Perspectives and explanations of successful executive nurse leadership in English NHS Trust Boards
Background: Executive Nurses are members of English NHS unitary Trust Boards; they hold a complex role that is pivotal to securing high-quality patient care. Executive nurses can be cited as being responsible when care failings are identified. Despite its stated importance, limited research has examined the role in the last 20 years. This study aimed to understand the perceptions of successful executive nurse leadership from the perspective of chief executive officers, medical directors, and senior leaders from within the health system and of executive nurses themselves to explain the potential forces that might explain why successful leadership may be experienced in the way that it is described. In understanding and explaining successful executive nurse leadership, it is hoped that any recommendations could accelerate implementation into practice. Methods: A critical realist and narrative study design was used to conduct semi-structured interviews with 19 participants. The participants shared their stories of successful executive nurse leadership within the boardroom; the data was analysed using critical realist and narrative thematic analysis. The Oxford Brookes University Research Ethics Committee granted ethical approval. Results: A narrative for each participant group was created. The four narratives were formed into a synthesis that created a meta-narrative describing the experience of successful executive nurse leadership and potential explanations of why it may be experienced that way. Executive nurses’ leadership experience can be characterised as a liminal space that they transition through. The potential explanations that form their experiences may lay in the perceptions held by the board about nurses and nursing, including the way the executive nurse talks about nursing to avoid being perceived as too ‘nursey’; the different perceptions between the credibility and authority between the medical director and the executive nurse held by the board and the invisible cultural clashes of New Public Management and professional nursing. Conclusion: Nursing does not speak for itself, meaning that executive nurses must first establish themselves as credible to be influential within the boardroom, in contrast to medicine, which assumes a higher status. Executive nurses lead using a relational approach that under-labours the policy-promoted contemporary leadership approach. Relational leadership capability is potentially drawn from the therapeutic skills acquired as a nurse. It enables executive nurses to build and sustain complex relationships that create collaboration and partnerships to achieve a common goal of providing safe patient care. To succeed, the executive nurse must navigate and be able to contend with the barriers, unconscious bias and prejudices associated with nursing and nurses articulated as ‘nursism’ through Fricker’s (2007) concept of epistemic injustice. Recommendations: For policy, education, practice, and further research focusing on explaining the cultural context of executive nurses, the leadership development of aspiring and future executive nurses. The need to engage with policy influencers within nursing, medicine and health services is recommended. New nursing narratives are needed to challenge the perceptions of nursing and break the silence of the hidden complex work that nursing involves.
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