- Email: [email protected]
Building Nursing Leadership Capacity: An Australian Snapshot
Building Nursing Leadership Capacity: An Australian Snapshot John Daly, PhD, RN, FACN, FAAN, Debra Jackson, PhD, RN, FACN, Michele Rumsey, RN, FACN, Karen Patterson, MMid(Res), GradDip (CBEd), RN, RM, and Patricia M. Davidson, PhD, RN, FACN, FAAN
L
eadership is a highly prized commodity across
system of universal healthcare that is accountable and
a range of contemporary industries, and
transparent.4 There are over 200,000 nurses in
healthcare is no exception where the stakes are high.1,2
Australia, working in hospitals, clinics, aged care facil-
Healthcare, previously viewed as peripheral to many
ities, and schools, and these individuals are integrally
other societal structures, is now front and center,
important to the effective and functional health sys-
largely due to increasing costs and the increased con-
tem. Moreover, Australia is intensely aware of the
3
sumption of gross domestic product. Australia is a
effects of globalization and the importance of a global
culturally diverse and pluralistic society supporting a
strategy for human resources for health.5,6
36
Nurse Leader
October 2015
T
he increasing politicization and scrutiny of healthcare underscores the importance of competent, confident, and courageous leadership.1 Broadly, leadership may be defined as “a multi-faceted process of identifying a goal or target, motivating other people to act, and providing support and motivation to achieve mutually negotiated goals.”7 These goals are increasingly fluid and subject to external forces- social, political and economic.8 An example of this is the intense focus on decreasing readmissions to hospital and lengths of stay that is driving clinical practice models and incentives.9 Increasing demands on the healthcare system, fiscal constraints and community scrutiny require leaders to be dynamic, reflexive, and resilient.10 Effective and responsive leadership is essential if organizations are to achieve their objectives and prosper. Health is a major area of concern globally and contributes significantly to societal stability.11,12 Moreover, it is evident that pandemics have no borders, and social determinants of health have a global reach.13 Increasingly, healthcare systems internationally are confronted by a myriad of challenges.14 Increasing demands for services include concerns about access and equity, human resources for health issues, the growing burden of chronic illness, demographic transitions, and in particular, aging populations, growing urbanization, maldistribution of human resources, quality and safety, escalating costs, and increasing complexity due to technological and scientific advances.6 Leadership is a key area of concern in healthcare because many of the complex issues facing the heath sector locally, nationally, and internationally require care management, foresight, and high-level leadership skills. Leadership must be exercised at many levels of healthcare organizations and by all health professional groups. In nursing, leadership capability and capacity is required in clinical practice, education, policy development, implementation, and research.2 Concerns for the development of the next generation of leaders is shared across disciplines and healthcare settings.15 Yet contextual factors can influence leadership in healthcare, particularly for nurses, whose value is on patient needs, not profits as a primary professional responsibility is for patient advocacy.16 Therefore, ensuring nurses have the necessary knowledge, skills, and competencies is of increasing importance among care delivery across settings and the career trajectory.17 Development of leadership capacity ideally starts at the undergraduate or pre-licensure level of education for health professional practice.18 However, the pressures on undergraduate health curricula are overwhelming. Though “new nurses should be able to demonstrate knowledge of leadership and management principles,”19 there is little evidence as to how this knowledge is able to be actualized or implemented in the health environment, particularly early in their career. Curriculum design needs to be responsive to these challenges and integrate leadership across the curriculum. This is likely to include just as much about personal development as professional skills and competencies. This can be challenging for both students and faculty who see nursing programs within a context of clinical skills. What is evident across the Australian healthcare system is the need for development of leaders within the context of their workplace. www.nurseleader.com
