This document discusses leadership in nursing. It begins by explaining that front-line nurse leaders are essential to healthcare organizations but are often promoted due to technical skills rather than leadership abilities. As many as 40% of new supervisors fail due to a lack of training. Historically, nursing has focused on a task-oriented model rather than vision and relationships. The document then introduces the Clinical Leadership Competency Framework, which is built on shared leadership. It describes the five core domains of this framework: demonstrating personal qualities, working with others, managing services, improving services, and setting direction. Specifically, it discusses developing self-awareness, managing yourself, continuing personal development, and acting with integrity under the domain of demonstrating personal qualities.

1. Leadership in Nursing
By
Rahmat Ullah
Nursing Director MTI KTH, Peshawar

2. Introduction
• Front-line nurse leaders are essential to all
aspects of any health care organization (Donaher,
Russell, Scoble, & Chen, 2007; Gallo, 2007; Kirby & DeCampli, 2008).
• Historically, these nurse leaders are promoted to
their role because of proficiency in technical
nursing skills rather than leadership ability (Garman,
Butler, & Brinkmeyer, 2006).
• It is estimated that as many as 40% of new
supervisors fail in their role due to lack of training
and proper preparation (Traynor, 2008).

3. Introduction
• Historically nursing has subscribed to a task-oriented
model of leadership that focuses on what mistakes are
made (Cummings et al., 2010), rather than on shared vision and
relationships.
• This model of leadership is perceived as dualistic and
dissonant, resulting in staff dissatisfaction and high
turnover (Cummings et al., 2010).
• The gap between what nurses know about management
and what they need to know can be vast.
• The only way hospitals can bridge this gap is to provide
educational resources to prepare a new leader for
successful performance (McLarty & McCartney, 2009).

4. Introduction
• Clinical leadership is not a new concept
• There is a need to optimise leadership potential
across the healthcare professions
• To enable this change to take place successfully
and to support nurses we need to further
develop the leadership capability within the
system
• Effective leadership at all levels is essential to
delivering and ensuring high quality, safe and
effective care

5. The Clinical Leadership
Competency Framework (CLCF)
• Built on the concept of shared leadership
– can come from anyone in the organisation, leadership and
is especially appropriate where tasks are more complex
and highly interdependent – as in healthcare
• Not everyone is necessarily a leader but everyone can
contribute to the leadership process by using the
behaviours described in the five core domains of the
CLCF:
1. Demonstrating personal qualities
2. Working with others
3. Managing services
4. Improving services and
5. Setting direction

7. Demonstrating Personal
Qualities

8. Clinical Leadership
Competency Framework
• Nurses showing effective leadership
need to draw upon their values,
strengths and abilities to deliver high
standards of care.
• This requires to demonstrate
competence in the areas of:
– Developing Self Awareness
– Managing Yourself
– Continuing Personal Development
– Acting with Integrity

9. Domain 1: Demonstrating Personal
Qualities
– Effective leaders need to draw upon their values, strengths
and abilities to deliver high standards of care.
– This requires leaders to demonstrate competence in the areas
of:
Element 1.1 Developing self awareness
The competency statements for Element 1.1 are:
– Recognise and articulate their own values and principles,
understanding how these may differ from those of other
individuals and groups
– Identify their own strengths and limitations, the impact of their
behaviour on others, and the effect of stress on their own
behaviour
– Identify their own emotions and prejudices and understand how
these can affect their judgment and behaviour
– Obtain, analyse and act on feedback from a variety of sources

10. Competency- Self Awareness
• Admits personal mistakes, learns from them, and
moves on to correct the situation
• Does an honest self-assessment
• Seeks corrective feedback to improve himself or
herself
• Sorts out his or her strengths & weaknesses fairly
accurately (i.e., knows himself or herself)

11. Increased Self-awareness
• Self-awareness
– The ability to recognize and understand your
moods, emotions, drives and their effect on
others
– The foundation on which self-development is built
• Increases as you receive feedback from others

12. Developing self awareness
Learning And Development Opportunities
• Obtaining feedback from a range of others in
preparation for appraisal
• Taking part in peer learning and exploring team
and leadership styles and preferences
• Taking part in case conferences as part of
multidisciplinary and multiagency team, and
obtaining feedback on effectiveness of own
contribution

13. Scenarios
• “Z” is a Head Nurse who received very poor feedback
on her management of patients with a particular
condition. She recognises that she feels uncomfortable
working with these patients and their clinical outcomes
with her are poor.
• Head Nurse “M” identified that she needed to be more
self-aware when mentoring and supervising staff.
Drawing on a new professional framework of
knowledge and skills, she was able to think through her
own preferences and ways of working, and how these
might impact on the professional relationship she had
with others.

