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Leadership at all levels of primary health care nursing
By Emma Berry and Felicity Black, participants in the APNA Transition to Practice Program
Source: APNA Primary Times Summer 2021 (Volume 21, Issue 2)
APNA’s Transition to Practice Program is helping nurses from all walks of life to become stronger leaders and mentors. Most importantly, the program is increasing the knowledge, skills, and confidence that participants can bring to primary health care nursing.
Regardless of career background, life experience or work setting, nurses are potential leaders at every stage of their career.1,2 As the influx of nurses into primary health care continues, and in the current climate of uncertainty and rapidly changing health care, it is essential that nurses’ leadership skills and attributes are developed and nurtured in the primary-health-care environment.
What is leadership in primary health care nursing?
‘Leadership’ will mean different things for nurses and primary-healthcare teams and can often be mistaken with ‘management’.2 Although there can be overlap between management and leadership, managers’ core roles are often to administer and maintain high-functioning work processes and team members. Leadership for nurses, however, is important for successful practice development and the provision of safe, effective and person-centred care.3,4
Leadership in nursing often overlaps with multiple domains, such as patient care, team and clinical processes, and community leadership. Leadership is also incorporated as part of the Nursing and Midwifery Board standards for practice for nurses (all registration types), where nurses are required to foster environments that will support a culture of safety, learning and engagement for health professionals and patients alike.5
The role of the nurse leader in primary health care is to bring nurses together as a team, guide nurses and ensure the delivery of safe care, maintain evidence-based practices, monitor patients’ care, and ensure that all members of the nursing team work toward optimum quality standards at all times.2,3 Nurse leaders in the primary-health-care setting are in the unique position of leading not only their nurse peers, but, as agents of connectivity, all members of the primary-health-care team. These teams may include doctors, pharmacists, medical assistants, receptionists, and administration staff, all of whom work with nurses daily and who will at times look to nursing leaders for guidance and advice.
Examples of strong nurse leadership in primary health care may involve:
- development of policies and procedures
- quality-improvement activities in the workplace (i.e., seeking ways to improve processes for better clinical or workplace outcomes)
- patient advocacy
- participation in local or national projects/programs/research to advance health care in Australia (and beyond).
"Good clinical leaders tend to be approachable and open, optimisitc, passionate, consistent, visible in practice and positive role models."
What does good leadership look like?
A good leader needs to be adaptable, resourceful, trustworthy and able to identify individuals’ specific needs and motivations. Effective clinical leaders can contribute to creating a healthy, functional, and supportive work environment.
‘Clinical leaders are experts in their field, effective communicators, empowered decision makers, clinically knowledgeable and competent, provide a vision, support others, provide guidance to patients and their families, and drive change by providing high-quality care.’2
‘Nurse leaders have a passion and vision for their nursing work and a commitment to excellence. They also showcase qualities such as courage, integrity, empathy and an ability to inspire and develop others.’8
Leadership in nursing (and arguably health care as a whole) is not simply a job title or qualification but encompasses multiple characteristics. A graduate nurse may become a nurse leader through contribution to quality-improvement activities, while an experienced nurse may lead through mentorship. Good leadership should exemplify what it means to provide professional and high-quality person-centred care, to improve patient and population outcomes and ideally contribute to the professional and personal development of others.
Experience of Emma and Felicity as local leaders
Nurse leaders need to be knowledgeable and well-equipped. They must promote the best available care and act as liaisons and advocates.6 Over the last 7 years, Emma has been an advocate for her mother, who has early-onset dementia. Emma coordinates a care team to allow her mother to remain living at home and she is now also helping others in similar circumstances navigate dementiacare needs. As an advocate for her mother’s care, Emma is making the most of her nurse leadership skills.
Since moving to Tasmania, Felicity has become very involved in the local community. She is a volunteer firefighter, an assistant supervisor at her local community shed and has joined the local progress association committee. The leadership skills she has developed throughout her nursing career have been crucial in enabling her to competently fill all these roles. She has found that in most situations, effective collaboration is needed to achieve a shared goal. Containing a fire, making a toolbox, and holding a community picnic all require good leadership.
Health-care leadership skills transfer easily across to other settings. Communication skills are utilised in every aspect of life. In the community, like nursing, a leader does not have to be the manager, captain or chief.2 Leaders can be found in every walk of life, any position or role, and every field.9 Anyone can be a great leader, they just have to display the relevant attributes and set a good example for others. In fact, both Emma and Felicity have seen new and relatively junior staff show great leadership skills in the nursing space.
"Emma and Felicity have seen new and relatively junior staff show great leadership skills in the nursing space."
