Nursing leadership: Oxymoron or powerful force?

The Voice of Ambulatory Care Nursing

Nursing leaders face many challenges on a daily basis. However, the fundamental challenge is addressing the impact of culture - societal, organizational, and professional that keeps nursing executives tied to the tactical when their energies should be directed to more long-term, strategic outcomes.

Cultural impact, combined with education and professional experience that emphasize a hands-on approach, surreptitiously works to incapacitate nursing leadership, threatening to transform the term "nursing leadership" into an oxymoron.

To ameliorate this situation, nursing leaders must shift focus from tactical to strategic, concentrating on the future state and the larger picture. To accomplish this, nursing leaders must build bench strength so their direct reports can act as fully functioning agents for nursing leadership. Further, nursing leaders must adopt a systems approach to better leverage the dynamics of interdependencies that are intrinsic to effective and efficient health care delivery.

Ultimately, nursing leadership must effectively transition from the operational (doing) aspect of work to the strategic (reflective) element of work by combining action and thought, thus making nursing leadership a force to be reckoned with.

Words that Collide

You've heard them before: "jumbo shrimp," "working vacation," "virtual reality." They are oxymorons and they highlight the fundamental contradiction in common phrases. Stand-up comedians include them in their acts because the inherent irony in an oxymoron is good for a quick laugh.

Given the continuing crisis state of the health care industry, will "nursing leadership" become the newest oxymoron?

To avoid this dubious distinction, nursing leaders must take stock of what they are currently doing and redirect their energy as well as the energy of their staff members. But achieving this shift in awareness, attention, and action requires a brief examination of the factors influencing the dynamics of nursing leadership.

The Evolution of Nursing: Nature and Nurture

Nursing struggled with its professional identity long before Florence Nightingale arrived on the scene. In ancient Egypt, for example, slaves served as nurses, a stigma still subtly felt by Egyptian women who choose nursing as their profession. The situation was not much better in Florence Nightingale's time when hospitals were squalid places and nurses were women who were not only untrained, but also often inebriated women of ill repute (Pulliam, 2003).

Based on her efforts and the efforts of the women who worked with her to provide aid and comfort to wounded soldiers during the Crimean War, Florence Nightingale became the icon for nursing - the individual recognized for elevating nursing to professional status. This rise in status, however, was not without cost. British military doctors did not welcome Florence and her compatriots; yet despite this hostility, she pushed on toward her goals to organize the care of the wounded and keep the field hospitals clean as a way to decrease unnecessary deaths.

Thus nursing as a profession was born in the social context of war, complete with its paternalistic, military hierarchy, within a society whose defining characteristic was, and still is to a great extent, a class system. The nature of a highly feminized profession emerged and was nurtured and shaped by the values (for better and worse) of its dominant male culture. Is it any wonder that struggling to find not only its voice, but its strength, is almost a part of nursing's DNA?

Learned Incapacity: The Cultural Impact

The influence that culture exerts on nursing leadership has created a set of unspoken assumptions about the functioning and dynamics of nursing and nursing leadership. Whether its source is societal, organizational, or professional, culture shapes the assumptions, beliefs, behaviors, and actions of those who live and work within it (Schein, 1997). In the case of nursing leadership, these cultural sources have worked in concert to compound their influence and tacitly shape expectations and behavior. Consider the following story as a metaphor for the evolution of nursing leadership:

The average elephant weighs 16,500 pounds. Elephants are still used as beasts of burden in Africa and India. How are these massive creatures domesticated? Why don't these animals break free from their captors? How is it that they are tamed and their strength and energies are harnessed? You would be surprised.

Young elephants are captured and separated from their mothers. A large, heavy rope or chain is attached to one of the animal's legs; the other end is secured to a huge tree. The baby elephant fights to break free but cannot move very far; its leg is tied to the tree. Over time, the elephant learns it can't break free and begins to struggle less. As the elephant becomes more docile, the massive rope around its leg is replaced with successively lighter weight ropes and these lighter ropes are secured to smaller and smaller trees.