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What do nurse leaders do?

The quality of clinical leadership is recognized as central to provision of high-quality care, creation and maintenance of supportive and innovative workplace cultures. However, leadership roles in professions differ from that in business and commerce, in that practitioners first learn the ‘craft’ of their profession, and then migrate from roles where they are primarily concerned with their own clinical practice to have oversight (and responsibility) for that of others. Whether or not any element of the clinician role is retained, a new learning process is associated with this transition, including acquiring skills of management as well as leadership. Traditionally poor at supporting staff through this, increasing awareness of individuals’ needs in relation to the demands of such a process has led to a burgeoning of leadership modules and courses for nurses, such as that provided through the Royal College of Nursing of the United Kingdom (http://www.rcn.org.uk/development/practice/leadership, accessed 4/12/2011).

Management of change is a core element of a leader’s role. In the current climate of health care, to be in a state of change is the status quo, occurring both in pursuit of innovation/quality improvement, and in response to resourcing crises. The importance of leadership and leadership style are common themes in models of change. However, other than case study and anecdote, to date, little systematic attention has been paid to what this means on a daily basis for those charged with such roles.

The study by Salmela et al. (2012) in this issue of JAN addresses this. Focused on nurses in management roles (Head Nurses and Directors of Nursing) in a time of major change (merger of two healthcare organizations, one a hospital, the other a primary healthcare centre), they set out to explore how these nurse leaders described and understood their main tasks and roles during this process. In-depth interviews were conducted in 2004, and the process of analysis using a phenomenological hermeneutic approach was undertaken over the following six years. The result was a three-dimensional model of the roles and tasks of nurse leaders for change: leading interpersonal relationships, leading processes, and leading a culture.

Leading interpersonal relationships encompassed the roles of being a team player, communicating, informing and interacting with others; of being a coach, supporting, encouraging, and bringing out the best in others; of taking on a parental role, being ‘mother’ to the team. It was about concern for people, and working with and through people to achieve results. Leading processes entailed co-ordination including that of resources; of having oversight of the whole, responsibility and making choices and decisions to ensure that all the strands of activity were woven together seamlessly. This was about keeping patient care at the centre, and ensuring the processes to achieve this. Leading a culture meant engaging in open dialogue and creating an atmosphere of openness; supporting and fostering an attitude in which patient care delivery remained true to core values and yet developed in line with best evidence. This centred around the values, norms, and history of the organization as well as its individuals.

Salmela et al. note that nurse leaders were interviewed immediately prior to the merger, i.e. they were ‘in the thick of it’. Interview at some later point might have resulted in different perspectives. Nonetheless, this account stands as a model of nursing leadership for change, and provides both food for thought and a template for others in similar positions. The study is a helpful addition to a science and knowledge base still in its infancy.