Fresh-faced new nurses are usually pretty far down the pecking order of hospital hierarchy. However, at Waikato Hospital, some nurses just a year or so on from graduation are having monthly chats with the senior executive team and discussing their honours research projects with the director of nursing.

The shoulder-tapped nurses – all young and only one male to date – are taking part in Waikato District Health Board’s new leadership programme, run in league with The University of Auckland and targeted at new nurses with leadership potential. With their research projects now handed in, three of the initial cohort are now wanting to move through to their doctoral studies next year.

Sue Hayward, director of nursing and midwifery at Waikato DHB, said in an interview last year with Nursing Review that the aim of the scheme was to identify nurses who were “obviously flying high” as they came into their second year of practice.

The now 13 nurses (there have been three intakes – one each semester) all stood out during their new graduate year academic studies and had demonstrated they were already applying critical thinking to their clinical practice.

Lesley Macdonald, who coordinates the programme and the DHB’s new graduate programmes, says it is deliberately seeking out those who are academically and clinically able.

“It is elitist in the true sense of the word and it is intended to be,” says Macdonald, who believes the profession could do better at nurturing nurses who show ability.

It’s not for everybody. It’s for those who are already looking at practice differently and critically,” says Macdonald. “We need to capture that and give them the chance to think creatively and innovatively and foster that skill development.”

Hayward said at the time that the programme was partly prompted by not always getting a large number of well-qualified and capable nurses applying for positions like charge nurse, nurse educator or clinical nurse specialist.

“We’re not the first ones to have done it – it’s been done in the past,” said Hayward. “We’re just wanting to try a slightly different way.”


The new programme did not exclude other nurses from following leadership paths and other programmes on offer at the DHB.

The leadership scheme’s nurses all enroll in The University of Auckland’s Bachelor of Nursing (Honours) programme, with the research methodology paper taught on the hospital site.

Coffee with the CEO

That research project was driven by service requirements, with ideas coming from their immediate managers, service managers, or Hayward herself.

Because an important component of the leadership programme is seen to be getting a good grounding in the nuts and bolts of how hospitals and DHBs are run. So the young leaders-to-be also meet monthly with different members of the DHB’s senior executive team, including the CEO.

opical research topics

The programme is unapologetically focused on ensuring that the would-be leaders are exposed to the machinations of how the health system works, rather than simply advanced clinical roles.

Hayward and Macdonald believe that what is lacking in many nurses’ career paths is not clinical role models but how clinical practice on the floor fits in with the ‘bigger picture’ of health system operations.

“We are exposing them a little bit more to the political world in which we as nurses work,” said Hayward last year.

Macdonald also believed that because nurses are rarely exposed to the operational context of health they are “uncomfortable” when later they move into senior roles and need to think both clinically and operationally.

“This is about teaching them early on how to do that,” says Macdonald.

This is useful if they go on to be a nurse practitioner or a charge nurse manager.

The honours dissertation topics are all topical and relevant as they have arisen from needs or ideas from the managers and then been approved by the team.

One of the first cohort of students worked with a general manager looking at a follow-up phone intervention with young women who present with alcohol-related admissions to the emergency department. Another looked at patient safety in the theatre environment, another the patient experience for an acute surgical patient, and the fourth looked at nursing roles in ED.

Professor Matthew Parsons of The University of Auckland says Counties Manukau DHB has now taken up the nurse leadership model, with three students in the first semester, and another DHB also close to adopting it.

Parsons and MacDonald says the model has also now been given national endorsement by Health Workforce

New Zealand, with nurses on the scheme meeting and presenting their work recently to HWNZ executive chair Des Gorman and director Graeme Benny.

In another first, three of the initial four are to move on to take up full-time doctoral internships next year in a partnership between the DHB, HWNZ, and The University of Auckland funded by the HWNZ Advanced Training Fellowship scheme and The University of Auckland scholarships.

“Again, they won’t be given choice in the matter (their PhD topics). They will be given their topics by the DHB (at general manager level or above) so they become change agents for priority areas of work,” says Parsons.

Macdonald says the scheme overturns the assumption that junior nurses are not ready to take on such challenges.

These fledgling nurses are being encouraged to fly high.



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