Leadership skills need to develop with continued exposure to professional practice and continuing professional education, and most importantly supportive and enabling environments that promote personal and professional growth. Indeed, the need for ongoing and continued opportunities to develop effective leadership capacity that translates into action is evidenced by the growing options for leadership education at the postgraduate level across academic programs in Australia and internationally. In the United States, the Magnet program is responsible for ensuring that professional practice environments inspire and motivate excellence in patient care and this is a model increasingly emulated in Australia and other countries.20 Clarifying the ambiguity between management and leadership remains of critical importance, as emphasis on the need for leadership in driving clinical practice improvement is of increased recognition.10,21 Driving clinical practice improvement is dependent on individual attributes as well as organizational factors. The pursuit of dynamic efficiency has been a key reform driver within the Australian healthcare system. The ideal system is one that is agile and self-improving.22 The key elements for services include factors that are well integrated and networked, provide local and ease of access to multidisciplinary teams linked to specialist services, and where patient autonomy is respected.22,23 Although there are a number of ways the elements of a system could be organized to achieve this ideal, effective leadership is recognized as critical in every interaction and at every level of the system. Kotter24 details eight incremental errors known to undermine reform efforts within any industry, even in the context of certain personal, financial and productivity gains. The successful reform efforts that demonstrated critical success factors involved investing in the capabilities of the next-generation workforce, distributing leadership, and building alliances. In recognition of the vulnerability of system reform efforts and awareness of leadership as a critical driver for sustainable systems transformation, the Australian Health Ministers Advisory Council commissioned the development of a health leadership framework, positioning it as a strategic priority.25 As the Australian College of Nursing (ACN) leveraged evidence that nursing leadership is strongly associated with the delivery of high-quality patient care and that nurses are well situated to be system leaders,26 ACN operationalized the guiding principles of the Australian Health leadership framework as follows: “Everyone owns leadership; developing capable leaders builds health leadership capacity; and the person you are is the leader you are.”27(p.4) ACN also considered the National Competency Standards for Registered Nurses, when developing a suite of leadership programs designed to support nurses’ leadership aspirations, for fellow colleagues as they transition at different stages of their career.27 At the operational level of the healthcare system, and using the Australian state of New South Wales (NSW) as an example, there has been significant investment over the past decade in leadership development. Initiatives have included the NSW Clinical Excellence Commission Clinical
Nurse Leader
37
Leadership Program and the NSW Nursing and Midwifery Office Take the Lead program for Nursing and Midwifery Unit Managers.28 In 2008, the report into acute care services in NSW Public Hospitals identified concerns regarding the division between clinicians and managers, which was felt to be widespread, and a major constraint to health system reform efforts.1 The report supported the restructuring of formal and informal teaching and learning opportunities from primarily discipline specific and individually focused to being interdisciplinary; that is, collaborating across clinical groupings, particularly bringing clinicians and managers together. Charged with the responsibility for leading leadership development, the NSW Health Education and Training Institute oversaw the development of a NSW Health leadership framework.29,30 The framework takes into account the requirement for leadership at all levels, with the intent of fostering dynamic capacity within the system, including promoting and supporting excellent care, results and change. Similar to the Australian Health Leadership Framework, the structure of the NSW framework was based on the Canadian LEADS in a Caring Environment framework, with the flagship program being the NSW Health Leadership Program.28 This interprofessional program is learner-centered and is informed by adaptive leadership principles, immunity to change theory, and leadership mode philosophies. The program is designed to be delivered over a 9-month period to teams of clinicians, managers, and executives. A comprehensive evaluation framework has been built into the program, with a public report due to be released in late 2015. Existing Australian-based literature highlights the difficulties