Original article
Nurses’ perceptions of leadership in an adult intensive care unit: A phenomenology study

https://doi.org/10.1016/j.iccn.2008.11.003Get rights and content

Summary

The purpose of this research was to explore ICU nurses’ perceptions of nursing leadership in the adult intensive care unit (ICU). The nursing profession needs leaders at all levels; ward, administration and executive and in an era in which there is a shortage of ICU nurses, nursing leadership is important, as positive leadership skills correlate with enhanced recruitment and retention of these specialist nurses. Six ICU nurses with at least 5 years experience in ICU nursing were recruited from a metropolitan hospital in Australia. Qualitative phenomenological methodology was used to depict the lived experiences of nurses’ leadership in the adult ICU. Data were collected through individual semi-structured interviews using open-ended questions and analysed using Giorgi's [Giorgi A. Toward phenomenologically based research in psychology. J Phenomenol Psychol 1970;1:75–98] descriptive method for data analysis. Five themes emerged and these were all inter-related: leading by example, communication, ability to think outside the management square, knowing your staff and stepping up in times of crisis. These findings highlight the importance of nursing leadership in the adult ICU and the need to ensure that all current and future nursing ICU leaders are adequately prepared and educated for this role. This information may also be used to assist in the development of leadership skills in ICU nurses.

Introduction

In the 21st century, healthcare organisations face many challenges, including increasing costs and demand on services, and new technology. This has resulted in the healthcare environment being one of complexity and change (Huber, 2006). Restructuring continues to occur in an attempt to reduce the economic burden. Furthermore, social and demographic changes have seen healthcare organisations recognise the importance of the role that nurses, the largest group of healthcare professionals, have as both leader and manager within these organisations (Daly et al., 2004, Huber, 2006, Yoder-Wise, 2003). Demand on intensive care unit (ICU) services and the requirements for ICU nurses are expected to increase in future with population growth and ageing. The AHWAC (2002) estimated a shortfall of 537 intensive care nurses in Australia in 2002. This is attributable to an ageing workforce, a reduction in hours worked per week, and lack of replacement of retiring nurses by younger nurses. In the past, younger nurses have been attracted to working in the ICU, for reasons such as the challenge and excitement of working in this demanding area. However, as the number of people entering nursing continues to decline and the nursing workforce continues to age, the number of younger nurses is diminishing, which is a contributing factor to the shortage of ICU nurses (Buerhaus et al., 2000, Cortes, 2004).

Conway and McMillan (2002) explored issues related to workplace culture of the Australian ICU. The major issues were an increase in workplace tension, a decrease in job satisfaction and that ICU nurse educators had a responsibility to undertake a leadership role in the ICU in order to address these issues. Tourangeau (2003) states that in the 21st century, we are seeing fewer nurse leader role models within healthcare organisations and that “the pool of current and future nurse leaders is diminishing” (Tourangeau, 2003, p. 624). Effective nurse leadership is linked to having access to opportunity, resources, and information. Nurse leaders with access to these structures are empowered and successful, which leads to healthcare organisations having greater overall achievement and improved retention of nurses (Upenieks, 2002).

The ICU nursing shortage is two fold, not only is attracting nurses to work in the ICU problematic, but the high turnover of ICU nurses is a major concern. Future demand on ICU services and the requirements for ICU nurses is expected to increase with population growth and ageing (AHWAC, 2002). The health care demands of the rapidly ageing workforce will impact on nurse recruitment and retention, a “crucial challenge” for all nursing administrators and leaders (Jackson and Daly, 2004, p. 352).

Currently in Australia, there is a paucity of research investigating nursing leadership in the adult ICU, from a nursing perspective. The government report by Heath (2002) identified effective nursing leadership as a long-term solution to the current recruitment and retention problems facing the profession. Other research supports the view that leadership is an important characteristic of the ICU nurse unit manager in the promotion of nurse recruitment and retention (Anthony et al., 2005, Boyle et al., 1999).

The phenomenon of leadership, as experienced by the nurses, was extracted from their perceptions to create understanding and meaning. The principal research question that guided this study was: What is the meaning of the phenomenon of leadership as experienced by ICU nurses in the adult ICU? For the purpose of this research, leadership was defined as the “use of personal traits and personal power to constructively and ethically influence patients, families and others toward an end point vision or goal” (Yoder-Wise, 2003, p. 2).

Section snippets

Method

Phenomenology, a qualitative research method was used for the study. Phenomenology is concerned with the lived experience of individuals and aims to disclose and explore the meaning of the experience (Burns and Grove, 2001, Streubert and Carpenter, 1999). This research method can be both descriptive and interpretive. Giorgi's (1970) descriptive approach was adopted for this study as it describes the participant experience in their own words, that is, to gain insight into meaning that people

Findings

“Leadership to me is good communication, leading by example, be consistent and stand by your decisions, [and] be positive.” (P5)

This narrative reflects one participant's perception of leadership in the adult ICU, a view shared by the other participants in this study. Four of the identified themes in this study–Leading by example, communication, ability to think outside the management square, and knowing your staff were consistent with the literature and are inter-related. Yoder-Wise (2003)

Conclusion

This study has explored six ICU nurses’ perceptions of leadership in the adult ICU. It is important to have an understanding of nurses’ perceptions of their workplace, especially on how they lead or how they are being led. Effective leadership has been associated with successful recruitment and retention of nurses (Cameron et al., 2004). In addition, Jackson and Daly (2004) cite the recruitment and retention of nurses, in Australia, as a crucial challenge given the ever increasing ageing

Acknowledgements

I would like to thank the nurses in this study who gave up their time to participate. Without them, this study would not have been possible. They each showed an enthusiasm for the study and graciously allowed the interview process to occur at their earliest convenience.

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