Spotlight on Nursing Leadership

31 May 2024

In Conversations with industry leaders on International Nurses Day 2024

In celebration of International Nurses Day 2024, we turn the spotlight on nursing leadership, engaging in insightful conversations with industry leaders who are at the forefront of healthcare innovation and transformation.

This month we had the pleasure of speaking with Professor Alison J McMillan PSM Chief Nursing and Midwifery Officer Australian Government Department of Health and Aged Care, Karen Linegar, Executive Director of Nursing and Midwifery at the Tasmanian Health Service and Lisa Cox Chief Nursing and Midwifery Officer Divisional Director Nursing, Surgical Services at Northern Health who shared their thoughts about International Nurses Day 2024 and nursing leadership.

The International Council of Nurses says, “nurses are key to healthier communities, responsive societies, thriving economies and powerful nations”. Their charter for change aims to value, protect, respect, and invest in our nurses for a sustainable future for nursing and health care. I believe this resonates here in Australia just as it does across the world.

The ICN presents 10 policy actions aimed to create and sustain health care systems that are safe, affordable, accessible, and responsive. Many of these policy actions are similar to the themes emerging through the consultation and research in developing the first Australian National Nursing Workforce Strategy.

May 12th celebrates the birth of Florence Nightingale who made such a difference to the lives of soldiers in the Crimean war and is credited with forming the basis of nursing training. Her principles of Infection Control are as valid today as they were 170 years ago.

This theme provides an interesting context to the provision of nursing care. In third world countries nurses provide much of the assessment and care in the absence or minimal support from a medical practitioner. Without nurses the standard of health care would be much lower than it is currently.  In our context there are several ways to acknowledge this statement. In managing the cost of care Nurses are central to the decision making with a patient including the use of consumables such as wound care dressings.

Given the plethora of dressings available making the best decision for the type of wound requirement may not be using the most expensive dressings. We know from the literature that nurses are central to minimising the patient length of stay and coordinating the patient journey through observation ,assessment and planning. Nurses are the single profession at the bedside or in the home who use their knowledge and skills to manage care delivery including the detection of infections developing and patient deterioration.

 With the development of Nurse Practitioners, the care of the whole patient episode is coordinated and includes the ordering of pathology, medical imaging and ordering of medications as required. So economically nurses are the largest sector of the health service but by good patient care nurses influence the cost to the community in a very practical sense.

Nurses provide care in so many settings from aged care to maternity care and everything in between. Within the acute care sector every specialist area is supported by skilled nurses and in the community sector areas are covered from  Mental health, Child and family support ,Drug and Alcohol, provision of care in the home programs ,palliative and community care etc.

Extensive research has been conducted over the years to determine the economic power of care that registered nurses contribute to both healthcare and human services sector. As a profession, nursing is entwined within many health and socioeconomic indicators, demonstrating a capacity to positively impact health outcomes, which extend to positive economic impacts.

Workforces with appropriate ratio staffing and improved educational level of nurses have shown to have a positive impact on health indicators, for example readmission rates, mortality rates as well as lower admission rates In addition, scope of practice credentialing and endorsements, such as in advanced nurse roles and nurse practitioners’ roles have also demonstrated a positive impact on community demand gaining access to services, models which provide more affordable and accessible (regional/rural) care and enhance overall health outcomes.

Governments at all levels local, state and federal are understanding these positive impacts, that such a large workforce can provide and have invested funding to create new models of care, extend scope of practice of advanced nurse and nurse practitioner roles and implement or support nurse ratios. A great example of this in 2022 was the Victorian Governments funding commitment  Making it free to study nursing and midwifery – which provided both nursing scholarships and employer support packages through the spectrum of professional nursing advancement roles (EN to RN transition, refresher programs, speciality nursing and midwifery postgraduate scholarships, nurse practitioner candidate and nurse practitioner scholarships and funding support to health services) demonstrating a commitment to invest in nursing and midwifery and increase the upskilling nurses and midwives at all levels. This in turn, allows the profession to increase in knowledge, competency and skill, which is in turn allows the higher provision of care and safety to patients and clients in the community.

