How to be a leader in nursing, whatever your role or seniority
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How to be a leader in nursing, whatever your role or seniority

Catherine Turnbull Journalist

Leadership in nursing is about inspiring colleagues to deliver the best care and improve patient outcomes, whether you are a student, newly qualified or a team leader

It is an outdated notion that leaders are only those who manage a team, or call all the shots. There is increasing recognition in nursing that everyone – at every level – can demonstrate leadership and develop as a leader.

Nursing Management. 29, 6, 6-8. doi: 10.7748/nm.29.6.6.s2

Published: 01 December 2022

The Chartered Institute for Professional Development defines leadership as ‘the capacity to influence people, by means of personal attributes and/or behaviours, to achieve a common goal’.

Does this sound familiar? Nursing leadership is now regarded as a core competency for improving clinical outcomes, and nurses are required to develop leadership skills from the start of their careers.

Florence Nightingale Foundation (FNF) research and policy associate Jessica Sainsbury oversees leadership projects on issues including international nursing, raising workplace concerns, and shared professional decision-making.

She believes the key to effective leadership is not about being the best or having the loudest voice, but being authentic and encouraging others to develop their strengths.

Embrace your inner leader: develop skills through everyday actions

It is free to join the RCN nurses in management and leadership forum, which offers peer support.

The forum’s professional lead, Christine McKenzie, says all nurses should embrace their inner leader, wherever they are in the profession, and believes leadership is an everyday action.

‘Leadership happens in a moment and in the moment,’ she says. ‘We need to recognise that we are all leading every day.’

Ms McKenzie says the vital skills for effective leadership include:

  • » Relationship. The ability to connect with others and build and sustain relationships. ‘We have moved away from networking to focus on connecting,’ she says

  • » Role model. You do not have to be in charge to be a role model. They influence, hold high standards, support colleagues, and know the limits of their own skills. Ms McKenzie says: ‘It’s what you do, not what you say’

  • » Policy. ‘Most nurses at a senior level influence and share policy. In a junior position, most implement policy and use their experience,’ she says. ‘This also helps shape policy. In the forum we embrace differences and diverse viewpoints’

Professional network

Despite leading from an early age, she did not feel she was a natural leader. ‘I actively avoided “leadership”,’ she says. ‘However, my experiences from childhood in Girl-guiding, then raising a young family and through to a career before I came into nursing shaped me into the leader I am today.’

When she took over as chair of the RCN students committee it was a notable step at the beginning of a new phase of her nursing career.

‘I was proud of my achievements as a student leader before commencing this role,’ she says.

‘However, I could not have predicted the exposure, skills learned and growth of my professional network as a result of being in a national student leadership role during the first wave of the pandemic.’

Ms Sainsbury is clear that anyone can be a leader, no matter their pay grade, social status, ethnicity or gender.

‘We need to adapt our support structures to create more opportunities to lead,’ she says.

‘This is why I am working with Health Education England on the student councils programme. I strongly believe we would have more effective leaders if a greater number were offered opportunities and leadership development earlier in their careers.’

Networking with peers and other professions helps, says Ms Sainsbury. ‘I strongly believe networking is key from day one of everyone’s nursing journey. We cannot know everything, we cannot solve everything, but we can work together to find solutions.

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Picture credit: iStock

‘We can work together for better outcomes. A good way to start networking as a student is to create professional social media accounts.’

In her recently published Be a Leader in Nursing: A Practical Guide for Nursing Students, Queen’s Nurse Heather Henry offers nursing students a handbook they can use as their leadership evolves.

Effective strategies

In the foreword to the book, Council of Deans of Health chief executive Katerina Kolyva observes that the list of opportunities for nursing students to gain exposure to leadership, to learn from role models and practise their own leadership are now vast and diverse.

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‘Students have demonstrated that leadership is not about hierarchy but rather about behaviour and the ability to inspire others,’

Katerina Kolyva, chief executive, Council of Deans of Health

‘In becoming proactive, students have demonstrated that leadership is not about hierarchy but rather about behaviour and the ability to inspire others,’ she says.

Surgical staff nurse in NHS Lothian Caitlin Davies is engaged in research for the HeaLiN: Healthfulness in Leadership in Nursing at Queen Margaret University, Edinburgh. This study has been exploring UK nurses’ experiences of effective leadership strategies during the pandemic, the findings of which will be published soon.

‘So many nurses have burnout and are demoralised post-COVID,’ Ms Davies says. ‘The past few years have been difficult for everyone working in clinical practice.

‘I’ve had my fair share of cries over work, and I’ve cuddled colleagues and friends because they’d have done the same. Now, more than ever, it is so important to look after yourself and each other.’

Becoming a role model

Ms Davies reflects on how seemingly small actions can be powerful signifiers of leadership in nursing.

