Employee satisfaction resulting in increased productivity has been linked to quality leadership. Discovering what type of environment facilitates the development of effective leaders and what traits and skills are characteristic of good leaders has been the subject of much dispute.

In Leadership: Improving the Quality of Patient Care, Angie Clegg summarizes a review of theories and early studies in relation to leadership. Early leadership theory focused on the traits of leaders. In the 1950's research changed from the study of leader traits to leader behaviors. Behaviors studied were classified

Feldman is a great advocate of storytelling and encourages nurses to adopt storytelling into their field of practice. Since communication is a major part of leadership education, becoming adept at storytelling will improve the ability to communicate and to share events with others. Storytelling allows the listener to be an active participant, using their imaginations, and to empathize with the characters. Stories are told to entertain, relieve tension, build camaraderie and teamwork, clarify values and teach valuable lessons (Feldman ).

According to Perra, trust is the belief or confidence in the integrity or reliability of another. Not only must a leader be trusting, but trustworthy as well. The development of trust comes from honest communication, the sharing of information, and the giving and receiving of feedback. She feels leaders need to have respect for themselves before they can respect and value diversity in others. Perra maintains that integrity, the application of trust, honesty, and caring towards relationships at the personal, organizational, and community level, enables leaders to look critically at current practices and advocate for patients and staff (Perra).

We only have to look around us to know change is inevitable. Sue Fitzsimons and Rita E. Numerof addressed how nurses can prepare for the changes occurring in nursing in The Executive Nurse: Leadership for New Health Care Transitions, edited by Sandra R. Byers. With a continued nursing shortage, all nurses need to anticipate they may be required to assume a leadership role. Managed care trends involve developing an increasing number of skills to enable nurses to coordinate patient care (Byers 34).

In Strategies for Nursing Leadership, Harriet Feldman states, "Leaders create visions: leaders dream of possibilities and envision the future, generating enthusiasm and excitement" (Feldman 9). Feldman refers to LaPierre, who identified three groups in society who bring about the diffusion of ideas: innovators (those who create the ideas), advocates (those who sell the ideas), and adaptors (those who implement the ideas (9).

According to Perra, communication establishes trust through the sharing of information, a willingness to listen, and providing feedback and effective conflict management. She feels leaders are change facilitators, willing to proactively seek change, accepting and demonstrating flexibility and adaptability (Perra).

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