Leadership styles in ethical dilemmas when head nurses make decisions


  • V. Zydziunaite RN, PhD, MNSc, MEdSc, BNSc,

    Professor of Education Science, PhD student, Corresponding author
    1. School of Health Sciences, Nursing Science, University of Tampere, Tampere, Finland
    • Department of Education, Vytautas Magnus University, Kaunas, Finland
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  • D. Lepaite PhD, MedSc, BAdmin,

    Associate Professor of Education Science
    1. Department of Study Programmes, Vilnius University, Vilnius, Lithuania
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  • T. Suominen RN, PhD

    Professor of Nursing Science
    1. School of Health Sciences, Nursing Science, University of Tampere, Tampere, Finland
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Correspondence address: Vilma Zydziunaite, K. Donelaicio str. 52-303, LT-44244 Kaunas, Lithuania; Tel: (gsm) +370-685-66795; (work) +370-37-327-821; Fax: +370 37 327823; E-mail: v.zydziunaite@kic.vdu.lt.



The overlooked aspect in Lithuania is the dearth of leaders among head nurses, who bear the responsibility for decisions in ethical dilemmas. Understanding the application of leadership styles is fundamental to ensuring head nurses' abilities to influence outcomes for healthcare providers and patients.


To identify the leadership styles applied by head nurses in decision making in ethical dilemmas on hospital wards.


The data were collected by questionnaires completed by head nurses (n = 278) working in five major state-funded hospitals in each of the five regions of Lithuania. The data were analysed using SPSS 16.0, calculating descriptive statistics and analysis of variance.


Head nurses apply democratic, affiliative, transformational and sustainable leadership styles when resolving ethical dilemmas. The application of leadership styles is associated not only with specific situations, but also with certain background factors, such as years of experience in a head nurse's position, ward specialization and the incidence of ethical dilemmas. Nurses having been in a head nurse's position over 10 years use primitive leadership styles, notably bureaucratic leadership, more often than do those head nurses with only a few years of experience in such a position.


The results highlight the need for head nurses to reflect on their practices and to find new ways of learning from practice, colleagues and patients. Head nurses' managerial decisions due to their ‘executive power’ can turn into a new state-of-the-art leadership in nursing.