and challenges that are associated with transferring learned leadership strategies, principles, and models into the clinical environment.31 Although the current leadership programs delivered across NSW have been positively evaluated by participants and demonstrated some improvements to patient outcomes, staff engagement and service performance metrics supporting leadership development within the realities of complex and busy clinical workplaces remain challenging.32,33 One study sought to understand the experience of nursing managers in adapting new leadership behaviors and skills in the heat of workplace challenges such as managing service interruptions, staff conflict, and responding to patient concerns. The report identified vulnerability due to role uncertainty, and diminished self-belief and intrinsic satisfaction drivers as key issues of concern.34 Furthermore, this study supported the growing literature suggesting a need for ongoing workplace support structures, beyond program graduation, to support the developmental journeys of leaders.31,35 Strategies such as coaching, mentoring, and learning circles could be crucial in ensuring that desired leadership behaviors are able to be maintained in the workplace setting.36 As in many areas of the healthcare system, Australia is vulnerable to a postcode lottery, where access to leadership opportunities is often isolated to areas of excellence. However, systematic initiatives supported across state-based jurisdictions are designed to distil innovation across the health
38
Nurse Leader
system. Each state and territory of Australia has a chief nurse, and their roles are focused on nursing and health policy development and implementation. In order, to coordinate nursing across Australia, the first Commonwealth Chief Nurse and Midwifery Officer, Rosemary Bryant, was appointed in 2008 and has also served as the 26th president of the International Council of Nurses. This is a critical role in building and sustaining a nursing voice nationally. Recruitment is currently underway for a replacement for Dr. Bryant as she retires shortly. As the forces of globalization increase and the human resources for health issues increase in focus, Australia cannot deny its place in a global community.8 Nursing leadership is of critical importance as universal healthcare becomes a dominant topic in global discourse.5,37,38 A significant issue to be addressed is an imbalance between demand and supply of adequate numbers of effective, competent leaders across the health professions.39,40 Leadership capacity building is being addressed across the health professions globally, though efforts often reflect a siloed approach rather than an integrated health professional team focus. This underscores the need for courageous leadership and a strategic focus.17 Like many other countries in the world, Australian nursing leaders must ensure that they assert their influence and apply the knowledge and expertise to shaping clinical care environments that foster excellence. Tribalism exists across the health professions, and nursing leadership can be usurped by nonnurse experts on nursing. Implications for patient care can be of concern where nursing leadership is weak or invisible.41 The Global Network of WHO Collaborating Centres for Nursing and Midwifery is poised to take a leadership role across the globe as these centers drive workforce capacity and leadership development.42,43
CONCLUSIONS In parallel with other developed nations, Australia is trying to juggle the challenges of increasing demands and diminishing resources. Within this context, nursing leadership is of critical importance, not only to position the importance of nursing in navigating the complex milieu of health and developing innovative and accessible models of care, but also to provide brave and courageous voices to ensure healthcare services are accessible and equitable. Laying the foundations for nursing leadership is critically important in baccalaureate curricula and reinforced in graduate degrees. Moreover, the most important foundation is the fostering of healthcare environments across the healthcare system that are supportive and enabling of nurses and allow their voices to be heard and their knowledge and skills utilized to the fullest extent possible. NL References 1. Garling P, Wales NS. Final Report of the Special Commission of Inquiry: Acute Care Services in NSW Public Hospitals. vol. 2. Sydney, Australia: Department of Premier and Cabinet; 2008. 2. Daly J, Speedy S, Jackson D. Leadership and Nursing: Contemporary Perspectives. Sydney, Australia: Churchill Livingstone; 2015. 3. Sisko AM, Keehan SP, Cuckler GA, et al. National health expenditure projections, 2013–23: faster growth expected with expanded coverage and improving economy. Health Aff (Millwood). 2014;33:1841-1850.