‘It’s all the small things; it’s a senior charge nurse helping with the lunches,’ she says. ‘It’s a deputy buying everyone an ice cream on a hot day, it’s a fellow newly qualified nurse helping me to take out a drain, or a support worker teaching me how to do last offices.

‘Everyone has the capacity for leadership because we all have a lot to learn from each other.’

Ms Davies has strived to lead in small ways herself. ‘I have tried to be a leader in the little things I do, particularly to support the well-being of others by being there for colleagues on a bad day, supporting students through their worries or doubts, or by simply filling everyone’s water bottles up,’ she says,

‘As soon as I put on my blue nurses’ uniform, I have to be a good role model for those around me, trying to emulate best practice.

‘This doesn’t mean I get it right every time or I always know what I’m doing because I’m still growing and learning as a nurse and as a leader.’

Having had a leadership role in the COVID-19 vaccines programme implementation, Queen’s Nurse Amy Sims is now operational development and network manager for Proud2bOps, a national network for operational leaders in health and social care.

Members face constant challenges and Proud2bOps is designed to be a forum where leaders can connect and share.

Ms Sims says for a manager to be an effective leader, they must understand the roles of those they lead.

‘It’s so important that you know what the challenges are, to fully support staff to reach their full potential,’ she says.

‘A leader should always be ready to encourage others to be the best they can, to develop and to learn. A leader should create opportunities, listen to others and always lead with compassion.’

Developing confidence

When she was a band 5 staff nurse, she enjoyed leading others, teaching them and seeing them develop and become confident.

‘I wasn’t always confident myself, but no one would have known this. I always did my best to appear positive and upbeat,’ she says.

‘I absolutely thrived on trying to be the best I could and enjoyed pushing myself, not just for me but for the team I was leading.’

Ms Sims says she counts herself fortunate to have had many great managers and leaders. ‘I specifically remember a ward sister when I was a nursing student.

‘She was seen as harsh by others, but I had total respect for her, she absolutely had the patients’ best interests at heart,’ she says.

‘I have also worked alongside poor leadership, but this taught me how not to do it. I saw the lack of engagement from staff, increased sickness and lower morale. Without this comparison, I wouldn’t have recognised what great leadership can achieve.

‘I have worked with lots of great leaders in many roles on different pay grades. There is some scope for growth with this and more opportunities for development should be made available. One of my biggest dislikes is referring to people by their band.’

When it comes to developing potential leaders, it’s important that managers support people in their teams, says Ms Sims. ‘Annual appraisals are a great way to get a plan in place, but usually nurses who want to progress will naturally approach their managers.

‘It’s so important to get to know your team. I would encourage team leaders to find out about what interests a staff member and get them involved in this.

‘A link nurse is a great way to take some ownership and develop leadership skills.’

Ms Sims has advice too for any nurse who finds they must ‘manage up’ as a result of having an ineffective manager. Communication and teamwork are key, she says.

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‘You must listen to others, to your team, and value everyone’s ideas and opinions. As leaders, we should never expect anyone to do something that we would not be willing to do ourselves’

Amy Sims, Queen’s Nurse and operational development and network manager, Proud2bOps

Nurses who feel their manager is ineffective should talk to them and explore ways they can achieve change themselves.

‘Unfortunately, personalities will clash,’ she says. ‘Rather than criticise the manager, I would suggest the nurse looks at the whole situation for positive changes they themselves can implement.’

Unique opportunities

Ms Sims became a Queen’s Nurse in 2020, and says the role allows her to network with nurses from all over the country.

‘It provides unique opportunities for nurses, and it is something I would advise nurse leaders to work towards.’

She recognises that leading others is difficult, and that some nurses will be naturally good at it, but says it is still a skill to learn.

‘You must listen to others, to your team, and value everyone’s ideas and opinions.

‘As leaders, we should never expect anyone to do something that we would not be willing to do ourselves. We must earn respect, not demand it. Compassionate leadership achieves great results.

‘There are so many leadership courses, and I would recommend that new leaders sign up for some of these.’

Ultimately, nurse leadership must be recognised and able to flourish at all levels of the profession, and from top to bottom of any healthcare hierarchy.

As RCN management and leadership forum professional lead Christine McKenzie observes, when nursing leadership is effective, team members can each contribute and act together, and by doing so produce positive clinical outcomes.

Find out more

Council of Deans of Health (2018) #150Leaders: Fostering Student Leadership. tinyurl.com/CDH-150-leaders

Florence Nightingale Foundation florence-nightingale-foundation.org.uk

Florence Nightingale Foundation Academy florence-nightingale-foundation.org.uk/academy

RCN (2021) Five Ways to Embrace Your Inner Leader.

RCN (2022) Introduction to Leadership Programme.

RCN (2022) Leadership Skills.

RCN nurses in management and leadership forum. RCN leadership forum.

Access RCNi’s leadership skills resources at rcni.com/rcniplus/topics/leadership-skills

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