14. Public
Arena
Open
Blind (spot)
Bad Breath
Salad Teeth
Hidden
Avoided
Private
Unknown
Unconscious
JOHARI Window: An Interpersonal
Communications Model
KNOWN TO ME UNKNOWN TO ME
KNOWN
TO
OTHERS
UNKNOWN
TO
OTHERS

15. ___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
___________
JOHARI Window: A Self-reflection Tool
KNOWN TO ME UNKNOWN TO ME
KNOWN
TO
OTHERS
UNKNOWN
TO
OTHERS

16. Figure 8.1
Self Disclosure/
Feedback/
Self-Awareness Cycle

17. Self-Disclosure
• Examples include your feelings about
– being a member of a professional group
– Job Description & security
– Policies and Procedures

18. Domain 1: Demonstrating Personal Qualities
1.2 Managing Yourself
• Nurses show leadership through managing
themselves: organising and managing themselves
while taking account of the needs and priorities of
others.
Competent clinicians:
– Manage the impact of their emotions on their behaviour
with consideration of the impact on others
– Are reliable in meeting their responsibilities and
commitments to consistently high standards
– Ensure that their plans and actions are flexible, and take
account of the needs and work patterns of others
– Plan their workload and activities to fulfil work
requirements and commitments, without compromising
their own health

19. Managing Yourself
Learning And Development Opportunities
• Liaising with colleagues in the planning and
implementation of work rotas and identifying
areas for improvement
• Managing service pressures
• Using feedback and discussion to reflect on how
a personally emotional situation affected
communication with a carer
• Meeting deadlines for completing written
clinical notes on time in conjunction with
meeting other demands
• Critically analysing and evaluating an area of
practice

20. Scenario
• A newly promoted nurse realises that his role has changed
with added responsibilities.
• He believes he can avoid making the mistakes that some of
his peers, in similar circumstances, have made.
• In conjunction with his line manager he develops a plan
that will be implemented over a six month time frame to
integrate the added responsibilities without impacting on
his colleagues and his own well being.
• At the three month point he reviews his progress with his
line manager and receives positive feedback.
• However, his colleagues identify that he appears more
stressed.
• He reflected on this and began to delegate some of his
responsibilities.

21. 1. Demonstrating Personal Qualities
1.3 Continuing Personal Development
• Clinicians show leadership through continuing
personal development: learning through
participating in continuing professional development
and from experience and feedback.
Competent clinicians:
– Actively seek opportunities and challenges for personal
learning and development
– Acknowledge mistakes and treat them as learning
opportunities
– Participate in continuing professional development
activities
– Change their behaviour in the light of feedback and
reflection

22. 1.3 Continuing Personal Development
Learning And Development Opportunities
• Taking an active part in journal clubs and
multidisciplinary training events and activities
• Seeking feedback on performance from clinical
colleagues and service users
• Seeking opportunities to learn from other
professionals in everyday practice or through formal
opportunities
• Reviewing own practice against peers and best
practice examples
• Taking part in critical incident event audits
• Undertaking to try a new intervention with
supervision/ mentoring

23. Scenario
• Midwife “B” has had good experience with her
own supervisor of midwives when she needed
advice and felt that it had improved her practice
by helping her to reflect on her actions.
• She decides to train to be a supervisor herself in
order to continue to develop her own mentoring
and learning skills.
• She researches how she can obtain relevant
training, and the associated costs, and presents a
cost/benefit case to her manager in support of
her request for training

24. 1. Demonstrating Personal Qualities
1.4 Acting with Integrity
• Nurses show leadership through acting with integrity:
behaving in an open, honest and ethical manner.
Competent clinicians:
– Uphold personal and professional ethics and values, taking
into account the values of the organisation and respecting the culture,
beliefs and abilities of individuals
– Communicate effectively with individuals, appreciating their
social, cultural, religious and ethnic backgrounds and their age, gender
and abilities
– Value, respect and promote equality and diversity
– Take appropriate action if ethics and values are
compromised

25. 1.4 Acting with Integrity
Learning And Development Opportunities
• Taking part in ethics discussions and forums
• Taking part in clinical case reviews with
multidisciplinary teams
• Acting as mentor to students and peers faced
with difficult ethical judgments
• Challenging behaviours that are contrary to
promoting equality and diversity

26. THANK YOU