Closing Reflections

I commenced this research intending to explore clinical leadership in nursing within a District Health Board setting in a study that was based on the principles of action research, that is research which is cyclic, qualitative and participatory. The role of Clinical Nurse Leader in the District Health Board matters. It matters to the organisation, it matters to the patients and it matters to me. Due to the nature of action research the evolution of the project was unpredictable but it was expected that myself at the outset as principal investigator alongside the participants would be involved in a responsive, emergent, flexible and reflective approach. Firstly, the professional preparation for the CNL role has been previously influenced and restricted to known leadership models and non-nursing management philosophy. In addition to this limited influence, there has been a very minimal amount of New Zealand research carried out on this role. I commenced this research aiming to inform any further evolution of the role and to improve the support afforded the role. I decided that those in the role would define the role and be co- researchers.

Action research with my colleagues has been challenging and complex, fascinating and, to some extent, an episode of discovery. It reaffirmed the way I know others and how that might appear and what that translates into, as Wadsworth describes, spoken or unspoken, conscious or subconscious. It also uncovered how I behave as a result of that knowing. I am reminded of the opening words of this thesis which finishes “exercise stewardship without control”. As a group, we completed a significant piece of research that explored the role of CNL without any control over how the research would unfold or what would be the outcomes. That is the beauty of action research. The qualitative nature of the research allowed for not only an opportunity to display just exactly how it is to be in the role of Clinical Nurse Leader but also to include both the challenges and privileges that this methodology affords the principal investigator. It was, as I said at the outset, to be a time of growth. I entered the research with my expectations of the group and in order to demonstrate reflexiveness and thus strengthen the validity, I recorded my perspective as we worked as a group.

I was entrusted with narratives that were deeply moving and personal about how it was to function in the role. These were powerful pieces of dialogue which spoke to the role, the reality of the practice under such expectations and how they all made sense of these. I witnessed the tiredness and the sense of apathy that they could not make a difference. I equally saw their commitment and obvious enjoyment of the role and the research, hence the reflections contained in “The Race”. Whilst at times, in the thick of it, the group expressed such apathy the solutions reached and the outcomes achieved were remarkable. The in-depth analysis of the role achieved by those in the role that this methodology afforded us resulted in useful, significant outcomes. This research will, I believe, contribute to making a difference. My comments in the final action research meeting reflect this belief.

I thank you all for the trust and for the gems of wisdom you gave me … I know we did a good job for our colleagues and those who will be the future CNLs that will walk down the hill to their cars tired but so secure that they made such a difference to their staff and their patients. To our group rest now and know you all were magnificent. I did not have the answers but gloriously and proudly we had the answers.

Post Script

The professional development proposal, which included preparation and ongoing professional support plus an intranet site and senior nurse lounge was presented, as an agenda item at Operations Managers’ forums; nursing directorate and senior nurse forums (see Appendix 7). All supported the professional development concept. This concept was electronically circulated to the CNL group with an invitation attached to meet with me if they wished to use the model. Four CNLs responded to the invitation. Three existing CNLs drew up a learning development plan for themselves and one further CNL discussed how ongoing work with the nursing team may be facilitated.

The intranet site has been established, entitled CNM Network, with photos and profiles of CNLs included. This is to be extended to other areas outside of the larger hospital. This project is well supported by the information technology and communication experts in the

DHB with future plans for it to be an interactive site. The proposal for the establishment of a Senior Nurse Lounge was first sent to the Chief Operating Officer then the Director of Nursing plus the nursing directorate. Following this, it was presented to the campus redevelopment committee who indicated their support and commitment to include senior nurses in their campus allocation of senior staff lounges for 2009. Lastly, the title of Clinical Nurse Leader was changed to Clinical Nurse Manager as of February 2007 following a national project that looked at senior nurse titles within district health boards in New Zealand.

APPENDICES