The search for the discipline of nursing.

AIM: This is a personal reflection on the need for visible academic leadership of the Discipline of Nursing. BACKGROUND: Health care is under tremendous pressure to reform. Therefore, does nursing have a strong enough discipline base to provide solutions to the reform agenda, or is it simply seen as a service agency. EVALUATION: The author draws upon a number of health policy references, and nurse leader position statements, to form an argument for leadership. KEY ISSUES: Nursing has always been described as invisible within health service development and activity. Therefore, if academic leadership is not articulated this will remain the case and nurses will continue to be seen as task-orientated skilled workers. CONCLUSIONS: Nurse Managers need to have a clear model of nursing and its discipline firmly embedded in their thinking before they can lead anything. IMPLICATIONS FOR NURSE MANAGEMENT: The implications are that Nurse Managers need to have a thorough grounding in the discipline of nursing, possess a clear vision of what nursing is, and should be, and possess the skills to bring this about. This paper provides some perspectives for Nurse Managers to consider with regard to their development.

Promoting leadership: the development of a nurse executive team in an acute hospital trust.

AIM: The purpose of this study was to evaluate how an executive nursing team, within an acute hospital trust in the south of England, developed their leadership characteristics through the use of a professional development programme. BACKGROUND: This paper offers an insight into how this team worked together to clarify their views of their new role and how the role would be enacted. METHOD: A questionnaire using quantitative and qualitative measures was used to explore the group's leadership style and evaluate the professional development programme. FINDINGS: The findings show how the development programme worked and what clarity it afforded the group in terms of their leadership style. Group work, building on the findings, helped them define their particular characteristics, skills and leadership ability and what further work was needed to demonstrate this. CONCLUSIONS: The issues raised, such as team-working, mutual purpose and personal development, are discussed in terms of their function within an integrated executive team with vision and goals. IMPLICATIONS FOR NURSING MANAGEMENT: In ensuring that the nursing service has positive purpose, direction and goals, there needs to be a strategic approach to corporate development; otherwise, nursing will struggle to lead itself within a fast changing health care system.

Consultant nurse-consultant physician: a new partnership for patient-centred care?

AIMS AND OBJECTIVES: The aim was to describe the process of role transition by an individual who has assumed the position of a consultant nurse in cardiovascular health care. The objective was to explain the 'gestalt' of being a consultant nurse and how the 'gestalt' has evolved. BACKGROUND: The development of the consultant nurse role is new, research has described the value and potential contribution of the role. The literature suggests that the role still requires further evaluation and description to be understood better. DESIGN. A free-association narrative interview method was chosen as the research design. METHOD: An in depth interview, tape-recorded and analysed along with field note analysis was the method for eliciting the narrative. RESULTS: The analysis of the narrative reveals an emerging 'gestalt' for being a consultant nurse. Various concepts and phenomena attributable to the role are identified from the experience described. The gestalt explains the journey of the individual through an 'apprenticeship' to role attainment, whereby a new sense of professional self or 'Me' is realized. CONCLUSION: The significance of the paper lies in the analysis of the narrative and the insights it gives to help other aspirant consultant nurses. It is through the understanding of these insights that individuals could plan their own learning and development to be achieved in the role of consultant nurse. RELEVANCE TO CLINICAL PRACTICE: To be effective and provide effective patient care, one can argue that appropriate learning needs to take place. Those that have been appointed to the role have battled to find achievement and acceptance. These battles may be made easier to win if the role is better understood and appropriate preparation provided. Only then will the real potential of the role be realized in improved patient care outcomes.

Mutual suffering: a nurse's story of caring for the living as they are dying.

The aim of this study was to uncover the meaning of the lived experience of mutual suffering in relation to the care of a dying patient. The study took place within an acute medical ward in a district general hospital on the south coast of England as part of a reflective practice development programme. Parse's human becoming theory provided a framework for the study and Parse's research methodology was adopted. Understanding the nature of human relationships within nursing practice is central to nursing work, enabling patients and their health-professional carers to live and work healthily in the context of human becoming. Illuminating mutual suffering through reflection enables nursing and health-care professionals to acknowledge the paradoxes of practice and, thus, create new strategies for the provision of care and the improvement of practice, so that quality of life is maximized for the patient and for themselves.

Supporting the role of the nurse consultant -- an exercise in leadership development via an interactive learning opportunity.

This paper discusses how a group of consultant nurses were supported over a period of three years by a process of interactive learning. The purpose of this learning was to help them develop the personal and professional abilities necessary for them to achieve success in the role. These personal and professional abilities are not new clinical skills, but the skills of leadership, self-awareness, confidence, self-belief and value clarification and a clear mental model of what it is they want to be within healthcare. An evaluation of the action learning methods reveals their success in helping the participants to achieve some competence and awareness in these personal and professional abilities, to reach a comfort zone in the role. However, the analysis also reveals the polarities and paradoxes such practitioners will have to negotiate if they are to achieve success and establish themselves within the role.

Introducing and developing nurse leadership through a learning set approach.

This study is an evaluation of how far the use of co-operative learning has helped six 'new' Directorate Senior Nurses (DSNs) at Salisbury District Hospital NHS Trust in the UK to develop their roles, and reflects on their acquisition of leadership skills and capability. The project has two elements: co-operative learning and evaluation research of both learning methods and leadership development. The six DSNs--five nurses and one midwife--agreed to take part in both aspects, with the research aspect consisting of tape-recorded, qualitative interview questions based on the leadership characteristics given by Krause [The Way of the Leader, Nicholas Brealey, London, 1997]. The research showed that co-operative learning was an effective way of learning leadership and role acquisition. The DSNs identified gaps in their knowledge and understanding of leadership. However, they found that, by exploring their life experiences through reflection and developing knowledge from theory as part of co-operative learning, they were able to construct strategies to help them manage their role in new and creative ways.

The relationship of nursing theory to practice and research within the British context: identifying a way forward.

In this column, the author presents the current relationship of nursing theory to practice and research within the British context and suggests a way forward as suggested by Nightingale in order to guide future development.