NURS 524 Week 8 Christian Nurse Leader Paper on Servant Leadership Example

The Christian Nurse Leader as Servant: Biblical Foundations, Current Evidence and a Practical Plan for Servant Leadership on a Nursing Unit

Introduction

Nursing has never lacked leaders who work hard. It has more often lacked leaders whose staff feel heard, supported and helped to grow. The pressures of the past several years, including staffing shortages, burnout and turnover, have sharpened the question of what kind of leadership keeps nurses at the bedside and keeps patients safe. Servant leadership, a model in which a leader's first question is whether the people led are flourishing, has drawn increasing attention in nursing research and in Magnet-designated hospitals. For Christian nurses, it also has a direct source in the teaching and example of Jesus. This paper examines servant leadership from three directions: its biblical foundations, its definition and place in nursing leadership, and the current research on its effects. It then sets out a practical plan for practicing servant leadership as a new nurse manager and considers the challenges of doing so.

Biblical Foundations of Servant Leadership

The clearest statement of servant leadership in Scripture comes when James and John ask for places of honor beside Jesus. Jesus answers that among the Gentiles, rulers "lord it over" their people, but "it shall not be so among you. But whoever would be great among you must be your servant, and whoever would be first among you must be slave of all. For even the Son of Man came not to be served but to serve, and to give his life as a ransom for many" (English Standard Version Bible, 2001/2016, Mark 10:42-45). The passage does not abolish leadership; the disciples will lead the church. It redefines greatness in leadership as service.

Jesus then demonstrated the principle. At the last supper, he took a towel and washed the disciples' feet, a task normally given to the lowest servant, and told them, "If I then, your Lord and Teacher, have washed your feet, you also ought to wash one another's feet. For I have given you an example" (English Standard Version Bible, 2001/2016, John 13:14-15), words spoken by the one the disciples rightly called Lord. The example joins humility with authority: Jesus remains "Lord and Teacher" while serving. Servant leadership is therefore not the absence of authority but its use for others.

Paul extends the same pattern to every believer. "Do nothing from selfish ambition or conceit, but in humility count others more significant than yourselves. Let each of you look not only to his own interests, but also to the interests of others. Have this mind among yourselves, which is yours in Christ Jesus" (English Standard Version Bible, 2001/2016, Philippians 2:3-5). Taken together, these passages describe a leader who holds real authority, uses it to meet the needs and develop the abilities of others, and measures success by the flourishing of those served.

Defining Servant Leadership in Nursing

O'Brien (2011) traces the modern concept of servant leadership to Robert Greenleaf, who proposed that the true leader is first a servant, and she connects it to the spiritual roots of nursing as a calling to care. Among the qualities O'Brien attributes to the servant leader are attentive listening and empathy, a concern for healing, self-awareness, a preference for persuading over compelling, foresight, a sense of stewardship, and a commitment both to each person's development and to the community the unit forms. In practice, a servant leader in nursing listens before deciding, invests in staff development, shares decisions with those affected, and treats the unit as a community rather than a set of positions.

Servant leadership differs in emphasis from transformational leadership, the style most often studied in nursing. Kelly and Tazbir (2014) describe transformational leaders as inspiring followers toward a shared vision and motivating them to perform beyond expectations. Servant leaders also inspire, but they look first to how each follower is growing and faring, on the assumption that organizational goals will be achieved through people who are developed and supported. Porter-O'Grady and Malloch (2016) note that leadership in complex health systems depends on relationships and the capacity of others to adapt, which suggests that a leadership style centered on developing others may be especially suited to health care.

Current Evidence on Servant Leadership in Nursing

Staff Well-Being, Engagement and Retention

The largest body of evidence concerns nurses' well-being and their intention to stay. Saavedra et al. (2025) systematically reviewed 14 studies with a combined sample of 7,041 participants, mostly female nurses, and in those studies, nurses who rated their leaders higher on servant leadership reported better attitudes and conduct at work, closer working relationships with those leaders, and more freedom to speak up. A broader review placed servant leadership within the job demands-resources model, in which leadership is a resource that protects against burnout and supports engagement. Montenegro Méndez et al. (2025) identified 38 observational studies, nearly 90% of them cross-sectional, and found that transformational, authentic and servant leadership styles all showed protective effects against burnout and promoted engagement, while abusive leadership was linked to more burnout. Transformational leadership was the most studied, which means the evidence for servant leadership specifically is thinner.

Turnover is a central concern for nurse leaders, and servant leadership appears to help. In a survey of 400 nurses in public and private hospitals in northern Jordan, Alolayyan et al. (2024) used structural equation modeling and found that servant leadership had a direct negative effect on nurses' turnover intention, which the authors attributed to its emphasis on empowerment, growth and engagement. Intention to leave is not the same as leaving, and a single cross-sectional study cannot establish cause, but the finding is consistent with the reviews above.

