Nursing's leadership illusion? Time for more inclusive, credible and clearer conceptions of leadership and leaders

What is leadership? In nursing discourse, commentary on leadership and leaders' presence, absence, lack and influence are perennial concerns. We rightly celebrate past ‘nurse leaders’, speculate on the practices and needs of current ones, and muse on how leaders and their leadership priorities will improve our current and future ills (Rafferty & Holloway, 2022). Nursing's preoccupation with leadership reflects wider commentary too. Whether in academic journals, conferences or exchanges in our workplaces and organizations: references to leaders and leadership abound in discourse not only about nursing, nurses and healthcare organizations but also around all professions, workplaces and organizations. One commentator estimated that there are around 57,000 books on leadership available on Amazon (Holt, 2021)—while a Google search on ‘leadership’ yields 4.5 billion hits in 0.59 s. Advice on leadership, it seems, is everywhere. At the same time, leadership itself is nowhere. Despite this tsunami of commentary, leadership is surprisingly elusive – when we try to pin it down readily: leadership is more mirage than matter. Because, as the compelling critique of Alvesson (2017) concludes: much writing and commentary on leadership is maddening – viewing leadership at once as “extremely varied, vague and fluctuating…(yet) something distinct and easily identifiable” (pages 28–29). Just as leadership could be inferred from the crystal clear articulation of a vision by a team member– so too leadership might be equally evident in that person's patient silence. Before or without the Leader… (there was) bad health, uncertainty, bewilderment, chaos, selfishness; after or with the Leader the confused get direction, the weak become confident, the egoistic start to identify with the institution and shortsighted can now see the light (the vision). (Alvesson, 2017, pages 29–30) Conversely, Disneyland narratives on leadership (Alvesson, 2017) centre on moral virtues and standing. A wholesomeness, integrity and authenticity that imbue leaders with distinctive wisdom and a power to inspire that reassures in the midst of precarious terrain and situations. Such leaders act with integrity and purity. There are positive aspects of these two discourses for nursing—they provide encouragement and order amidst bleak and messy situations. Where would nursing be without its references to and inspiration from nurses past and present—like Nightingale, Watson and Benner? Such figures were demonstrably transformative to the history of the profession. However, these narratives Alvesson (2017) continues, reflect less the reality of what leadership is, than post-hoc rationalizations that fit with dominant cultural narratives and categorize people questionably into either leaders and followers. Curiously, there is evidence that good leadership, at least in terms of its ability to deliver demonstrable results over time, is very different to these narratives—being reflected in neither demonstrable charisma nor moral virtue (Collins, 2001). Further, echoing a reductionism of these dominant leadership discourses, too often in nursing, notions of both ‘leader’ and ‘leadership’ are equated merely with possession of a senior role, academic credentials, particular competencies, or utterances. Thus, notions of a ‘nursing leader’ or ‘nursing leadership’ are cast to arise inherently from the possession of a senior role, such as Dean, Chair or Head of Department or the possession of a higher degree, such as a doctorate. Such possessions are not taken to reflect past leadership practices or present leaderly skills but are handled as symbols and synonyms of leadership itself. ‘Nurse leader’ becomes the synonymous label for those who are most or more senior in rank or credential in nursing organizations or academic departments. Nursing leadership can also viewed to be implicit in particular leaderly competencies (Heinen et al., 2019), such as the ability to analyse organizational systems (Heinen et al., 2019), align with institutional goals (Heinen et al., 2019), articulate a vision or to possess and express charisma. How do we know leaders? Their leadership can be inferred from particular behaviours or competencies. This echoes the Hollywood circularity criticized by Alvesson (2017). These competency-based approaches also reify leadership as an ‘it’ that can be readily captured or inferred (Alvesson, 2017) independent of the context, minds or intentions those involved. Most damagingly, in organizations in which we and others have worked, we have observed some bestow the notion of being a ‘nurse leader’ or even ‘the leader’ squarely on themselves. Self-proclamations of leadership and leader can be innocently done—but also can express actions grounded in ego that, via notions of habitus, seek to attain additional credibility, power or authority over others via intimidation or fear (Thompson & Clark, 2018). This may come