As the clinical landscape becomes increasingly complex, health care organisations are increasingly turning to clinical leaders. Clinical leadership has increasingly become a focus of much attention in health care systems across the world, with its enhanced effectiveness being identified as a possible solution to achieving positive patient outcomes and overcoming deficiencies in the quality of health care delivery. The dominant leadership model offered in professional development programs across the world has been transformational leadership (Martin et al. 2014), a model identified as the preferred leadership style by nurses (Andrews et al. 2012). However, given the calls for more effective leadership other leadership models have been considered as ways of improving the nursing workplace and patient outcomes. These have included ethical leadership (Makaroff et al. 2014), aesthetic leadership (Mannix et al. 2015), and congruent leadership (Stanley 2017).
Based on the findings of a 2015 study that sought to better understand clinical leadership in a contemporary nursing context the purpose of this presentation is to present a re-conceptualised model of clinical leadership for advanced practice nurses in designated leadership roles in clinical settings.
Methods:
A mixed methods approach using an online descriptive survey and conversation-style interviews employed in the study sought the views of registered nurses on the aesthetics of contemporary clinical leadership. Quantitative data from the online survey (n=66) were subject to descriptive analysis with content analysis applied to the qualitative survey responses (n=31). Narrative data from the interviews (n=12) were analysed thematically.
Results:
The findings of the study revealed that the characteristics in clinical leaders most valued included being supportive and communicating effectively. Clinical leaders who embody aesthetic leadership were found to shape their practice with a strong moral compass, embrace nursing values and beliefs and practice critical self-reflection. Through this type of leadership clinical leaders convey a visible, composed leadership style that has a positive effect on the nursing workplace. From a subsequent synthesis of these findings and making metaphorical comparisons between a clinical nursing workplace and a symphony orchestra it was possible to enhance current understandings of clinical leadership from both practical and theoretical perspectives.
A number of similarities were found to exist between a clinical setting and a symphony orchestra. For example, both encounter the range of human experiences of happiness, pain, loss and success; and those individuals working in both settings come to their workplace with specialist skill sets. Both settings are overseen by a manager: one a conductor and the other a unit manager; and both have leaders who lead by example: one a concertmaster (1st violin) and the other a clinical leader in an advanced practice role.
Not all clinical leaders are concertmasters. A concertmaster in a clinical setting is an advanced practice nurse in a designated clinical leadership role. Concertmasters in this context practice in a way that can only come with professional and moral maturity, gained from extensive clinical experience. They also thoughtfully draw on different leadership styles, depending on the circumstances and the context. In doing so, their clinical leadership will be artful and reflect a model of artful clinical leadership.
Conclusion:
Clinical leadership is a complex process and its application can have profound effects on nursing workplaces. The model of artful clinical leadership encourages consideration of the notion of different levels of leadership expertise in the same way that nursing practice has been identified by Benner's (1984) model from novice to expert. Artful clinical leadership offers a new and different way of conceptualising clinical leadership in nursing. In doing so, this model identifies the qualities and attributes required by advance practice nurses in or aspiring to senior clinical leadership positions.