What Would Florence Think Of Nursing Now?

What would Florence think of Nursing now?  This is the topic for May #NurseBloggers2020 written as part of 2020 The International Year of the Nurse and Midwife.

#NurseBloggers2020 May Topic

Many people associate Florence Nightingale with the “lady with the lamp” a title that was bestowed on Florence as she walked through the hospital halls and wards checking on patients during the Crimean war. A lesser well-known title that was bestowed on Florence was “the lady of the hammer”. 

Florence earned this title through her tenacity in occasionally breaking into storerooms to obtain medical supplies for the hospital patients. The Army Generals gave her the nickname of “lady of the hammer”. Florence became known and respected for her perseverance, teaching, writing, persuading and arguing along with a no-nonsense but caring approach to patient care. The literature also cites her amazing capacity for work, along with her determination and her understanding of statistics.

There is no doubt that Florence’s thinking and approaches were way ahead of the times but what would she think of nursing today and what can be learnt from Florence that applies to modern-day nursing?

Florence and modern-day nursing

I think that Florence would be very proud of the modern-day nursing profession, with the extended scope of practice for nurse specialists and advanced nurse roles. The ability for nurses to be prescribers and to participate in nurse-led research, understanding the importance of data collection to demonstrate nursing outcomes in relation to patient care.  I think  Florence would also be proud of the collaboration with medical and allied health team members and the multi-disciplinary approach to patient care.

2020 The International Year of the Nurse and Midwife

This is an important year for Nursing globally, never has there been such as a focus on nursing and the contribution that nursing is making during this pandemic.

The World Health Organisation published the “State of the World’s Nursing 2020: Investing in education, jobs and leadership” report; in April this year.

This is perhaps where Florence might frown and wonder why it has taken so long for nurses to be given opportunities to have; “influential roles in health policy formulation and decision making that contribute to the effectiveness of health and social care systems”.

The State of the World’s Nursing 2020 report identifies that 90% of the nursing workforce is female, with only 25% of leadership positions in health globally being held by women. A statistic that I don’t think Florence would approve of somehow.

The WHO report calls for leadership programs to be in place or organised to nurture leadership development in young nurses. My previous blog posts for #NurseBloggers2020 have looked at some of the larger issues coming over the hill for the nursing profession. Particularly around recruitment and retention, promoting psychological safety and different modalities that need to be explored to support some of these changes. Out of all the challenges identified so far, I think that leadership opportunities for nurses presents as the largest.

Challenges for aspiring nurse leaders

For many clinical nurses, the decision to take up a management or leadership position presents as a dilemma. The dilemma is to leave the patient bedside or not. I know from personal experience this was something that I wrestled with in my career decisions. The very reason that many nurses go into nursing is to care for patients. To make a decision that can appear to take you further away from the bedside is a challenge most nurses face at some point in their career. The decision to pursue a nursing leadership position depends on several factors; 

  • how many positive role models you have worked with as a nurse that inspires you to want to be a leader
  • Access to leadership training and development opportunities early in your career
  • Childcare arrangements and flexible working patterns to facilitate involvement in leadership development programs
  • Access to mentorship and coaching to support your personal development
  • There is also the issue of pay for nurse leadership roles as clinical shift work can in some parts of the world pay more than a leadership role and acts as a disincentive for some nurses.

Leadership opportunities

Throughout my nursing career, I have actively sought opportunities that have helped me to develop my leadership skills. I have had some wonderful opportunities in my nursing career for example; a study tour to the Netherlands to understand their approach to managing chronic disease, being accepted for the NHS Nurse Consultant Leadership program for Older people. I held a Professional Executive Committee Nurse Role that was introduced into Primary Care Trusts early in the 2000s. All of these opportunities took me out of my comfort zone and challenged my thinking on so many levels but also provided me with valuable learning about leadership and taught me much about the political nature of health along with how to influence and to be strategic. 