October 2015
4. Al Abed NA, Davidson PM, Hickman LD. Healthcare needs of older Arab migrants: A systematic review. J Clin Nurs. 2014;23:1770-1784. 5. Campbell J, Dussault G, Buchan J, et al. A universal truth: no health without a workforce. Forum Report, Third Global Forum on Human Resources for Health. Geneva, Switzerland: Global Health Workforce Alliance and World Health Organization; 2013. 6. Chen L, Evans T, Anand S, et al. Human resources for health: overcoming the crisis. Lancet. 2004;364:1984-1990. 7. Davidson P, Elliott D, Daly J. Clinical leadership in contemporary clinical practice: implications for nursing in Australia. J Nurs Manag. 2006;14:180187. 8. Davidson PM, Daly J, Meleis A, Douglas M. Globalisation as we enter the 21st century: reflections and directions for nursing education, science, research and clinical practice. Contemp Nurse. 2003;15:162-174. 9. Dimick JB, Ghaferi AA. Hospital readmission as a quality measure in surgery. JAMA. 2015;313:512-513. 10. Davidson PM, Dennison-Himmelfarb C, Alsadaan N. Governance of nursing practice: steps for the quality and safety of healthcare. In: Daly J, Speedy S, Jackson D, eds. Leadership and Nursing: Contemporary Perspectives. 2nd ed. Sydney, Australia: Churchill Livingstone; 2015:129-140. 11. Kennedya SB, Nisbettb RA. The Ebola epidemic: a transformative moment for global health. B World Health Organ. 2015;93(1):2. 12. World Health Organization. World health statistics report 2015. Geneva, Switzerland: WHO; 2015. 13. Marmot M, Wilkinson R. Social Determinants of Health. Oxford, UK: Oxford University Press; 2005. 14. Global Health Workforce Alliance. Health workforce 2030: towards a global strategy on human resources for health. Geneva, Switzerland: WHO; 2014. 15. Chemers M. An Integrative Theory of Leadership. Mahwah, NJ: Psychology Press; 2014. 16. Wolf GA. Transformational leadership: the art of advocacy and influence. J Nurs Adm. 2012;42:309-310. 17. Davidson PM, Daly J, Hill MN. Editorial: looking to the future with courage, commitment, competence and compassion. J Clin Nurs. 2013;22:26652667. 18. Scott ES, Yoder-Wise PS. Increasing the intensity of nursing leadership: graduate preparation for nurse leaders. J Nurs Adm. 2013;43:1-3. 19. Smith S, Farra S, Dempsey A, Arms D. Preparing nursing students for leadership using a disaster-related simulation. Nurse Educ. 2015;40:212216. 20. Brady-Schwartz DC. Further evidence on the Magnet Recognition program: implications for nursing leaders. J Nurs Adm. 2005;35:397-403. 21. Dignam D, Duffield C, Stasa H, Gray J, Jackson D, Daly J. Management and leadership in nursing: an Australian educational perspective. J Nurs Manag. 2012;20:65-71. 22. Duckett SJ. Health workforce design for the 21st century. Aust Health Rev. 2005;29:201-210. 23. Duckett SJ, Willcox S. The Australian Health Care System. South Melbourne, Australia: Oxford University Press; 2011. 24. Kotter J. Leading change: why transformation efforts fail. Harvard Bus Rev. 2007;85(1):96-103. 25. Health Workforce Australia. National Health Workforce Innovation and Reform Strategic Framework for Action, 2011-2015. Adelaide, Australia: Health Workforce Australia; 2011. 26. Wong C, Giallonardo L. Leadership and its influence on patient outcomes. In: Daly J, Speedy S, Jackson D, eds. Leadership and Nursing: Contemporary Perspectives. 2nd ed. Sydney, Australia: Churchill Livingstone; 2015:153-70. 27. The Australian College of Nursing. Leadership@ACN. Available at: http://www.acn.edu.au/leadership. Accessed May 30, 2015. 28. New South Wales Government. Take the lead 2. http://www.health.nsw.gov.au/ nursing/projects/Pages/take-the-lead-2.aspx. Accessed May 29, 2015. 29. Health and Education Training Institute, NSW Ministry of Health. The NSW Health Leadership Framework. Available at: http://www.heti.nsw.gov.au/ programs/leadership/nsw-health-leadership-framework. Accessed May 30, 2015. 30. Bowen S, Zwi AB. Pathways to “evidence-informed” policy and practice: a framework for action. PLoS Med. 2005;2:e166. 31. Atsalos C, O'Brien L, Jackson D. Against the odds: experiences of nurse leaders in Clinical Development Units (Nursing) in Australia. J Adv Nurs. 2007;58:576-584. 32. Debono D, Travaglia JF, Dunn AG, et al. Strengthening the capacity of nursing leaders through multifaceted professional development initiatives: a mixed method evaluation of the ‘Take The Lead’ program. Collegian, in press. 33. Travaglia J, Debono D, Milne J, et al. Report of the Mid-Program Evaluation of ‘Take the Lead’. Sydney, Australia: University of New South Wales, Centre for Clinical Governance Research; 2011.
