Nursing leadership: influencing and shaping health policy and nursing practice

Examining the role of nurse executives in homecare through the lens of the Sociology of Ignorance and Critical Management Studies

This article presents a novel theoretical approach to explore nurse executives' paradoxical identity and agency of executive and nurse in homecare organizations. This complex phenomenon has yet to be well theorized or analyzed. Through a synthesis of literature, we demonstrate that Critical Management Studies, as informed by Foucault, and the Sociology of Ignorance, can create a different understanding of the complex interplay between knowledge and nonknowledge (ignorance) that positions nurse executives in both influential and precarious ways in homecare organizations. This theoretical framework has the potential to allow for the explicit exploration of nurse executives' strategic epistemic and discursive positioning and highlights hierarchal power structures within homecare organizations. We posit that this framework, that spans nursing, management and sociology disciplines, sets a different understanding of homecare organizations as epistemic landscapes, exposing institutional knowledge and ignorance dynamics that remain largely concealed and unchallenged, yet are integral to understanding nurse executives' epistemic agency.

Elucidating strategies used by clinical nurse leaders to facilitate fundamental care delivery: A qualitative study

AIM

To investigate the strategies used by nurse leaders to facilitate fundamental care delivery in their clinical area.

DESIGN

An interpretative qualitative design study reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ).

METHODS

Twenty-four self-identified nurse leaders from across Australia were interviewed between November 2020 and April 2021 to discuss their strategies for facilitating fundamental care. Data was analysed using inductive thematic analysis.

RESULTS

Nurse leaders' experience of facilitating fundamental care produced two major themes, delivery of fundamental care (comprising three sub-themes: valuing fundamental care, understanding and developing staff capacity and supportive relationships), and monitoring of fundamental care (including three sub-themes: visibility in the clinical area, embedding fundamental care in the practice setting and specific direct actions).

CONCLUSION

Facilitating fundamental care delivery is complex. This study highlighted the importance of nurse leaders' individual characteristics, and nurse leaders' ability to establish and maintain relationships alongside the role of informal and formal monitoring of fundamental care delivery.

IMPACT

Findings from this study build on existing research into fundamental care and contribute to our understanding of the role, characteristics and actions of nurse leaders to facilitate fundamental care. The results demonstrate the complexity and intricacy of nursing leadership to facilitate fundamental care, and that a dynamic 'thinking and linking' approach is required. The results show individualized practice which may create challenges for new nurse leaders seeking guidance, and for monitoring nurse leader activity. Further research is advocated to explore insights and tools to optimize nurse leaders' endeavours in facilitating fundamental care.

PATIENT OR PUBLIC CONTRIBUTION

This study was designed using insights generated from patient and public involvement in nursing leadership and fundamental care.

The Ambassador Project: Evaluating a Five-Year Nationwide Leadership Program to Bridge the gap Between Policy and District Nursing Practice

District nurses have a crucial position in healthcare provision and are expected to use leadership practices to ensure optimal quality patient care. To better equip them, a leadership program named the ambassador project was developed to support the development of a liaison role between policy and district nursing practice. This research aims to evaluate from different perspectives the impact of this nationwide, five-year leadership program for district nurses at the organizational, regional, and societal levels. A mixed-methods study was conducted using two focus groups based on peer-to-peer shadowing (n = 14), semistructured interviews (n = 13), and an online questionnaire (n = 45). The analysis shows that the impact of a nationwide leadership program for district nurses was perceived as predominantly positive, and nurses experienced an increase in courage, assertiveness, professional pride, and leadership skills. They obtained confidence in representing the group of district nurses at the organizational, regional, and societal levels when speaking with various key stakeholders from the healthcare system. They were able to bridge the gaps among daily practice, policymaking, and politics by using translations and shaping actions and information into terms suiting the needs of those involved.

Exploring the influence of the nursing and medical professions on policy and politics

BACKGROUND

The Nursing Now global campaign is aimed at raising the profile of nursing and its influence on policy and politics. Calls for the profession to have an increased role in policymaking are not new, but recent developments offer significant opportunities to advance this message.

AIM

To compare and contrast the published scholarly evidence, indexed in Web of Science (WoS), relating to how medicine and nursing influence policy and politics.

METHOD

A bibliometric analysis of scholarship was undertaken to determine how medicine and nursing influence policy and politics. Indexed articles in Web of Science were compared to examine the evolution of scholarly contributions by both professions.

RESULTS

Since 1990, nursing and medicine have been consistent contributors to scholarship on policy and politics. At the same time, there has been an exponential growth in scholarly output, but nursing is now starting to fall behind. Nursing has focused on the necessary knowledge and skills, whereas medicine has focused on acting on specific issues.

CONCLUSION

There are multiple opportunities for nursing scholars to accelerate their indexed output to inform evidence-based advocacy, and influence policy and politics. These endeavours will increase their potential to inform future healthcare.

Nurse practitioners' perceptions of their ability to enact leadership in hospital care

AIMS AND OBJECTIVE

To gain insight into nurse practitioners' (NP) leadership roles in Dutch hospital care, by exploring the perceptions regarding their current leadership role and the differences with their previous role as a registered specialised nurse.

BACKGROUND

To meet today's challenges of the increasing healthcare demands, the employment of NPs is proliferating. NPs have the ideal position to play a pivotal role within healthcare reforms, yet full expansion of their scope of practice and expertise is having limited success. Long-term sustainability of NPs depends on the ability to perform and develop a leading role.

DESIGN AND METHODS

This qualitative descriptive study was conducted in fifteen Dutch hospitals. Data were collected from April-July 2018, and purposive sampling was used for eighteen semi-structured interviews. This study is conducted and reported according to the COREQ checklist.

RESULTS

Three main themes concerning NPs' current leadership role emerged, and they were all linked to a successful positioning of NPs. All themes seemed to be of influence on NPs' scope of daily practice. Direct patient care was emphasised, and leadership on other levels appeared to be underused. Most NPs desired to reshape their profession. However, unprofitable use of their leadership skills especially on professional and organisational level and lack of supportive factors seemed to hinder them.

CONCLUSIONS

An adequate use of leadership is crucial for role development and positioning of NPs. Further development of the NP profession can help to better differentiate between the tasks of registered specialised nurses and NPs.

RELEVANCE TO CLINICAL PRACTICE

Leadership in nursing contributes to the improvement of the quality and efficiency of health care. Further positioning of the NP profession depends on a profitable use of leadership competencies. Besides, NPs should collaborate with healthcare organisations, educational institutions and professional associations to value the NP profession in the current healthcare system.

Emancipatory reflection on a nursing practice-based ethical issue about nurses’ paternalistic decision-making for patients

Objective

This study aimed to demonstrate and promote the skill of critical emancipatory reflection through reflecting on a nursing practice-based ethical issue about nurses’ paternalistic decision-making for patients. Meanwhile, critical awareness will be developed and the underlying issues of paternalism in nursing decision-making will be analyzed. Then, by applying the procedure, improvement in nursing decision-making practice will be expected.

Methods

Taylor’s model of emancipatory reflection with four steps, including construction, deconstruction, confrontation, and reconstruction, is utilized to guide the author’s reflection.

Results

Guided by the socialization theory, the author’s personal and professional socialization is seen to be associated with the formation of the value of paternalism. The theory of reflexivity is applied to unearth the related issues, including deeper personal value, work environment, as well as historical and cultural contexts. Moreover, the power derived from policy, work relationship, and nursing administration, which could induce paternalism in the author’s nursing decision-making practice, was critically debated using the hegemony theory. Finally, new insights into paternalism will be achieved, which enable change in terms of how to facilitate patients’ autonomous decision-making.

