Servant Leadership in Nursing: What It Is, How to Practice

A great nursing leader sustains their team through constant evolution and growth. However, there are different styles for achieving great results, and some have proven better for patient outcomes, facilities, and nurses.

For example, servant leadership has proven to be an excellent choice for nurse managers.

In this article, we will explore how servant leadership can influence a healthcare facility at all levels, creating a workplace where staff and patient satisfaction align with the facility’s goals, including improving morale and staff retention.

What is servant leadership in nursing?

Servant leadership is a leadership philosophy where a leader’s main focus is serving others instead of exercising power. Servant leaders prioritize the needs, development, and health of their team. In nursing, servant leadership prioritizes the growth and wellbeing of staff and patients, empowering nurses to deliver compassionate, high-quality care through supportive, collaborative leadership.

This “leading from the bottom up.” approach reimagines the hierarchy so the healthcare facility manager sits at the bottom, supporting the staff who, in turn, support the patients. This approach is:

Patient-centered
Supportive of staff
Moral-based
Focused on empathy, active listening, and collaboration

A servant leader nurse manager might work a shift on the floor when staffing is short, actively seek input from staff on policy changes, or prioritize getting nurses the equipment and training they need to do their jobs well.

If you are interested in becoming more effective as a nurse manager, consider applying servant leadership in your facility.

What are servant leadership principles?

Servant leadership originated in 1970, when Robert Greenleaf introduced it as a moral-based leadership theory. The principles of this approach include:

Empathy: Understanding and focusing on getting to know your staff better
Humility: Acknowledging that a leader needs the rest of the team and doesn’t have all the answers
Active listening: Taking the time to actively listen and being open to discussion
Engagement: Taking responsibility and being an active part of the team by working alongside the nurses
Empowerment: Giving nurses the autonomy to make their own decisions

Sounds great, doesn’t it?

As you can see, servant leadership is an excellent expression of teamwork in nursing that you can apply in your healthcare facility.

Let’s analyze how your facility can benefit significantly from this management approach.

Why servant leadership matters for nurse managers

Making a major transition to a new management style, such as servant leadership, will give your facility many advantages.

Servant leadership benefits

Your facility will see measurable positive outcomes after implementing servant leadership:

Nurse engagement and retention: If you support your nurses and improve workplace culture, they will want to stay.
Psychological safety in nursing: Clinical performance increases when nurses feel psychologically safe.
Reduced burnout and turnover: Nurses who feel supported will feel less friction and disengagement, helping you reduce burnout and turnover.
Patient safety: High servant leadership scores correlate with lower medication errors and fewer patient falls.

Servant leadership vs. other nurse leadership styles

How does servant leadership differ from other nursing leadership styles?

Different nursing management styles can have a significant impact on:

Job satisfaction
Retention rates
Patient outcomes

Let’s take a look at the characteristics of each and how they compare to servant leadership.

Transformational leadership

A transformational nurse leader focuses on a long-term vision for the future by helping strengthen individuals and inspiring them. This style works great for mentoring.

Transformational leaders primarily drive organizational vision and change, while servant leaders prioritize meeting the immediate needs of their staff and patients. Servant leadership is more oriented toward service and humility, whereas transformational leadership emphasizes inspiration and vision-casting.

Democratic leadership

Democratic leaders encourage participation and shared decision-making among team members. This style is very effective for roles focused on team success and quality improvement.

Democratic and servant leadership share significant overlap in their collaborative nature. The key distinction is that servant leadership explicitly prioritizes service to others as its foundation, with leaders actively working to meet staff needs and foster their development.

Democratic leadership focuses more on inclusive decision-making processes without necessarily emphasizing the leader's role as a servant to the team.

Autocratic leadership

Autocratic leaders make decisions independently with little input from staff. They maintain strict control and expect compliance with established protocols.

An autocratic nurse leader has a “because I say so” style. It can work well during emergencies and disaster situations. However, having a leader constantly telling nurses what to do can be a disaster for day-to-day morale.

