Fran’s Brief Guide to Nursing Leadership


NurseVader-001Nursing Leadership – that’s what I do. I need to tell anyone who’s interested in this career pathway that it’s not an easy path to take, and one which I sometimes feel very torn about.

I love clinical nursing practice and have been a Clinical Nurse Specialist and Consultant – yet someone has be a leader and when the opportunity came to manage a large team – I took it.

Unfortunately, Nurse Managers/Leaders aren’t always looked on very kindly by their nursing team and often for good reason. My experience has taught me that when a nurse moves into management, loyalties are challenged and all good intentions can be stomped over by the upper health echelons who expect nurses in management to see their nursing world differently and betray their colleagues. It’s almost as if nurse managers get sucked into the “Dark Side of the Force” and forget their nursing roots of caring and compassion because they have to meet budgets and maintain a precarious relationship with powerful health executives or face oblivion!

So how does a nurse remain true to Nursing Philosophies and core beliefs and not get sucked into the Dark Side of health management?

I like to look at working in health management as being torn between 2 sorts of forces. There’s Corporate Governance which I think is the “dark side” and the prevailing power in the health system; and then there’s Clinical Governance the emerging force that threatens the power of corporate governance and the force which enables nurses to remain true to their core nursing values. Working within a Clinical Governance framework and fostering particular leadership qualities is the how a nurse interested in pursuing a career in management can remain a caring nurse as well as being a good and useful Nurse Leader.

So here the types of qualities I believe make an effective Nurse Leader that nurses can admire and respect:

  • Effective Nurse Leaders see their nursing team as their clients. These Nurse Leaders care about and advocate for their team just as the clinical nurses care and advocate for a patient. The Nurse Leader is the nursing team’s representative within the corporate health framework to ensure that nurses are listened to and well-resourced so they are able to perform their clinical duties to the best of their ability.
  • Effective Nurse Leaders know that relationships are of primary importance to human beings and therefore must establish a respectful, trusting relationship with their nursing team.
  • Effective Nurse Leaders work to empower their team, listen to their ideas and value these ideas.
  • Effective Nurse Leaders fully empathise and accept all the members of the team for who they are and the abilities they each bring to the team
  • Effective Nurse Leaders have general and self awareness that enables them to reflect on their practice as well as foster reflection in their team.
  • Effective Nurse Leaders build on individual and team strengths and are deeply committed to the growth of every individual; individual differences are celebrated and learning is is encouraged and nurtured
  • Effective Nurse Leaders understand that when mistakes are made it’s probably because a particular system has failed NOT a person and the system that has failed has to be examined and improved to ensure that similar mistakes aren’t made again.
  • Effective Nurse Leaders must never forget their clinical roots and must be able to pitch in a help out their team at a moments notice and lead by example. They must be able to lead with expert clinical knowledge and keep up-to-date in that knowledge.
  • Effective Nurse Leaders use persuasion NOT coersion and build consensus within the team to ensure that high quality work can be sustained
  • Effective Nurse Leaders need foresight to anticipate and avoid difficulties that the team might experience.

Is all of this a big ask? Yes it is but it is very worthwhile to enabling clinical nurses to practice to the best of their ability. These leadership qualities are what ensures that nurses work within a Clinical Governance framework.

These leadership qualities ensure that all that Clinical Governance stuff  (team work, evidence-based practice, continuous quality improvement, learning organisations, accountability, sustainability, care that is integrative, participatory, coordinated,  safe, excellent, fair, responsive, inclusive blah, blah, blah!)  that everyone harps on about  can be a reality.

So there you have it – Fran’s Brief Guide to being a Nurse Leader; and a leader who doesn’t get lured into the dark side of the health management work-force.

Image courtesy of Patrick Purcell


  1. Nurses are people too! Hi Fran, I could really identify with your approach to being a great team leader/manager.

    For me I got out of management when it became more about saving health dollars and less about the patients or staff I was responsible for. I am now VERY happy not being the boss any more.
    I agree wholeheartedly with your point about managers not forgetting their clinical roots…my best managers have all been those that have progressed up the ranks and have been prepared to still get in and help when the days were hyperhectic.

    I also agree with your last point where management should be proactive and not just reative to situations. Nowdays managers are expected to work with unrealistic budgets that are cutting staff numbers that results in reactive management styles.

    Do many health managers receive training on how to be a great manager? I believe great managers are not so much born but are created from learning from other great managers.


  2. thanks Rich and I agree that anyone can learn to be a great manager. However, I think you have to be very clear about what you’re doing and prepare to be unpopular with upper management, stand your ground and use all your expert knowledge for the benefit of staff. Effective managers have to reflect on their practice and be prepared to be unpopular if you don’t “kiss-up” to your upper executives. It’s not easy – but I wouldn’t have it any other way.

  3. Jennifer Nini, Recruitment Coordinator This is a well written article and has a great message, and having worked in management and recruitment for many years have always felt that the saying “people don’t leave jobs, people leave managers” tends to ring true a lot of the time. Middle management is tough because you have to manage upwards (your senior/exectuive managers) and downwards (your direct reports/nurse). I recommend reading “Working with Emotional Intelligence” it is a great read and further elaborates on people/managers in the workplace.

  4. JP Nurseforce Well written article – there is a saying that “people don’t leave jobs; people leave managers” and this is true whether you work in the nursing industry or not. I recommend books like “Emotional Intelligence” and “One Minute Manager” as this will also help enlighten and demystify management and people in the workplace. Good luck to all those managers out there trying to manage upwards (senior/executive managers) and downwards (direct reports/nurses), remember you are dealing with people, and not robots!!

  5. What a brilliant article Fran,it isobvious that you speak of experience.I agree with the other comments,you have to know what you are doing ,be able to take risks where needed,develop the team so that there is a good outcome for the patient and then the department.

  6. This is a good piece, but I have to ask why it is that so many nurse managers aren’t actually very good at all. In my 30-year experience, the really good nurse managers I have dealt with both as subordinate and superior are etched into my brain forever. They were really good, outstanding and exemplified many of the principles mentioned here. However, they can be counted on two hands. The remainder, which must be in the hundreds over my career, failed totally to recognise their staff (at all levels) as assets, managed by indifference or by methods that were just plain brutal and distanced themselves from the staff on the floor and patients as quickly as they possibly could.

    So who out of you reading this can name 10 nurse managers they have encountered in their career who exemplify some or all of the qualities mentioned in this article? After 30 years I can name six.


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