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Leadership is not expected solely of managers. At any stage of their career, nurses are expected to be able to demonstrate leadership in their day-to-day role. However, newly qualified nurses, who often experience a challenging transition from nursing student to registered nurse, may lack the confidence to demonstrate leadership. Nurse managers can support junior nurses to develop their leadership skills, notably through training, mentoring, reflection and action learning. By guiding newly qualified nurses in the use of different leadership approaches, experienced nurses can contribute to enhancing the quality of patient care. This article discusses how nurse managers can support newly qualified nurses to develop their leadership skills.
Nursing Management. doi: 10.7748/nm.2022.e2031
Peer reviewThis article has been subject to external double-blind peer review and checked for plagiarism using automated software
Correspondence Conflict of interestNone declared
Rainey D, Monaghan C (2022) Supporting newly qualified nurses to develop their leadership skills. Nursing Management. doi: 10.7748/nm.2022.e2031
Published online: 30 May 2022
This article aims to discuss how nurse managers can support newly qualified nurses to develop their leadership skills. After reading this article and completing the time out activities, you should be able to:
• Identify the leadership skills newly qualified nurses are expected to possess.
• Have a better understanding of the challenges involved in the transition from nursing student to registered nurse.
• Define leadership and describe various styles of leadership and their characteristics.
• Formulate a plan for how you would assist a newly qualified nurse to develop their leaderships skills.
• Leadership is not exclusively an attribute of managers and nurses at all levels need to be able demonstrate leadership
• Newly qualified nurses should have developed, during preregistration education, some leadership skills by observing registered nurses while on placements
• Many newly qualified nurses already possess the traits required for leadership but most will need support to become competent and confident leaders
• There is no single leadership style that is adequate in every situation and nurses often draw on a blend of leadership styles
• There are many ways in which newly qualified nurses can be supported to develop their leadership skills, including training, mentoring, reflection and action learning
Nurses at all levels need to be able demonstrate leadership. Traditionally, leadership was regarded as an essential attribute of managers. However, modern concepts of leadership focus on how a person may influence those around them, and as such it is an essential attribute of any nurse (Kirkham 2020). Optimal leadership assists in ensuring the provision of high-quality patient care, while the negative effects of suboptimal leadership have been demonstrated in healthcare scandals such as that uncovered at Mid Staffordshire NHS Foundation Trust (Francis 2013). Newly qualified nurses need to be aware of the attributes and qualities required in a leader (Kirkham 2020). These attributes and qualities take time to develop and newly qualified nurses need regular practice to become confident in applying them. It is therefore beneficial to introduce leadership skills in nursing students’ education.
In the UK, the Future Nurse: Standards of Proficiency for Registered Nurses (Nursing and Midwifery Council (NMC) 2018) emphasise leadership. One of the seven proficiencies required of nursing students to achieve entry onto the NMC register is ‘leading and managing nursing care and working in teams’ (NMC 2018). The theory underpinning the seven NMC proficiencies for registered nurses is taught at university and the associated skills are developed in the clinical environment under the guidance of practice supervisors and practice assessors during placements. However, the Future Nurse standards of proficiency (NMC 2018) were published in 2019 and assessing whether they have translated into effective leadership skills among newly qualified nurses will take time.
Core leadership skills such as insight, self-confidence, sociability and initiative can be inherent to an individual, but how that individual uses these skills will determine whether they can be an effective leader. Certain leadership skills are more important than others depending on the individual’s profession; for example, the chief executive of a large company may need different leadership skills to a clinical nurse specialist leading a small team (Kirkham 2020). Stanley (2017) undertook a literature review to identify the core leadership skills required of healthcare professionals – see Box 1. However, this was not an exhaustive list and an effective leader in healthcare may possess other qualities and skills, for example the ability to inspire others or drive change (Kirkham 2020).
• Team worker
• Good communicator
• Approachable
• Supportive
• Provides good-quality care
• Possesses vision
• Possesses integrity
• Is honest
• Respects others
• Can empower other people
• Possesses clinical expertise
(Adapted from Stanley 2017)
Review your governing body’s standards for education and identify the leadership skills newly qualified nurses require in practice. Which would you regard as the most important?
Newly qualified nurses should have developed, during their preregistration nursing course, some leadership skills by undertaking clinical placements and observing the registered nurses they worked alongside during those placements. Leadership-related proficiencies expected of newly qualified nurses when they start to practise are listed in Box 2 (NMC 2018). Although newly qualified nurses may have acquired some or all of these skills during their preregistration nursing course, in the authors’ clinical experience many of them are unaware of these skills. To become effective leaders, newly qualified nurses need support and guidance to ensure that they use the leadership skills they have acquired positively and effectively.