itself from insecurity of those making such claims—but this ultimately comes with much wider harms for those subject to this lack of leadership. Reviewing these various limitations of nursing and leadership: so what, who cares? Alas, the adoption of these conceptions around leadership and leaders in nursing is not only conceptually problematic but also damaging because it serves to confine leadership around pre-existing gradients to a select few of more privileged people, effectively ‘othering’ and even excluding those deemed not to be leaders or to possess or manifest leadership competencies and behaviours. While the irony of us arguing this as two White men from high-income countries is not lost on us, unfortunately, this serves to reinforce past and existing intersectional privileges and hierarchies about who leaders are and can be—and who then is deemed to practise leadership in and through their work. This damages nursing and nurses because it serves to separate and disempower those falling outside of senior positions (themselves more likely to be White and male) or without higher degree qualifications from the possession and expression of leadership. While our rejection of much of the dominant narratives around leadership and leaders in nursing is far from nihilistic or solipsistic, what are the alternatives? How then can nursing and nurses adopt approaches to leadership and leaders that reflect the full richness and diversity of leadership? For this, we offer some alternative considerations. “A leader is anyone who take responsibility for finding the potential in people and processes and who has the courage to develop that potential.” (Brown, 2018) This definition appeals to us especially because it is inclusive: anyone can be a leader—and everyone can practise leadership—irrespective of seniority, title, rank, place or qualifications. It acknowledges the importance of internal courage in the external tangibles of influencing both other people and processes to realize potential. While it does not speak to the lack of power and privilege that may constrain an individual's capacity or ability to act, it aligns with conceptions of nursing leaders and leadership that consider alternative approaches that can empower more nurses of all roles across all the hierarchies in our organizations to embrace leadership practices. Indeed, we believe many current and past scandals in nursing and involving nurses partially have their roots in a lack of leadership across hierarchies of organizations and workplaces. To be best placed to address the huge scale and immense complexity of the world's healthcare challenges, nursing needs inclusive conceptions of leadership and its leaders that extend to all nurses, irrespective of their personality, seniority, qualification or qualifications. Extensive critiques of common yet contentious ways to view leadership and leaders (Alvesson, 2017; Hall & Janman, 2010) question much of the dominant discourse around leadership and leaders in nursing. This embeddedness of leadership with context and relationships directly questions research or practices which seek to identify the presence and influence of key facets of leaders and leadership, deemed to be inherent ‘in’ leaders. These collectively point to the somewhat frustrating yet ultimately fair conclusion that leadership is not a solid or readily inferable ‘it’ residing either in people or their practices, but is always bound by and in context (Hall & Janman, 2010) and relationships (Clarke, 2018). It is better then to focus on leadership practices over attributes which—like nursing practices—can only be evaluated and understood in their context in terms of effectiveness and ethics. Liberating leadership practices from being inherently present or absent in people or aligned with privilege promotes inclusivity—and provides a stronger justification for the constellation of leaders needed in nursing practice and policy. A fair dose of ego and intersectional privilege blights supposed leadership in nursing (Darbyshire et al., 2020; Thompson & Darbyshire, 2013; Watson & Thompson, 2008). However, the ego is best recognized as the enemy of the effective leader—contributing to defensiveness, narcissism, gaslighting and bullying. Unfortunately, this conduct continues to be masked and even legitimized because it is perpetrated under the self-proclamation of being ‘a’ or ‘the’ leader. When you next catch yourself calling yourself a leader—get over yourself (Sousa & Clark, 2021). Remember: like being funny, humble or honest – the label of ‘leader’ gains almost all of its potency and legitimacy only when bestowed by others. In this way, leadership is best viewed as a ‘gift word’—a recognition used thoughtfully and generously to recognize leadership in others (Sousa & Clark, 2021). Parts of this editorial were included in the keynote address by Clark to the “Future Proof Nursing” Conference, October, 2022. Nil. None. Ethics approval was not required for this work.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.