Our lives today are dominated and influenced by politics and business. These are turbulent days in the healthcare industry. There is increasing demand for stronger accountability and questioning of the nature and delivery of nursing and healthcare services (Pointer & Orlikoff 1999, Adams 2005). The Florence Nightingale Foundation Leadership Scholarships programme, for example, gave the rationale for their scholarships –‘It is recognised that there is a serious need to invest in bespoke leadership experiences, for those with the potential to reach the most senior leadership positions in nursing and midwifery. The requirement to provide leadership in achieving high standards of clinical outcomes, excellent patient experience and safe patient care, is of the utmost importance’. The programme is looking for senior nurses with ‘outstanding ability to operate in the highly political and increasingly business orientated health scene’ (http://www.florence-nightingale-foundation.org.uk/Leadership.htm).
Given this constantly changing, fast pace, uncertain and complex nursing and healthcare context, all current and aspiring nurse leaders and managers and all those who work in healthcare must ask and provide, for themselves, a honest response to the question, ‘why should any nurse be led by you?’ This question has been a significant driver in two professional doctorates in work-based learning on the processes of leadership development (Alleyne & Jumaa 2007; Jumaa 2005c). The inspiration for this question came from a Professor of Organisation Behaviour at the London Business School, England and a seasoned senior Management Consultant (Goffee & Jones 2000). Why should any nurse be led by you? Are your knees knocking? Are you scared when you asked yourself this question? Do you experience some sense of self-doubt? You are not alone. Since 1990 when the question, ‘why should anyone be led by YOU?’ was asked of hundreds of business executives, in dozens of companies in Europe and the United States (USA), ‘the response is a sudden, stunned hush. All you can hear are knees knocking’ (Goffee & Jones 2000, p. 63). Leading and getting followers behind you in this era of knowledge and information age is very difficult. This is why we need to have evidence-based approaches to engage nurses and secure their commitment to nursing and healthcare goals.
The time is now. We need to get on with leading and managing and get the results our stakeholders need and desire (Jumaa 2005a, Phillips 2005, Jumaa & Rendal 2007). When we write and talk about leadership or/and management and leadership development (MLD) we need to stop debating about their definitions. What is crucial is to state our assumptions and the definitions we are using in and for a particular context. We need to make a case for our own perspectives. Leadership and management are many things to many people. Understanding leadership, according to Rost, is a perennial task. It has been so for well over the last hundred years because it is a fundamental, universal and pervasive part of what goes on in human organizations (Rost 1993). Amongst others we do know that there is evidence that effective leaders use a variety of distinct leadership styles, and that people perform well if leaders motivate them and create a sense of significance, a sense of community and a sense of excitement (Goffee & Jones 2000). We also know that an effective nursing and healthcare leader needs to be, amongst other roles, a stakeholder manager, a strategic planner, a craftsperson, a strategy ‘fixer’, a reflective leader, a strategy ‘fitter’ and a provider of continuous quality service (Jumaa 2005b). An organization is only as great as the vision of those who serve and act as stewards. They give the organization direction and help it stay current, relevant and compelling to its members (Jumaa & Picard 2008).
This special edition is on Nursing Leadership Development. We appreciate the time and effort from all those who contributed to this publication particularly the authors of the 14 papers (nine original articles; four commentaries and one book review) from Australia, Canada, Israel, Sweden, United Kingdom (Wales and England) and United States of America. We want to extend a special thank you to Carol Huston President, board of directors, International Honor Society of Nursing – STTI, Rosemary Kennedy, Chief Nursing Officer, Wales, Gwen Sherwood Vice president, board of directors International Honor Society of Nursing – STTI and Patricia Thompson, Chief Executive Officer, AONE – American Organisation for Nurse Executives for taking time off their national and international duties to contribute to this edition. These are national and international nurse leaders either elected by you or appointed on your behalf.
Based on the evidence that organizations that encourage and facilitate a culture of learning among employees in the work place outperform those that do not (Goffee & Jones 2000, Goleman 2000, Burgoyne et al. 2004, Phillips 2005, Phillips et al. 2005, Mabey 2005, Alleyne & Jumaa 2007), this editorial is presented under four sections. They are the basis for effective and sustained leadership activities. There is evidence that effective and successful leadership judgements are made based on both numbers (efficient resources utilization – RU) and stories (effective client/patient satisfaction – CS) (Jumaa 2005c, Jumaa & Crossant 2007). This assertion is borne out by the papers from Huston, Kennedy and Thompson. The four sections are:
• providing health gain direction through specific and agreed nursing and health goals (RU);
• gaining commitment of your patients and colleagues through explicit nursing and healthcare roles (RU);
• facilitating change for improved health status through employing clear nursing and healthcare processes (CS); and
• achieving the best results for your patient and teams through the efficient, creative and responsible deployment of people and other resources within an atmosphere of open nursing relationships (CS).