www.nurseleader.com
34. Newman C, Patterson K, Clark G. Evaluation of a support and challenge framework for nursing managers in correctional and forensic health. J Nurs Manag. 2015;23(1):118-127. 35. Patterson K, Newman C, Clark G. Strengthening Local Nursing Leadership Study Report. Sydney, Australia: Justice Health & Forensic Mental Health Network; 2014. 36. Broome M, Gilbert J. Developing and sustaining self. In: Daly J, Speedy S, Jackson D, eds. Leadership and Nursing: Contemporary Perspectives. 2nd ed. Sydney, Australia: Churchill Livingstone; 2015: 199. 37. 66th World Health Assembly. WHA66.23. Transforming health workforce education in support of universal health coverage. Geneva, Switzerland: WHO; 2013. 38. World Health Organization. Transforming and scaling up health professionals' education and training. Geneva, Switzerland: WHO; 2013. 39. World Health Organization. The world health report 2006: working together for health. Geneva, Switzerland: WHO; 2006. 40. Buchan J, Aiken L. Solving nursing shortages: a common priority. J Clin Nurs. 2008;17:3262-3268. 41. Davidson PM, Du H. Nurses do not have proprietary rights on caring: but we do on clinical practice models. J Nurs Manag. 2015;23:409-410. 42. World Health Organization. Strengthening nursing and midwifery: progress and future directions 1996-2000. Geneva, Switzerland: WHO; 2001. 43. Daly J, Rumsey M, Homer C. Nursing & Midwifery editorial. Nursing & Midwifery LINKS. Sydney, Australia: Global Network of World Health Organization Collaborating Centres for Nursing & Midwifery Development; 2015.
John Daly, PhD, RN, FACN, FAAN, is head of UTC/WHO Collaborating Centre for Nursing, Midwifery & Health Development, dean of Faculty of Health at the University of Technology in Sydney, Australia. He can be reached at [email protected]. Debra Jackson, PhD, RN, FACN, is professor of nursing, Oxford Brookes University & Oxford University Hospitals NHS Trust, in Oxford, UK, and School of Health, University of New England. Michele Rumsey, RN, FACN, is director of operations and development, WHO Collaborating Centre for Nursing, Midwifery & Health Development, Faculty of Health, at the University of Technology in Sydney, Australia. Karen Patterson, MMid(Res), GradDip (CBEd), RN, RM, is a doctoral student, Faculty of Health, at the University of Technology, Sydney, Australia; and is honorary associate professor at the University of Wollongong, and clinical senior lecturer at the University of Sydney. Patricia M. Davidson, PhD, RN, FACN, FAAN, is dean and professor of nursing at the School of Nursing, Johns Hopkins University, in Baltimore, Maryland, and Faculty of Health, University of Technology, Sydney, Australia. 1541-4612/2015/ $ See front matter Copyright 2015 by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.mnl.2015.07.003
Nurse Leader
39
L
eadership is a highly prized commodity across
system of universal healthcare that is accountable and
a range of contemporary industries, and
transparent.4 There are over 200,000 nurses in
healthcare is no exception where the stakes are high.1,2
Australia, working in hospitals, clinics, aged care facil-
Healthcare, previously viewed as peripheral to many
ities, and schools, and these individuals are integrally
other societal structures, is now front and center,
important to the effective and functional health sys-
largely due to increasing costs and the increased con-
tem. Moreover, Australia is intensely aware of the
3
sumption of gross domestic product. Australia is a
effects of globalization and the importance of a global
culturally diverse and pluralistic society supporting a
strategy for human resources for health.5,6
36
Nurse Leader
October 2015
T
he increasing politicization and scrutiny of healthcare underscores the importance of competent, confident, and courageous leadership.1 Broadly, leadership may be defined as “a multi-faceted process of identifying a goal or target, motivating other people to act, and providing support and motivation to achieve mutually negotiated goals.”7 These goals are increasingly fluid and subject to external forces- social, political and economic.8 An example of this is the intense focus on decreasing readmissions to hospital and lengths of stay that is driving clinical practice models and incentives.9 Increasing demands on the healthcare system, fiscal constraints and community scrutiny require leaders to be dynamic, reflexive, and resilient.10 Effective and responsive leadership is essential if organizations are to achieve their objectives and prosper. Health is a major area of concern globally and