Boundary matters: Clinical leadership and the distinctive disciplinary contribution of nursing to multidisciplinary care

Aims.  To describe Irish nurses’ views of clinical leadership and to describe their clinical leadership development needs.

Background.  Nurses are often unclear about the precise nature of clinical leadership and its impact on the processes and outcomes of care and little is known about their self-perceived clinical leadership development needs.

Design.  Seventeen focus group interviews were conducted with a purposive sample of 144 nurses from 13 practice settings. A conceptual lens was provided by the work of Bernstein and Young who emphasise the epistemological, practical and relational significance of boundaries and how they relate in fundamental ways to professionals’ sense of their distinctive disciplinary identities and membership of specialised communities of practice.

Methods.  Focus group data were collected using semi-structured topic guides. Analysis was facilitated by NVivo 7© and interpretation was informed by a conceptual framework arising from the interplay of emerging themes and the literature review.

Results.  The implications for clinical leadership development of two critical concepts, ‘representing nursing’ and ‘compensatory action’, are discussed in detail.

Conclusions.  Clinical leadership development should emphasise the development of all nurses as clinical leaders in the context of the delineation, clarification and articulation of their distinctive contribution in multidisciplinary care settings.

Relevance to clinical practice.  Clinical leaders are recognised as practice experts and as leaders in their particular fields. Recognition and influence in and beyond the immediate context of care depends greatly on their ability to articulate the distinct nursing contribution to patient care. This ability provides an essential resource to resist the ongoing blurring, effacement and dilution of nurses’ roles.