Identifying the characteristics of clinical leadership in mental health nursing and how they are developed

Abstract

Background: Leadership is recognized as an essential skill for nursing and crucial for the ongoing development and advancement of the nursing profession. Significant evidence supports the value of clinical leadership in nursing, in particular its positive impact on recruitment and retention and most importantly on the quality of consumer outcomes. Leadership is generally viewed from a nursing management perspective which is problematic for defining and understanding clinical leadership. Providing direct care is central to clinical leadership and is a clear distinction from formal nursing management positions. Research examining clinical leadership is minimal and limited to focusing on definition, examining the benefits, and identifying attributes. How clinical leadership skills are developed has received considerably less attention, particularly in mental health settings. Understanding how these skills are developed is important in considering what the profession can do to prepare future generations of nurses for clinical leadership roles. Aims: The aims of the study were to investigate the characteristics of clinical leaders working in mental health nursing and to enhance understanding of how these skills and attributes are developed. Methods: A grounded theory methodology was chosen to guide this research due to the paucity of relevant literature. The study was conducted in two phases. Phase one involved interviewing nurses working in a mental health setting to elicit their experiences of, and views about clinical leadership. Participants were asked to identify nurses they regarded as clinical leaders. The peer identified clinical leaders became the participants of phase two. Interviews focused on journeys and experiences of these nurses, specifically on their perceptions of how they developed the knowledge and skills of clinical leadership. Data were analysed using the constant comparative method consistent with grounded theory. Data analysis occurred at three stages including open coding, axial coding and selective coding. Findings: Characteristics for clinical leadership identified in phase one included: effective communication; calm and confident in a crisis and facilitating professional development of others. In phase two a process of Intentional Modelling emerged as the substantive theory for clinical leadership development in mental health nursing. Intentional Modelling was identified as a process underpinned by reflective practice and high quality clinical skills. Importantly the process equips nurses with the skills to develop and refine their own clinical leadership capabilities. Discussion and conclusion: Clinical leadership in mental health nursing is essential as its influence impacts well beyond the clinical area. The impact on nursing retention and recruitment is particularly important for mental health nursing as attracting new graduates into this specialist area of nursing continues to be challenging. The substantive theory of Intentional Modelling explains the process of clinical leadership development in mental health nursing that utilizes reflective practice and reflection in action. The Intentional Modelling process may provide a structure to encourage the development of clinical leadership skills in nursing students and graduate nurses and provide a framework that makes reflective practice more clinically relevant and meaningful.

Date of Award	2017
Original language	English
Supervisor	Brenda Happell (Supervisor), Kerry Reid Searl (Supervisor) & Kim Foster (Supervisor)