Nursing is a collaborative profession, which requires participatory approach towards achieving the goals and objectives of the institution. Although nursing profession strives towards transformational leadership, still these exist gaps, which hinders staff motivation and retention within the profession. Nurses usually leave the profession and they take roles in non-nursing activities. It has been observed by the author that majority of the nurses in one of the hospitals in Afghanistan are engaged in non-nursing studies, especially medical and business administration. This is alarming us that the hospital one day or the other may challenge the institutions in terms of nursing shortage. This tragedy is linked with lack of opportunities for higher education in nursing, lack of career development opportunities, lack of national policy and regulatory body, and low image of nursing profession within the community. In Afghanistan, the situation of nursing profession is worst in terms of growth and development opportunities.

On the other hand, nursing leadership which is the focus of this paper plays a pivotal role in motivating staff nurses to retain within the profession. Leadership is a core concept which has a great importance in the organizational management. Effective leadership requires effective leaders and leadership skills and style. Leadership styles differ from person to person and from context to context, however the ultimate vision is towards effective management. The leadership style is either towards concern for the people or towards concern for production. On the model of transformational leadership, leaders motivate subordinates to achieve the shared vision. Thus, transformational leadership concerns both the people and the production; and viewed as the most effective model of leadership (Bass, 1999, p. 11). The styles of leadership other than transformational, either increases dependency and demotivation or decreases productivity. Whereas, transformational leadership is the best style to lead, not only because it directs, but also provides opportunities for development and learning; hence, motivating nursing staff to feel responsible and retain within the profession. Transformational leadership involves four main concepts which include individualized consideration, intellectual stimulation, inspirational motivation, and idealized influence (Doody & Doody, 2012). This paper focuses on the analysis of the above four components of the transformational leadership model and its outcome towards motivation and staff retention which are the topic of concern for the nursing leaders and for the nursing profession as a whole.

Through the concept of individualized consideration, the leader encourages the followers and supports them to reach the higher level of competency and performance. It is very much evident that leaders have the responsibility of providing directions and support for the subordinates. Indeed, it is what the staffs expect for their professional development. Many studies have conducted which showed retention associated with poor leadership, lack of guidance, and lack of development opportunities even in the developed world (West, Griffith, & Iphofen, 2007). Thus, nursing leadership and leadership strategies are important to empower nurses and enhance nurse's development. Provision of on-duty direction, mentorship, and supervision plays a vital role in learning the desired practice towards production. Besides that, technology and nursing knowledge is dynamic, changing from time to time; hence it is needed to update and prepare nurses with the current developments.

Involvement of nurses in the committees and meetings and keeping open communication also play a vital role in the capacity development and staff motivation, as it provides sense of value and worth to the nurses. Transformational leadership addresses psychological needs of the nurses besides other technical needs. One of the important concerns which is usually shared by the nurses is unavailability of freedom within the profession, which discourages nurses to be involved in nursing professional activities. This concern is basically rooted from the time of Nightingale that although she demonstrated the best required leadership to accomplish key developments, as cited by (Selanders, 1998) she was “not able to empower other nurses and this continues to have a lasting impact on nursing's development” (West, Griffith, & Iphofen, 2007, p. 127). Therefore, there is a need to limit on hierarchy and bureaucracy, which hinders development and involvement of nurses and nursing profession. Above all, transformational leadership is as reflected by Doody and Doody (2012) that “Nurse leaders need to be more expressive, for example, through words of thanks or praise, fair workload distributions, and individualized career planning, mentoring and professional development activities to motivate followers individually” (p. 1215). These strategies not only play role in the production, but also play an important role in vitalizing intrinsic motivation towards the task and professional commitment.

