Foundation of Nursing Leadership

Other resources

"From Ward to Board" -

This report by The King’s Fund, in partnership with the Burdett Trust for Nursing, has focused on the role of nurse executives in helping boards to assure themselves of the quality of clinical care. Based on observations at seven pilot sites, this report suggests there are valuable lessons to be learnt about the role and attributes of the nurse executive, but also lessons about the structure, processes and behaviours of boards.

The report shows that nurse executives have a key role to play in:
1) helping to create the right culture and climate to have open discussions about quality
2) leading by example and constantly reinforcing the importance of clinical quality to all aspects of the business
3) stimulating discussion about what types of information boards want and need to know in order to assure quality
4) presenting, analysing and interpreting hard data and identifying the clinical impact of that data
5) serving as a conduit of information about the patient experience through the use of soft intelligence and compelling narrative
6) helping boards to tap into the emotional content of the patient experience
7) role-modelling appropriate behaviours around presenting and receiving negative feedback from and about patients. The review can be downloaded here (pdf format 256 Kb).

RCN Report on the role of the ward sister and charge nurse

This report is based on focus group discussions with around 90 ward sisters and charge nurses from children, mental health and adult ward settings from NHS trusts across England. The report describes the current context and experiences of ward sisters and charge nurses, and makes several reccommendations in order to strengthen their role for the delivery of quality patient care. The review can be downloaded here (pdf format 1.44 Mb).

Research on Team Leadership

Review of the Literature on Team Leadership which was commissioned by the Health Foundation. The review can be downloaded here (pdf format 632Kb) and contains an analysis of the key literature on teams, team development and team leadership. It also provides an evidence base to a variety of team interventions and should be of particular use to those who are trying to develop team leadership prorgammes.

10 High Impact Changes

The NHS Modernisation Agency, through its work with thousands of NHS clinical teams, has identified ten high impact changes that organisations in health and social care can adopt to make significant, measurable improvements in the way they deliver care. The changes draw on the learning from our work and build on the successes already achieved. They are rooted in the day-to-day experience and achievements of thousands of frontline clinical teams right across the NHS. The high impact changes are evidence based. They have been field tested and evaluated in real life NHS settings and developed and adapted to have the best chance of success.

If the principles were adopted systematically by the whole NHS:

the experience of patients would be greatly enhanced by more appropriate and timely care
hundreds of thousands of clinician hours, hospital bed days and appointments in primary and secondary care would be saved
clinical quality and clinical outcomes would be tangibly improved
it would be easier to attract and retain staff and there would be more enjoyment and pride at work

Click here to download the document (pdf format - 489 Kb)

A pilot study to assess the case for e-learning in the NHS by David Dawes and Ali Handscomb (published in NT Research Vol.7 No.6 2002)

This is the largest published e-learning study with a sample of 400 learners studied over three months. It showed the following:

There is a high demand for e-learning, and the motivation is primarily personal development and personal interest, with less than 25% being motivated by career development
The most essential characteristics of an e-learning programme is that it is free and accredited to an external organisation
The largest barriers to staff accessing professional development are work-life balance, lack of money and lack of time, although managers seem to have less problems with funding than clinicians
44% of students did not tell their manager that they were undertaking the courses
63% of NHS clinicians had access to a computer at work and only 20% of NHS clinicians had access to NHS-Net
The majority of students (58%) studied at home and of those who had access at work and home, 59% chose home as their prefered location.
64% of NHS staff had no support at work and only 3% of NHS tsaff were allowd to access courses on duty
People with little or no technical skills are as succesful at e-learning as those with high technical skills (i.e. they are as succesful at starting and completing courses and make the same number of technical support requests)
The most popular time for accessing the courses is in the evenings and weekends
The average time spent online was 25 minutes and 73% of students spent less than 30 minutes online
60% of students who had undertaken any e-learning gave examples of how they had used it in practice in dealing with stress in the workplace, managing competing demands/priorities, managing teams better, managing meetings better and personal development.
85% of staff would recommend e-learning to friends and colleagues

Click here to download the document (pdf format - 957 Kb)

“When you wish upon a star – the lack of impact of Chief Executives on their Trust’s star rating” by David Dawes published in the Health Service Journal in 2002

This study aims to identify the contribution of the Chief Executive to the change in their Trusts’ performance rating from 2000/01 to 2001/02. It involved an analysis of the Trusts whose performance could be directly compared in the two years, and of the characteristics of the organisation’s Chief Executive.

Following the recent publication of the second round of NHS Performance Ratings (DOH, 2002), the NHS Leadership Centre undertook a study to try and identify the contribution that Chief Executives make to their organisation’s star rating. This is the first time that changes in Trust’s overall performance can be compared over time, and was an opportunity to see what impact the Chief Executive had on these changes. As this was a limited study, the factors considered were the gender of the Chief Executive, how long they had been in post, whether this was their first Chief Executive post and whether the Chief Executive had been changed between the two Performance Ratings.