Conclusions

The process of refection makes it clear that respecting patients’ right and performing patient-centered caring are the bases to change the paternalism existing in the nursing decision-making practice currently. The reconstruction step assists the author in terms of how to value the patients’ autonomy and balance patients’ safety and choice, rather than being overprotective; carry out risk assessment, and search for strong evidence to counterbalance the positive and negative aspects of risk-taking; communicate with patients appropriately in a manner that they can comprehend; spend more time to explore patients’ preference and choice; make every effort to elevate the patients’ decision-making capacity; implement patient-centered care and shared decision-making in nursing practice; consult with other colleagues and obtain the required support when limitations or challenges exist; try to justify and avoid hidden paternalism behind policy or guidelines; deal with the power in hand well and fairly; and also positively face the powers that constrain the author.

Percepção de estudantes de doutorado em enfermagem sobre planejamento de carreira e prioridades de pesquisa

Resumo Objetivo: O objetivo deste estudo foi descrever os pontos de vista de estudantes de doutorado em enfermagem antes do início e durante o doutorado sobre mudanças no planejamento da carreira e prioridades de pesquisa. Métodos: O estudo foi de natureza qualitativa, tendo sido realizado com 16 entrevistas no Instituto de Ciências da Saúde, Faculdade de Enfermagem. Foram realizadas entrevistas individuais com 16 estudantes de doutorado matriculados em diferentes especialidades acadêmicas. Após as entrevistas, as gravações de áudio foram primeiramente transcritas e depois categorizadas. Os dados foram submetidos a análise de conteúdo. Resultados: Após análise de conteúdo, três temas principais (“mudanças no planejamento da carreira”, “prioridades de pesquisa” e “desenvolvimento”) e seis categorias foram formuladas a partir dos dados obtidos. Os participantes afirmaram ter consciência de ter feito várias mudanças nos planos de carreira ao iniciar seu projeto de doutorado, e o trabalho no projeto mudou o desenvolvimento profissional e melhorou as habilidades acadêmicas. Conclusão: Nossos resultados indicam que os estudantes de doutorado devem ser apoiados para serem eficazes na carreira, e a formação no período pós-doutoral também deve ser apoiada. Políticas efetivas em relação ao aperfeiçoamento de enfermeiros doutorandos também devem ser desenvolvidas e implementadas com base em evidências sólidas da utilidade desses suportes.

Using social media to engage nurses in health policy development

AIMS

To explore nurses' views on future priorities for the profession and to examine social media as an engagement tool to aid policy discussion and development.

BACKGROUND

Nurses are often not directly involved in policy creation and some feel it is a process they cannot easily influence.

METHODS

A descriptive mixed methods study of a Twitter chat hosted by the Chief Nursing Officer for Scotland was undertaken. Data were gathered using an analytics platform and NCapture software. The framework approach aided thematic analysis to draw out themes.

RESULTS

Sixty-four people took part in the Twitter chat (#CNOScot) and posted 444 tweets. Nurses called for investment in technology, nursing research, education and mental health. Primary care and advanced practice roles to support older adults with complex health and social care needs were also seen as vital to develop further.

CONCLUSION

Social media can help reach and engage nurses in policy discussion and ensure there is better continuity between policy and practice but some groups risk being excluded using this digital medium.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing leaders should consider social media as one of many engagement strategies to ensure nurses and other stakeholders participate in policy debate that informs health strategy development.