On the other hand, a servant nurse leader focuses on open communication within the team.

Situational leadership

This style requires the leader to adjust their approach to the situation. This style has similarities with servant leadership, but the motive varies. Situational leadership is a tool to get the task done, whereas servant leadership is a philosophy focused on the growth of the person.

A great hospital administrator will know how and when to use each kind of leadership.

How to practice servant leadership as a nurse manager

How can nurse managers implement servant leadership?

Here are some actionable tips and leadership strategies for nurse leaders to implement servant leadership.

1. Perform listening rounds

When employees believe their voice matters, they report safety concerns, suggest improvements, and remain engaged during change. You can improve the overall work environment by implementing rounds to build trust. Use questions that invite nurses to speak:

How are you doing today?
What could make your shift harder or easier today?
How can we help you as a team?

Schedule listening rounds consistently, ideally weekly or biweekly, so staff come to expect and value this dedicated time. Focus on being fully present during these conversations by putting away your phone, making eye contact, and avoiding multitasking.

Take notes on what you hear and, most importantly, follow up on concerns raised. If a nurse mentions inadequate supplies or scheduling conflicts, circle back within a few days to share what action you've taken or explain constraints if immediate changes aren't possible. This follow-through demonstrates that listening rounds are genuine opportunities for input rather than performative gestures.

Vary the timing of your rounds to connect with staff across all shifts, including nights and weekends. Night shift nurses often feel disconnected from leadership, so making the effort to be present during their hours sends a powerful message about equity and inclusion.

2. Build psychological safety

Working in healthcare relies on honesty to stay safe. However when mistakes happen, clinicians may stay quiet to avoid being blamed. Psychological safety solves this by separating mistakes from punishment.To build psychological safety and help with nurse engagement, you can use the 4 Rs. Here are some examples of servant leadership applied to psychological safety:

Reinforce: “Thank you for flagging that mistake.”
Redirect: “We should look at the protocol and see where the confusion happened.”
Repair: “I’m sorry about before; I was busy.”
Reassure: “We are a team, and we can solve situations together.”

When negative events occur, acknowledge the emotional difficulty before explaining rationale: "I know this is frustrating" before pivoting to context. This validation of feelings prevents dismissiveness that erodes trust.

3. Develop your team to create more leaders

Organizations often treat frontline nurses as task-completers rather than knowledge workers capable of complex decision-making. This creates a cycle where nurses are denied development opportunities and in turn don't develop skills beyond what is asked of them. This ensures tasks get done, but holds your nursing team back from being resilient when emergencies occur. These are some strategies to develop your team into leaders:

Delegate decisions, not just tasks
Offer opportunities to lead small initiatives
Encourage education goals for your nurses (such as specialty training)
Ask about your nurses' goals and how you can help them to get there

4. Conduct regular one-on-ones (1:1s)

A part of nursing management best practices is to conduct one-on-ones with your nurses. This means to check in with them without focusing too much on their tasks.

Holding regular one-on-ones helps build relationships that make difficult conversations easier later. The consistency signals priorities—protecting this time despite competing demands demonstrates that developing individuals is core to leadership, not something done when convenient.

You can ask these 5 questions:

What’s going well?
What’s your biggest issue?
Where and how can I support you?
What are you learning?
How is your work-life balance?

5. Give your help during stressful periods

Being absent during the hardest moment of the shift—whether that includes short staffing, deteriorating patients, or backed-up admissions—creates the perception that you don't understand or care about actual work. Your presence as a leader serves multiple functions: allows firsthand observation of systemic problems invisible from an office, enables real-time problem-solving instead of bureaucratic delays, and builds social capital that transcends formal authority.

Don’t just stay in your office. Ask “how can I help?” during stressful periods or significant changes. Even small acts can make a big difference in how you go from a controlling manager to a supporting one:

Bring water
Help during a turn
Answer a call bell

6. Remove small frictions in the workplace

Small frictions can build up into massive cognitive and emotional burdens that drain finite reserves of energy. For example, a malfunctioning scanner adds minutes to every medication pass—multiply this across twelve-hour shifts and dozens of nurses, and thousands of hours are wasted on preventable frustration.