contributes significantly to societal stability.11,12 Moreover, it is evident that pandemics have no borders, and social determinants of health have a global reach.13 Increasingly, healthcare systems internationally are confronted by a myriad of challenges.14 Increasing demands for services include concerns about access and equity, human resources for health issues, the growing burden of chronic illness, demographic transitions, and in particular, aging populations, growing urbanization, maldistribution of human resources, quality and safety, escalating costs, and increasing complexity due to technological and scientific advances.6 Leadership is a key area of concern in healthcare because many of the complex issues facing the heath sector locally, nationally, and internationally require care management, foresight, and high-level leadership skills. Leadership must be exercised at many levels of healthcare organizations and by all health professional groups. In nursing, leadership capability and capacity is required in clinical practice, education, policy development, implementation, and research.2 Concerns for the development of the next generation of leaders is shared across disciplines and healthcare settings.15 Yet contextual factors can influence leadership in healthcare, particularly for nurses, whose value is on patient needs, not profits as a primary professional responsibility is for patient advocacy.16 Therefore, ensuring nurses have the necessary knowledge, skills, and competencies is of increasing importance among care delivery across settings and the career trajectory.17 Development of leadership capacity ideally starts at the undergraduate or pre-licensure level of education for health professional practice.18 However, the pressures on undergraduate health curricula are overwhelming. Though “new nurses should be able to demonstrate knowledge of leadership and management principles,”19 there is little evidence as to how this knowledge is able to be actualized or implemented in the health environment, particularly early in their career. Curriculum design needs to be responsive to these challenges and integrate leadership across the curriculum. This is likely to include just as much about personal development as professional skills and competencies. This can be challenging for both students and faculty who see nursing programs within a context of clinical skills. What is evident across the Australian healthcare system is the need for development of leaders within the context of their workplace. www.nurseleader.com
Leadership skills need to develop with continued exposure to professional practice and continuing professional education, and most importantly supportive and enabling environments that promote personal and professional growth. Indeed, the need for ongoing and continued opportunities to develop effective leadership capacity that translates into action is evidenced by the growing options for leadership education at the postgraduate level across academic programs in Australia and internationally. In the United States, the Magnet program is responsible for ensuring that professional practice environments inspire and motivate excellence in patient care and this is a model increasingly emulated in Australia and other countries.20 Clarifying the ambiguity between management and leadership remains of critical importance, as emphasis on the need for leadership in driving clinical practice improvement is of increased recognition.10,21 Driving clinical practice improvement is dependent on individual attributes as well as organizational factors. The pursuit of dynamic efficiency has been a key reform driver within the Australian healthcare system. The ideal system is one that is agile and self-improving.22 The key elements for services include factors that are well integrated and networked, provide local and ease of access to multidisciplinary teams linked to specialist services, and where patient autonomy is respected.22,23 Although there are a number of ways the elements of a system could be organized to achieve this ideal, effective leadership is recognized as critical in every interaction and at every level of the system. Kotter24 details eight incremental errors known to undermine reform efforts within any industry, even in the context of certain personal, financial and productivity gains. The successful reform efforts that demonstrated critical success factors involved investing in the capabilities of the next-generation workforce, distributing leadership, and building alliances. In recognition of the vulnerability of system