Supervision and Leadership in
Advanced Nursing Practice
two of the core elements of
advanced practice are the ability to challenge professional boundaries and to pioneer
innovations. Inherent in both these abilities is the concept of leadership that, in the
context of modern healthcare, requires the advanced practitioner to analyse complex
situations and functions, create new possibilities and to communicate these to others
as
both desirable and achievable. Leadership is, therefore, contingent upon a high level
of
interpersonal competence that enables others not only to understand what the leader
intends but also to feelmotivated to share in making that intention a reality. Leaders,
by
definition, have followers. They also, through education and experience, have the
,professional maturity needed to challenge the status quo and to try something new
.even if this means taking a chance on something that may or may not succeed
-begins by examining theoretical ideas about leadership, and in parti5
,cular, four sub-elements defined by Yates (1999) as `the four Es': envisioning
enabling, empowering and energising. Each of these is discussed and related to
contextual issues such as the organisational setting and the qualities required by the
leader. Styles of leadership are then addressed with particular reference to democratic
-and transformational approaches that facilitate followers to actively participate as co
owners of the vision and thus to demonstrate commitment to it. In the second part of
,the chapter the emphasis is on the practical dimensions of leadership in healthcare
with an overview of initiatives, such as the introduction of the Leadership Centre by
the NHS Modernisation Agency, which have been used in the NHS to identify
potential leaders and help those individuals to develop their skills. Leadership
-initiatives aimed specifically at nurses, such as the Leading Empowered Organisa
tions programme, are also discussed. The next part of the chapter addresses issues that
,are related to leadership. These include differentiating leadership from management
,and identifying the support that leaders need if they are to achieve their aims. Finally
the chapter presents a discussion of the ways in which advanced practitioners can
provide clinical and professional leadership both within their own local sphere of
.influence and in the national arena
Characteristics of leadership
Yates (1999), and others such as Adair (1984), Armstrong (1994), O'Connor (1994)
and
Cole (1997), argue that leadership is mostly about understanding people, especially
-about getting them working together, and about listening and making real connec
,tions with them. It also depends on having a unique vision, making strategic choices
'designing and enabling an organisation to get the job done. Yates identified `four Es
:of leadership
.Envisioning: creating a vision and developing a plan to achieve it .
Enabling: choosing the right people with the necessary skills to get the job done and .
.rewarding them for it
Empowering: people to achieve the vision in a two-way contract between the leader .
,and the followers in which successes, failures, rewards and sanctions are defined
.and both are held mutually accountable
Energising: people to act by expressing the vision, often in a charismatic way, as a .
.story that builds up understanding and motivates the followers into action
Envisioning and energising
The vision is the essential component that provides a common purpose that inspires
-the team to act. Handy (1991) argues that the vision has a number of key character
istics. First, it must be new, something different. If it is merely a duplicate of the
present or is a replica of what someone else is doing, it is not a vision. Second, the
vision must make sense to others, capture people's imagination but still be in the
bounds of possibility. Third, it must be understandable and stick in people's minds so
that they remember it. Fourth, the leader must live the vision, show that they believe
in it, but, finally, remember that achieving it is the work of others ± followers ±
without
whom it will remain a dream. Vision, therefore, has a practical component in terms of
.planning and setting goals
Enabling and empowering
Leaders have followers. The aim of the leader is to develop a team of followers that
.bonds and works collaboratively and willingly towards the achievement of the vision
This can occur within a small multidisciplinary team, community, ward, department
'or an entire organisation. Covey (1992) describes this as achieving `interdependence
which is characterised by a feeling of `we can do it, we can cooperate, we can
combine
,our talents and abilities and create something greater together'. Interdependence
therefore, is a concept that leaders should aim to create in the team, as it will
.accomplish far more than each member could achieve alone
Interdependence, however, does not happen without effort and commitment, and
the leader has to create positive relationships and mutual respect with and between
group members. Leaders should aim to achieve a balance between the needs of
individuals and the work to be done by them. This requires finding the time to listen
to
team members in order to begin to understand what motivates them, identifying what
-will make the job sufficiently challenging to give them a sense of personal achieve
ment, what values they have and what rewards are important to them. If leaders
understand the frustration, limitations and drivers of their team members then they
are better able to provide the necessary support. Enabling is thus a way of breaking
.down barriers and addressing concerns proactively
Team members also need to know what is expected of them, what are the objectives
and standards they should work to, what is their authority for making decisions and
what degree of control will be exercised over them. Communication is a key element
in clarifying these issues and developing a team spirit. O'Connor (1994) identifies five
:features necessary for effective communication. It should be
Goal-directed .
Coherent ± consistent, clear and logical .
Appropriate to the situation .
Controlled .
Able to be learned ± coaching and paraphrasing can create understanding .
Opportunities for team members to seek clarification, guidance and receive feedback
-are essential. One-to-one discussions, team meetings, informal chats, written infor
mation and many other kinds of interaction may achieve this. Internal and external
networking is also useful in obtaining support, seeking new ideas and widening
.horizons