Psychological Safety as a Mechanism

Evidence on how servant leadership works points to psychological safety, the shared sense that staff can speak up, ask questions and admit mistakes without fear. The strongest study is longitudinal. Ahmed et al. (2023) followed 1,204 nurses in 27 hospitals in China over three waves and found that servant leadership at the first measurement reduced nurses' burnout at the third measurement through its effect on psychological safety at the second, and that nurses' trust in the leader strengthened that effect. The time-lagged design gives more confidence about direction than a one-time survey, though it cannot rule out every alternative explanation.

Not every study finds servant leadership central. In a sample of 306 nurses from Japanese hospital wards, Hontake et al. (2026) traced engagement back to psychological safety and psychological safety back to the ward's climate, and in that model the servant leadership score itself carried no significant weight. This finding is a useful corrective. It suggests that a manager's personal style matters chiefly as it shapes the climate of the unit, and that a servant leader who serves individuals generously but leaves a fearful climate unchanged may achieve little.

Patient Safety and Quality of Care

Evidence linking servant leadership to patient outcomes is limited. Singh et al. (2024) pooled 27 studies on transformational and servant leadership in relation to patient safety and quality of care. They found evidence of a medium to strong relationship between transformational leadership and patient safety, with effects on quality of care that were indirect, operating through organizational culture and staff outcomes. Far fewer studies addressed servant leadership. The most reasonable reading of current evidence is that servant leadership improves conditions for staff, such as psychological safety, engagement and intention to stay, that are themselves associated with safer care, but that direct evidence of an effect on patient outcomes has not yet been established.

Measuring Servant Leadership

Part of the reason evidence is limited may be measurement. Hall and O'Malley (2026) set out to create an instrument for servant leadership behaviors aligned with the Magnet model. Their Healthcare Servant Leadership Scale was cut from an initial pool of attributes, refined by expert reviewers and then field-tested with two hundred nurse leaders, ending as a short thirteen-item tool with four reliable components. A practical, validated measure allows hospitals to assess servant leadership behaviors, track development and, in time, study their relationship to unit outcomes more rigorously.

Servant Leadership and Shared Governance

Servant leadership has a natural home in shared governance, the structure many hospitals use to give nurses authority over decisions about their own practice through unit and organizational councils. Porter-O'Grady and Malloch (2016) describe effective leadership in health care as creating the conditions in which those closest to the work can make good decisions, and shared governance is one of the clearest expressions of that idea. A manager who practices servant leadership treats the unit practice council not as a formality to be managed but as a partner whose recommendations carry weight. In practice, that means bringing real decisions to the council, such as the design of a new admission workflow or the unit's response to a rise in falls, and giving the council the data and time it needs. It also means accepting decisions the manager would not have chosen when they are safe and supported by evidence.

This connection matters for the evidence reviewed above. If servant leadership works partly through psychological safety, then shared governance is one of the ways a servant leader builds that safety across a whole unit rather than one relationship at a time. Nurses who see their council's recommendations adopted learn that speaking up has consequences, which is the essence of a psychologically safe climate. That link may also answer the Japanese finding that climate mattered more than leadership style: a servant leader's most important act may be to build structures, such as a strong council, that shape climate long after any single conversation.

The Leader's Own Formation

A final theme in the account given by O'Brien (2011) is that servant leadership grows out of the leader's inner life. Leaders cannot sustain service to others if they are depleted, resentful or seeking approval. For the Christian nurse leader, that means attending to prayer, Scripture, rest and community, not as private matters separate from leadership, but as the source from which service flows. Jesus himself withdrew to pray before choosing the twelve (English Standard Version Bible, 2001/2016, Luke 6:12-13), which suggests that even the most demanding decisions are best made from a settled spirit. A practical step is for the new manager to protect a short period at the start of each day for reflection and to meet regularly with a mentor who can speak honestly about the manager's motives and blind spots. A leader who receives care and correction is better able to offer both. Over time, the nurses on the unit notice the difference between a manager who serves out of obligation and one who serves out of a settled sense of calling, and the second is far more likely to earn the trust on which servant leadership depends.

Answering the Criticism That Servant Leadership Is Soft

A common criticism is that servant leadership is too soft for the hard decisions of management, such as discipline, staffing cuts or holding staff accountable for safety. O'Brien (2011) answers that servant leadership includes stewardship and healing, both of which require honesty. A servant leader who allows unsafe practice to continue is not serving patients or the nurse involved. The biblical model supports this view. Jesus served his disciples and also corrected them directly, as when he rebuked Peter (English Standard Version Bible, 2001/2016, Mark 8:33). Service, in this view, is measured by the good of the other person, which sometimes requires a difficult conversation. Accountability conducted privately, with respect and a plan for growth, is an act of servant leadership rather than an exception to it.

A 90-Day Plan for a New Nurse Manager

The evidence above suggests a practical plan for a nurse manager beginning on a 32-bed medical-surgical unit. Its aim is to build psychological safety and staff development, the mechanisms through which servant leadership appears to work.

In the first 30 days, the manager listens. The manager meets individually with every nurse and assistant for fifteen minutes, asking three questions: what helps you do your best work, what gets in the way, and what would you like to learn in the next year. The manager attends huddles on every shift, nights and weekends as well as days, taking notes without promising quick fixes. This phase reflects O'Brien's emphasis on listening and awareness and gives the manager an honest picture of the unit's climate.