Providing health gain direction through specific and agreed nursing and health goals? (RU – Resources Utilization)
Providing health gain direction through specific and agreed nursing and healthcare goals with key stakeholders is mandatory. Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles (http://www.icn.ch/definition.htm– The ICN Definition of Nursing). What this means is that if you are a nurse you must subscribe to these value position statements. Therefore any leadership development process you create must address some but ideally all these strategic nursing issues. They should, in essence, form the basis for your definition of management and leadership development activities.
Dr Marrow, co-author of this editorial, for example, agrees with the ICN statement and believes that leadership is about the skills and the ability to inspire others by being an effective role model which includes having vision for future developments. It is also about self-awareness, the ability to work effectively as a team member and being able to reward and have faith in the capabilities of those who work with you. As a Reader in International Nursing Development within the University of Cumbria in the North West of the United Kingdom, Dr Marrow has facilitated the development and delivery of an MSc in Health Care Leadership. The philosophy on leadership on this programme, for the past 7 years, focuses on the importance of facilitating academic skills which enable leaders to make sound decisions based on strong evidence. These skills incorporate: critical appraisal techniques; the ability to undertake research and change initiatives; and the understanding of wider professional and political influences on health care.
The first two papers by Julie Matthews, Darren Leech and Carol Huston are about current and future provisions for health gain direction. The commentary paper by Julie Matthews and Darren Leech alerts us to the current ‘private sector’ situation in the UK National Health Service (NHS). They made a very strong case to increase nursing leadership development at the board level. Carol Huston, in her capacity as the President of the International Honor Society of Nursing, makes a compelling plea for nurses to wake up to the enormous challenges facing nurses globally. Eight competencies are prescribed as essential for nurse leaders in the year 2020.
Gaining commitment of your patients and colleagues explicit nursing and healthcare roles? (RU – Resources Utilization)
Gaining commitment of your patients and colleagues through explicit nursing and healthcare roles is of significant importance to Patricia Thompson; Picker-Rotem, Schneider, Wasserzug and Zelker; Bobbie Sue Whitworth and Carina Furaker the authors of the four papers in this section: one commentary and three original articles. ‘Key Challenges Facing American Nurse Leaders’ a commentary by Thompson found that the top three challenges were: managing financial challenges, assuring patient safety and quality and dealing with the workforce. These were closely followed by the need: for nursing leadership development and succession planning; to redesign patient care delivery; to create stronger relationships between the academic and practice settings. This compelling story of the challenges faced by the nurse leaders in American healthcare is reflected throughout this edition as evidence of the global strategic issues facing nurse leaders.
Picker-Rotem, Schneider, Wasserzug and Zelker made a case for a more structured and transparent approach using peer evaluation to identify and select new nursing leaders in hospital settings. They argued that leadership, as opposed to clinical expertise, is not usually acquired in the classroom. Leadership abilities involve many traits that are difficult to define and analyse. They assumed that whether inherent or acquired, leadership is more easily recognized by fellow nurses rather than by upper managers, who do not come in direct contact with all staff members. Is there a relationship between different personality factors of female-registered nurses and their method of dealing with conflict? This is the focus of the paper from Bobbie Sue Whitworth. She found no statistically significant correlation between female-registered nurses’ personality factors and methods of dealing with conflict. The literature, however, reveals that interpersonal conflict among nurses is a significant issue for the nursing profession. The United States is faced with a serious nursing shortage, in part as a result of job dissatisfaction related to conflict in the workplace. The conclusion is that understanding conflict management styles can increase registered nurses’ positive conflict outcomes and lead to improved relationships, increased job satisfaction and increased retention of registered nurses. The fourth paper by Carina Furaker contributes to an understanding of the managers and the importance of nursing education in Registered Nurses professional development.
Facilitating change for improved health status employing clear nursing and healthcare processes (CS - Client/Patient Satisfaction)
Facilitating change for improved health status through employing clear nursing and healthcare processes is the main concern of the six papers (one commentary and five original articles) in this section. In essence the focus is on the question, ‘to what extent are good management and leadership synonymous with good nursing?’ If you agree that nurses need to implement the following: ‘provide health gain direction’; ‘gain commitment of patients and colleagues’; ‘facilitate change for improved health status’; and ‘achieve the best results for patient and teams’, then you already are agreeing and valuing the processes of achieving good management and leadership within your nursing and healthcare contexts.
These transformation processes (see Figure 1), if clear and unambiguous, will lead nurses to implement good management and leadership while simultaneously delivering high-quality care and service for and with patients, clients and colleagues (see Jumaa & Alleyne 2002, 2007, Kennedy & Jumaa 2002, Jumaa et al. 2005, Phillips 2005, Phillips et al. 2005, Alleyne & Jumaa 2007, Jumaa & Rendal 2007). Good management and leadership in the UK derive from there accepted key purposes which are to ‘provide direction, gain commitment, facilitate change and achieve results through the efficient, creative and responsible deployment of people and other resources’ (MSC 2005). Professor Mintzberg in his article ‘Nursing as Blended Care’ (Mintzberg 2004) provides a vivid illustration of good nursing as good management and leadership.
