Caroline Shuldham: Senior nurse leaders are tough but they can’t flourish in a blame culture

Nurse directors need exceptional qualities and skills to provide effective leadership. But they only give their best when they receive the support that every other member of staff has a right to expect

Nurse directors need exceptional qualities and skills to provide effective leadership. But they only give their best when they receive the support that every other member of staff has a right to expect

Picture: Alamy

Optimistic, knowledgeable, forward-looking, willing to be challenged and able to instil confidence – these are just some of the qualities displayed every day by effective nurses in board or other senior leadership positions.

Directors of nursing lead and manage a range of staff and services and require considerable leadership skills to fulfil their roles. Their core values include compassion and the ability to inspire and engage others while focusing on patients and service improvement.

Senior leaders are accountable, but do not work alone. Their effectiveness is determined largely by how well they collaborate and build relationships with other staff.

Advice and support

A good leader will establish a positive culture and engage senior and junior colleagues. They set direction, give and accept advice and support, and can appreciate the other person’s perspective. But at the same time they have to manage their own anxieties about the risks associated with an environment in stress, where the ability to provide a safe, effective service may be fragile.

Senior nurse leaders have wide influence within and beyond nursing, and support disciplines such as procurement, IT and housekeeping services. They promote a climate in which safety is valued and problems can be raised and managed, thereby reducing risks.

Cycles of change

Such leaders can deal constructively with difficult situations, such as talking to patients or families about errors and to staff about poor performance, or raising issues in committees. They use their voice and enable others to do so.

Challenging the status quo, seeking ways to improve services, and going through cycles of change to make things happen, combined with identifying talent and teaching and coaching others, are all attributes of good leadership.

Decision-making is important, because indecision is stifling and easily leads to stagnation. It blocks the action of other staff. A chief executive I knew encouraged staff to make decisions, taking the view that the majority would be right and remedial action would usually correct the others.

From ward to board

Senior leaders know their organisation well, from ‘ward to board’, and are visible, approachable and receptive. Many spend time in the clinical setting, speaking and listening to patients and staff. In my experience this connection with staff is a key factor in fulfilling a senior leadership role.

Nurse directors need emotional intelligence and an innate toughness to deal with challenges. Unfortunately, their role in ensuring excellent standards is not always acknowledged publicly and they can feel vulnerable and unsupported. When things go wrong, even the best nurse leader can be undermined by recriminations or find their job security threatened.

Under pressure

Leadership skills are most likely to be developed where there are shared values and beliefs and an open, supportive culture in which creativity is encouraged, communication is effective, people collaborate and the next generation is nurtured. Many nurse directors work in such environments but too many do not. Organisations under continuing pressure may be unable to provide a supportive environment for senior nurses or anyone else. Then behaviours can deteriorate and staff at all levels are affected.

Effective senior nurse leaders ensure their staff are treated with consideration, but they themselves also need to be treated well. They flourish where they experience the same standards that any member of staff should expect from their manager and colleagues.

Caroline Shuldham is chair of the RCNi editorial advisory board. A former nursing director, she is an independent adviser on research, teaching and mentoring




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