collection list Tomlinsons was published in 2010 (Tomlinsons 2010). This database is an extensive and informed list that guides university library purchases worldwide. In all cases, the most up‐to‐date version (after 2010) was selected, and further relevant recent textbooks were identified by experts. Although this textbook analysis is a novel, rich and detailed approach, used for the first time to support conceptual analysis in nursing, there is a risk of omissions, despite best efforts to locate all relevant material in a systematic manner.

7. Conclusion

Through careful and robust analysis, the concept of authentic leadership was refined and contextualised for nursing leadership and practice. This concept analysis defines authentic leadership as leadership drawing from individual life experiences and nurtured through leadership development programmes that comprise self‐awareness, transparency, balanced processing, internalised moral attitude, caring, shared decision making and moral–ethical courage within a supportive organisational culture. Authentic leadership ultimately contributes to improved employee well‐being and satisfaction, ethical work environment and higher performance and safety standards. However, it is important to note that while associations are observed, causation is not conclusively established. Further research testing the components of the concept would be useful, and overall, it is advised that a consistent approach to the understanding and measurement of authentic leadership is developed to enable robust examination of the usefulness of this approach to future nursing practice.

Conflicts of Interest

The authors declare no conflicts of interest.

Peer Review

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer‐review/10.1111/jan.16496.

Data Availability Statement

Data available upon reasonable request.