Commentary on McIntosh and Tolson J D (2009) Leadership as part of the Nurse Consultant role: banging the drum for patient care. <i>Journal of Clinical Nursing</i> 18, 219–227

To begin, this commentary is informed by the reviewer’s own experience as a nurse and a man grounded in North American (Canadian and American) nursing and leadership research, learning and experience. McIntosh and Tolson heavily reference American research related to transformational leadership, not so much because it is American but because the preponderance of the research related to leadership theory and application has been centered in North America (Drucker 2001). Also, much of the historic leadership research (and a great deal of contemporary research) reflects organisations both public and private from a predominant masculine perspective (Bass 1990). It is only within the last few decades that feminist research has begun to make inroads into unique leadership capacities and characteristics as expressed by women leaders and more predominantly female groups (Eisenberg & Spinner-Halev 2005). Also complicating the application of much of contemporary leadership research are the significantly different political, cultural and social conditions and circumstances influencing both work and health care between Great Britain and North America (Thompson 2005). Also affecting the perspective of leadership as applied to nursing and nurses is the contextual framework within which that leadership is expressed (Wooten & Crane 2003, Force 2004, Schein 2004). While Yukl certainly discusses how the complexity of the context and processes associated with leadership reveals significant omissions, critical to the discussion is the contextual framework within which leadership expressions unfold (Yukl 2005). For example, leadership of a task-based manual labour workgroup differs considerably from the leadership expected of a high-level research, academic or professional workgroup. The environmental, content, contextual and role expectations of these differing groups require specific and clear differentiation with regard to effective leadership approaches (Hooker & Csikszentmihalvi 2003). With regard to nursing, consideration must be given not only to gender specific issues having an impact on leadership but also to recognising and accepting the reality that nurses are knowledge workers and members of a professional workgroup. Leadership attributes of a professional workgroup call for fundamentally different interactions, communication, facilitation and integration, all of which require a particular leadership capacity (Porter-O’Grady 2001). So often missing in the discussion of nursing leadership, also apparent in this article, are the contextual and organisational implications related to professional knowledge workers and leadership requisites for managing this group (Batson 2004). It is difficult to distinguish in this article any difference in the individual and unilateral transformational leadership capacity of the leader of a functional-task workgroup and that of a professional knowledge-based workgroup. In the examples related to the interviews of nurse consultants and other nurse leaders, the focus of their leadership perspective was deeply embedded in their individual function as leaders with virtually no reference to the more contextually derived understanding of transformational application locating leadership in the hands of the practitioners at the point of service. Had this perspective been in evidence, we would have seen more exemplars in these leaders of their shifting the locus of control for decisions, mentoring practice-driven leadership skills, empowering practitioner-leaders, engaging more practice-based leaders at the Trust strategic and governance level and reflecting more contemporary complexity-based applications of distributed leadership (Hess 2004). Some of the feedback language was telling with regard to the level of leadership development and maturity within a professional frame of reference. Linguistic examples such as ‘shop floor’, ‘directing’, ‘keeping it under control’, all suggest a more linear, industrial, functional understanding of the role and application of leadership on the part of the interviewees, much of it hardly transformational. McIntosh and Tolson characterise in the nurse consultant role many of the attributes and actions of leadership behaviours now necessary for the expression of point-of-service clinical leaders (Wickramasinghe et al. 2005). They also note that many of these leadership characteristics actually go beyond some of the foundational elements of transformational leadership. Interesting and important to this discussion is their discovery that such leadership applications require real understanding, skill and knowledge with regard to leadership; indeed, suggests its application requires a particular level of expertise (Antonakis et al. 2004). What is evident in the feedback from the interviews is that same consistency and discipline of understanding is vividly non-apparent in the responses from the various nurse leader interviewees. It is impressive to see the broad cross-section of leadership insights shared by nurse leaders. It is equally impressive how little consistency and cross-referencing these identified behaviours have from leader to leader. This article makes a significant contribution to the understanding (or lack of it) of leadership and its application within the nursing profession. To this reviewer, it points out much of the inadequacy of generalised transformational leadership theory as it is more specifically applied to leadership of professional knowledge workers (Stewart 2002). Much of the linear and vertical social, organisational and structural overlay to the discussion of leadership creates a perceptive format resulting in concepts and constructs that fail to adequately and appropriately articulate leadership roles and behaviours in the professions (Malloch & Porter-O’Grady 2005). Furthermore, it reflects a paucity of clarity around the relevance of existing roles and their genuine contribution to practise, clinical outcomes and value sustainability. Imagine how the roles of nurse consultant, senior leader, clinical manager, etc. might be reconfigured, delineated differently and deepened in their value and contribution if it reflected more clearly delineated professional, knowledge worker, gender reflective and equity-based representations in both definition and expression (Porter-O’Grady & Malloch 2007). While McIntosh and Tolson have clearly contributed to the foundation of current understanding, it might now be time to deepen that understanding, and broaden leadership concepts, applications and research to include a deeper and broader representation of leadership capacity unique to the profession of nursing.

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