Clinical Nurse Leaders Within a New Zealand Setting: the Culture of Business and the Profession of Nursing

Abstract

This thesis reports on an action research project undertaken to explore the role of the Clinical Nurse leader (CNL) in a District Health Board (DHB) in New Zealand. The CNL role has evolved against a backdrop of significant reforms that took place in the country in the 1990s. These reforms altered how public health services were funded, organised and delivered. Nursing leadership positions at both executive and clinical level were challenged in the reforms, as health services were expected to function using a market model. Not surprisingly, this clashed with the humanism of nursing. The action research project involved seven CNLs researching with the principal investigator to explore the role and establish how support afforded the role could be further improved. The research had two phases: Phase One involved each CNL being interviewed one-on-one and Phase Two involved a series of 10 action research meetings and related activities. The findings of the interviews consisted of 24 themes that related to the role of the CNL, the attributes of the CNL, the skills and knowledge requirements of the CNL, and the experience of being a CNL. These themes were presented by the principal researcher at the second action research meeting as the starting point for the group to decide its agenda. After three meetings, the group chose to focus on two themes: the conflict experienced between the leadership and management aspects of the role; and professional development afforded the role. The group identified what was important, agreeing the role was one of leadership and management as well as patient care. Plans for role development for themselves and for the advancement of new CNLs were also created. The project provides an important contribution to our understanding of the work of the CNL. Not only did it produce outcomes related to role, support and scope but it also shed light on the importance of the relationship between the role and its context of the DHB. The culture of business and the profession of nursing and a shared understanding of responsibilities as a way forward were recommended.