A servant leader removes the barriers that can turn the workplace stressful. For example:

Broken scanners
Unclear protocols
Inadequate supplies
Workflow constraints

If you pay attention to the little details, you will improve morale in the workplace.

Create a formal process for reporting equipment issues and workflow obstacles—a shared document, suggestion box, or regular huddle agenda item with feedback loops so staff know when issues are addressed. But keep in mind, you need to follow-up with these issues.

When nurses see reported problems lead to actual solutions—even small ones—it builds trust that their input matters.

7. Share the reasons behind decisions and new policies

Transparency about decision-making builds trust by revealing constraints and trade-offs you're navigating. Explaining "why" prevents rumor mills that fill information vacuums with worst-case speculation.

Whenever you make a new decision or a change of policy, try to explain clearly:

What is changing
Why it is changing
How you will support team members through the change

Even when decisions are unpopular, you can usually maintain trust through honesty about constraints and values guiding choices.

8. Recognize contributions publicly

In high-pressure healthcare, excellent work often goes unnoticed because it's expected—nurses save lives every shift, yet this can feel mundane over time. Public recognition teaches the entire team what behaviors are valued, creating implicit cultural standards. On the other hand, poor recognition communicates to your team that efforts don't matter, resulting in nurse disengagement.

Praise in public, coach in private. Some best practices to keep in mind include:

Sharing specific wins in huddles
Encouraging peer-to-peer praise
Tying recognition to impact: “Your quick escalation helped the patient avoid transfer.”

9. Invite perspectives before final decisions

Being included in decision-making can change people's relationship to outcomes. When nurses participate in shaping policies, they shift from being passive recipients of mandates to active stakeholders.

Frontline nurses often possess expertise that managers lack about what actually functions in practice when on the unit floor. Excluding this expertise can result in policies that look good on paper but fail when tested. Before making final decisions, try implementing shared governance practices. For example, you can:

Present the situation
Ask for input
Make the call
Reflect insights back to the group

This last point is key for all team members to know that their opinions were heard.

10. Measure success

Share metrics transparently with your team so they see how their participation in servant leadership practices produces tangible results. This reinforces engagement and builds trust that leadership follows through on commitments. You can evaluate success through nurse performance evaluations and these 3 categories.

Workforce well-being

Some indicators of team well-being include:

Turnover
Call out rates
Burnout indicators
Engagement survey scores

Team performance

Reflect on team performance based on:

Hand-off errors
Fall rates
Response times
Near misses + reporting frequency

Patient experience

Some indicators of the patient experience include:

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores

Complaint patterns
Patient family satisfaction

FAQs about servant leadership in nursing

Let’s analyze some FAQs about servant leadership in nursing.

What are the benefits of servant leadership for nurses and patients?

Servant leadership benefits nurses, patients, and the entire facility:

For nurses: When a nursing manager is there for their nurses, nurses will be more likely to practice at the “top of their license” in a spirit of collaboration.
For patients: Nurses will focus on providing more attentive, compassionate care, leading to better patient outcomes.

Can servant leadership reduce nurse burnout?

Yes. Servant leadership aims to remove all factors that could cause burnout among nurses.

A servant leader will help nurses find meaning in their work, reduce friction, and help them manage stressful situations, thereby reducing burnout.

Does servant leadership improve patient safety?

Yes. Supportive leadership is linked with better patient outcomes. Some human factors that can improve patient safety include:

Inclusion
Empathy
Empowerment

Servant leadership is the future of nursing

The healthcare landscape is constantly changing, making it more important for nurse managers to treat their nurses better and improve how services operate.

By learning more about servant leadership, you are implementing well-being into your facility. The results of this kind of leadership will benefit everyone, especially patients.

If you want to learn more about making your healthcare facility a great place to work, you can read more articles in Nursa’s resource center for healthcare leaders.

Sources:

Servant leadership strategies for nurse leaders

Key takeaways: