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Introduction

1.1 About This Book

In 1999, Colleen Wedderburn Tate (1999, p. 3) said, “Some healthcare staff are no longer working for patients, but are more motivated by pronouncements from government ministers, exposes in the media, and the latest scandal about misuse of public money.” As we begin this dialog about nursing leadership, we wonder if anything has changed. After decades of talking about, writing about and searching for what we mean by nurse leaders, has anything really changed in practice, at the bedside or in the involvement of nurses at the wider decision‐making table? We propose that nurses, more than any other healthcare employee group, need leaders, need to gain a deep understanding of leadership and need to be leaders for the profession. Because without a clear understanding of what leadership means, how it is recognised and how it is practiced, nursing and patient care will be poorer. It is in an effort to redress this shortfall that this book is written.

We believe that since Wedderburn Tate’s (1999) statement above, nurses continue to have only superficial influence over healthcare resource decisions. While managers, healthcare service administrators, many medical practitioners and their teams still see themselves as “all powerful” in terms of their decisions and leadership of nurses and some other health professionals. Thousands of nurses graduate and are employed every year, only to leave their chosen profession the following year or the one after. This is because they become frustrated by their lack of influence or power over the work they do, the contribution they could potentially make or their inability to contribute to or influence decisions. They become frustrated that they can’t provide the level of care they believe their clients/patients deserve. In addition, nurses often see their great ideas or projects relegated to lower priorities or ignored altogether by aloof hospital administrations and managers who (it should be acknowledged) are also under great pressure to deliver an effective health service with diminishing resources.

However, there is another issue with nurses and leadership. Nurses have been almost conditioned to see others (managers/doctors) as their leaders. When undertaking a number of studies exploring perceptions of clinical nurse leadership between 2001 and 2017 (Stanley et al. 2023), hundreds of clinical‐level nurses were approached and asked to identify colleagues they saw as clinical leaders. The most common response was, “What, nurses as leaders–no, don’t you want to talk to my manager?”. Wedderburn Tate (1999) confirmed this, saying, “nurses who are successful leaders do not recognise themselves as such” and it seems nurses have not been taught that their leadership potential is in their hands. Reassuringly, some respondents in Stanley’s studies (Stanley et al. 2012, 2014, 2017; Stanley 2019; Stanley and Stanley 2019) were able to point to highly skilled, effective and influential clinical‐level nurses who displayed and practiced leadership as part of their clinical role. After decades of discussion and training about leadership in nursing, the majority of clinically focused nurses still fail to grasp the value of leadership to their practice and their responsibilities as leaders in the health service. When exploring perceptions of leadership with student nurses, James (2020) and James et al. (2022) found that student nurses rarely saw themselves as leaders then or in the future, and many felt unprepared to take on the concept of leadership. Although in the United Kingdom (UK) nurses are expected to demonstrate leadership at the point of registration, there remains a disparate approach to leadership education and preparation (James 2023). While the nursing curriculum remains full of clinical skill competencies and nurses take on more and more of these, leadership seems to be advertised as something one can pick up with a quick course. It is our opinion that leadership requires much further consideration and thought from early within the development of a nurse, application of critique to traditional theoretical positions and ownership by nursing as a profession (James et al. 2023).

It is our conclusion that nursing leadership is essential, not just to pay lip service to the nursing profession and bolster its ego or place in the scheme of the health service but to make a genuine contribution to improving patient care and making the health service more robust and responsive to client/patient needs (James et al. 2023). This book sets out to offer a clear and straightforward perspective on what nursing leadership means and how it can be recognised and applied in practice.

The book is aimed at undergraduate nurses as a useful resource and may be of use to a range of qualified and practicing nurses who wish to review their insights into nurse leadership. It aims to inspire and support nurses in both understanding and developing their approach to leadership in nursing. It also aims to serve as a useful resource for nurses who are more advanced in their careers and who are interested in developing their leadership skills and broadening their awareness or leadership potential as nurse leaders. It is a contemporary introductory text that links current key debates and thinking in leadership as it applies to nursing practice.

Chapter 1 sets out the importance of leadership in nursing and why leadership is important in nursing now. It describes how the book is structured as well as considering the difference between leadership and management. Chapter 2 begins with an oversight of definitions of leadership, nursing leadership and an exploration of several leadership theories. Chapter 3 explores the attributes seen as vital for effective nurse leadership to prevail. This is presented as hard and soft skills and attributes and it goes on to explore why these skills are vital for nurse leaders to be successful. Chapter 4 outlines the importance of an understanding of self‐care for leaders to be successful and remain vital. Chapter 5 offers an outline of the role of nurse leaders in driving innovation and change in the health service. Chapter 6 provides an overview of the relationship between leadership and teams, suggesting that nurse leaders need to understand how teams function and recognise their place when helping teams work. Chapter 7 takes the relationship of the leader to others further by exploring the significance of “networking” as a skill in the “toolbox” of effective nurse leadership. Chapter 8 looks at the central place of values for nurse leaders to be their best selves. Chapter 9 deals with the challenges nurse leaders face in the application of leadership, and Chapter 10 considers the flip side of leadership, followership, and how this can impact on the effectiveness of nurse leaders. Throughout the book, the value of applying nursing leadership is outlined, and the component parts of leadership are expressed.

1.2 Leadership and Management are Different!

Leadership and management are equally important, interdependent and inter related; however, they are also different and distinct, serving different purposes and requiring different skills (St George 2012; West et al. 2015; Gumbo 2017; Leech 2019; Nene et al. 2020; Stanley et al. 2023). In the health service, leadership and management are frequently seen as one all‐encompassing thing (Stanley et al. 2023). However, Wood (2021, p. 284) suggests that “Working out who leads and who manages is difficult, with the added anomaly that not all managers are leaders, and some people who lead work in management positions.” This has the potential to lead to role ambiguity (Stanley 2006; Cutcliffe and Cleary 2015; Nene et al. 2020), and conflict can occur when clinicians take on management roles without appropriate training, support or instruction (Nene et al. 2020; Stanley et al. 2023). Likewise, tensions can occur between clinical leaders and managers, when leaders feel that their efforts are hampered by management or organisational aspirations or targets (Stanley 2006; Kerridge 2013; Orvik et al. 2015; Scully 2015; Stanley 2017a, 2017b; Nene et al. 2020). Zaleznik (1977) makes the point that management and leadership positions require different types of people which may be problematic in healthcare with the tendency for role overlap (Stanley 2006; Cutcliffe and Cleary 2015; Nene et al. 2020). Kotterman (2006) argues that a well‐balanced organisation requires a blend of leaders and managers to succeed, and while there are overlaps, there is clarity in the distinction when explored further. This is important if you are interested in becoming a leader and/or manager.

Reflective Activity 1.1

Before you read on … Think about someone you have worked with who you saw/see as an inspirational leader. The only restriction placed on this activity is that you must think of a clinically focused nurse or midwife. Not a manager, not a doctor, not another health professional, not a relative or friend who is not a nurse. Think primarily of a clinically focused nurse/midwife.

Why did you think of this person?

What was it about...