In Future Nurse: Standards of Proficiency for Registered Nurses, the Nursing and Midwifery Council (2018) identifies a number of proficiencies that will equip newly qualified nurses with the underpinning knowledge and skills required for their role in leading and managing nursing care and in working effectively as part of an interdisciplinary team. Some of the proficiencies that specifically relate to leadership are:
• Understanding the principles of effective leadership, management, group and organisational dynamics and culture
• Exhibiting leadership potential by demonstrating an ability to guide, support and motivate individuals and interact confidently with other members of the care team
• Demonstrating the ability to monitor and evaluate the quality of care delivered by others in the team and lay carers
• Demonstrating the ability to challenge and provide constructive feedback about care delivered by others in the team
(Adapted from Nursing and Midwifery Council 2018)
The transition from nursing student to registered nurse can be challenging (Welch et al 2019). Newly qualified nurses have to contend with stressful and pressurised clinical environments (James and Bennett 2020) and manage the transition from being a student to being an accountable, responsible and autonomous professional. Stressors for newly qualified nurses in the transition period include taking charge of shifts, prioritising patient care and delegating tasks to other members of the team (Welch et al 2019).
According to Halpin et al (2017), many newly qualified nurses feel they do not possess the required skills when they enter practice, which leaves them feeling vulnerable and results in many leaving the profession (Wray et al 2021). Duchscher (2009) termed this phenomenon ‘transition shock’ and many preregistration nursing courses have supportive measures in place – such as longer final placements focused on developing leadership and management skills – to try to mitigate its effects. However, many newly qualified nurses still find the transition period stressful due to workload and the expectation that they will demonstrate immediate competence and critical decision-making.
It is important that nurse managers reduce stress among newly qualified nurses. One way of achieving this is to ensure that newly qualified nurses are able to manage the demands of working in a clinical environment by supporting them to develop their leadership skills, which in turn may improve retention (Roche et al 2015).
Leadership has many meanings and there is no universal definition of it. For the Chartered Institute of Personnel and Development (2022), leadership can be seen broadly as the ability to influence people to achieve a common goal. Overall, leadership is concerned with a shared aim, vision, purpose or goal, the leader possessing the ability to work towards it (Kirkham 2020) while persuading others to follow willingly (Mullins and Christy 2016). However, leadership needs to be adapted to the task undertaken, which means that a leader needs to be able to change their leadership style according to the situation (Maxwell 2017).
There are different styles of leadership associated with different characteristics and a variety of underpinning theories. Table 1 gives an overview of the main leadership styles and their characteristics. It is important to acknowledge that there is no single leadership style that will be adequate in every situation (Rolfe 2011). There are similarities and differences between leadership styles, with aspects that may complement each other. For example, Quinn (2017) identified that the ‘empowering’ aspect in the transformational leadership style can complement the ‘rewarding’ aspect of the transactional leadership style. Xu (2017) acknowledged that adopting various aspects of different leadership styles may be the most effective way to meet the demands of a particular situation. Nurses therefore often need to draw on a blend of leadership styles.
Read the domains and competencies of emotional intelligence listed in Table 2 and consider how you might adopt them in your workplace. For example, consider how self-awareness might assist you in supporting newly qualified nurses in your clinical area to develop their leadership skills
• Emotional self-awareness – do I recognise my own emotions and how they might affect or guide the decisions I make?
• Accurate self-assessment – am I aware of my own strengths and limitations?
• Self-confidence – do I know and understand my own capabilities?
• Empathy – am I aware of others’ emotions? Do I readily listen to their concerns?
• Organisational awareness – do I have a clear understanding of my organisation’s decision networks, policies and procedures?
• Service orientation – do I understand and appreciate the needs of staff members and patients?
• Emotional self-control – how do I control my own emotions?
• Transparency – do I display openness, honesty and approachability?
• Adaptability – how willing am I to adapt to change?
• Achievement orientation – do I strive to achieve excellence in care?
• Initiative – do I set clear goals and use opportunities that may assist me to reach those goals?
• Optimism and being appreciative – can I see the positive aspects of a situation?
• Inspirational leadership – do I motivate, encourage and support team members?
• Influence – how do I positively influence team members?
• Developing others – do I use feedback and guidance to inspire team members?
