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Leadership the key to quality of care

At the recent National Nursing Forum, a searching and necessary conversation opened up the pressing issue of standards of care and the public perception of nurses. 

"The causes of disasters in care, such as at Mid-Staffordshire, were identified: inadequacy of nursing staff and a fall in the standard of essential care, a significant shortfall of nursing leaders in hospitals and the infiltration of inappropriate application of aspects of corporate approaches into healthcare organisations."

Chief of Army Lieutenant David Morrison’s oft-quoted admonition to his troops in the midst of scandal, that the standard you walk past is the standard you accept, might risk overuse, but when it comes to the quality of nursing care we need to take it seriously.

When delegates to the Australian College of Nursing’s National Nursing Forum, were faced with this challenge, presented by Professor Philip Darbyshire FACN in his keynote address, Fallen angels?: Responding to nursing’s crisis in care, they were forced to do some soul-searching.

Darbyshire confronted delegates with the incremental change that has taken place in the public perception of nurses. Since the publication early this year of the very public Mid Staffordshire NHS Foundation Trust Public Inquiry, the once sterling reputation of nurses as trusted and compassionate carers has come under question. In the UK, the steady growth of apathy, increasing nurse workloads and financial pressures resulted in a severe failure in the provision of care to consumers. Forum delegates reached a consensus: Australia could face a similar disaster.

After he had presented his paper, Darbyshire facilitated a panel discussion on nursing care provision. The panel consisted of Professor Ged Williams FACN, immediate past executive director of nursing and midwifery of the Gold Coast Health District, Adjunct Professor Annette Solman FACN, executive director of nursing and midwifery of the Sydney Children’s Hospitals Network, and Susan Emerson MACN, director, care environments and service strategy. The panel opened the floor to questions from the audience, allowing delegates to probe the issues with these senior nurse managers who are the conduits between the nursing workforce and health service executives; and so began an honest conversation about quality care.

The success of the panel can be attributed to the proactive delegates. The causes of disasters in care, such as at Mid-Staffordshire, were identified: inadequacy of nursing staff and a fall in the standard of essential care, a significant shortfall of nursing leaders in hospitals and the infiltration of inappropriate application of aspects of corporate approaches into healthcare organisations. Person-centred care and compassion are important elements of healthcare and should not be ignored or forgotten as it is these elements that can make a critical difference to the care experience and outcome for an individual. External issues touched on included the view that the standard of eligibility to enter nursing has fallen, opening the door wider for anyone to enter nursing where previously those who sought a nursing career held a deep-seated passion for health care. These issues have compounded, damaging the nursing profession’s reputation and undermining public trust.

It is here that I would insist upon the significance of nurse leadership and essential care standards. Nurse leadership does not solely rely upon generic leadership skills but also those skills which are characteristic of nursing. We need nursing leaders in all areas and at all levels of organisations.

No one can overstate the effect of an immediate supervisor who has championed the work of nurses or a senior nursing administrator who remains accessible to the staff, solves problems and ensures management is aware of relevant issues. Directors of nursing and nursing unit managers are part of the glue that holds health organisations together. Clinical leaders have a significant role to play in mentoring, supervising, promoting clinical excellence, supporting colleagues and inspiring those around them through example. Competence, honesty and vision are nursing leadership attributes that translate down through all levels of nursing to new graduates. The body of evidence that demonstrates the impact of nursing leadership on staff retention and recruitment as well as care outcomes is significant and yet appears at times to be almost completely ignored.

The voice of the forum clearly outlined avenues where the situation can be turned around. Delegates agreed that the nursing workforce needs to support directors of nursing and nurse managers at all levels. In return, nurse managers must engage in regular honest conversation, walk-arounds and informal and structured feedback sessions with staff and, finally, hear the voices of consumers and use their direct words in representing them to the executives of organisations.

Leadership skills must be fostered early in a nurses’ career; consistent leadership should be exercised and colleagues should appear as allies, while strong leadership should be encouraged by the building of strong teams. As nurses, we need to be engaged with our political and social agenda so that we can be advocates for the communities we work in. As individuals, we can re-evaluate our personal philosophies, engage in public dialogue and be agents of positive change.

The problems identified are complex and require multifaceted approaches; our workplaces are not linear and our solutions need to recognise the need for innovation. We need to recognise our individual responsibility and build the Australian and international nursing profile.

The forum offered delegates a chance to reconnect with the greater meaning of our work. Leadership can shape culture and create ownership of work, but this takes willpower and time. This willpower was demonstrated throughout the National Nursing Forum.

“The world doesn’t change one person at a time,” as the writer Margaret Wheatley has said. “It changes as networks of relationships form among people who share a common cause and vision of what’s possible.” Each of us maintains a circle of influence, in which we all have the opportunity to lead. We are all responsible for exercising this leadership in our day-to-day work lives. We can look for opportunities to demonstrate support and leadership in each of our roles and this will ultimately contribute not only to better workplaces but also to improved patient care.

Adjunct Professor Debra Thoms is chief executive of the Australian College of Nursing.

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