In command of care: clinical nurse leadership explored

Who are the clinical nurse leaders? What are the qualities and characteristics of clinical nurse leaders? Why are they seen as clinical leaders and what might their experiences of clinical leadership be? This paper outlines a research project that sought to explore these questions. The research involved surveying registered/qualified nurses from D to H grade ( n= 830) who staffed 36 clinical areas in one acute NHS Trust in the English Midlands. Only 188 questionnaires were returned, but the data proved a rich source of information about clinical leadership, the attributes of clinical leaders and who might be recognised as a clinical leader. F-grade sisters were seen as strongly associated with the role. The questionnaire was followed by interviews with 42 qualified nurses from D to H grade on four clinical areas in the same NHS Trust, and these were followed by eight further interviews with nurses identified from the interviews as clinical nurse leaders. The results demonstrate that clinical leaders appeared to be present at all nursing levels and in considerable numbers, but they were often not the most senior nurses and their approach to clinical leadership was based upon a foundation of care that was fundamental to their values and beliefs or view of nursing and care. The study also indicated that the type of clinical area had an influence on who might be seen as a clinical leader. The attributes of clinical leaders appeared to be clinical competence, clinical knowledge, approachability, motivation, empowerment, decision-making, effective communication, being a role model and visibility.

In command of care: Toward the theory of congruent leadership

This is the second of two papers that discuss clinical leadership in the light of a research study which explored who the clinical nurse leaders are, what the characteristics and qualities of clinical leaders might be, why some nurses are seen as clinical leaders and what their experiences might be (Part 1 (Stanley, 2006)). Outlined are contemporary views about leadership and nursing, with emphasis on transformational leadership. Also explored is the new theory of congruent leadership. It is proposed that congruent leadership is a theory best suited for understanding clinical leadership because it is defines leadership in terms of a match (congruence) between the activities, actions and deeds of the leader and the leader's values, principles and beliefs.

Iranian Nurses' Status in Policymaking for Nursing in Health System: A Qualitative Content Analysis

Presence of nurses in policy making will result improvement of nursing practice, and increase qualification of patients' care, but still few nurses are involved in policy debates and health reforms and their status in policy making for nursing is not clear. The aim of this study was to elucidate Iranian nurses' status in policy making for nursing in health system. This is a qualitative study. Using purposive sampling 22 participants were interviewed to gain deep understanding from the phenomenon of status of nurses in policy making. Of these 2 were not nurses but the members of Iran's council for health policy making. Data were analyzed by employing conventional content analysis. Nurses' status in policy making declared base on the implications of three main themes including "the policy making framework", "perceived status of nurses in policy making", and "the manner of nurses' participation in policy making". The conclusion of the present study is that Policy making for nursing is a subcategory of Iran's macro health policies. What made the status of nurses more efficient in policy making for nursing was their practice and rate of participation in the appointed positions and the society. Results of this study represented major points of weakness in nursing policies and some recommendations for modifications.

Role of directorates in promoting nursing and midwifery across the various States of India: call for leadership for reforms

BACKGROUND

While the roles and responsibilities of nursing professionals have multiplied over the years, but there are huge concerns with regard to the development of the nursing workforce and human resources (HR) issues for their career growth. The major lacuna is in not involving the nursing professionals in policy framing and decision-making. As a result, there is a leadership crisis of the nursing workforce across India.

OBJECTIVES

The paper, is part of the WHO supported study, entitled "Study on Nursing and Midwifery in India: a critical review", is developed with the objective to review the current organizational and management structure for the nursing positions at the State Directorates in India and obtain a Leadership perspective to strengthen nursing management capacities to address maternal health issues.

MATERIALS AND METHODS

The study descriptive and qualitative in nature and the sources of information were both primary and secondary collected from 16 states of India.

RESULTS

Since none of the states have neither a Nursing Cell nor the post of Director Nursing, final decision-making powers rest with state health secretaries and medical directors. The nursing management structure majorly managed by senior policy makers from the medical fraternity, and provides very little scope for nursing professionals to participate in policy decision making to bring about reforms. There is no uniformity on HR issues concerning career graphs and pay structures across the states.

CONCLUSIONS

In order to strengthen nursing as a profession and for facilitating their role at the policy level, more powers and autonomy needs to be given to them and this requires HR policy guidelines for nurses. Setting up a separate nursing directorate, to be headed by a senior nursing professional, is suggested in every state along with a strong nursing division at the National level. This total paradigm shift will empower nursing professionals to take up the leadership role at the policy level to bring about necessary reforms. Across the country, nursing professionals repeatedly echoed one requirement: To reframe nursing leadership at all levels.

