Nurse leadership: redesigning the wheel

It has been my privilege to work in the National Health Service (NHS) for over 40 years and, as I contemplate my next career move, it is interesting to consider the lessons learnt over the years. After qualification, I started work as an enthusiastic staff nurse in a busy theatre department in Edinburgh, eventually progressing to Director of Nursing for the University Hospitals Division in Lothian (based at the Royal Infirmary of Edinburgh) – a role in which I continue to remain enthusiastic and busy. As I look back, I realise that many things have changed beyond all measure including, of course, technical developments that were almost unimaginable in the 1970s. Significant improvements have also been achieved in clinical practice, making it safer and more ethical, while the patient is frequently treated as a partner in their own care. Some aspects remain constant, however, and one of these is the need for excellent leadership at all levels in the organisation. What the leadership structure looks like, the support that is offered to develop leaders, and how results are measured, have undoubtedly changed with the prevailing culture of the time, but the positive impact on patient care and on the team has been firmly acknowledged. It is important to note that I am not talking about “management,” which is to do with policies, processes and systems, but about “leadership” which is concerned with inspiration, judgement and action. In the intense and demanding priorities of the moment, it is vital to spend time and effort on the individuals who will be expected to deliver the service and to support them in the increasingly challenging job. Several initiatives are in place in Scotland which have combined to provide an inspiration for nursing and midwifery staff, focusing on the senior charge nurse role, but impacting on the whole team. These include “Leading Better Care”1 (2008) and “Releasing Time to Care”2 (2009) and, within Lothian, the “Compassionate Care Programme”.3 It is the benefits from these initiatives that I wish to highlight, as well as reflecting on some of the issues that have emerged in the context of the current NHS environment.

Context

Firstly, it is worth considering the context of healthcare within Scotland – since, although the principles of the NHS are consistent with the rest of the United Kingdom, there are differences. Health is a devolved power in Scotland which means that it falls to the Scottish government to set out the priorities for health and healthcare and to set policies for the implementation of these priorities. The establishment of a Scottish National Party government in Scotland, associated with a Westminster Labour government, has posed some interesting opportunities and, although many priorities remain the same, implementation differs. There are, for example, different organisational structures for the delivery of services with “Health Boards” as the accountable bodies and board officers carrying executive responsibility on behalf of the “Government Health Department”. There are no health Trusts in Scotland but “Divisions” and “Community Health Partnerships” form the structural framework for the delivery of services. The population in Scotland is 5,168,5004 (as at 30 June 2008) which is, of course, small in comparison to England. This means that initiatives can be progressed on a national basis reasonably quickly and – although the principles are applied in different settings – they are applied within a consistent framework. This has been the case with the implementation of the “Leading Better Care” programme.