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Advancing nursing leadership: developing and equipping nurse leaders is vital if quality health services and good patient health outcomes are to be achieved and maintained.

International research shows a positive correlation between the advanced nursing role and quality patient health outcomes. (1,2) However, achieving this is an on-going challenge for nurse leaders faced with limited resources in a tight economy and a rapidly changing health care environment.

Significant forces currently affecting health care delivery include changing health policy and legislation, an ageing population, medical technology advances, hospitals absorbing more costs, workforce supply issues, and public expectations and demands for technological interventions. (3) In this complex environment, one identified means of preserving quality patient health outcomes is leadership development for nurses.

As early as 1998, the Report of the Ministerial Taskforce on Nursing advocated the introduction of nursing leadership and management studies within nursing education programmes. (4) Supporting business skill development in nursing leaders was seen as a vital step "to more fully utilise the skills and competencies of nurses throughout the health and disability services sector". Leadership development was being promoted to encourage nurses to "take a fuller role in strategic decision-making". (4)

The importance of effective nursing and midwifery leadership has more recently been stressed in the World Health Organisation (WHO) publication Strategic Directions for Strengthening Nursing and Midwifery Services. (5) This publication was produced in response to the 2001 World Health Assembly resolution 54.12. This resolution recognised that the global shortage occurring in nursing is of major concern, and that it is vital to effectively harness the significant contribution nurses make to health care systems, if quality patient outcomes are to be maintained into the future. In forming this strategy, WHO and its nursing and midwifery partners identified five key result areas (KRA). Two of the five pertain specifically to nursing leadership:

KRA3: Practice and health system improvement Nursing and midwifery expertise is fully integrated into decision-making processes at all levels, and health systems use best available practices for the care of individuals, families and communities.

KRA5: Stewardship and governance Stewardship and governance of nursing and midwifery services involve the government, civil society and the professions to ensure the quality of care. (5)

In addition, workforce development in nursing leadership has been recognised as a critical, resource in preserving quality health services in Australia. The 2002 Senate report The Patient Profession: Time for Action. Report on the Inquiry into Nursing acknowledged that nurses today "are highly skilled, highly educated and articulate". (6) It recognised that one significant limitation preventing nurse leaders making a fuller contribution within current health service structures was that they are given "an onerous task to perform without being equipped with the skills necessary to lead and manage teams of professionals". In light of this evidence, two key recommendations were made regarding nursing workforce development.

Recommendation 57: that the Commonwealth and States encourage providers of health care services to support nursing leadership by integrating nurses into the organisational hierarchy through their appointment to and meaningful participation in management; and by promoting nurse involvement in decision-making relating to nursing practice and clinical patient care.

Recommendation 58: that the Commonwealth and States ensure that nursing leaders are provided with the necessary in-service training and development to support them in their constantly evolving roles.

Furthermore, the International Council of Nurses' policy statement Promoting the Value and Cost-Effectiveness of Nursing stresses the importance of nursing workforce development:

"Nursing education, especially management and leadership development programmes, must help nurses become skilled and articulate in demonstrating the value and cost effectiveness of nursing to the health services. Nurses, especially nurse leaders, must have a good understanding of the purpose and nature of health care reform, and the contribution nursing can make at all levels of health care delivery, and in planning, management and policy development for health care services. Where health care reform is in its planning stages, nurse leaders must play a leadership role in policy development related to the appropriateness, nature and purpose of health reform." (7)

As illustrated, a number of key international. reports and publications indicate that workforce development in nursing leadership is vital to preserving healthy communities in the future. In New Zealand, nurses are negotiating daily the challenge to provide best practice patient health care on limited resources, within a rapidly changing environment. Leadership development is clearly one way of supporting nurses to make effective contributions within health service structures, and equipping them with the knowledge, skills and attributes necessary to lead health care teams into the future.


(1) Aiken, L.H., Clarke, S.P. et al. (2002) Hospital nurse staffing and patient mortality, nurse burnout and job dissatisfaction. JAMA; 288: 16, 1987-1993.

(2) Needleman, J., Buerhaus, P, et al. (2002) Nurse-staffing levels and the quality of care in hospitals. N Engl J Med; 346: 22, 1715-1722.

(3) US Department of Health and Human Services. (2002) Projected Supply, Demand and Shortages of Registered Nurses. 2000-2020. Rockville, Maryland: National Center for Health Workforce Analysis.

(4) Ministry of Health New Zealand. (1998) Report of the Ministerial Taskforce on Nursing: Releasing the Potential of Nursing. Wellington, New Zealand.

(5) World Health Organisation. (2002) Strategic Directions for Strengthening Nursing and Midwifery Services. WHO: Geneva.

(6) Senate Community Affairs Committee. (2002) The Patient Profession: Time for Action. Report an the Inquiry into Nursing. Canberra: Australian Senate.

(7) International Council of Nurses. (2004) Health care systems position statement: Promoting the value and cost-effectiveness of nursing. Retrieved October 10, 2005, from

Sarah Brophy, RN, BA, MBA, is a clinical nurse educator in the department of nursing, Christchurch Hospital.
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Author:Brophy, Sarah
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:1USA
Date:Apr 1, 2006
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