Nursing Leadership, Missing Questions, and the Elephant(s) in the Room: Problematizing the Discourse on Nursing Leadership

To expose inconsistencies and contradictions in the nurse leadership literature ("text"), this article adopts a deconstructive approach and draws upon the work of Derrida in examining the text or discourse. What is almost entirely missing in the literature are articles that ask difficult, searching questions that challenge some of the taken-for-granted truths or maxims about nursing leadership. The current examination of the literature, described in this article, shows: (a) a lack of convergence of the literature and health care/nursing organizations concerning leadership, (b) a conflation of nursing leadership with managerial or administrative positions, and

Evaluation of leadership practices: how to develop a vision

Leadership competencies and more specifically a strategic vision are essential to managing increasingly complex healthcare organisations and change. However, Switzerland, like many other countries, has identified a lack of leadership skills among nurse leaders. Therefore the Royal College of Nursing’s (RCN) Clinical Leadership Programme has been adapted, implemented and evaluated in the Swiss nursing context. The aim of this qualitative study was to evaluate the Leadership Programme’s support for vision development. In-depth interviews with six nurse leaders, who were purposefully selected according to the quantitative results of the overall mixed-methods evaluation project were included. Interviews were audio-recorded and transcribed prior to qualitative content analysis. Findings showed the different approaches used in the process of vision formation. Some used cognitive-analytical techniques and proceeded very methodically and systematically, whereas others described a more intuitive approach. Some also used a combination of both approaches. Participants experienced fostering and hindering factors on different levels – personal as well as organisational. The identified factors in vision development may be helpful in the planning of educational programmes to facilitate visionary skills among nurse leaders. Vision formation requires time for reflection and the ability of creative thinking, which is distinct from day-to-day management tasks.

Advancing leadership capacity in nursing

To address the potential shortage of nurse leaders, the profession must evaluate current strategies in both education and practice. While many new graduates dream of becoming a nurse practitioner or nurse anesthetist, few transition into practice with the goal of becoming a nurse leader. To increase the number of nurses capable of leadership, the profession must address 2 critical issues. First, effort must be made to augment faculty and students' conceptualization of nursing such that leadership is seen as a dimension of practice for all nurses, not just those in formal leadership roles. In so doing, leadership identity development would be seen as a part of becoming an expert nurse. Second, a comprehensive conceptual framework for lifelong leadership development of nurses needs to be designed. This framework should allow for baseline leadership capacity building in all nurses and advanced leadership development for those in formal administrative and advanced practice roles. The knowledge and skill requirements for quality improvement and patient safety have been explored and recommendations made for Quality and Safety Education for Nurses, but parallel work needs to be done to outline educational content, objectives, and effective pedagogy for advancing leadership development in nursing students at all levels.

Redefining the school nurse role: an organizational perspective

PURPOSE

This paper aims to identify organizational readiness for change towards adoption of a redefined role of the school nurse as a strategic option in the context of a health promoting school approach. This new role is consistent with planned change directed at life habits and life conditions.

DESIGN/METHODOLOGY/APPROACH

A questionnaire based on a modified version of the organizational readiness for change (ORC) framework was e-mailed to 122 top and middle managers (response rate of 74 percent) in 42 local health organizations in the Province of Quebec, Canada, during the fall of 2009.

FINDINGS

In total, 90 percent of participants perceived the proposed role as a solution to fulfil their school health program needs, especially to plan and integrate health promotion projects. The lack of resources and nursing support emerged as factors hampering the capacity of school nurses to play such a role.

RESEARCH LIMITATIONS/IMPLICATIONS

Additional implications of the ORC framework are needed in order to better address organizational readiness for complex changes in specific health-related settings.

PRACTICAL IMPLICATIONS

Access to information technology and the development of computer skills would help enhance this encompassing role in health promotion.