Leadership in the current health setting
As the health-care sector continues to deal with the COVID-19 pandemic’s ever-changing challenges, effective leadership is more important than ever.10 Primary health care is central to Australia’s national and local responses to COVID-19 and there is potential for the overall primary-care workforce to become overwhelmed.11,12 Primary health care nurses have an important role in providing preventative health care as well as continuity of care for patients with acute, chronic illness during and beyond the pandemic. It is essential that we support one another to not only meet the needs of our patients, but also maintain an effective nursing workforce for the future. Supporting our existing colleagues and those new to the area by promoting self-care practices, optimal work–life balance and participating in social activities and team-building exercises is a great way to demonstrate leadership in the nursing team.
Nurse leaders are integral to the health-care system and strong leadership is essential to the everyday running of health-care environments. The primary-health-care setting is no exception. Nurses can influence all primary-health-care staff to ensure that patients are given the best and safest care possible. Good leaders can come from every level and do not have to be managers. They can guide, influence and motivate others to follow them on the path to success. Leadership skills developed in nursing are not only useful in the health-care setting, but in all areas of life.
The Transition to Practice Program has been funded by the Australian Government Department of Health.
1. E Dean, ‘Nursing leadership: which type is right for you?’, Nurs Manage, 2021, 28(2):14–17, doi:10.7748/nm.28.2.14.s11.
2. University of New Mexico, ‘Importance of leadership in nursing’, University of New Mexico website, 4 December2018, accessed 1 September 2021. https://rnbsnonline.unm. edu
3. RN Dossary, ‘Leadership in nursing’, in A Alvinius (ed), Contemporary leadership challenges, IntechOpen, 2017, doi:10.5772/65308.
4. V Hughes, ‘Standout nurse leaders… What’s in the research?’, Nurs Manage, 2017, 48(9):16–24, doi:10.1097/01. NUMA.0000522171.08016.29.
5. Nursing and Midwifery Board of Australia, ‘Professional standards’, 2021, accessed 8 September 2021. https://www. nursingmidwiferyboard.gov.au
6. R Taylor and S Martindale, ‘Clinical leadership in primary care’, Prim Health Care, 2013, 23(5):32–38. doi:10.7748/ phc2013.06.23.5.32.e795.
7. D Stanley, D Blanchard, A Hohol, M Hutton, A McDonald and A Lee. ‘Health professionals’ perceptions of clinical leadership: a pilot study’, Cogent Med, 2017, 4(1), doi:10.1080/2331205X.2017.1321193.
8. K Keast, ‘How to become a nurse leader’, HealthTimes, 23 February 2016, accessed 1 September 2021. https://healthtimes.com.au
9. T Valiga, ‘Leaders, managers, and followers: working in harmony’, Nursing, 2019, 49(1):45–48. doi:10.1097/01. NURSE.0000549723.07316.0b.
10. J Daly, D Jackson, R Anders and PM Davidson. ‘Who speaks for nursing? COVID-19 highlighting gaps in leadership’, J Clin Nurs, 2020, 29(15-16):2751–2752, doi:10.1111/jocn.15305.
11. M Kidd. ‘Australia’s primary care COVID-19 response’, Aust J Gen Pract, 2020, 49, doi:10.31128/AJGP-COVID-02.
12. C Ashley, S James, A Williams et al. ‘The psychological well-being of primary healthcare nurses during COVID-19: a qualitative study’, J Adv Nurs, 2021, 77(9):3820–3828, doi:10.1111/jan.14937
About the authors
Emma Berry’s nursing career includes 11 years in the hospital sector and nearly 10 years in general practice. On moving to general practice, Emma became aware that the working environment provided little support for nurses, who needed a wealth of knowledge and experience to work autonomously with a range of patient populations. After a very brief time working in general practice, Emma was promoted to a nurse manager position. She also completed postgraduate study in the area and is currently acting as a mentor in the APNA Transition to Practice Program. This experience is helping strengthen Emma’s leadership skills, which she can implement both professionally and outside her nursing networks.
Felicity Black completed her undergraduate nursing studies in England, followed by 2 years working in a National Health Service hospital before returning to Australia.
During 12 years in a private emergency department in Melbourne, culminating in the role of Nurse Unit manager, she learned the importance of sound and effective leadership in nursing. Felicity recently moved to Tasmania, where she has been working in general practice for the last 6 months. Although many of her acute nursing skills have transferred easily across to practice nursing, there has been an enormous amount to learn, and Felicity has benefitted tremendously from participating in the current APNA Transition to Practice Program