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Research review

Confidence in leadership among the newly qualified


Newly qualified health professionals do not always feel confident about their leadership abilities and may feel unsure of their leadership role


The Francis report highlighted the importance of strong leadership from health professionals but it is unclear how prepared those who are newly qualified feel to take on a leadership role. We aimed to assess the confidence of newly qualified health professionals working in the West Midlands in the different competencies of the NHS Leadership Framework. Most respondents felt confident in their abilities to demonstrate personal qualities and work with others, but less so at managing or improving services or setting direction.

Citation: Morley M et al (2013) Confidence in leadership among the newly qualified. Nursing Times; 109: 42, 15-16.

Authors: Mary Morley is director of therapies, South West London and St Georges Mental Health Trust, London; Lisa Bayliss-Pratt is director of nursing, Health Education England; Liz Bagley is education quality and performance manager, West Midlands Deanery, Birmingham; Steven Alderson is national medical directors’ clinical fellow, Health Education England.


The Francis report (Francis, 2013) stated how important it is for nurses and other professionals to exhibit strong leadership skills to ensure patients are always put first. However, how prepared those professionals who are newly qualified feel about taking on such roles is unclear. As a result of this, we aimed to ascertain how confident newly qualified staff working in the West Midlands felt in their leadership abilities. We used the NHS Leadership Competency Framework (Fig 1) to measure confidence in:

  • Demonstrating personal qualities;
  • Working with others;
  • Managing services;
  • Improving services;
  • Setting direction (NHS Leadership Academy, 2013).

Newly qualified health professionals working in NHS trusts in the West Midlands were invited by their preceptors to complete an electronic survey asking them to rate their confidence across the framework’s five leadership competencies and the various components of each.


Of the 59 responses received, 41 were completed by nurses and 18 by allied health professionals. Respondents’ qualifications included undergraduate diplomas (n=16), undergraduate degrees (n=29), postgraduate diplomas (n=13) and master’s degrees (n=1); 43 worked in acute trusts, 11 in primary care, three in mental health trusts, and two in other workplaces.

Overall, most respondents (57%) said they were confident in their ability to demonstrate personal qualities, with nearly 20% rating themselves as “very confident”. The remainder felt “somewhat confident” (21%) or “not at all confident” (3%). Similarly, most respondents reported that they were confident (60%) or very confident (25%) in their abilities to work with others.

When asked about their ability to manage services, only 9% rated themselves as “very confident”. Most felt they were “confident” (53%) or “somewhat confident” (32%); just 5% selected “not at all confident”. In terms of the different components of managing services, respondents were least confident in using data about performance to identify improvements, understanding what resources are available and in contributing to service plans (Table 1).

In rating confidence in the ability to improve services, 12% of respondents were “very confident”, 38% “confident”, 30% “somewhat confident” and 7% “not at all confident”. They were least confident in expressing the need to change processes, putting forward suggestions to improve service quality and questioning established practices that do not add value (Table 1).

On setting direction, 10% rated themselves “very confident”, 39% “confident”, 39% “somewhat confident” and 13% “not at all confident”. They felt most confident consulting with others, but lacked confidence in their decisions about the future direction of the service, gathering and analysing data and making recommendations for improvements.


Most respondents reported being confident or very confident about demonstrating their personal qualities or working with others but felt less so at managing or improving services, or setting direction. These findings may not be surprising. While the demonstration of personal qualities and team-working are well established in health professionals’ training (McNair, 2005), the importance of newly qualified staff managing and improving services and setting direction is less so. Nevertheless, both the Francis (2013) and Keogh (2013) reports highlight the importance of listening to the views of the most junior health professionals and engaging them in improving services - their energy must be “tapped and not sapped” (Keogh, 2013).

It is important to acknowledge that while newly qualified professionals may lack confidence in their own abilities, objective measures and reports of others may show them to be competent.

This is a small study; further research using a larger sample might give a clearer indication of where newly qualified professionals lack confidence. This could also help to determine whether such professionals lack confidence, competence or both - and whether the solution is offering more preparation for leadership or simply working on building confidence.

Key Points

  • The Francis report states that all nurses need strong leadership skills
  • It is unclear whether newly qualified professionals feel able to adopt a leadership role
  • Most newly qualified health professionals feel confident in demonstrating personal qualities and in working with others
  • They are less confident in managing and improving services and setting direction
  • Although professionals may not feel confident in their abilities, they may be competent leaders

Readers' comments (3)

  • bill whitehead

    This is a useful and timely study. Our recent literature review (part 1 of our case study report at Chesterfield Royal Hospital) also noted the potential for a discrepancy between confidence and competence. Whitehead et al (2012) Preceptorship Programmes in the UK: a systematic literature review, part 1 of the report for this project Available from

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  • As a nurse of some 32 years, I find the results not unsurprising. Although students are taught about leadership, I don't feel we should be expecting them to feel competent in this area. After all, where have they had the experience when all practice has been through the lens of being a trainee.
    Im not sure what the point was in the study. Seem obvious to me what the findings would be.

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  • Not much power to a survey with 59 responses.

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