ORIGINALITY/VALUE

Findings have the potential to better inform health authorities regarding the new role of the school nurse as a strategic option in health promotion. This study also provides an application of the theoretical framework showing the need for additional empirical tests.

Exploring leadership in community nursing teams

AIMS

This article is a report on a study investigating how leadership is perceived in community nursing teams and how these perceptions are translated into working practices of team leaders.

BACKGROUND

The consensus in community nursing literature is that leadership is important, and especially so in a time of change. However, little empirical evidence exists on how leadership works in practice.

METHOD

The study adopted an exploratory descriptive design, utilising individual semi-structured interviews and focus groups in four case-studies, with a total of 54 participants. Two case-studies focussed on district nursing teams and two involved public health nursing teams, located in two geographical areas. Participants debated their understanding of the concept of leadership, its associated practices and behaviours in teams, if they saw themselves as leaders, and what preparation was required. The study was undertaken in 2009. Framework analysis techniques were employed to analyse the data.

FINDINGS

A 'quasi-family' model of leadership emerged, with significant emphasis on the importance of personal relationships and support. Nursing grade had a greater impact on perceptions of leadership than geographical context or professional and clinical focus.

CONCLUSION

No clear fit with any existing theoretical framework was identified. However, nurses in the highest grade banding, in particular, demonstrated practices associated with transformational leadership. Nurses expressed the very clear need to be acknowledged, respected and valued, and that those who provided this support were regarded as good leaders.

Developing leadership in nursing: exploring core factors

This article provides an introduction to the issue of nursing leadership, addressing definitions and theories underpinning leadership, factors that enhance leadership in nursing, and the nature of leadership content taught in undergraduate programmes. Highlighted are differences between leadership and management, and the notion that leadership can be 'learned'. The authors also point out that there is a discrepancy between how leading undergraduate nursing programmes prepare students primarily in the transition of education to practice, and the suggestion from a number of nursing publications that leadership in nurses should be fostered throughout their education.

Nursing students' leadership and emotional intelligence in Turkey

The purpose of this study was to determine nursing students' leadership and emotional intelligence. The study was conducted as a descriptive study in a nursing school in 2008. The sample comprised 69 junior and 85 senior nursing students and was based on voluntary participation. Data were collected through a data sheet, a leadership style questionnaire, and the Bar-On Emotional Intelligence Quotient Inventory. There were no statistically significant differences in leadership orientations and emotional intelligence between junior and senior students (p > 0.05). Although there was a significant relationship between emotional intelligence and task-oriented leadership (r = 0.427, p = 0.001), there was no significant relationship between emotional intelligence and people-oriented leadership (r = 0.076, p = 0.367). Students' emotional intelligence score was average, and their people-oriented leadership score was approximately half of the total score. It is recommended to develop strategies for improving nursing students' people-oriented leadership skills during their nursing education.

Determinants of the intention of elementary school nurses to adopt a redefined role in health promotion at school

Background

The quest for greater efficiency in the provision of primary healthcare services and the implementation of a "health-promoting school" approach encourage the optimal redefinition of the role of school nurses. School nurses are viewed as professionals who might be significant actors in the promotion of youth health. The aim of this study was to identify the determinants of the intention of elementary school nurses to adopt a new health-promotion role as a strategic option for the health-promoting school.

Methods

This study was based on an extended version of the theory of planned behaviour (TPB). A total of 251 respondents (response rate of 70%) from 42 school health programs across the Province of Québec completed a mail survey regarding their intention to adopt the proposed health-promotion role. Multiple hierarchical linear regression analyses were performed to assess the relationship between key independent variables and intention. A discriminant analysis of the beliefs was performed to identify the main targets of action.