Personal Challenges

There were equally as many personal challenges in developing my leadership skills as a single parent with young children as there were benefits. Would I go back and change anything? Absolutely not.

I would, however, advocate that more needs to be done to support nurses earlier in their careers to have access to leadership development that will allow them to progress their careers as nurse leaders. My point in sharing my personal experiences is to highlight that much more still needs to be done around equality, the flexibility of working hours and access and resourcing of leadership opportunities for nurses if we are to see more leadership positions in health globally held by women. 

Mentorship

The mentors that I have had throughout my nursing career have been invaluable. To have access to a nurse in a more senior nursing position to talk through challenges and guide me to see and learn things about myself when I couldn’t see the wood for the trees helped me to stay on the leadership track. I learnt that whilst I didn’t necessarily have committee experience at an executive level I did have valuable clinical experience that I could bring to the table making sure that the voice of the patient was never left out of the debates. Mentorship helped me to realise that I could make a difference to patient care through developing leadership skills in younger nurses when I was no longer providing care at the bedside. It still surprises me how many senior nurses don’t seek out mentorship as part of their development.

The State of the World’s Nursing 2020 Report 

The State of The World’s Nursing 2020 report calls for Nurse leadership to be developed at country, regional and global level and identifies that nurses should be considered on a par with other health professions for appointment to leadership positions. The question remains as to how we grow nurse leaders of the future that are equipped with the right knowledge, skills and experience that will be required if this goal is to be achieved. The traditional approaches will no longer serve us as nurse leaders in future decades. Different ways of thinking and more funding to access experiential leadership opportunities are needed not just in health but beyond.

Collaboration

There is much that can be achieved through collaborative leadership development through shared learning opportunities, practice placements, secondments; learning from the best who are out at the forefront of leadership either in healthcare or the corporate world. Economically there is much to be gained through shared resources and learning. 

Leadership approaches for nurses do not need to be confined to specific programs for nurses but need to offer leadership opportunities that allow for different perspectives and approaches to learn together as multidisciplinary teams both from inside and outside of health. There is much to be gained from a multidisciplinary multi-agency approach to leadership development.

Character Strengths

Let’s go back to Florence’s character strengths for a moment. I think if Florence was to present at a conference today she would argue that nurses have the power to influence and be the modern nurse leaders that are required for today’s challenging health care environment.  That they don’t need permission to do this; they don’t need to take no for an answer and do need to find ways to influence those who are the key decision-makers. Too often the patient’s voice is missing from the boardroom discussions; this is where nurse leaders’ strengths lie in advocating and articulating for patient care.

Perseverance and Tenacity

As a nurse leader perseverance and tenacity are two qualities that are still very relevant in today’s modern health care environment.  Perseverance and tenacity are closely linked to passion and drive.  The more passionate you are about something the more you persevere and the more tenacious you are particularly when it comes to patient care. Nurses in leadership positions need to be able to articulate why something needs to change and must always be able to relate that change back to the impact that the change will have on patient care and support their argument with data.

Arguing

I am not advocating that nurses should argue, however knowing how to have a difficult conversation and having the skills to influence and present ideas and using data to support those ideas are important in modern-day nursing. Nurse leaders need to be able to hold a strategic conversation and know which battles to pick and which to let go. Understanding the politics of health and healthcare is another valuable skill to have.

The final words go to Florence as I think that there is so much that still resonates in her words today as they did when she was alive;

I think that one’s feelings waste themselves in words; they ought to be distilled into actions which bring results”

Call to action

What actions and results does the nursing profession need to take to drive and sustain progress towards increasing leadership opportunities to 2030 and beyond? 

What actions will individual nurses take to lobby and influence if as the WHO report suggests that we need to commit to a decade of action for investment in nursing education, jobs and leadership?

Time to reflect on both of these actions…

Eva Storey is a nurse and a resilience coach working with Nurses supporting their work-life balance.

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