The second component of the transformational leadership is intellectual stimulation which involves encouragement and welcoming of new ideas. Innovation and creativity is an important part of nursing discipline. McEwen and Wills (2011) have explained that esthetic knowledge (i.e. creativity and art of nursing) “incorporates empathy and understanding” (p. 12). It is always been encouraged that nurses should be innovative in their practice and patient management. Innovation and creativity comes from intellectual stimulation through engagement and understanding the points of views of the subordinates. As a leader, it is vital to encourage staff to find new ways to problem solving and encourage reasoning before taking any decision. Through this component, the leader focuses on the resolution of the problem; not on blaming. The leader further explores the idea and has no fear of replacing any ineffective idea with the new one to be tested. The leader involves nurses in the decision and creation of any new way forward. These strategies motivate nurses to practice according to the requirements of the institution to achieve the same mission for which the leader struggles. Therefore, team is built working towards the same direction and goal. Transformational leaders use evidence-based practice to guide ideas and way forward, instead of focusing on ordinal practice. The leaders struggle to facilitate up-to-date learning opportunities, including learning resources facilities, sharing of knowledge, and exchange of ideas to promote practice and enhance learning. Promotion of nursing practice and enhancement of learning have a positive effect in improving the quality of care which is expected by the clients. Another strategy which enhances intellectual stimulation is to give responsibility for the trained staff who has got some training to participate in teaching opportunities and be involved in sharing the knowledge with other staff who have not taken that specific course. This strategy not only facilitates knowledge sharing, but also motivates staff in terms of self-worth and value to be engaged in nursing activities and retain within the profession. Subsequently, the staff takes initiatives towards planning higher education in the nursing profession.

The third component of the transformational leadership theory is focusing on inspirational motivation. The leader tries to set a vision which is inspiring subordinates and makes certain that, the vision is of the interest of the followers. The leader is communicating optimistic about the future goals and provides meaning for the task which is on hand. According to the inspirational motivation, nurses need to be physically and mentally engaged in the purpose for which they struggle. Once the purpose and the meaning are identified, they produce energy to take the leader and the subordinates forward towards the goal they strive. The leader reflects on the competencies and abilities of the subordinates and they are encouraged to believe on their abilities. Therefore, the nurses are willingly engaged and provide possible effort in their performance. The word motivation is defined as “the force within the individual that influences or directs behavior” (Marquis & Huston, 2006, p. 444). This force can only be created and shape or direct an individual's behavior, when there are motivators to address motivational needs. Therefore, Herzberg included; recognition, advancement, growth and development, and responsibility as the key motivators beside others for any individual (Huber, 2010, p. 201). Recognition is the basic need of an individual through which the future commitment and way forward of an individual is designed. Unfortunately, the recognition of the nursing profession is yet not in a position to attract people towards itself. There are many researches advocated for public acknowledgment and recognition of the nursing profession (West, Griffith, & Iphofen, 2007, p. 126) to make a position for the nursing profession within the community and the disciplines. Ultimately, recognition and acknowledgement whether public or institutional would play an important role in motivating individuals to retain in the profession and strive beyond the expectation. Similarly, advancement and growth and development of the nurses are crucial motivators in motivating them towards retention and commitment in achieving the goals and objectives of the organization. Staff mostly acquire and struggle for the opportunities for growth and development. They are discouraged if they would not be able to achieve their goals towards growth and development and ultimately ends up into turnover. In fact, at international level, nursing profession has remained ignored in terms of higher education opportunities for the nurses. It is worst in their region than any other part of the world. Therefore, those who are at the top management of the nursing in coordination with public and private entities should struggle to facilitate in designing higher education opportunities, especially postgraduate specialty and doctoral studies for the nurses. This is how the profession would develop and motivate nurses in staying in the profession. These strategies not only play an important role in motivation of nurses, but they also play role in job satisfaction and ultimately patient satisfaction. A transformational leader always tries to motivate his/her subordinates. Motivation has direct impact on performance of staff and ultimately on the care provided. On the other hand, demotivation negatively affects nurses' performance and patient care, thus affects patient outcome. On the theory of transformational leadership, the leader provides equal opportunities for growth and development of staff, including provision of in-service sessions and provision of intensive orientation for new comers on vision, goals and expectations of the organization. Therefore, it becomes very clear to the staff from day one that, what is required from them throughout their stay and what opportunities are available to be availed. Furthermore, frontline staffs are provided with the opportunities of involvement in the committees where executive decisions are made. This is considered to be a good opportunity for learning managerial skills, development, and empowerment beside a responsibility. Transformational leaders inspire subordinates through motivation; they project duty to become a pleasure.