Results

A total of 73% of respondents expressed a positive intention to accept to play the proposed role. The main predictors were perceived behavioural control (β = 0.36), moral norm (β = 0.27), attitude (β = 0.24), and subjective norm (β = 0.21) (ps < .0001), explaining 83% of the variance. The underlying beliefs distinguishing nurses who had a high intention from those who had a low intention referred to their feelings of being valued, their capacity to overcome the nursing shortage, the approval of the school nurses' community and parents of the students, their leadership skills, and their gaining of a better understanding of school needs.

Conclusions

Results suggest that leadership is a skill that should be addressed to increase the ability of school nurses to assume the proposed role. Findings also indicate that public health administrators need to ensure adequate nurse staffing in the schools in order to increase the proportion of nurses willing to play such a role and avoid burnout among these human resources.

Is the ward sister role still relevant to the quality of patient care? A critical examination of the ward sister role past and present

AIMS AND OBJECTIVES

To examine the UK ward sister role in contemporary and historical context.

BACKGROUND

The ward sister role once key to nursing is now confused.

DESIGN

A critical examination of the changing role of the ward sister. Sources consulted: nursing textbooks 1877-1971, nursing and medical periodicals 1912-2010, official government reports 1947-2010, research studies on nursing 1960-2010, secondary works on nursing history.

METHOD

An historiographical analysis of archival sources which interrogates primary and secondary evidence to make transparent interconnection, coherence, consistency and reliability.

RESULTS

As a consequence of professional, educational and managerial changes, the traditional authority of the ward sister for nursing standards, ward services and ward facilities is diminished. Ward sisters are primarily motivated by nursing rather than managerial values. Hence, there is disparity in the title 'ward sister' espoused by ward sisters and the public and the title 'ward manager' espoused by non-nursing managers. This is not just terminology, but concerns the kind of values enshrined by the term and entrusted to the role.

CONCLUSIONS

Until the late 1970s, the ward sister was key to maintaining standards of care. She was the trustee of a tradition and transmitted its values. Subsequent organisational and professional changes have diminished the authority of the role. History may suggest the need to examine and strengthen the ward sister role in the light of its original orientation.

RELEVANCE TO CLINICAL PRACTICE

The ward sister role could have a fundamental effect on the quality of patient care if it were to regain its former scope and authority.

Nursing shaping and influencing health and social care policy

AIM

This paper seeks to consider how nursing as a profession in the United Kingdom is developing its role in shaping and influencing policy using lessons learnt from a policy study tour undertaken in the United States of America and extensive experience as a senior nurse within the government, the health service and more recently within a Professional Organization.

BACKGROUND

The nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care.

METHODS

This paper critically reviews recent UK and USA literature and policy with relevance to nursing.

RESULTS

Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solutions that promote and increase the participation of nurses in the political process and health policy. There are lessons to be learnt in the UK from the US nursing experience. These need to be considered in the context of the UK and devolution.

CONCLUSIONS

Although much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making, there is a need for greater co-ordination of action to ensure that nursing is actively supported in influencing and shaping health and health care policy.

IMPLICATIONS FOR NURSING MANAGEMENT

All leaders and other stakeholders require to play their part in considering how the actions set out in this article can be taken forward and how gaps such as education, fellowship experience and media engagement can be addressed in the future.

Preparing the air for nursing care: A grounded theory study of first line nurse managers

Abstract

The first line nurse managers’ opportunities to lead nursing care seem to be diminishing. The aim of this study was, therefore, to gain an understanding of the first line nurse managers in their experiences in the development of nursing care as part of a wider research programme. Finnish nurse managers wrote narratives at the beginning of five different leadership courses in this grounded theory study. ‘Preparing the Air for Nursing Care’ emerged as a core category. It was formed by two major categories. ‘Being Concerned about Nursing Care’ describes the nurse managers’ focus on the development of nursing care, the nursing caregivers’ health and knowledge and a concern for the whole organisation. The second major category ‘Creating the Direction and Content of Nursing Care’ describes the nurse manager working together with the staff to create individual and family-centred best practice, initiating relationships and dialogues for nursing care, and a culture of caring. A typology was created that explained the four main modalities to emerge from the data: ‘the Active Developer’, ‘the Passive Thinker’, ‘the Impulsive Creator’ and ‘the Routine Manager’.