• Change catalyst – do I initiate change? Do I provide guidance and direction throughout the change process?
• Conflict management – do I recognise conflict and resolve it appropriately?
• Building bonds – do I establish and maintain support mechanisms?
• Teamwork and collaboration – do I strive to strengthen team building and appreciation of colleagues?
(Adapted from Goleman et al 2002, Stoller 2021)
Emotional intelligence is an increasingly recognised concept in healthcare and has been associated with patient satisfaction and effective leadership (Stoller 2021). Emotion can be regarded as information and as such can convey meaning (Caruso and Salovey 2004). Lambert (2021) explained that leaders who are able to recognise their own emotions, and how these affect their actions and others within the team, are more likely to provide effective leadership. For instance, an emotionally intelligent leader might consider other team members’ feelings; be able to identify if one of them is upset; and ask themselves why that person might feel that way, thereby displaying empathy.
Table 2 outlines the four domains of emotional intelligence identified by Goleman et al (2002): self-awareness, social awareness, self-management and relationship management. The four domains encompass 19 competencies that provide the basis for emotionally intelligent leadership (Goleman et al 2002). Antoniou and Cooper (2005) noted that, with self-assessment and coaching, an individual may be able to become proficient in all 19 competencies. Stoller (2021) acknowledged that an emotionally intelligent leader does not need to be proficient in all 19 competencies but will usually be proficient in at least one competency from each domain.
Many newly qualified nurses may already possess the traits required for leadership. However, to become competent and confident leaders, most of them will require encouragement and support. Such encouragement and support will also have a positive effect on their well-being and job satisfaction, ultimately enhancing staff retention and the quality of patient care (Cummings et al 2021).
There are many ways in which newly qualified nurses can be encouraged to develop their leadership skills. One common approach is for newly qualified nurses to complete a formal leadership training course (Wheeler and Stoller 2011). Evidence-based leadership courses for nurses have been shown to enhance leadership skills, especially where they are related to the specific needs of participants (Galuska 2014, Cummings et al 2021). For a nurse to attend such a course, organisational and managerial support is required as well as funding. Many hospitals provide internal leadership training, which does not generally require funding but does require support from managers if nurses are to be allocated time to attend (Rosengarten 2019).
For newly qualified nurses who are just beginning to develop their leadership skills, formal training may not be the ideal method of learning the practicalities of leadership. Initially they may learn more from experiential learning in practice. Displaying leadership is a complex skill and learning it in clinical practice often involves learning from others.
One practical strategy for supporting newly qualified nurses to develop their leadership skills is practice-based mentorship (Hodgson and Scanlon 2013), whereby a newly qualified nurse is partnered with an experienced nurse who is a competent and confident leader. Mentoring works best when the mentee feels comfortable with the mentor and both are able to engage in open and honest discussions with each other (Allen et al 2009).
The mentor should assist the mentee to identify their strengths, areas for development and learning objectives (Allen et al 2009). Learning objectives should be SMART (specific, measurable, attainable, relevant and timebound) (Jones and Bennett 2018) and consensually agreed between mentor and mentee, and dates should be set for review and feedback (Allen et al 2009). The nurse manager of the clinical area should allocate time for the mentor and mentee to discuss feedback and feedforward (planning ahead for future positive learning).
The mentor and mentee should formulate learning objectives aimed at developing the mentee’s confidence and competence and related to the development of leadership skills required day-to-day in the clinical environment. Such a set of objectives can enhance newly qualified nurses’ competence and confidence and ultimately increase their job satisfaction (Katrinli et al 2008).
For example, an initial learning objective for the mentee can be for them to take responsibility for coordinating the care of a group of patients. This will support the mentee to develop prioritisation, organisation, delegation and communication skills. Once that objective has been achieved, the mentee can progress to coordinating the allocation of work in the clinical environment. This may include leading multidisciplinary team discussions related to the care of specific patients; ensuring that the skill-mix of staff on duty is appropriate; and ensuring that team members take sufficient breaks and finish their shifts on time. As their leadership skills develop, the mentee can be given further responsibilities, with continued feedback and feedforward from the mentor, ensuring that each new objective is enhancing the mentee’s decision-making abilities and leadership skills.
Another way of supporting newly qualified nurses to develop their leadership skills is reflection, which can be undertaken as part of a mentorship programme or by the nurse independently. Reflection is a process that enables an individual to develop their understanding of how and why situations and events have occurred (Johns 2013). Reflection has been shown to be an important aspect of self-care, learning and professional growth (Prestia 2019). There are various layers of reflection (Johns 2013), shown in Box 3.