The last component of the transformational leadership theory focuses on idealized influence, which is role modeling. This concept reflects the leader's behavior that generates the reactions of the subordinates. The leader acts as role model in reflecting the expectations to the subordinates. The leaders symbolize the values, mission, and vision of the organization which are expected from the followers to endure with encouragement and respect. This act will influence nurses and similarly would pass to others as a value to be followed. In addition, it would also provide the leader a degree of respect, value, importance, influence, and admiration from the followers. Doody and Doody (2012) cited from Wang, et al. (2011), that “When a leader is a role model for staff, it becomes less likely that there will be resistance to change new initiatives that are to be implemented” (p. 1212). A great leader is the one who acts on what he says. When a leader is displaying the vision, mission, and goals and objectives of the organization, the followers strive to follow the leader and do the same. In fact, the followers hesitate to deviate from the path on which leader is going through; rather, they would always follow the leader. Therefore, Doody and Doody emphasized that “This idealized influence can be encapsulated in the philosophy and ethos of the service/unit and its mission statement” (p. 1212). It is vital for the leader to involve nurses and sometime even the community being served in the design of any statement which would enhance motivation and compliance. When we are saying that nurses should work based on evidence, the same is applicable for the nursing leaders. Studies which were conducted showed that “in Germany and Hong Kong, nurses cited organizational climate as a key cause for their dissatisfaction (Demerouti et al., 2000; Siu, 2002)” (West, Griffith, & Iphofen, 2007, p. 127). Organizational climate includes leadership styles and the culture of the organization. Sometimes, leaders behave in a way that discourages subordinates to stay within the organization. Appraisal and criticism are part of the employment within an organization. The way a leader handles these two concepts varies; a leader criticizes in public while other appraises in public. But, the best and motivating leader is to appraise in public and criticize in private. This is a method to motivate the person and engage him/her respectively in closing the gaps and building up on the strengths. Furthermore, behaving in the interest (acceptable interest) of the subordinates facilitates commitment, motivation, and involvement. A study conducted by McGuire and Kennerly in 2006, as cited by McEwen and Wills (2011), reveals that nurse managers who were with the transformational leadership were more likely to inspire nurses' sense of commitments to the organization.

The aforementioned concepts of the transformational leadership model elaborate on involvement and motivation of the subordinates in the vision, missions and goals and objectives of the organization. Each element of the transformational leadership is connected in terms of respect, encouragement, and influence. According to McEwen and Wills (2011), nursing believed on hierarchical structures, which is an old paradigm emphasized on rationality and logical decision making. This paradigm is evolving into a new paradigm that “values mutuality, affiliation, cooperation, networking, and an emphasis on human relations” (p. 419). Transformational leadership is strongly associated to high productivity, high employee satisfaction, and low turnover. Effective leadership has a great impact on staff motivation, staff satisfaction, and staff retention. Nursing profession is one of the most ignored professions therefore; attracting people to the profession is left a challenge. Most of the time, staff turnover is due to the dissatisfaction resulted from the strict organizational leadership. For this, the organizations need to adapt a flexible method to lead. It purely depends on the leader's capabilities to establish a better working relationship and working environment for staff motivation. “Leadership skills are essential to creating a motivating, visionary, and adaptable environment in which staff can flourish. When leadership roles are integrated with management functions, innovative problem solving can be achieved” (Thompson, 2012, p. 24).

Leaders play an important role to improve efficacy and efficiency of the organization through engagement of nurses in workplace by adopting transformational leadership. This idea is supported by Salanova, Lorente, Chambel, & Martínez (2011), “Nurses' supervisors with a transformational leadership style enhances different 'extrarole' performance in nurses and this increases hospital efficacy. They do so by establishing a sense of self-efficacy, but also by amplifying their levels of engagement in the workplace” (p. 2256). Transformational leadership also contributes towards wellbeing of the employee. The findings of a research by Munir, Nielsen, Garde, Albertsen and Carneiro (2012), suggested that “transformational leadership style may improve perceptions of work–life balance and employee wellbeing” (p. 512). This indicates that those who are under the pressure and stress cannot effectively and efficiently function. As a result, the outcome would not be satisfactory therefore; it leads to staff and customer dissatisfaction. Job dissatisfaction in line with negative outcome leads to mental disturbances, especially for those who are with higher moral values.

Transformational leadership motivates followers by appealing to higher ideas and moral values, where the leader has a deep set of internal values and ideas. This leads to followers acting to sustain the greater good, rather than their own interests, and supportive environments where responsibility is shared (Doody & Doody, 2012, p.1212).

