Portal de Periódicos da CAPES

Editorial: Lead us not

2009; Wiley; Volume: 18; Issue: 14 Linguagem: Inglês

10.1111/j.1365-2702.2009.02850.x

1365-2702

Debra Jackson, Roger Watson,

Nursing Roles and Practices

Leadership is a word that invites critique and interrogation; it is a term that is nebulous, in that it is widely used and rarely defined. Leadership tends to be presented as a panacea for all of the ills that we face. However, leadership is not necessarily a virtue. While it is generally presented in positive terms, one does not have to look very far back in history to find examples of leaders who led people and even whole nations to disaster. The Light Brigade was, presumably, led into the valley of the shadow of death and Europe was striven, in the middle of the last century, by a veritable overdose of leadership. It is also worth noting that the British public showed the most successful leader of that period – Winston Churchill – their appreciation by voting him out of power at the first opportunity following the end of World War II. That should be a warning to all who aspire to leadership: leadership is not the same as popularity. The concept and virtue of leadership has recently been questioned in the UK broadsheet newspaper The Financial Times (Broughton 2009). Broughton is critical of Master of Business Administration (MBA) degrees for ‘churning out’‘future leaders’ and reminds readers that the ‘rise of the MBA almost exactly mirrors the rise of the economic system that is now in the hospital emergency room’ (p. 13). Leadership tends to be represented as a generic concept, therefore, we often fail to recognise that it is context-specific. Particular sets of circumstances demand particular sorts of leaders and particular types of leadership. Leadership strategies that are successful in one situation may fail in another. It is not unusual to see organisations uncritically adopt models of leadership and implement them solely on the basis they have been successful elsewhere, without recognising the crucial contextual differences that can make previously successful leadership models and interventions fail (Atsalos et al. 2007). As a concept, leadership is rarely critiqued. It is highly sought in the employment market, with advertisements for managerial and advanced positions almost always calling for applicants to hold leadership skills. Many of us have been present in interviews (either as applicant or as a member of the panel), in which aspiring appointees are questioned about leadership, and expected to be able to speak with authority on the subject. Perhaps, because of this, an industry has been spawned around the concept of leadership, the MBA being one obvious manifestation. In nursing, the Royal College of Nursing in the UK runs a leadership programme and the NHS in the UK buys into another leadership programme. In the desire to demonstrate and gain skills in leadership, there is no lack of people willing to spend time and money participating in leadership courses and seminars, thus being able to demonstrate leadership knowledge, at least in their CVs. Byrne (2007) has commented on leadership courses conducted in classrooms, and while it is important that organisations ensure they cater for the developmental needs of all staff, when considering leadership, interesting questions are raised. Can effective leadership be taught? How much does effective leadership rely on skills (which can be taught and learned)? And how much does it rely on personal qualities (which are largely innate)? We believe that, effective leadership is a combination of personal qualities and skills learned over time, and in the absence of key personal qualities, no amount of formal classroom teaching can create a leader. Organisations commonly look to their managers to take on leadership roles and to demonstrate leadership. However, leadership and management do not necessarily co-exist. As the literature indicates, it cannot be assumed that a person sitting in a managerial role will necessarily possess or be able to demonstrate sound leadership qualities (Schwartz & Tumblin 2002, Jackson 2008). In fact, much of the mayhem that besets large organisations – examples abound in the financial services industry at the time of writing – can be laid at the door of poor leadership, by people who were (perhaps) perfectly competent managers. This can be – at least sometimes – attributed to the mistaken belief that a leader is someone who simply implements predetermined policies, handed down from above. This type of ‘leadership’ often blindly ploughs into implementing change, heedless of even well-justified resistance and critique, with critics of the change being labelled as blocking, or ‘resistant to change’ (Darbyshire 2008:39). Leaders, in these circumstances, are often judged by their loyalty to a higher agenda and their ability to lead people and organisations into disaster – provided the agenda is adhered to – rather than their ability to lead people out of the disaster. The latter kind of leader is often seen as maverick and disloyal. There are some senior positions that are clearly leadership positions and, while there is often an implicit assumption that incumbents in these positions will have leadership skills, these skills are often poorly articulated. However, in an editorial about professors as leaders, Watson and Thompson (2008) presented criteria paraphrased from the National Conference of University Professors in the UK, and these criteria clearly capture some of the key elements of leadership (in the context of professor-ship) such as professional standing, authority in a field, accountability and highly developed communication skills. However, professors are often appointed on the basis of success in research and scholarship alone. That being the case, it cannot be assumed that even a highly successful researcher will necessarily be a successful leader; the above criteria seem more like baseline requirements upon which other – less tangible – aspects of leadership can be built. Though often not dealt with explicitly, leadership is frequently mentioned in relation to advanced nursing practice roles, with clinical and professional leadership identified among the competencies held by advanced nurse practitioners (Furlong & Smith 2005, Carryer et al. 2007). While this is ideally the case, again, one cannot assume that simply being a highly skilled practitioner with advanced clinical knowledge will necessarily signify that any individual has particular leadership skills. Furthermore, there is relatively little to suggest how such leadership competencies might be enacted in the context of these busy and demanding clinical roles. Carryer et al. (2007) produced findings that identified clinical leadership as one of three core roles of the nurse practitioner. However, they also highlight the lack of clarity and robustness around the term and call for further research into clinical leadership, particularly in the context of advanced nursing practice. Aspects of leadership are occasionally specifically addressed when examining change processes or introducing new policies or guidelines. In a paper exploring the implementation of Best Practice Statements in Scotland, Ring et al. (2005) discussed the influence of opinion leaders in being able to influence attitudes and uptake of the new guidelines, either positively or negatively. They concluded that environmental and personal changes were needed to ‘create the right conditions’ (p. 1054) for implementation of the new guidelines, and so identified that both opinion and clinical leaders were required to facilitate the necessary change (Ring et al. 2005). Shih et al. (2009) examined leadership from a different stance. They explored the experiences of senior nurses during the severe acute respiratory syndrome (SARS) epidemic in Taiwan (2002–2003), and explicitly, how senior nurses enacted and embodied their leadership roles in the face of the crisis. It is unknown whether the leadership skills apparent in Shih et al. (2009) study were innate, gained through the career and personal experiences of a lifetime, gained through participation in leadership training, or an amalgam of all three. However, regardless of how their skills were gained, the experiences of these leaders provides information that highlights the context-specific nature of leadership, and how important efficacious leadership is in guiding nurses through times of crisis and turmoil. Though most nurses may not be confronted with crises the magnitude of SARS, as were the nurses in the paper by Shih et al. (2009), nurses everywhere show leadership every day in many ways and in many contexts, yet remarkably little about leadership in nursing appears in the peer reviewed literature. Given how frequently the importance of effective leadership for nursing is acknowledged, it is somewhat surprising how (relatively) few papers specifically examine leadership and how it is, has been, or could be enacted in the various professional domains of nursing. There is a need to explore innovation in leadership, to reflect on the characteristics of effective and ineffective leadership in nursing and health care. JCN welcomes scholarly papers and research reports that critically examine leadership issues in nursing. There is a need to scrutinise those leadership interventions and strategies that are successful and effective, as well as those that are unsuccessful and ineffective.