Advancing nurses into leadership leads to better outcomes for all

The nursing profession has been undervalued due to a gendered lens and suffers from a lack of public recognition, further exacerbated by COVID-19. For centuries, nurses have battled to find their professional authority and professional identity. Nursing is seen as an assistive job to doctors. Therefore, nurses and nursing leaders can feel limited professional autonomy and authority than top hierarchical hospital management and doctors. Nurses are oppressed in terms of their scope of practice, career progression, nursing education and leadership opportunities. Some countries managed to turn the table on nursing to gain its professional identity and raise career profile. However, there is still great deal to be done.

When a nurse leads a health system, it has a positive impact on staff retention, recruitment, and staff satisfaction, ultimately on patient safety, and patient satisfaction. In addition, nurses’ practice in a range of health care settings including health promotion, disease prevention, care coordination, acute, and palliative care. This range provides a knowledge base for nurse leaders to ensure patients receive cost-effective, accessible, and high-quality care, in a patient-centred manner. Strengthening nursing leadership supports universal health coverage, enhances health, promotes gender equality, and supports economic growth.

Woman in nursing are further segregated from healthcare leadership positions due to being both a woman and a nurse. Regardless of majority representation, male nurses escalate the leadership ladder faster than their female colleagues, a phenomenon deemed the ‘glass escalator’. Meanwhile, female nurses experience a ‘glass ceiling’ and are challenged with finding the balance between work and family. Hinderances for the female nurses to reach leadership consistently reported in literature; lack of female role models, balancing family responsibilities along with career responsibilities, paucity of affordable, accessible, and evidence-based leadership opportunities and lack of networking opportunities. Simultaneously, many leadership roles are required to have full-time work capacity; 76% of nurse unit managers are full-time workers which is average 43 hours per week which challenges nurses with family caring responsibilities. Even though 87% of the nurse unit managers are women, only handful of nurses reach higher leadership positions such as CEOs in health services or deans in academia.

To drive change a system level, organisation driven approach is required. Organisational enablers reported in the literature include an empowering environment, flexible work arrangements, and accessibility to mentorship. An empowering organisational culture fosters autonomous practice and values nurses’ skills and knowledge. Constraints and facilitators for nurses to reached leadership positions were studied and reported in many works of literature in general perspectives. However, specific barriers and facilitators affecting female nurses and multi-level strategies to improve female nurses’ leadership were understudied.

Advancing Women in Healthcare Leadership (AWHL) is committed to understanding the barriers and enablers specific to women in nursing leadership, through the Nursing Leadership research theme. Beginning in 2022 this project will systematically review available literature, identifying gaps and effective strategies focused on progressing nurses into leadership positions. We will work with other partners, Eastern Health and Australian College of Nursing, to conduct qualitative research to strengthen understanding of these strategies in the Australian context. This is an developing area of research with numerous opportunities to collaborate, if interested please contact the team here.

MEET THE RESEARCHER

Mihiri Pincha Baduge is a critical care registered nurse at Austin Health and begun her PhD with AWHL in 2021. She will utilise her previous experience as a registered nurse in Australia and Sri Lanka to explore the barriers and enablers specific to women in nursing leadership.

PhD Supervision Team

Professor Helena Teede
Monash University

Professor Leanne Boyd
Eastern Health