The impact of intersectionality on nursing leadership, empowerment and culture: A case study exploring nurses and managers' perceptions in an acute care hospital in Aotearoa, New Zealand.

Abstract

<h4>Aim</h4>This study determines whether the culture within an acute care hospital empowers 'all' nurses to be leaders by exploring intersectionality and nursing leadership in the context of the social environment.<h4>Background</h4>Nurses practice leadership in their day-to-day activities as clinical leaders alongside traditional roles of management and leadership. However, some nurses do not acknowledge nursing work as leadership activity, nor is it seen so by others where hierarchical leadership approaches remain prevalent. Social constructs of gender and race are barriers to accessing formal leadership positions for some, while dominant power structures such as class diminish the value of bedside nursing work. Unexplored is the impact of the intersection of these and other social identities on nurses being leaders.<h4>Design</h4>An embedded case study design.<h4>Methods</h4>Thirty-one participants participated in semi-structured interviews. Four levels of analysis including inductive and deductive approaches were applied to the data. The research complied with COREQ guidelines for reporting qualitative research.<h4>Results</h4>This study shows nurses do not identify themselves as leaders without an associated title and the pathway to leadership varies depending on intersecting social constructions.<h4>Conclusion</h4>The impact of the organisational structures and the experience of navigating intersecting social constructions on nurses being leaders goes unseen, privileging some while disadvantaging others.<h4>Relevance to clinical practice</h4>Health organisations need to be aware of intersectionality in the workplace and explore equity in their structures to be genuinely empowering. Nursing leadership must examine strategies that challenge and decolonise the nursing profession. Bedside nurses should be given more power and respected as leaders of the patient experience, achievable through a renewed emphasis on the fundamentals of care and resonant leadership, which can neutralise a culture of managerialism. Intersectionality can inform the development of new nursing leadership roles that enable nurses to remain clinically active, widening opportunities.