This series explores the four pillars of advanced clinical practice and here, Regina Tavengwa explores the pillar of leadership and management.
I have been in my current role as a matron for eight years, with a background of practicing as an advanced nursing practitioner and supporting nurses to take on more advanced roles. Advanced clinical practice is a defined level of practice within clinical professions such as nursing, pharmacy, paramedics and occupational therapy. This level of practice is designed to transform and modernise pathways of care, enabling the safe and effective sharing of skills across traditional professional boundaries [1].
The leadership and management pillar
The leadership pillar in nursing emphasises the importance of not just clinical skills, but also the ability to collaborate, manage, and guide teams effectively within healthcare settings. Nurses at all levels are expected to demonstrate leadership behaviours that align with their role, whether it’s leading a team, managing resources, or advocating for patients. The pillar highlights several key areas, such as:
Teamwork and collaboration
Nurses need to be skilled in working alongside multidisciplinary teams, ensuring that communication is clear, and that patient care is coordinated and efficient, which often translates to patients being seen on time, reduced waiting times and leads to patient satisfaction. This includes involving all staff in shared learning from incidents, promoting transparency and creating a culture that allows growth [2].
Leadership skills at varying levels
Whether at the entry-level or more senior roles, nurses should be capable of leading with confidence. This might mean stepping into leadership roles when necessary or supporting the leadership of their colleagues. For example, a senior nurse at band six should be confident to take on the role(s) of a band seven sister and coordinate the running of a unit or support staff and patient queries [3].
Management responsibilities
As nurses progress in their careers, they take on more managerial duties, including overseeing staff, managing resources, and ensuring the delivery of quality care. Effective management requires strategic thinking, decision-making, and problem-solving skills. Staff must be supported to attain the relevant skills, either by their line managers during appraisals or through learning opportunities which are shared or identified as essential for staff [4].
Professionalism and ethical leadership
Nurses are expected to lead by example, modelling professional behaviour, and adhering to ethical standards in clinical practice. They should advocate for patients’ best interests, uphold confidentiality, and encourage a culture of respect and accountability [5].
My experience as a leader
I think one aspect that’s always intriguing for me is transformational leadership in nursing, where leaders inspire and motivate their team to not just perform their duties but also develop personally and professionally. This type of leadership can significantly impact the work environment, patient care outcomes and team morale. An understanding of emotional intelligence and situational leadership has allowed me to foster a culture of constant adjustment and adaptability.
Collaborative leadership in multidisciplinary teams is key and requires a unique set of communication and coordination skills to involve all team members as relevant in decision-making. Leaders must aim to encourage participants to actively engage and show their support by being positive and nurturing in their feedback to staff.
I think that nurse empowerment is critical to create an environment where nurses feel confident in their decision-making and leadership potential. Often, nurses are in the best position to advocate for patients, yet they might not always feel empowered or supported to take on leadership roles, especially in a clinical setting. Building a culture where nurses can lead confidently, voice concerns, and implement changes is critical, thereby creating a psychologically safe environment.
In order to build strong relationships with the team and empower the team through continuous learning, I always encourage staff to pursue professional development opportunities. As a leader, I encourage openness and vulnerability to build stronger, more trusting relationships with the teams.
In healthcare environments, disagreements or miscommunications can arise, but my understanding of conflict resolution helps me to navigate and resolve conflicts effectively, maintaining positivity and a patient-centred work environment.
I have also noticed how important it is for nursing leaders to focus on coaching, mentorship and career development for newer nurses as a transformative way to develop future leaders, improve staff retention and quality of care. It’s also a great way to help staff build their confidence and leadership abilities.
Challenges and solutions
One challenge is balancing the leadership demands with the need for direct patient care. I often juggled multiple responsibilities, so finding time to foster empowerment or focus on mentorship can be challenging.
Another challenge could be overcoming resistance to change when trying to implement new leadership practices, like encouraging more collaboration or giving nurses more autonomy in decision-making. In environments that have long-established routines, some team members might be hesitant to shift the culture, especially if they feel the changes might affect their workload or team dynamics.
Effective delegating of certain tasks or responsibilities to trusted team members allows focus on mentoring or supporting others. Another effective strategy for managing change is transparent communication, explaining the rationale and actively listening to feedback can help reduce resistance.
One successful approach that I have used is regular check-ins with the team. Brief, consistent touchpoints where team members can share updates, concerns, or suggestions – known as ‘huddles’ – help to create a culture of openness and allows for early identification of issues before they snowball, which can alleviate some of the pressure in a busy clinical environment. Another strategy that’s been effective in some situations is debriefing after difficult situations.
I’ve also incorporated more self-reflection and peer feedback. Taking time after a leadership opportunity to reflect on what worked, what didn’t, and asking for feedback from colleagues helps to continually refine my approach.
Time management and prioritisation are key strategies in balancing leadership responsibilities with patient care. I have explored resilience training for leadership as the role is emotionally and physically demanding, and strategies to stay grounded, focused, and motivated during tough times are essential for leaders and their teams.
In conclusion
Clinical leadership plays a pivotal role in shaping the quality of care and ensuring the success of nursing leadership in the clinical environment. A strong clinical leader not only fosters a supportive environment but also promotes growth, innovation, and resilience among staff. Being aware of the challenges in leadership allows organisations to provide the necessary support, training, and resources to develop and sustain effective leadership for individuals working at that level and or aspiring to be clinical leaders.
References
1. What is advanced clinical practice? NHS England.
https://www.hee.nhs.uk/our-work/
advanced-clinical-practice/
what-advanced-clinical-practice
2. Conway J, Baratt J. Enabling the research pillar of advanced practice. Int J Advancing Prac 1.2 2023:57–8.
3. Bass B. The Bass handbook of leadership: Theory, research, and managerial applications. New York, USA; Simon and Schuster; 2010.
4. Skår R. The meaning of autonomy in nursing practice. J Clin Nurs 2010;19(15–16):2226–34.
5. Hamric A, Hanson C, Tracy M, O’Grady E. Advanced practice nursing. An integrative approach. Philadelphia, USA; Elsevier Saunders; 2014.
Declaration of competing interests: None declared.
