Abstract
The authors of this paper address a universal phenomenon: that of the change in work practices for nurses in formal supervisory and leadership positions. They explore how the role of nurse managers in Norwegian nursing homes has become increasingly ‘managerial’ (which they seem to use interchangeably with administrative), reflecting a move toward New Public Management-inspired reforms to healthcare services. The paper clearly shows that the nurse managers perceive that their roles have moved away from the professional leadership roles of the past to more bureaucratic roles. The nurse managers describe their distress at their inability to use their preferred leadership strategies, such as directly supervising patient care. The authors conclude that the increase in managerial tasks delegated to units has weakened nursing leadership. The conclusion is a logical one within the paradigm of leader-centric approaches to leadership that they espouse, where leadership is perceived to be about motivating and supervising nurses to accomplish planned goals and the leader seeks to influence others to achieve rational goals. The implication of their conclusion (although not explicitly discussed) is that ‘clinical leadership’ status quo should be resumed.
Might it be, however, that rather than returning to the previous models, leadership theory needs to be updated? As healthcare environments become increasingly complex, reliable outcomes can only be assured if there is resilience to adapt processes in response to the unexpected and therefore becoming a High Reliability organisation (Weick and Sutcliffe, 2007). Goal-based leadership is proving less successful in these shifting environments, where deference to experts is the key to containing undesirable events and leadership becomes more about a state of mindful watching and creating the flexibility in the environment for those at the front end to respond to the unexpected without any hiatus or disruption in the service.
There are increasing criticisms of theories that focus on how leaders influence their rather passive, or subordinate, ‘followers’, and Uhl-Bien et al. (2007) suggest that it is time to shift leadership from the industrial age to the knowledge era, where leadership is seen more as a complex dynamic of knowledge management and adaptation than as a position of authority and supervision. Complexity Leadership Theory acknowledges three interdependent domains of leadership: adaptive, administrative and enabling. Absence of any domain is as disabling as dominance. In formal organisations, one cannot disentangle leadership from bureaucracy and so administrative leadership, invested in specific roles, far from being a distraction is a key function.
This paper identifies a problem when administrative leadership dominates, but rather than seeking to reject administrative leadership functions as inappropriate for ‘clinical leadership’, isn’t it now time to embrace them and to think creatively about how to balance them with adaptive and enabling leadership?