In more basic terms, nurses provide a cluster of direct care, advocacy, education, health prevention and empowerment to patients with the aim of improving their health or health outcomes, which ultimately leads to a healthier community and also has cost-effective/saving impacts within the community.

Continuing to attract and retain nurses into the health system is vitally important. Community surveys consistently show that the general public believe, overall, that nurses are compassionate, trustworthy and dedicated. Nurses are often the first point of contact in a healthcare setting and the last health professional people interact with before discharge. This highlights the important and lasting impact nurses have in caring for people. 

There is high interest in nursing as a career, but many people also have outdated beliefs about what the role of a modern nurse really looks like. Some think it is still a ‘female’ job and that the primary role of nurses is to assist doctors. The community often underappreciate that nurses today perform sophisticated tasks and work in many different areas of the health system, not just in hospitals. 

The common health issues facing Australians have changed, owing mostly to the ageing population. People are living longer, but doing so with chronic conditions (heart disease, diabetes, cancer). Many experts argue that nurses’ scopes of practice could be optimised to ensure nurses can continue to meet changing community needs.

Supporting emergent nursing leaders is crucial if we are to continue retain and attract people into nursing, maintain that public trust in the profession and ensure we can continue to meet the changing community health needs.

Research has found that although 50% of nurses have trust in their leaders, there is still work needed to build more positive and safer workplaces. Nurses note that more support is needed to help nurse leaders drive these positive changes.

As mentioned above nurses are critical to good health care systems and leadership is not always recognised to occur informally as well as formally. In developing emerging leaders, we support and coach the confidence to lead care provision regardless of the setting and to be the patient advocate.

Nursing leadership is critical to ensuring the voice of nurses is heard politically to influence how the care dollars are spent. There is also a focus on development of management skills in our leaders as to ensure sound economical and human resource management occurs- again influencing the economical basis of health. 

Nursing is a career with many leadership levels and pathways. Supporting emerging leaders is essential to ensure succession management in all health service areas – wards, units, access, operations and right through to corporate/executive.

A front facing nurse develops leadership skills within their clinical setting, for example Trauma Team Leader in a trauma resuscitation, yet often nurses do not have confidence they have leadership skills and/or experience and shy away from applying for leadership roles because of same.

Supporting emerging leaders provides positive impacts such as confidence, extended knowledge, collegial or professional support and mentorship, and builds nurses confidence for leadership roles.

Supporting emerging leaders leads to strong nursing leadership which ensures everyone feels valued, boosts morale and sets a healthy workplace culture. A happy and healthy workplace leads to high levels of patient care, staff and patient satisfaction and retains the workforce, just to list a few measures. This in turn leads to pride within the workforce in the delivery of care provided.

We will all require access to health care at some stage of the life span, and nurse leaders need to ensure emerging leadership starts and is supported within front facing roles right through the hierarchy of nursing within health service structures to ensure the patient remains the focus/the ‘why’ and that consistent high-quality care is delivered.

I have had a great deal of advice provided to me over the years, some of it helpful and less so. I also think the advice and guidance you need early in your leadership journey might differ from that as your own leadership style matures.

But the one thing over all else that comes to mind was from a CEO of a large metropolitan health service in Victoria, who said “it is the action and choices you make in adverse situations that can influence your reputation well beyond the immediate situation”.

Take advantage of opportunities, believe in yourself and your personal values, and be a lifelong learner. Be compassionate and support those nurses coming behind you.

I have had an array of advice and mentorship during my leadership career, it is hard to narrow it to ‘the best advice’.

For me, especially as a more introverted leader, the most important advice I have received, is to be myself and to stop comparing myself to others or be intimidated by others who may have a louder voice in the room. I am in the role for a reason and need to stand confidently in those shoes.

Certainly, for me this has taken some time to master, however with multiple leadership styles documented, every leader is different, just like everybody’s physical looks are different. While we may admire or aspire other people’s personal appearance/traits, we cannot change into a 6-foot-tall person, when only 5 foot tall, the same goes for leadership styles. You will not succeed trying to copy another’s leadership style, rather you need to develop and refine your own style.

I think leadership is a continuous improvement cycle, however I truly believe that leading authentically and with kindness and empathy is the key. This does not mean you need to be liked by everyone, but that you lead consistently with your values and are considerate of others.