Barriers encountered by Senior nursing leadership lack of autonomy

What is it about?

A study of senior nursing leadership (Directors of Nursing) in New Zealand public hospitals undertaken between 2009 and 2011 indicated that there is a lack of autonomy and power to make decisions at the executive decision making table. Contributing factors were found as (1) the perceptions of the role by the Senior Executive Management as an advisory position rather than having an active and overt influencing voice, and (2) the overall lack of control Directors of Nursing had over the nursing budget. The study found that nurses in public hospitals are reporting in a dual accountability system where they are reporting professionally to the Director of Nursing and operationally to the Service Manager who is not employed in the capacity of a nursing staff member. This reporting structure removes power and autonomy from the Director of Nursing and creates a blurred line of accountability for nursing staff. Both of these factors contribute to a lack of decision making authority by nursing that filters down through all levels of nursing and subsequently impacts on the delivery of patient care.

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Why is it important?

This work is timely as healthcare sectors are undergoing constant and rapid change and there is a need to understand and adapt in the face of change. The study is important as it highlights not only a nursing legacy that underpins the perceptions of nursing but how the lack of power and autonomy influences the ability nursing has to provide nursing care. The current global need to find efficiencies in the delivery of healthcare with a growing and aging demographic, in combination with a growing consumer trend has placed pressure on nursing to provide individualized care within a budget. What is not clear is how that can be achieved. The Magnet forces in the United States accreditation system offer solutions to achieving effective and efficient quality care but require nurses to have power and autonomy to do so. Nurses working in publicly funded healthcare systems are subject to a different set of economic and political drivers that require Magnet solutions to be adapted.