Congruent leadership: values in action

AIM(S)

To discuss the significance of an appropriate leadership theory in order to develop an understanding of clinical leadership.

BACKGROUND

Leadership theories developed from management and related paradigms, particularly transformational leadership, may be ineffective in supporting nurses to gain insights into clinical leadership or to develop and implement clinical leadership skills. Instead, congruent leadership theory, based on a match between the clinical leaders' actions and their values and beliefs about care and nursing, may offer a more firm theoretical foundation on which clinical nurses can build an understanding of and capacity to implement clinical leadership or become clinical leaders. Evaluation The information used is drawn from the contemporary literature and a study conducted by the author.

KEY ISSUE(S)

Leadership can be better understood when an appropriate theoretical foundation is employed.

CONCLUSIONS

With regard to clinical leadership, congruent leadership is proposed as the most appropriate theory.

IMPLICATIONS FOR NURSING MANAGEMENT

It is important to recognize that leadership theories based on a management paradigm may not be appropriate for all clinical applications. Education should be aimed specifically at clinical leaders, recognizing that clinical leaders are followed not for their vision or creativity (even if they demonstrate these), but because they translate their values and beliefs about care into action.

Doctoral graduates in mental health nursing in Victoria, Australia: the doctoral experience and contribution to scholarship

The last decade has seen a substantial increase in the number of psychiatric or mental health nurses in Victoria, Australia who hold doctoral qualifications. The literature refers to the importance of scholarship for the professional development and recognition of nursing as a discipline. However, there is a paucity of literature addressing the contribution of nursing doctoral graduates to scholarship in mental health nursing or indeed the broader nursing profession. This paper presents the findings from a survey of psychiatric nurse doctoral graduates currently residing in the State of Victoria. A questionnaire was developed by the authors and distributed to the known doctoral graduates. The main findings demonstrate considerable variation in the discipline and topic of inquiry and in the extent to which doctoral studies had led to dissemination of research findings and engagement in further scholarly activity. The strengthening of mental health nursing knowledge requires scholarship and doctoral graduates are expected to make a major contribution, through research and the dissemination of findings. This paper presents a descriptive overview of doctoral graduates in one State of Australia with a particular focus on research and scholarship.

Managerial leadership for nurses' use of research evidence: an integrative review of the literature

BACKGROUND

Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Leadership behaviours of nurse managers and administrators have been identified as important to support research use and evidence-based practice. Yet minimal evidence exists indicating what constitutes effective nursing leadership for this purpose, or what kinds of interventions help leaders to successfully influence research-based care.

AIMS

(1) To describe leadership activities of nurse managers that influence nurses' use of research evidence; and (2) to identify interventions aimed at supporting nurse managers to influence research use in clinical nursing practice.

METHODS

A search of electronic databases was conducted for studies on behaviours or activities of nurse managers/administrators and the use of research evidence by nurses. Sifting, screening, and quality assessments were done by two reviewers. Results were synthesized by study type (quantitative and qualitative) and reported.

RESULTS

Twelve studies met inclusion criteria (eight quantitative, four qualitative). Three activities were found in quantitative studies that influenced nurses' use of research: managerial support, policy revisions, and auditing. Qualitative studies showed organizational issues as barriers to managers' abilities to affect research use, while role modeling and valuing research facilitated research use. Four studies, one of which was experimental, included an intervention to support managers, but all had insufficient information about leadership development.

CONCLUSIONS

To date, important descriptive work highlights the strategic role managers have in research transfer. Both facilitative and regulatory activities appear to be necessary for managers to influence research use. These findings have important implications for evolving theoretical models describing factors that affect the process of research utilization. It is time to move the science forward and test a hypothesis linking leadership to outcomes. Qualitative methods are essential for understanding the process of leadership for research transfer.