Leading and leadership: reflections on a case study

joyce p . (2010) Journal of Nursing Management 18, 418–424
Leading and leadership: reflections on a case study Aim The aim of this case study was to explore if observing leaders in the context of their day-to-day work can provide an insight into how they lead in particular circumstances. Background The study was carried out in a small organization which was set up 5 years ago. Methods A case study methodology was used. Data were collected by field notes of non-participant and participant observations. Follow-up interviews were transcribed and analysed to contextualize the observations. A reflective diary was used by the researcher to add to the richness of the data. Results The data demonstrates how the leader responded in key circumstances during scheduled meetings with staff, interactions in the office and during coffee time. These responses are linked to literature on leadership in the areas of power, personal development, coaching and delegation. Conclusions The findings suggest that observing a leader in the context of their day-to-day work can provide evidence to validate what leaders do in particular circumstances. Implications for nursing management The implications of the findings for nursing management are the opportunities to use observation as a tool to understand what managers/leaders do, how they manage or lead and why others respond as they do, and with what outcomes.     

Challenges in healthcare delivery in an economic downturn,in the Republic of Ireland

carney m . (2010) Journal of Nursing Management 18 , 509–514
Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland Aim The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Background Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Evaluation Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study’s aim. Key issues Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. Conclusions In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. Implications for nursing management As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.     

Enhancing the nurses' role in healthcare delivery through strategic management: recognizing its importance or not?

Aims  To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nurses' vocabulary.
Background  Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role.
Methods  A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100.
Results  Less than 10% of journal titles contained the word strategy . What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident.
Conclusion  The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent.
Implications for nursing management  Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.     

Public health nurses perception of clinical leadership in Ireland: narrative descriptions

Aim  The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses' in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery.
Background  Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles.
Method  Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery.
Results  Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective.
Conclusions  Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor.
Relevance to nurse managers  Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.