Putting the Strategic Capability Development Formula into action [see Figure 1, (http://www.l4t.teganet.com/about.htm)] is the overall basis for the transformation processes needed to convert good nursing into good management and leadership, and good management and leadership into good nursing. A number of commentators (Kennedy & Jumaa 2002, Jumaa et al. 2005, Phillips 2005) have stated that big gains in patient services improvement are realized when practitioners, managers, leaders, researchers, educators and employers rely on their people and adopt nursing and healthcare practices, such as the CLINLAP/LEADLAP Model that tap their capabilities.
In her Commentary, Rosemary Kennedy cited the proverb which reads, ‘it’s tough trying to keep your feet on the ground, your head above the clouds, your nose to the grindstone, your shoulder to the wheel, your finger on the pulse, your eye on the ball and your ear to the ground’ yet this is what we seem to be asking our nurse managers, at all levels, to do! If nurses are to become something of the contortionists that this proverb indicates, they have to start limbering up and learning the tricks of the trade at an early stage in their careers – the earlier the better. The CLINLAP Model (Phillips 2005) is adaptable enough to serve as the 21st century Chandlery cupboard if commissioned for this purpose. Facilitating change for improved health status through employing clear nursing and healthcare processes are explored from different viewpoints in the next six papers. The focus for Sara Horton and Gwen Sherwood is the process of reflection as a key instructional strategy for preparing transformational nurse leaders. Iain W. Graham and Eleanor Jack explored the strategic approach to corporate development. Vicki Lucas, Heather K. Spence Laschinger and Carol A. Wong investigated leadership skill for empowering staff. Jeanne Morrison’s focus was on how Emotional Intelligence levels and conflict skills could be used to improve interpersonal relationships in a healthcare facility. Finally in this section, Lara Carver and Lori Candela examined understanding how to relate to the different generations of nurses and how tapping into their individual strengths can lead to improved nursing work environments.
Achieving the best results for your patient and teams through the efficient, creative and responsible deployment of people and other resources within an atmosphere of open nursing relationships (CS - Client/Patient Satisfaction)
The final section of this review has two papers – one commentary from Jumaa and a book review by John Lawler. The book, Nursing Leadership is written by Sally Shaw. The aim of the paper by Jumaa is to raise awareness about the apparent lack of formal activities and the paucity of published papers on nursing leadership development at the board level in the United Kingdom (UK). The paper suggests a way forward through a brief outline of the ‘F.E.E.L’ good factors that could be cultivated in nursing leadership development at the board level.
Sadly, a threat running through most of the papers in this edition is ‘perceived’ as well as ‘real dissatisfaction’ with the current state of affairs within the nursing profession: acute shortage of much needed staff; a very high level of stress experienced by staff; and increased conflict in the workplace. These are just some of the sources of the dissatisfaction. These sentiments are captured in the paper by Rosemary Kennedy who argued that there is a lack of nurturing in the workplace. Which means, often, one of the greatest frustrations for staff is to return to their workplace, after a Continuing Professional Development (CPD) activity, fired up with energy and enthusiasm only to be smothered by a blanket of depression and suppression. The outcome of this lack of authenticity within the workplace is having a devastating effect on the socialization of novice nurses who need time to learn the complexities of professional nursing and the protection of a mentor. These situations are compounded by the nursing profession’s earned reputation for being unkind to its newest members, and that reputation is rooted in reality. There is evidence that the experience of new nurses as they are socialized into the health care environment of the 21st century is fraught with a high degree of bullying and horizontal violence. Research suggests that in many cases, the harassers are nurse colleagues (Huston 2008). Unfortunately, there is also public evidence of the nursing profession earning a reputation for being unkind to its older members. What else do we need to do in order to develop the future nurse leaders to become the managers we need and the leaders we want? Rosemary Kennedy writes about the initiatives in Wales and across the UK to address the situation. Developing leadership capability in Carol Huston’s Essential Nurse Leader Competencies for 2020 would be a significant positive step forward.
Implementing the best results for your patients and teams through the efficient, creative and responsible deployment of people and other resources within an atmosphere of open nursing relationships are still goals that are achievable. Such achievements are documented in the research and development projects cited in Jumaa’s paper. Both formal evaluations and informal conversations received about the MSc in Health Care Leadership at the University of Cumbria, for example, highlighted the students’ successes on completion of the programme. These successes include: development of complex clinical care strategies and protocols; critical reflection and practitioner research; confidence to articulate their work to others; promotion within and without their institutions and access to PhD study. Nevertheless, it is not a perfect world and there are issues that many students have to work through to achieve at this academic level. Working full time, studying in the evenings and weekends and in some cases having to look after loved ones or families are indeed very challenging. Learning to become critical and present a critique of what is learned is often a key concern for students and frustration sets in when the reality of linking theory to practice in the workplace is difficult. Tenacious students with their eyes set firmly on their goals often win through to achieve their objectives. This is one attribute that makes for good and effective leadership – never give up!!