As a new decade dawns on a new era of nursing, we welcome in 2020 as the Year of the Nurse and the Midwife. This momentous decision by the World Health Organization (WHO) is a sign of the significant change ahead and the increasing recognition of the value of nurses, affirming that: ‘the world needs us’ (Stilwell, 2019).
In 2020 we celebrate the bicentennial of Florence Nightingale (NHS England, 2020). However, that is not all—2020 is also the year in which we applaud the unique contribution that nurses and midwives make to the delivery of safe and effective care; the year in which we draw attention to the often challenging situations in which we work and sometimes live; and the year in which we raise awareness of the considerable investment that still needs to be made to ensure global health for all (WHO, 2020a).
With this knowledge, nurses are in a strong position to learn from, and teach others about, global health needs (Dressel and Mkandawire-Valhmu, 2019) and as Shailaja (2019) purports: ‘To become global transforming leaders, nurses need to be visionaries and know how to turn ideas into reality’.
A good example of how nurses can be supported to become visionaries is that of the Nightingale Challenge—Nursing Now's global initiative—which encourages healthcare employers around the world to provide learning opportunities that will support the leadership and development of a group of nurses and midwives aged 35 years and under who will add value to their working environments and help raise the status and profile of the professions as a whole (The Burdett Trust, 2019).
With a number of major commitments marking efforts to improve health globally, including the United Nations Sustainable Development Goals (SDGs) (Kickbusch, 2020), strengthening the leadership skills of the nursing profession is essential if as nurses we are to help achieve three of the seventeen SDGs—namely promoting health and wellbeing, gender equality and economic growth—as well as having a significant influence on many others, including for example, education and poverty (International Council for Nurses (ICN), 2017). This is no more evident than through the work of Rosa and Upvall (2019) who purport that each of the SDGs represents an opportunity for nurses to contribute to societal health through adopting environmental approaches to care, and they call on all nurses to demonstrate professional insight into the relationship between human health, animal welfare, the environment and planetary wellbeing, as only then, they argue, will nurses be able to positively influence the effective delivery of the SDGs.
Collaboration
In the report a Voice to Lead (ICN, 2017), Dr Li Xiuhua, President of the Chinese Nursing Association, opines that nursing leaders should collaboratively create a longstanding sustainable development strategy, one which not only promotes the advancement of nursing science, nursing careers and industrial development but also improves the health of the population. By promoting and caring about global health, nurses are able to educate themselves and others, and in so doing, create possibilities for improved global healthcare, increased health outcomes and reduced costs in the communities in which we work (Dressel and Mkandawire-Valhmu, 2019).
High-quality healthcare leadership is fundamental in helping to shape organisational culture, with effective leaders emphasising the importance of delivering safe and compassionate care
Healthcare leadership
Fundamental in helping to shape organisational culture, is the importance of high-quality healthcare leadership, with effective leaders emphasising the importance of delivering safe and compassionate care (West et al, 2015). Furthermore, effective leaders ensure the voice of patients are heard, that staff are supported using an empathetic, fair and compassionate approach, and consider the need for continuous professional development essential in order to improve service delivery (West et al, 2015). Conversely, disengaged leaders, high turnover, poor organisational culture and dysfunctional external relations are just some examples of the characteristics of health care organisations that can affect their capacity to deliver optimum care (Vaughn et al, 2019).
Considerable emphasis has been placed on the importance of certain leadership styles that can facilitate effective healthcare delivery. Within nursing, authentic leadership, with its emphasis on leaders demonstrating self-awareness, understanding others, practicing ethically and embracing leadership transparency, has been found to be an important leadership style in supporting the delivery of quality care (Laschinger and Fida, 2015).
Authentic leadership
With its origins in Greek philosophy, authentic leadership requires aligned leaders to be temperate in their behaviours and have a central set of attributes that enable them to consider all options before making any decisions; to act fairly, courageously and with wisdom, while demonstrating fairness towards others (Riggio, 2014).
Authentic leadership has been shown to encourage the development of trust, the creation of healthier and engaging work environments, and positive interpersonal relationships (Wong and Cummings, 2009).
Authentic leaders, according to Laschinger et al (2013), create a sense of openness with others, provide opportunities through which they can challenge and share opinions, encourage the development of positive change and ultimately promote nurses' wellbeing. Comparably aligned with authentic leadership, is that of servant leadership, although Liden et al (2014) argue that being authentic is a central tenet of servant leadership, through which the attributes of authentic leadership can be applied.
Servant leadership
The traditional approach to leadership, which Fahlberg and Toomey (2016) regard as ‘a power grab’—the drive to pursue and obtain ultimate power, status and control—is in direct contrast to that of servant leadership. Servant leadership theory stems from the post-modern work of Greenleaf, first published as an essay in 1970 (Greenleaf, 1970), in which he argues: ‘The servant leader is servant first. It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead’.
