October 2017 April 2016 | Page 4

Te Puawai

Editorial
Professor Jenny Carryer RN, PhD, FCNA(NZ) MNZM
Executive Director

Lately I have been thinking a great deal about the conundrum of
clinical leadership. Since the National Government came to power in
2008 there has been increased political rhetoric about the value and
importance of clinical leadership. This could be seen as an ironic
reversal of the steady implementation of generic management under
the National Government of the 1990s.
Firstly I am never 100% sure when politicians or policy makers refer
to clinicians or clinical leadership, whether or not they are actually
thinking about nursing alongside medicine. Probably some are and
probably many are not. But more importantly I have become
increasingly aware of the challenges for clinical leaders to genuinely
impact the decision-making processes where there is a substantial
management presence.
Jenny Carryer

Recently I was privy to the distress of a senior nurse clinician. After some years of sharing
disturbing audit data with appropriate management to no effect, she shared the data in a
conference presentation as an example of the pitfalls of the audit process. Suffice to say that a
fairly punitive response quickly followed. With courage and commitment she continues in her
current role but without any particular changes to the level of service being provided to her patient
group despite the obvious evidence based need.
Inherent in clinical leadership is the ability to assess patient need and ensure that a service is
responding safely and effectively. Clinical outcomes and patient safety are the overriding focus of
clinicians of any ilk. In order to actually make such changes one needs budgetary authority and
control of staffing decisions. Alternatively one needs to know that one’s advice will be taken
seriously by those who do control the budget or hold the power to alter staffing levels.
But those who most often hold that power are frequently focused on the need to address the
“bottom line”, meet imposed targets and ensure that the organisation is not brought into disrepute
through failure to meet external and often public accountabilities. District Health Boards are deeply
risk averse but it seems to me as an outside observer that they are focussing on the wrong kind of
risk and thus generating much more significant risks in the process.
If we genuinely valued clinical leadership then the activity of the clinician described above would be
celebrated and applauded. Her only driver was patient safety. Theoretically it is what we all care
about most! And theoretically it is the whole point of clinical leadership.

© Te Puawai

College of Nurses Aotearoa (NZ) Inc
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