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Developing courage in health and social care

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Developing courage in health and social care

Peter Ellis
18 June 2024

The last paper in this series identified that leaders and managers in health and social care need courage to undertake their roles.  This courage is identified within the Chief Nurse’s 6Cs which applies to all nurses and midwives in the UK (Department of Health, 2012). Here, courage is defined as the ability to act on something which is personally challenging. 

The Nursing and Midwifery Council (2018) expect nurses to demonstrate courage. When the courage of leaders in health and social care settings fail, bad things can happen.  When these leaders are brave, it can help protect service users and deliver positive outcomes. If leaders continually choose the path of least resistance, eventually they become blinded to what is right and wrong; failing to exercise courage and do the right thing becomes their normal way of working.  

This paper will consider how health and social care leaders and managers can go about developing courage, testing it in their own leadership practice.  We will consider some of the traits of courageous leadership and why courage is a virtue to be developed and admired in health and social care leaders.  

Developing courage as a leader

Much of the power exercised by leaders and managers is called legitimate power, which stems from the position they hold in a team or organisation. Legitimate power creates the moral grounds for leaders to exercise courage (Gabriel, 2014) because their role puts them in the position where courage, the exercise of power and decision-making is both expected and required. Leaders and managers who are struggling with courage need to review and understand the power invested in them by the role they occupy.  

Courage is not something we develop over night when we become a leader or manager.  As with anything in life, courage will develop and grow if we exercise it; especially when as a leader, we choose to do something we are uncomfortable with. Repeatedly doing what we fear helps us develop resilience with courage following behind, as what was once too difficult to do becomes something we have mastered through experiential learning (Lowery, 2019).  For example, challenging unprofessional behaviours in the team is difficult to do, but becomes easier as we do it more.  There are two reasons for this, one is that people learn to expect and accept being challenged (this in turn starts to change their behaviours) and the second is that the leader starts to develop ways of being challenging that they are comfortable with and begins to understand how people react. 

In developing courage, Lowery (2019) also suggests that leaders need, among other things, to develop purpose. It is much easier to be courageous when you know what you are about.  Leaders who understand their purpose, their mission, vision, aims and objectives have something to be courageous about. Leaders looking to develop courage therefore need to give some thought as to what the purpose of their role is, and then what they need to do to achieve this.   

Leaders who are courageous choose to be so. They confront difficult situations and people; learning how to cope which in turn helps forge courage. They critically reflect on situations and identify what went well and what went wrong. They identify how, in the exercise of courage, they were able to influence things (Byrne et al, 2018). Becoming more reflective is a trait the best leaders and managers have. 

Courage is as much about learning to cope with failures as it is about successes.  Courageous leaders learn to accept that failure happens, learn from it and carry on (Byrne et al, 2018).  The litmus test of a courageous leader is that they retain the ambition and drive to carry on trying new things and innovate even after some failures.  If a leader wants to learn to be courageous, they need to learn from failures, reflect, and carry on. 

Courageous leaders are readily accountable for their actions and the actions of people who they have delegated tasks to.  Accountability, in this sense, is more than just being able to face one’s employer, but it is learning to do things one can be proud of, being accountable to oneself, and wbeing accountable morally and ethically.  Moral courage in this sense is learning to act on one’s values and ethics even in the face of potentially negative outcomes.  Moral courage, it is suggested can be grown through education, self-directed study and with support from one’s manager (Pajakoski et al, 2021) perhaps in supervision, and evidently through understanding one’s personal values and ethics.

Testing your courage

Courageous leaders learn to test their courage and reflect on these tests. Courageous leaders accept that it is they who must face difficult situations.  New leaders need to test their courage by not delegating difficult conversations to others, but by taking on these conversations themselves.  This might mean intervening in an exchange between colleagues or a service user and a colleague, it may mean challenging a team member who is known for being strong when they need challenge.  

Leaders can test their courage by letting go and delegating tasks to staff.  Courageous leaders learn that they do not need to do everything, and that courage means letting tasks go, developing others but also accepting accountability.

For some new leaders, testing of courage is something best done with the support of a supervisor or manager.  This means gaining validation for the action from the senior colleague, creating a strategy to act on the issue, acting and then reflecting with them.  Reflecting with someone else helps not only learn from the situation but creates the setting for the senior colleague to test and question the action — being questioned in this way helps build resilience and courage as much as it tests, at least in part, by exploring vulnerability (Papaux, 2016).  


Just because someone has developed moral courage as a leader or manager does not mean that they do not need to exercise coping strategies.  People exercising courage in the workplace need to believe they have the power to change things.  People who learn to cope with the stresses of exercising moral courage are the same people who also take the time to understand the situation, mobilise their knowledge and use this to bolster their positive exercise of courage (Hong et al, 2023).   

Conversely, people who exhibit low levels of courage adopt coping strategies which suggest they feel they have no influence over how things are going to be and so feel demotivated and powerless (Hong et al, 2023).  Such leaders have little grasp on the realities of the situation and choose to become indifferent and have a negative attitude to work. 

It seems coping is, at least in part, related to the ability look on the positive side, believe in oneself and then identify and apply knowledge to situations. 


In this paper we have reminded ourselves about what courage in leadership is and the important role it has in protecting patients.  We started to identify some strategies leaders and managers might use to start to develop courage in the workplace. We saw that leaders have a legitimate right to act by virtue of their place in an organisation.  

We discussed how courage is like a muscle which needs exercise to grow and develop, and that leaders need to use it or it will never develop.  Courage is best exercised when it has a purpose or vision behind it, to this end managers and leaders need to be aware of their purpose and the aims and objectives they are working to. 

We identified that being courageous is a choice.  Leaders need to choose to be courageous and learn to reflect on the exercise of courage.  We considered how learning to be courageous as a leader also means learning to accept that failures happen and to move on from them.  Courageous leaders accept accountability and engage in self-development activities, so they better understand what they are required to do. 

We identified that courageous leaders learn to test their courage from time to time, and in doing so they develop better and more meaningful coping strategies.


Byrne A, Crossan M and Seijts G (2018) The Development of Leader Character Through Crucible Moments. Journal of Management Education 42(2): 265-293

Department of Health (2012) Compassion in Practice: Nursing, Midwifery and Care Staff – Our Vision and Strategy.

Gabriel Y (2015) The caring leader – What followers expect of their leaders and why? Leadership 11(3):316-334.

Hong N, Qichao N, Dong C. et al. (2023) A study on different types of moral courage and coping styles of clinical nurses: based on potential profile analysis. BMC Nursing 22:418.

Lowery K (2022) ‘What are you willing to do?’: the development of courage in social justice leaders. International Journal of Leadership in Education 25(1):1-20.

Nursing and Midwifery Council (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: NMC

Pajakoski E, Rannikko S, Leino-Kilpi H and Numminen O (2021) Moral courage in nursing – An integrative literature review. Nurs Health Sci 23:570–585.

Papaux E (2016) The Role of Vulnerability in Supervision. Transactional Analysis Journal 46(4):331-342.

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