Academic journal article Nursing Praxis in New Zealand

Perceptions of Policy and Political Leadership in Nursing in New Zealand

Academic journal article Nursing Praxis in New Zealand

Perceptions of Policy and Political Leadership in Nursing in New Zealand

Article excerpt

Introduction

It is most common to think of leadership in nursing as positional leadership: individuals who take the helm of health sector institutions, professional organisations and nursing teams. There is, however, equally vital leadership required of those nurses who take the nursing disciplinary perspective into decision making fora within nursing itself and in the wider health policy environment. This paper considers "leadership" in the broadest sense. Nursing leadership may develop first in positions at the most local level, and then may evolve in sophistication, range and scope. In New Zealand, as in the US (Institute of Medicine, 2010) and the U.K (Front Line Care, 2010) there seems to be a gap in the discipline of nursing between emerging leadership by position and that which is required for the discipline to sit comfortably at policy tables. We use "discipline" rather than "profession" to connote "a branch of learning or scholarly instruction" rather than a vocation (as cited in Brown [Ed], 2002, p.693 [discipline], p. 2358 [profession]). For purposes of this study, politics is the art and acts of persuasion and policy is the set of values behind acts of government. New Zealand has undergone major changes in the healthcare system over the last 25 years. This included what could have been described as a deconstruction of the nursing workforce. The relationship between the government and its departments was redesigned leaving the healthcare system (including the nurse at the bedside) unclear not only about who was responsible for decision making, but also who was accountable for performance and outcomes (Hughes & Carryer, 2011). One of the most radical changes within the government structure that affected New Zealand nursing involved the State Sector Act 1988. This Act in effect eliminated the nursing division that existed in the Department of Health and reconfigured, by minimizing, nursing representation at the national level. At that time the Department of Health was renamed as the Ministry of Health. Continued restructuring occurred until 1993.

The health reforms of the 1990s affected hospital operations, especially nursing. Nurse managers at the nursing ward level and above were eliminated in favor of generic managers who could be selected from any industry (Buchan & North, 2008), and previously discipline-specific budgets were centralized. During the 1990s there was increased substitution of registered nurses (RNs) by unlicensed personnel. Length of hospital stay decreased, workloads increased and senior nurses and new graduates began to leave the country (Carryer, Diers, McCloskey & Wilson, 2010). New Zealand essentially lost two generations of nursing leadership in the reforms.

Purpose

The purpose of this study was to examine present perceptions of policy and political leadership in nursing in New Zealand. The study was undertaken with the sponsorship of The College of Nurses-Aotearoa.

Methods

The research was designed as a qualitative, descriptive study addressing the question of what perceptions of New Zealand nurse leaders have of nursing's policy and political development in the country?

The study was granted expedited approval by the Human Research Committee of Yale University, USA. Interviews were conducted using the framework published by Cohen and colleagues (1996). Cohen stages nursing's political development and sophistication by summarizing key components into four stages (Table 1), each with four components. As nursing's policy and political development grows, nursing's language, affiliations and activities turn from a concentration on internal nursing issues to a view leading to societal and health service delivery changes. (Cohen et al., 1996)

Respondents were Fellows of the College of Nurses Aotearoa (NZ) Inc who volunteered through a standard solicitation of the College. At the time, there were 95 Fellows. Fellows of the College were, by definition and membership criteria, "leaders". …

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