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'Frontline clinical leaders should be making the decisions to maximise good patient care'

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Asking ‘why is clinical leadership important’ is rather like asking ‘why is the sky blue’?

The easy answer is of course that ‘it simply is – you only have to look at it’.

However, important questions like this are to easily dismissed and side-stepped by constructing answers that allude to the ‘obvious’ and good old fashioned ‘common sense’.  In contrast to this there are the much longer and richer answers, based on evidence and critique, which reveal the real world that arises from ‘simple’ questions with complex answers. 

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 Let’s start at the beginning – ‘Leadership’ may simply be described as the process of organising a group of people to achieve a common goal. However, in reality, common goals, leaders and organisations come in all shapes and sizes. There are those who would also add that we must be very careful not to confuse Leadership with Management or indeed Seniority. You can be a manager without necessarily being a leader and you can be a senior without being a leader. There are many permutations of that triad, and they are concepts that are all intimately linked.

What then is a clinical leader? Well definitions abound, but for the nursing profession the most literal interpretation is a ‘Leader’ involved in ‘Patient Care’. Why is that important?  It is important because nursing is founded on, defined by, and driven by our raison d’etre - delivering professional patient care. ‘Patient Care’ is what we do, it is what we are – it is at the vey heart of our practice.  To lead that clinical activity must therefore be at the very forefront of our professional priorities, particularly at a time when the NHS is so vulnerable.

And we must tell ourselves repeatedly that we are all in our own different ways clinical leaders if we have influence in any way on patient care. This is the foundation of our code of conduct that clearly places a burden of responsibility on all of us to maintain the highest standards of professionalism and practice at all times. And thus we are all, in a surprising variety of ways, in someway responsible for leading our profession.

However, the diversity of clinical leadership is a concept that we must explore, there are many models, many theories, and many good (and bad) examples that we must learn from. 

For example, it may be argued that the nurse executive is involved in clinical care as their decisions directly influence it. Equally the nurse educator or researcher will have impact on the quality of patient care. 

However, today it is the frontline clinical leaders who will be, and should be at the centre of that matrix of decision makers who aim to maximise good patient care. 

For me the most important focus of good clinical leadership in nursing is that it is not founded on getting people to climb the ladder, but more on those strong leaders who have the vision to hold the ladder steady whilst others climb it!

Dr Dave Barton is the academic lead for nursing at Swansea University.



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Readers' comments (1)

  • I agree with everything that Dave Barton says. One of the biggest problems is that we do not identify and nurture nurse leaders early enough, and many of our "early career" leaders lack confidence and support. I belong to an organisation called Sigma Theta Tau International which is an international nursing organisation specifically dedicated to developing and supporting "a global community of nurse leaders". If you want to know more visit or contact me at

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