Guest Editorial
Nursing's need for leadership
Alan Pearson
Professor of Nursing; Director, Deakin Institute of Nursing Research, Deakin University, Geelong VIC
PP: 051 - 052
Article Text
About two years ago, a number of well known, outstanding nursing scholars, whilst visiting Australia, asked me to name 12 outstanding leaders in Australian nursing. They stressed that they were not referring to power holders or senior managers; they meant nurses who offered real leadership to a large proportion of nurses, in the area of nursing itself. They also stressed that they were not referring to professionalisers or unionisers (saying that the former concentrated on promoting elitism, and the latter focused on mobilising others to fight to increase income and improve material conditions); they meant nurses who lead others towards the valuing of nursing itself and its recognition as an important component of civilised life. You may have reacted differently, but I could only name two. The US leaders were not at all surprised, because they had posed the same question to many Australian nurses, and the reaction was the same. They told me that a great shortage of leaders exists in the US (although they insisted that it was not quite as bad as here in Australia). On a recent visit to the UK, things were pretty much the same as in the US. They seem to have a few more leaders than we have, but there is increasing concern in that country about the lack of real leadership.
If we, as a huge occupational group, are to ever take control of our own destiny, rather than simply hanging on and limping from crisis to crisis, then nursing urgently needs to focus on growing more leaders, and on conducting our affairs in ways which support leaders. The reality of being a nurse in Australia supports, I believe, such an assertion. At the moment, nursing's only power base lies in the use of industrial muscle (stemming from a masculine oriented trades union ideology) or in the use of weak arguments related to professionalism (again, stemming from a masculine oriented ideology, this time professionalisation). The results lie before us quite starkly:
- Both orientations have led us to hive off lower order tasks (as in professionalisation) to non-nurses and second level nurses and thus to the creation of (as in trade unionism) incredible job demarcation.
- The development of hierarchical career structures which still reward nurses in relation to the distance between them and the patient or client.
- The nonexistence of nursing in health care as far as the media and policy makers are concerned. For example, when do we ever see nurses being interviewed as experts in aged care, in the care of AIDS patients or in health promotion by TV companies? Similarly, how could policy makers call a health care institution 'Medical Centre' if they were fully aware of the centrality of nursing in such institutions.
- The virtual nonexistence of senior representation of nurses in the public service. We have no Chief Nurse at the Federal level, and in most states, only a token nursing advisory role.
It is therefore not all surprising that nursing staffing levels are inappropriately calculated; that management and funding systems which are totally incompatible with contemporary nursing ideology are being rigorously imposed on health care agencies; and that nurses are swamped with unnecessary, unworkable and ill advised changes. Nursing needs some strong, creative and courageous leaders - NOW! How do we identify potential leaders; nurture them; grow them; and support them?
Bevis (1990) suggests that a crisis in leadership, arising from a lack of leadership preparation, has led to a deep frustration and disenchantment towards leaders and leadership within nursing. There is increasing evidence that this is so. Few clinicians now speak of their own local leaders with high regard; nurses are cynical about the motives of current power holders and people who are leaders by virtue of their position; nurses are scornful about the use of power by power holders in nursing.
How many leaders of today in nursing, who are in such a position by virtue of the job they occupy, are able to lead in terms of possessing the appropriate skills and in being afforded legitimacy by the group? It is my view that there are too few. To remedy this, we need to take immediate steps to identify leaders (and not to make their lives difficult because they stir up trouble!); provide educational opportunities to develop leadership skills; and, most importantly, develop strategies to promote leaders within the nursing community.
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