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Can you help the nursing profession rise to the leadership challenge?


Too often those already in post are the focus of leadership development, obscuring the needs of the next generation, says Elisabeth Fradd. Leave a comment on on this story to contribute to a national debate on the future of NHS leadership

We must urgently seek out potential leaders across all aspects of nursing, because the workforce is ageing and many nurses will retire in five to 10 years.

Nurses are expected to deliver high quality, compassionate care in increasingly complex clinical and social environments. They provide leadership every day in many ways and in many contexts. Yet, given how frequently the importance of effective leadership is cited in health reform, it is surprising the nursing profession has not collectively responded to this challenge. This may be because the NHS as a whole is only just beginning to grasp the vital role of leadership. NHS chief executive Sir David Nicholson recently said: “We have not systematically identified, nurtured and promoted talent and leadership.”

Nursing has a number of opportunities to put this right – not least in the report of the Prime Minister’s Commission on the Future of Nursing and Midwifery.

Former health minister Lord Darzi said: “Within the patient experience, nursing and nurse leadership roles are the most important enablers in really transforming what happens in a ward or the community.” It is, therefore, the duty of existing nurse leaders to foster talent by supporting and encouraging the next generation by every means possible. As well as the usual formal development programmes, this support could include mentoring by recently retired experienced senior nurses, secondment opportunities outside the NHS to see how things could be done differently or through the establishment of leadership development networks.

Escalating budget pressures mean it is even more important to identify and invest in those who are going to be able to lead and innovate with confidence. We need to spot leaders using criteria such as those set out in the Hay Group’s report Nurse Leadership: being nice is not enough.

The Hay Group identified the following factors that should be used to select staff for accelerated development programmes: an eagerness and willingness to learn something new; a breadth of perspective that enables the individual to take a wider view on issues; an understanding of others; and personal maturity, which includes the ability to take feedback and use difficulties as a chance to learn.

It must be accepted by those already in leadership positions that it is their responsibility to bring on the next generation of leaders. Different organisations and specialties need leaders with different skills and backgrounds. The approaches needed to spot, develop and support future leaders must be flexible enough to accommodate this. Boards must seek assurance that existing clinical leaders are being supported and potential leaders found, in order to drive change locally and across organisational boundaries.

If we are truly committed to the leaders of the future, healthcare organisations of all kinds, including schools of nursing and their leaders, have a responsibility to spot future leaders and ensure core competencies are built into development programmes – competencies like managing uncertainty, business skills, commissioning and political acumen. In this way, existing leaders can help those further down the organisational ladder understand the context in which they will have to operate – a vital prerequisite to successful leadership in complex environments.

Any significant change in healthcare on the scale intended requires bold leadership at all levels to sustain the necessary reforms. This is why nurse leaders must act now to find those capable of following them. It is also why nursing must grasp the opportunities to demonstrate the capability and capacity of nurses to lead.

Dame Elisabeth Fradd is an independent adviser on health services. She was previously assistant chief nurse at the Department of Health and director of nursing at the Commission for Health Improvement

Should the NHS identify potential leaders, or should it be left to individual nurses? Nursing Times and the National Leadership Council wants YOUR views. Post comments below or click here to email us.


Readers' comments (8)

  • the profession needs to identify individuals who are wholly and completely concerned with only two things: improving patient care, and improving pay and working conditions for nurses. These two are inextricably linked, and rather than having self serving leaders who are simply sychophantic and respond only to government pressure and the plethora of inititiatives/guidelines/pledges and other useless minutiae they constantly regurgitate, they need to do what they are paid for and listen to the public and the profession, not ministers or civil servants (now there's an oxymoron!)

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  • Martin Gray

    Too often people are promoted to positions because of academic qualifications rather than hands-on experience. When this happens it often results in 'yes' people being promoted rather than those which have the insight into the real problems of service delivery and staff morale.

    Whilst I agree with the comment above I still think that experience has a lot to do with getting the profession back on the right track. All too often those with both the experience AND the other essential qualities of leadership are overlooked in favour of 'ticket collectors' who think that having a paper qualification deems them best for promotion, despite the fact they do not have the role experience required to fulfill such posts. So perhaps the present leadership and management need to look at all the aspects of potential leaders for the future rather than rely on paper qualifications.

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  • My experience is that managers rarely have higher qualifications than their subordinates - so the above comment is quite strange.
    Those with MBAs tend to have studied for these AFTER gaining promotion rather than before. Very few are graduates and most are full of their own importance and treat their nursing colleagues with contempt. The Foundation trusts tend to believe that front line staff require MacDonald style motivation with "Staff member of the month", silly non academic certificates and leaflets containing patronising comments.
    ..and they wonder why no-one wants to be a nurse.

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  • Although I agree that leadership should be nurtured, unfortunately in my experience this does not occur. Instead managers and nurse leaders do not want nurses to have an opinion when it comes to leadership. For a leader to nurture up and coming leaders they need to be able to listen and take on board what nurses are saying on the shop floor not just dictate what should be done to follow national guidelines. If leaders involved staff in decision making instead of dictatorship they would increase staff moral and improve performance. Managers and Leaders sometime pretend to listen but dismiss suggestions from staff even if there is a possibility it could work purley because they think they are the only ones with the best ideas. So how can these type of managers and leaders acknowledge whether there is potential in someone to become a leader?

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  • Nursing is my second degree - I have had a career as an entrepreneur and have managed and led others already... If my skills and qualifications are redundant in nursing, and my extensive experience will not 'count' towards promotion, then the NHS of the future is foolish! It is my uniqueness, commitment and compassion which drew me to the profession, and it will be a sad day if nursing only welcomes 'blank canvasses'. It is mostly the mature students who have experienced life which contribute most on my course.

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  • As long as senior Nurses are counted as "one of the numbers" in the clinical setting, it is very difficult to ensure that appropriate training, secondment and work experience is accessed. Very often the "management" side of health care is learned once clinical seniority and experience is gained. This very often produces senior managers with a clinical background who take several years to " learn the ropes" of management and Health economies. In the private sector the management skills are a basic necessity; the business is then learned. I believe NHS managers should have a clinical background- so it's off to the drawing board and university pre and post graduate education should incorporate business management skills.

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  • It has been my experience that many managers don't like sharing the sweeties. It is a private members club and if your face doesn't fit your not invited. As soon as the M&S slacks and the clipboard go on, any nurse in uniform becomes a piece of meat at market to be used .and abused

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  • For a leader to nurture up and coming leaders they need to be able to listen and take on board what nurses are saying on the shop floor not just dictate what should be done to follow national guidelines. I agree that leaders who involve staff in decision making increase staff moral and improve performance. Leaders who listen and apply what they have heard to the decision making process would produce a more involved and pro-active staff group. Managers and leaders have to recognise that increasingly the staff they lead are all intelligent well educated individuals with great potential to become the future leaders of the NHS

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