Structural positioning of nurse leaders and empowerment

Aims and Objectives To analyse the reporting structures of nursing leaders of publicly funded hospitals and seek both the views of nurse leaders and Chief Executive Officers/Chief Operating Officers on the structural positioning of nurse leaders in the organisation. Background Concern that the continuing restructuring within hospital structures and focus on economic outputs in health services is diminishing the value of nursing leadership. Design Qualitative surveys with Nursing leaders and Chief Executive Officers of public hospitals. Methods Seventeen Directors of Nursing and 10 Chief Executive Officer/Chief Operating Officers’ responses were received using two semi‐structured questionnaires. Themes were developed from data coded and analysed by hand. Results Four broad themes emerged from analysis of the data: (1) variable positional reporting between Director of Nursing and Chief Executive Officers occurred; (2) variable levels of inclusion and influence at the executive decision‐making level; (3) ambiguous financial responsibilities and accountabilities held by Director of Nursing; and (4) blurred lines existed between operational and professional reporting lines. Findings unique to the research indicate that the varying levels of visibility and inclusion impact on the structural positioning of nurse leaders which influences authority and empowerment. Conclusion Responses from the data analysis indicate that the structural power of nurse leaders defined by the factors of opportunity, power and proportion were hindered by dual accountability reporting lines and a lack of financial control. Relevance to clinical practice The structural positioning of nurse leaders is vital to ensure that they are empowered and able to meet the adaptations required in a changing environment that supports the delivery of effective, quality healthcare.