A key for the success of a transformational leader is to possess a high moral stand, self-confidence and be consistent, and be with extraordinary ideas, to admire others while managing the staff and their issues. Similarly, to nurture motivation and facilitate engagement in work, Cottingham (1988) proposed six strategies for a transformational leader. These strategies, include; know the people you work with, help people to learn and develop, provide frequent feedback about performance, award responsibility and status to coworkers, reward coworkers for a job well done, and make information available to all (McEwen and Wills, 2011, p. 420). First, knowing subordinates based on their strengths, weaknesses and their interests is a key to design interventions in terms of capacity development and appraisal. Some people do express themselves, while others do not. The leader has to promote an environment open enough, so everyone should express their knowledge, skills, and talent. There might be a suppress person who would be enough talented than the one who is very much dominant. Therefore, knowing the strengths, weaknesses, and interests in a particular area is important to assign tasks accordingly; this would facilitate motivation and engagement at work. Second, after the leader identified gaps in one's skill and knowledge, then it is easy to plan developmental needs accordingly. The leader should not address the gaps only, but also engage his/her staff in activities beyond the organizational need, as the staffs always expect to develop personally and professionally. They should be exposed to new knowledge and new technologies relevant to their professional growth. They should also be involved in workshops, seminars, and meetings. These involvements facilitate leadership skills, problem solving, and decision making capabilities of the staff. Additionally, they also provide a sense of worth to the employee which leads to motivation. As Tomey (2000) stated that “feelings of accomplishment, responsibility, importance, challenge, advancement, and new experiences and opportunities for growth contribute to self-fulfillment” (p. 77). Third, provision of timely feedback about the performance is another strategy for a transformational leader to motivate staff. The leader should not wait for the formal feedback, rather he/she should provide a spot feedback for the staff in a positive way. It happens that feedback is given by the end of the year, which is not constructive at all, as it won't help timely correction. It is also worth to emphasize again that positive feedback should be given in public; while negative feedback should be given in private to facilitate encouragement. Furthermore, the feedback should be specific enough to enable the staff to achieve. According to Tomey (2000), “accentuating the positive with plenty of praise and positive feedback may increase the frequency and desired behavior” (p. 81). As a result, the staff is motivated towards work and profession. The fourth strategy for a transformational leader is to award responsibilities to the employee. The leader engages the followers in activities that help them grow and develop. Recognition of the potential is an essential element for this strategy in which the person feels himself/herself as an accepted member of the organization. Tomey (2000) included them as social needs of an individual “acceptance by one's peers, recognition as an accepted member of a group, being an integral part of the operation, giving and receiving friendship, and affectionate relation with others” (p. 77). The fifth strategy for transformational leader focuses to reward his/her employee when they are doing the best work. Reward is a key motivator for the subordinates. A research was conducted against the view that rewards destroy people's intrinsic motivation, and concluded that “rewards can be used to enhance people's intrinsic motivation” (Pierce, Cammeron, Banko, and So, 2003, p. 576). Therefore, rewards and praise should be part the organization's culture to motivate staff in doing the best possible performance. The sixth strategy for a transformational leader is to make information available to all. The leader should involve the staff in decision making and problem solving activities and events. If any incident occurs in a particular area, then everyone who is part of that area and engaged in the same situation should have access to the information. This would help the subordinates in identifying strategies for prevention of such incidents, beside identification of corrective measures. Participation of the staff in these activities should be encouraged and the efforts to be acknowledged. As mentioned, this would help the staff in developing decision making and problem solving skills. Hung, Rundall, Cohen, Tallia, and Crabtree (2006), asserted that, implementation of a participatory model “enhances information-sharing, work satisfaction, and commitment to organizational decisions, all of which can lead to beneficial outcomes such as increased productivity and stability in primary care practices” (p. 946).

In conclusion, we can say that motivation is created from internal (the ability of an individual) and external (in this case it could be transformational leadership style and its components) feasibilities to perform collaboratively for the best outcome (Marquis, & Huston, 2006). If this process is maintained, the best outcome is expected. On the other hand, if there is any gap in this process then the outcome would negatively be affected. Nursing profession has strictly led throughout the history, therefore, there is a need for a flexible style to lead nurses in order to attract them in the profession, retain them, and motivate them towards their performance. Four dimensions of the transformational leadership, which include; individualized consideration, intellectual stimulation, inspirational motivation, and idealized influence are interconnected with each other and they all lead towards staff motivation. Strategies for transformational leader are an excellent guide to motivate staff. There are many people who are not comfortable to function in stressful environment, while many others require sort of push and guidance. To cover these two contradictory necessities, transformational leadership which involves supervision and guidance which also called mentorship is a key answer.