Kristiina Hyrkäs

Clinical nursing leadership – perspectives on current topics

Welcome to this themed edition that compiles articles focused on Clinical Nursing Leadership. We are very pleased to include international representation from authors writing on clinical nursing leadership in Australia, Canada, Finland, Norway, Sweden, the United Kingdom and the United States of America. The subjects of the papers are highly relevant to the current context of health care systems. Regardless of where in the world the authors are, the same issues and challenges are raised. Similarly, regardless of whether or not the topic is addressed from a practical, abstract or theoretical point of view, many of the external and internal pressures identified are the same: the reality of a decreasing and aging work force, the increasing demands of an aging population, increasingly complex medical care and ever-increasing financial imperatives. These factors all have significant impact for the nurses at the bedside and for their patients. Additionally, as a global society, we are evolving out of the industrial age. Cook (2001) noted that progression to the quantum age would inevitably impact health care and health care services. Whether one embraces the idea of the quantum or information age, changes are evident. It s clear that organizations have begun to use different languages. They employ and apply new concepts such as meta-thinking, complex adaptive systems, adaptive capacity, purposeful work, outcomes orientation, fluid work requirements and variable effects. The dilemma then, for nursing, lies in the fact that both knowledge and practice are changing rapidly, dramatically and concurrently. While most would generally agree that good nursing leadership is required to achieve good quality nursing care, there is evidence that suggests our current understanding of clinical nursing leadership is lacking. The terminology and concepts, though developing, may not be evolving as rapidly as the environment and may not capture leadership as it is experienced in practice today. Cook (2001) noted that the concept of clinical nurse leadership was not clearly defined in literature that was published between 1992 and 1997 in the UK, USA and Australia. In fact, the term was sometimes used interchangeably with nursing management. Because the concept lacked definition, he was able to find very few experimental or empirical studies and most of the papers were anecdotal and opinion led. In 2006, Stanley (2006) noted that while there was a great deal of literature on nursing leadership, there was still very little that specifically considered clinical nurse leadership. He discussed the contributions of several authors but again noted that there was no general agreement on a definition and the concept remained elusive. He described three different contexts in which clinical leadership had been presented in the literature: (1) clinical leadership programs or evaluations, (2) work of managers who work in clinical settings and (3) work of clinicians who practice at an expert level and who have or hold a leadership position. Obviously, the various authors understood the concept quite differently. When we recently conducted our own literature search (see Box 1) using the CINAHL, PubMed, and Ovid databases, we found no more agreement on a definition of clinical nurse leadership than either Cook or Stanley. We propose that a clinical nurse is certainly one involved in clinical practice with knowledge, experience and understanding of providing nursing care. We suggest that leadership implies authority in the broadest sense of the word, is nonhierarchical and not confined to a specific set of skills, attributes or traits. One can deduce, then, that clinical nursing leadership reflects all of the complexity of the culture, the organization, the practice setting and situational variables of each clinical nurse leader. To date, we have not found a body of work that has captured the essence of the clinical nurse leader, the environment in which they operate or how and where the impact is felt. The Journal of Nursing Management has devoted several issues to various aspects of leadership in the past. This is the first time that there is an issue devoted entirely to clinical nursing leadership. While the concept remains elusive, the authors reflect on their own professional experiences, expertise and insights to illuminate the issues that they believe nursing managers need to consider. Each of the component Journal of Nursing Management, 2008, 16, 495–498