reform efforts and awareness of leadership as a critical driver for sustainable systems transformation, the Australian Health Ministers Advisory Council commissioned the development of a health leadership framework, positioning it as a strategic priority.25 As the Australian College of Nursing (ACN) leveraged evidence that nursing leadership is strongly associated with the delivery of high-quality patient care and that nurses are well situated to be system leaders,26 ACN operationalized the guiding principles of the Australian Health leadership framework as follows: “Everyone owns leadership; developing capable leaders builds health leadership capacity; and the person you are is the leader you are.”27(p.4) ACN also considered the National Competency Standards for Registered Nurses, when developing a suite of leadership programs designed to support nurses’ leadership aspirations, for fellow colleagues as they transition at different stages of their career.27 At the operational level of the healthcare system, and using the Australian state of New South Wales (NSW) as an example, there has been significant investment over the past decade in leadership development. Initiatives have included the NSW Clinical Excellence Commission Clinical
Nurse Leader
37
Leadership Program and the NSW Nursing and Midwifery Office Take the Lead program for Nursing and Midwifery Unit Managers.28 In 2008, the report into acute care services in NSW Public Hospitals identified concerns regarding the division between clinicians and managers, which was felt to be widespread, and a major constraint to health system reform efforts.1 The report supported the restructuring of formal and informal teaching and learning opportunities from primarily discipline specific and individually focused to being interdisciplinary; that is, collaborating across clinical groupings, particularly bringing clinicians and managers together. Charged with the responsibility for leading leadership development, the NSW Health Education and Training Institute oversaw the development of a NSW Health leadership framework.29,30 The framework takes into account the requirement for leadership at all levels, with the intent of fostering dynamic capacity within the system, including promoting and supporting excellent care, results and change. Similar to the Australian Health Leadership Framework, the structure of the NSW framework was based on the Canadian LEADS in a Caring Environment framework, with the flagship program being the NSW Health Leadership Program.28 This interprofessional program is learner-centered and is informed by adaptive leadership principles, immunity to change theory, and leadership mode philosophies. The program is designed to be delivered over a 9-month period to teams of clinicians, managers, and executives. A comprehensive evaluation framework has been built into the program, with a public report due to be released in late 2015. Existing Australian-based literature highlights the difficulties and challenges that are associated with transferring learned leadership strategies, principles, and models into the clinical environment.31 Although the current leadership programs delivered across NSW have been positively evaluated by participants and demonstrated some improvements to patient outcomes, staff engagement and service performance metrics supporting leadership development within the realities of complex and busy clinical workplaces remain challenging.32,33 One study sought to understand the experience of nursing managers in adapting new leadership behaviors and skills in the heat of workplace challenges such as managing service interruptions, staff conflict, and responding to patient concerns. The report identified vulnerability due to role uncertainty, and diminished self-belief and intrinsic satisfaction drivers as key issues of concern.34 Furthermore, this study supported the growing literature suggesting a need for ongoing workplace support structures, beyond program graduation, to support the developmental journeys of leaders.31,35 Strategies such as coaching, mentoring, and learning circles could be crucial in ensuring that desired leadership behaviors are able to be maintained in the workplace setting.36 As in many areas of the healthcare system, Australia is vulnerable to a postcode lottery, where access to leadership opportunities is often isolated to areas of excellence. However, systematic initiatives supported across state-based jurisdictions are designed to distil innovation across the health
38
Nurse Leader