Click here to download the document (word format - 61 Kb)

Nurses on Board - An analysis of nursing leadership in first and second wave PCTs by David Dawes and Karen Dobson. This was published in Primary Health Care in 2001.

This audit was carried out by the National Nursing Leadership Project in order to better understand the development of nursing leadership in the first and second wave Primary Care Trusts (PCTs). This involved a postal questionnaire and follow-up telephone interview with nurse board and executive members from PCTs, supplemented with clarification interviews with other PCT staff such as nurse managers and co-opted nurse advisors. This ensured that every PCT has been contacted in a number of ways to validate the information.

Key Findings

1. It is quite difficult to identify how PCTs are providing nurse leadership within their organisation. Because PCTs have been given free reign to develop their own approaches to nursing leadership and management, there are a number of different models that have emerged. At a simple level, there are two basic models:

• Type A PCTs – these are PCTs which have a full-time nurse director or manager who sits on the Board and Executive.
• Type B PCTs – these are PCTs which have a part-time clinician who sits on the Board and Executive.

2. There are also a few PCTs who are still in the process of creating their structures so their approach cannot yet be determined.

3. There is no “One Best Model” for providing nurse leadership within a PCT. A large number of PCTs are developing clinical-managerial working arrangements which seem to be working well, with either a clinician on the board and manager on the executive or vice versa. A number are also accessing nursing advice externally to the PCT, either linked to local community trusts or further afield. What is clear is that if the nurse leadership is provided by clinical nurses, then there is a need for strong managerial and administrative support to help them cope with the workload, and if the nurse leadership is provided by nurse managers then there is a need to establish strong links with the local clinical community to help empower clinical nurses.

4. Many Clinical Board and Executive nurses are experiencing time pressure to fulfil all the aspects of the post into a part-time role. The time commitment for part-time clinical Board Nurse varies considerably, and a number of nurses commented that they work more than they are “officially supposed to”, usually squeezed in around clinical commitments or at home in evenings and weekends.

5. One area of concern is whether PCTs have access to advice and support from a senior experienced nurse. When examining acute trusts, it is easier to identify senior nurses through a combination of their job title, level of remuneration and whether they sit on the Trust Board or not. None of these indicators are consistent in PCTs, so for example a number of Directors within PCTs do not have a board position, and have levels of reimbursement comparable with middle or senior managers within acute trusts. The individual characteristics of board nurses and the level of reimbursement are poor indicators of the level of seniority, with full-time managers on the board paid anything from £25,000 to over £60,000 per year. Also, some of the part-time board members sit on Boards of nearby community trusts as either Directors of Nursing or as professional advisors.

6. Many Board and Executive nurses feel quite isolated, and there is a strong desire to share practice with colleagues from other PCTs and to develop networking and support mechanisms. Many nurses feel that are receiving good levels of support at a local level and can access courses, development opportunities and regional director networks, although a number feel that they are treated differently from acute trust nurse directors.

Click here to download the document (word format - 223Kb)

Primary Care Trusts - Two Years On by David Dawes. This was published in Primary Health Care in 2002.

This article will take stock of the current situation regarding nurse leadership and PCTs as we head toward the fourth and perhaps final wave. It will revisit some of the findings in "Nurses on Board", which was the first comprehensive study of the role of Board and Executive nurses in the first two waves of PCTs (Dawes & Dobson, 2001) and will address the impact of PCT mergers, “Shifting the Balance” and the continued evolution of PCTs. It will then look at what the future may hold and the implications for nurses operating at strategic leadership positions within PCTs.

Click here to download the document in (word format - 50 Kb)

Getting on against the odds - developing black and minority ethnic nurse leadership

Leadership development remains high on the Government's agenda. Getting on Against the Odds is a practical learning resource produced by the us, aimed at managers and clinical professionals. It supports the development of nurses, midwives and health visitors from black and ethnic communities and features the triumphs, successes and struggles of black and ethnic nurses, midwives and health visitors. It offers solutions, options and a way forward.

Most importantly, it should make us consider what part we will each play to ensure that black and ethnic nurses, midwives and health visitors are enabled to take on NHS leadership roles within our diverse workforce and communities. Getting On Against the Odds was launched at the PCT Conference in London in 2001 and can be downloaded here (1.5 Mb pdf - Adobe Acrobat format)

Budgeting for change

This is a workbook designed to help nurses understand and manage budgets. The guide is divided into nine sections

Budgets.
Managing & Controlling spend.
How is the Health Service financed?
Benchmarking & sharing best practice.
Preparing a Business Case & Managing Change.
Managing the Nursing resource.
Leadership Skills.
Numerical Exercises.
Practical Case Study.
Each section includes case studies to help practically illustrate each subject area.

Click here to download the workbook (pdf format - 883 Kb)