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Leading to something better

Nurse leadership – important for the workforce and the community.

The Australian College of Nursing’s new strategic direction positions ACN as the national organisation for nurse leaders and those with an interest in nurse leadership. This new direction recognises the key role that nurse leaders and nurse leadership have in the delivery of care to the community. This move was not a hasty decision but rather a considered acknowledgement that there is a need, in the current Australian healthcare environment, for an organisation to recognise the role of nurse leadership in healthcare, to nurture and grow such leadership and, in-turn, improve the healthcare outcomes of those in our communities.

ACN’s strong belief, which is supported by national and international literature, is that robust nurse leadership across all levels of healthcare will lead to better patient outcomes – surely a common goal for all healthcare professionals. In-fact, as far back as 1994, Linda Aiken’s seminal work on magnet hospitals showed a clear link between nursing leadership and better patient outcomes.

More recently, a report the Queensland Department of Health published last year indicated that the combination of strong nurse leaders and nurses acting effectively in executive positions resulted in continuous improvements in positive patient outcomes and consumer-centred, quality care. Time and time again this research has been replicated across countries and healthcare systems and the same conclusions have been reached – effective nurse leadership equals superior patient results.

When discussing nurse leadership and how it can affect care outcomes, it’s important that 21st-century leadership models engage members of staff at all levels. Whilst there are individual leaders, there is also the relationships that occur between leaders, and between leaders and those with whom they work. This has a critical impact on the culture that is created and ultimately the care that is provided. Recognising the link between good leadership, a positive work environment and care outcomes is critical as we consider the challenges healthcare faces in coming years. Prominent nurse academic, ACN fellow and board member, Christine Duffield, was the project director of Glueing it Together: Nurses, their work environment and patient safety, a NSW Health-funded project that noted the quality of nursing leadership was significantly related to job satisfaction, nursing turnover and patient safety. Nurse leadership and its link to better patient outcomes was a common denominator in many of the key findings:

  • Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward.
  • Work environment factors such as nurses’ autonomy, control over their practice and good nursing leadership on the ward were statistically significant predictors of job satisfaction.
  • The work environment, including aspects such as nurse leadership, the presence of a nurse educator on the ward, adequate resources, nurse autonomy and nurses’ control over their own practice, are important for providing safe patient care.
  • Stability of the ward environment, whether by reducing nurse turnover or stabilising nursing leadership, and providing skilled human resources, improves patient outcomes. 

This report, and many more like it, clearly outline that a well-qualified nursing workforce and high-quality, visible nursing leadership across all levels of the healthcare hierarchy are hard to underestimate.

It should be noted that it is not just at the ward level that nurse leadership is key to enhancing patient outcomes. Health services benefit from having established nurse leaders throughout all levels – from the ward to the board. Nurse leaders can provide balance within the executive team. They can drive a system-wide approach in support of consumer care. Nurse leaders need to be recognised for their ability to contribute to patient care outcomes by maintaining effective nursing care as well as contributing to the development and implementation of organisational strategies.

At times, the executive presence of nurses can be met with some resistance. A failure to recognise the contribution to the overall management of an organisation that nurses in these leadership roles can provide leads to limited operational responsibility. In addition, the absence of nurse leadership through to the executive level can result in a nursing and midwifery workforce with increased staff turnover and poorer work environments which, in-turn, lead to negative patient outcomes.

As a sector we need to ensure that nurse leaders are represented across all levels of the healthcare system and, of most importance, are provided with the right resources to act effectively. The overarching benefits of this are realised directly through higher standards and quality of care, with improved health and consumer experience and positive health outcomes.

As the national nursing organisation for nurse leaders, ACN will be seeking ways to grow and develop nurse leaders and demonstrate the positive impact that effective nurse leaders can have on the workforce, the organisation and, ultimately, the outcomes of patient care. Effective nurse leadership is good not only for the profession but also for the community.

Adjunct professor Debra Thoms is CEO of the Australian College of Nursing.


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