The art of clinical leadership in contemporary nursing

Abstract

There is little doubt that leadership is a complex process and the quality of its application can have profound effects on organisations and workplaces. As a concept, leadership has been variously depicted, defined, and discussed in in the literature. In the new millennium clinical leadership has increasingly been a focus of attention in health care systems across the world, with various reports identifying enhanced clinical leadership as a solution to overcoming deficiencies in the quality of care delivered to consumers of health care services. In the complex world of health care this view is perhaps too simplistic. However, there is little doubt that clinical leadership effectiveness does have a role to play in the quality of health care delivery, regardless of the clinical setting. To this end, this study set out to explore the aesthetics of clinical leadership in contemporary nursing. A mixed-methods approach was adopted for the research, underpinned by the philosophical orientation and assumptions of critical social theory and the works of Habermas. Initially, an integrative review of the contemporary nursing literature was conducted to uncover empirical understandings of clinical leadership. Data were then collected from an online descriptive survey and conversation-style interviews with 12 registered nurses who worked in designated clinical leadership roles. The respondents to the survey were nurses from across the world, recruited via online social networks and e-learning platforms and the clinical leaders interviewed were from Australia. Quantitative data collected from the online survey were subject to descriptive analysis using SPSS software. The qualitative responses to the survey were initially subject of content analysis using aesthetic leadership dimensions. Data collected from the interviews were analysed thematically. The findings from these three data sources are presented as part of a series of six published papers in this thesis. The integrative review revealed, from a relatively small evidence base, attributes of clinical leadership have a clinical focus, a follower/team focus or a personal qualities focus; all attributes to needed to sustain supportive workplaces. The survey results indicated that the aesthetic leadership characteristics in clinical leaders most valued included being supportive and effective communication. Taking risks and challenging processes were least likely to be evident among clinical leaders. Analysis of the narrative data collected during the research revealed that advanced practice nurses in designated clinical leadership roles embodied aesthetic leadership, reflected in a strong moral compass that shapes their practice. The data also revealed that when clinical leaders enact aesthetic leadership they are critically self-reflective and embrace core nursing values and beliefs. Through this type of leadership they convey a visible, composed role model that has a positive effect on the nursing workplace. From subsequent synthesis of these findings, and using of the symphony orchestra as a metaphor, a model of artful clinical leadership emerged. This model offers a new and different way of conceptualising clinical leadership in contemporary nursing. Using the established notion of levels of expertise, in much the same way as has occurred clinical nursing practice, this model identifies the qualities and attributes to be an artful concertmaster in the contemporary clinical nursing world.

Date of Award	2015
Original language	English