In days 31 to 60, the manager acts on what was heard and shares decisions. The manager reports back to staff the three most common themes from the conversations, chooses one problem that staff identified as most important, and forms a small group of volunteers from all shifts to solve it. The manager also begins a simple practice for psychological safety: at each huddle, thanking the person who raised a concern or reported a near miss. Closing the loop on staff concerns builds the trust that Ahmed et al. (2023) found strengthened servant leadership's effect on burnout.

In days 61 to 90, the manager invests in growth and sets accountability. Each staff member agrees with the manager on one development goal for the year, such as a certification, a role on a council or precepting. The manager holds any necessary accountability conversations privately and promptly, framed around the person's growth and patient safety. The manager also asks a trusted colleague or the director to rate the manager's behaviors using a servant leadership scale such as the one developed by Hall and O'Malley (2026) and compares the result with a self-rating, so that the manager's own development is measured rather than assumed.

Challenges in Practicing Servant Leadership

Practicing servant leadership on a busy unit carries real challenges. Time is the first: listening sessions, coaching and shared decisions take more time than issuing directions, and nurse managers often oversee large staffs with little administrative support. Organizational culture is the second; in hierarchical settings, a manager who shares decisions may be seen by superiors as indecisive. The third is personal. A leader who serves by doing tasks for staff, as many charge nurses do, may confuse being busy for others with serving their growth. The Hontake et al. (2026) findings suggest a fourth challenge: individual service will not change outcomes if the unit's climate remains fearful, so the servant leader must work on climate deliberately. These challenges do not invalidate the model, but they require the leader to protect time for listening and coaching and to explain the approach to superiors in terms of retention and safety.

Conclusion

Servant leadership asks nurse leaders to spend their authority on the flourishing of the nurses and assistants they lead, following the example of Jesus, who came "not to be served but to serve" (English Standard Version Bible, 2001/2016, Mark 10:45). Current research, though mostly observational, associates servant leadership with lower burnout, lower turnover intention, stronger leader relationships and greater psychological safety, with a longitudinal study suggesting that psychological safety is the path through which it works. Evidence for direct effects on patient outcomes remains limited, and some findings suggest that unit climate matters more than any leader's style alone. For the Christian nurse leader, these findings point in the same direction as Scripture: serve by listening, developing people, sharing decisions and building a community where staff can speak, and hold others accountable for the sake of their growth and their patients' safety. A practical plan, measured honestly and revisited with staff each quarter, turns that calling into daily practice on a real nursing unit, where the test of servant leadership is not what the leader intends but what the nurses experience.

References

Ahmed, F., Xiong, Z., Faraz, N. A., & Arslan, A. (2023). The interplay between servant leadership, psychological safety, trust in a leader and burnout: Assessing causal relationships through a three-wave longitudinal study. International Journal of Occupational Safety and Ergonomics, 29(2), 912-924. https://doi.org/10.1080/10803548.2022.2086755

Alolayyan, M. N., Nusairat, F. T., Abualhuda, S. A., & Azar, S. (2024). Association between servant leadership and nurses' turnover intention: Evidence from Jordan. BMJ Leader, 8(3), 253-257. https://doi.org/10.1136/leader-2023-000903

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Hall, H., & O'Malley, P. (2026). Development and psychometric testing of an instrument to measure servant leadership behaviors in Magnet nurse leaders. Worldviews on Evidence-Based Nursing, 23(5), Article e70178. https://doi.org/10.1111/wvn.70178

Hontake, T., Nishi, M., Kuzushima, S., & Kamizawa, N. (2026). Effects of organizational climate and servant leadership on work engagement among Japanese nurses: The mediating role of psychological safety. Journal of Nursing Management, 2026(1), Article e5755950. https://doi.org/10.1155/jonm/5755950

Kelly, P., & Tazbir, J. (2014). Essentials of nursing leadership and management (3rd ed.). Delmar Cengage Learning.

Montenegro Méndez, S., Laguía González, A., & Moriano León, J. A. (2025). Is leadership a resource? A systematic review of its role in burnout and engagement among nurses within the JD-R model. Journal of Nursing Management, 2025, Article 8853148. https://doi.org/10.1155/jonm/8853148

O'Brien, M. E. (2011). Servant leadership in nursing: Spirituality and practice in contemporary health care. Jones and Bartlett Publishers.

Porter-O'Grady, T., & Malloch, K. (2016). Leadership in nursing practice (2nd ed.). Jones & Bartlett Learning.

Saavedra, S., Ruiz-Palomino, P., Pérez-Contreras, R., & Gonzalez-Sanz, J. D. (2025). Impact of servant leadership on the work environment and the attitudes and behavior of nursing professionals as a function of gender: A systematic review. Journal of Nursing Management, 2025, Article 8825138. https://doi.org/10.1155/jonm/8825138

Singh, A., Yeravdekar, R., & Jadhav, S. (2024). Investigating the influence of selected leadership styles on patient safety and quality of care: A systematic review and meta-analysis. BMJ Leader, 8(3), 208-214. https://doi.org/10.1136/leader-2023-000846