Servant leadership is unique in that servant leaders demonstrate humanitarian attributes (Box 1). They affirm their intent to be effective leaders and have a set of core multi-dimensional leadership competencies (Box 2) that enable them to be so (Coetzer et al, 2017).
Box 1.Characteristics of servant leaders
- Authenticity
- Humility
- Integrity
- Listening
- Compassion
- Accountability
- Courage
- Altruism
Coetzer et al, 2017
Box 2.Servant leader competencies
- Building relationships
- Empowerment
- Stewardship
- Compelling vision
Coetzer et al, 2017
Furthermore, servant leadership, argues Savel and Munro (2017), is considered ‘more than just a leadership style’, it is, according to the Robert K. Greenleaf Institute for Servant Leadership (2016): ‘a philosophy and set of practices that enriches the lives of individuals, builds better organizations and ultimately creates a more just and caring world’.
Fundamentally, the principle role of the servant leader is to cultivate and develop followers, so they are able to achieve their full potential (Savel and Munro, 2017).
Nurses as servant leaders
Characteristics of servant leaders, argues Fahlberg and Toomey (2016), are witnessed in some of the best nursing leaders who speak up, volunteer, and advocate—all of which bring nurses to a place where we can be of value. This is supported by Jit et al (2017) who argue that servant leaders demonstrate compassion and altruistic calling, traits which help to build the foundation of a strong workforce and imbue a sense of ‘cohesiveness, collaboration and sustainable relationships’.
A nurse servant leader seeks to determine the needs of their staff and frequently asks how they can support the team to resolve problems and promote their personal growth (Sherman, 2012).
Nurses must speak with one voice
In global healthcare, the nursing profession is considered the largest (Groenwald and Eldridge, 2020) and with nurses making up 50% of the workforce and providing 90% of the hands-on care (Kennedy, 2018), if nurses from all nations were to come together and speak with one voice then the profession would hold considerable power and could establish both political and social change (Shamian, 2014).
Despite nursing being such a large professional group, its representation at the global top decision-making tables is considered weak, and therefore, correspondingly, so is the voice of nursing. The risk is that if nurses do not sit firmly at those tables, others will decide what we can do, how we are educated, and undermine our ability to utilise our skills and knowledge to positively influence global health (Scammell, 2018).
Disappointingly, however, this risk to the profession is often exacerbated by the hostility generated towards each other—a term coined lateral violence.
Lateral violence
Commonly known as workplace bullying, lateral violence is both harmful and unacceptable, and when nurses leave their jobs as a result, it can create gaps in the nursing team, leading to increased workloads and decreased morale (Rainford et al, 2015).
As challenging as this may be, however, perhaps we need to stop condemning the profession so vehemently for this, for as Rainford et al (2015) argue, the significant patient workload could be considered a contributory factor in increasing the risk of lateral violence and as Matheson and Bobay (2007) opine, the behaviours exhibited could simply be an outward projection of the tensions, challenges and role conflicts encountered by nurses who are frustrated by the lack of power, worth and autonomy that exists. It is important, perhaps now more than ever, that nursing leaders locally, nationally and globally take a firm stand and seek to challenge the continuance of this toxic scourge on the profession, whatever the cause.
One way in which we can do this is by nursing leaders adopting a servant leadership approach. Embraced by many nurse leaders, servant leadership helps to build trust; followers believe that the leader authentically considers the importance of their welfare, which in turn leads to increased levels of engagement, creating healthy working environments, which are ultimately attractive to nursing staff (Sherman, 2012).
‘If nurses from all nations were to come together and speak with one voice then the profession would hold considerable power and could establish both political and social change.’
Conclusion
2020 is the Year of the Nurse and the Midwife, and this window of opportunity may soon slam shut again (Salvage and Stilwell, 2018). Now is the moment to shift the paradigm, to be taken seriously, when the old certainties and ways are being shaken by economic crisis, climate change, insecurity, a deep desire for stronger social solidarity, and the rising clamour of women's voices—and of nursing policy leaders (Salvage and White, 2019). And as the WHO Director-General Dr Tedros Adhanom Ghebreyesus calls ‘on all countries to invest in nurses and midwives as part of their commitment to health for all’ it also requires new ways of working, new thought processes and new behaviours (WHO, 2020b).
Key Points
- Nurses are in a strong position to learn from, and teach others about, global health needs
- Fundamental in helping to shape organisational culture, is the importance of high-quality healthcare leadership
- Characteristics of servant leaders are witnessed in some of the best nursing leaders who speak up, volunteer, and advocate
- Despite nursing being such a large professional group, its representation at the global top decision-making tables is considered weak, and therefore, correspondingly, so is the voice of nursing. if nurses from all nations were to come together and speak with one voice then the profession would hold considerable power and could establish both political and social change