system. Each state and territory of Australia has a chief nurse, and their roles are focused on nursing and health policy development and implementation. In order, to coordinate nursing across Australia, the first Commonwealth Chief Nurse and Midwifery Officer, Rosemary Bryant, was appointed in 2008 and has also served as the 26th president of the International Council of Nurses. This is a critical role in building and sustaining a nursing voice nationally. Recruitment is currently underway for a replacement for Dr. Bryant as she retires shortly. As the forces of globalization increase and the human resources for health issues increase in focus, Australia cannot deny its place in a global community.8 Nursing leadership is of critical importance as universal healthcare becomes a dominant topic in global discourse.5,37,38 A significant issue to be addressed is an imbalance between demand and supply of adequate numbers of effective, competent leaders across the health professions.39,40 Leadership capacity building is being addressed across the health professions globally, though efforts often reflect a siloed approach rather than an integrated health professional team focus. This underscores the need for courageous leadership and a strategic focus.17 Like many other countries in the world, Australian nursing leaders must ensure that they assert their influence and apply the knowledge and expertise to shaping clinical care environments that foster excellence. Tribalism exists across the health professions, and nursing leadership can be usurped by nonnurse experts on nursing. Implications for patient care can be of concern where nursing leadership is weak or invisible.41 The Global Network of WHO Collaborating Centres for Nursing and Midwifery is poised to take a leadership role across the globe as these centers drive workforce capacity and leadership development.42,43
CONCLUSIONS In parallel with other developed nations, Australia is trying to juggle the challenges of increasing demands and diminishing resources. Within this context, nursing leadership is of critical importance, not only to position the importance of nursing in navigating the complex milieu of health and developing innovative and accessible models of care, but also to provide brave and courageous voices to ensure healthcare services are accessible and equitable. Laying the foundations for nursing leadership is critically important in baccalaureate curricula and reinforced in graduate degrees. Moreover, the most important foundation is the fostering of healthcare environments across the healthcare system that are supportive and enabling of nurses and allow their voices to be heard and their knowledge and skills utilized to the fullest extent possible. NL References 1. Garling P, Wales NS. Final Report of the Special Commission of Inquiry: Acute Care Services in NSW Public Hospitals. vol. 2. Sydney, Australia: Department of Premier and Cabinet; 2008. 2. Daly J, Speedy S, Jackson D. Leadership and Nursing: Contemporary Perspectives. Sydney, Australia: Churchill Livingstone; 2015. 3. Sisko AM, Keehan SP, Cuckler GA, et al. National health expenditure projections, 2013–23: faster growth expected with expanded coverage and improving economy. Health Aff (Millwood). 2014;33:1841-1850.
October 2015
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John Daly, PhD, RN, FACN, FAAN, is head of UTC/WHO Collaborating Centre for Nursing, Midwifery & Health Development, dean of Faculty of Health at the University of Technology in Sydney, Australia. He can be reached at [email protected]. Debra Jackson, PhD, RN, FACN, is professor of nursing, Oxford Brookes University & Oxford University Hospitals NHS Trust, in Oxford, UK, and School of Health, University of New England. Michele Rumsey, RN, FACN, is director of operations and development, WHO Collaborating Centre for Nursing, Midwifery & Health Development, Faculty of Health, at the University of Technology in Sydney, Australia. Karen Patterson, MMid(Res), GradDip (CBEd), RN, RM, is a doctoral student, Faculty of Health, at the University of Technology, Sydney, Australia; and is honorary associate professor at the University of Wollongong, and clinical senior lecturer at the University of Sydney. Patricia M. Davidson, PhD, RN, FACN, FAAN, is dean and professor of nursing at the School of Nursing, Johns Hopkins University, in Baltimore, Maryland, and Faculty of Health, University of Technology, Sydney, Australia. 1541-4612/2015/ $ See front matter Copyright 2015 by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.mnl.2015.07.003
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