• Reflection on experience – reflecting after an event with the aim of gaining insights for future practice
• Reflection in action – taking time to consider a situation from various perspectives with the aim of moving forward to the desired outcome
• Reflection in the moment – having an awareness of one’s thoughts, feelings and responses during a situation. An internal dialogue is used to ensure congruence between the interpretation of the situation and the response to it
• The internal supervisor – engaging in an internal dialogue with oneself while talking to others, thereby interpreting and making sense of the conversation
• Mindful practice – using reflection as a way of ‘being’ characterised by maintaining an awareness of self as the situation unfolds. This is complemented by an ability to visualise the desired outcome
(Adapted from Johns 2013)
With guidance from a competent leader, newly qualified nurses can reflect on negative and positive clinical experiences, examining their application of leadership skills, whether or not these were effective and why. In this way, newly qualified nurses can attempt to make sense of clinical situations using past experiences combined with their acquired professional knowledge. Reflection further develops newly qualified nurses’ self-awareness, enabling them to analyse their behaviour and consider whether or not it was appropriate in the circumstances. In that sense, reflection is an example of experiential learning and a critical aspect of knowledge development (Horton-Deutsch and Sherwood 2008).
Newly qualified nurses can further enhance the reflective process by using a journal to record their thoughts. This has been demonstrated to enhance critical thinking, enabling nurses to consider their practice and how to apply new knowledge in the future (Kuiper et al 2010, Garrity 2013). It may also be beneficial for newly qualified nurses to use a reflective tool – for example Gibbs’ (1988) Reflective Cycle or Johns’s (1995) Model of Reflection – to structure their reflection (Howatson-Jones 2016).
Reflection enables newly qualified nurses to go beyond empirical knowledge and use their personal experience and ethical understanding to inform their leadership practice (Johns 2013). Furthermore, reflection enables newly qualified nurses to enhance their critical thinking and self-awareness skills. If reflective practise is undertaken in a positive and supportive environment, it can be transformational, assisting nurses to develop professionally and personally (Ghaye and Lillyman 2010).
Reflection can be effectively implemented using action learning sets. Walia and Marks-Moran (2014) defined action learning as an educational process whereby people work and learn together by reflecting on real practice situations. Action learning not only develops participants’ own knowledge and skills but also enhances their understanding of others (Walia and Marks-Moran 2014). This is relevant when developing leadership skills because it is imperative that leaders acknowledge that others differ in their personalities, motivations and in the actions they take.
A typical action learning set comprises between six and eight participants. Ideally, the facilitator is someone from outside the participants’ clinical area. Hetherton et al (2021) acknowledged that, in the case of newly qualified nurses, it is particularly important to ensure that they feel they are in a safe environment where they can openly discuss their experiences. The action learning sets should have scheduled dates and times and nurse managers should ensure that newly qualified nurses are given time to attend. During the discussions, participants share positive and negative experiences and ask thought-provoking questions. This enables them to explore clinical situations and encourages ‘deeper’ reflection (Jones and Bennett 2018).
By participating in action learning sets, newly qualified nurses can develop active listening and questioning skills, which are important elements of leadership. They can develop their critical thinking skills by engaging with new knowledge and new ways of thinking. By critically appraising their own and others’ clinical experiences, they can recognise the consequences of different approaches to care, which will support them to develop their leadership skills. Leadership skills such as confidence and communication skills can be developed through the use of action learning sets (Hetherton et al 2021).
Action learning sets can provide a supportive learning environment for newly qualified nurses, enabling them to gain peer support through discussion, questioning and the sharing of ideas and perceptions (Richardson et al 2008, Whitehead et al 2016). Action learning sets can comprise nurses who are peers or are from different professional levels.
Nurse managers can work collaboratively to develop action learning sets across clinical environments, enabling newly qualified nurses to discuss their experiences in different clinical areas and learn from other nurses’ experiences. Action learning sets can also include other members of the multidisciplinary team who have the same goal as nurses (Jones and Bennett 2018).
Newly qualified nurses often feel challenged by the transition from nursing student to registered nurse. Displaying leadership is a complex skill and no single leadership style is suitable for every situation. An effective leader will draw on aspects of different leadership styles to ensure high-quality patient care is achieved. It is important that nurse managers reflect on how they can support newly qualified nurses to develop their leadership skills and confidence in decision-making, delegation and communication, thereby positively influencing patient care.
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