What are the core components that enable nurses to be adaptive leaders in a shared role of community and practice nursing?

Abstract

Health care today is an unpredictable, changing dynamic environment which presents an abundance of challenges for all who work in it. As a response to challenges in complex health care systems (Dickson, 2014) integrated care approaches are being developed to improve care delivery between different health sectors (Meads, 2006). Integrated health care means having the right service in the right place at the right time (Thomas & While, 2007) and requires skilful, adaptive and flexible leadership (Doody & Doody, 2012; Heuston & Wolf, 2011) to navigate the complexities. Integration of services is now at the forefront of DHB strategic plans across the New Zealand. One important aspect and central to the Better Sooner More Convenient national strategy for improving population health in New Zealand is the improvement of the integration of primary care and community nursing services and development of the supporting infrastructure. Nurse leaders are key players in service redesign for health care improvements (Penprase & Norris, 2005). The management of integrated nursing services is challenging and requires organisations and nursing leaders to successfully navigate the process. It is therefore crucial that effective leadership is developed to promote a successful cohesive and collaborative health care environment (Aitken & von Treuer, 2014; Guo, 2009). The purpose of this study was to explore with Practice Nurses and District Nurses what key components are essential to enable nurses to become adaptive leaders within a shared primary and community health model. The vast array of definitions in recent literature that describe leadership demonstrates the complexity of the concept. However what is evident is that leadership requires an activity that foster adaptiveness and engagement of people to face challenges, change their perspectives and develop new behaviours and habits (Heifetz & Laurie, 1997). Primary and secondary health services are becoming more integrated, meaning there is an increasing need for nursing leadership to be more diverse, adaptive and innovative. Factors such as whether or not the team and the organisational environment use the strengths of the team in a spirit of joint decision making also have a significant effect on the ability of the nurse to lead. A qualitative participative research design was used in this research. A Balanced Scorecard (Kaplan & Norton, 1993) was developed to provide a performance management framework within which the researcher could identify critical success factors in four main categories: the customer; support and resources; internal learning; and growth, which have to be in place for nurses to be adaptive leaders in a shared role of community and practice nursing. Fifteen participants, including District Nurses, Practice Nurses, a practice owner and a practice manager, agreed to take part in the study. Eleven nurses agreed to take part in the focus groups while the practice owner, practice manager and two nurse managers agreed to take part in individual interviews. Thematic analysis was used to identify codes, categories, themes and sub-themes from the data. The findings suggest that key to nurses being adaptive leaders and vital for successful integration of nursing services are a supportive work environment, working in collaboration, having good communication, sharing information and building relationships. As nurses continue to work in challenging complex changing environments, it is crucial for nurse leaders to have an understanding of the enablers and barriers to sustainable integrated nursing services that influence adaptable and effective nurse leadership.