You trained to be a nurse: what gives you the right to lead? September 2013

Director of nursing SONIA GAMBLEN asks whether being a good nurse qualifies you to become a manager and leader, and she reflects on what characteristics and skills that nurse leaders need to foster or acquire.

Over the years, managers and health professionals have had a turbulent past.

To ease the warring factions, contemporary healthcare policy encourages managers to foster an understanding of the constraints in which public health systems have to operate.

So does being a good nurse qualify you to become a manager and leader?

Whether you manage few staff or many staff, you will be responsible for a variety of equipment, resources, buildings, contracts, and budgets. You collectively endeavour to deliver a complex service to your customers.

I would suggest that there is no other service that operates across such diverse and complex organisational structures as health services.

But you trained to be a nurse; what gives you the right to practice management and leadership?

Unlike most other services, we all have a vested interest in the end ‘product’ of the health service. The demand for our service is increasing: technology, biomedicine, and expertise has revolutionised quality of life and life expectancy – and will continue to do so.

In such an explosive and dynamic environment you are required to manage competing demands from the community you serve, the health professionals within your teams, and the budget afforded you by your accountant.

Today there is growing debate around the management style required to effectively manage such dynamic and complicated services. The term leadership has become synonymous with management.

I suggest that management and leadership are different and that both are necessary attributes for all health service managers in different amounts at different times.

Can leadership be taught? I am not so sure. I think leadership is an innate gene which for some, given the right circumstances, is awakened, while for others, it remains dormant (mindful that in some circumstances leadership can be narcissistic or maleficent!). Do not underestimate your influence; be it good or not so good, you will be copied!

The attributes depicted on the table (see sidebar) are by no means exhaustive, but they do demonstrate the differences between management and leadership. I believe some of the characteristics are more easily learned while others require insight, reflection, and collegial altruism.

Traditionally, management preparation has included in-depth study and analysis of finance, marketing, operational management, management science, strategy, organisation management, and information technology. This knowledge is indeed an asset in managing present and future healthcare services.

I would stress the need to become acquainted with such phenomena if you are to fully interpret financial reports, outcomes data, structural changes, and organisational strategy in a meaningful way to the people who look to you for guidance and support.

Leadership, however, entails good working relationships, including regular communication, trust, and mutual respect between you and your teams. These characteristics are crucial to ensuring work satisfaction for you and your staff and to ensuring a quality service results.

Integral to any unit, department, or organisation is the distribution of power and authority; both are dangerous if not used constructively and yet necessary to stimulate creativity and achieve desirable results.

You cannot achieve this by sitting in an office or reading it from books – an important part of your education is to understand how each person contributes to the service and to ensure that full potential is optimised.

You understand the importance of evidenced-based practice – you need to apply this to managing and leading. This will require you to engage, research, and communicate with others in the field before proposing any changes to equipment, working patterns, organisational structure or resource allocation.

What I am trying to make you understand is that you must continue to learn throughout your management career. You may have acquired a set of competencies in your practice thus far; you will need to develop these further as the context of health care shifts between settings, between markets, and between professionals.

As you progress through the next chapter of your career, unless you take the time to reflect upon your decisions, successes, and sometimes, failures, you will not accrue experience. Experience is gained through a process of reflection. Do not be confused: length of service does not equate to experience nor necessarily expertise!

So you are a manager and a leader; you need to decide where your knowledge gaps are and what type of education, training or learning will help fill that gap. This requires you to acknowledge your strengths and weaknesses and to remedy deficits during a process of continuous reflection and career long learning.

A mix of academia, placement practice, and reflection throughout your careers would to me seem a balanced diet on which to feed.

Sonia Gamblen is director of nursing for Tairawhiti District Health Board. Her research for her Masters of Management degree looked at the leadership and management requirements to be a clinical nurse manager.