Responding to the opportunities : a grounded theory of clinical nurse leadership learning

Background: Currently there is limited information available on how to support leadership learning in the clinical setting. Many of the cultural issues associated with organisational systems failure are believed to be associated with a lack of clinical leadership development and this is a current problem for health services. There is emerging evidence that most of this learning occurs within practice. However, how this social process exactly takes places within the nursing profession is not entirely clear. Maximising opportunities in practice to learn to lead successfully are dependent on making the processes of leadership learning visible. Aim: To identify and describe leadership learning in practice and the processes influencing such learning, in a group of Clinical Nurse Leaders (CNL) from a variety of clinical backgrounds. Methods: A constructivist grounded theory approach has been used in this study. Semi-structured interviews with CNLs enabled the collection of in-depth data of leadership learning in practice. Through an analytic process of coding, constant comparison, memo writing and conceptualisation, a theory of responding to the opportunities has been generated. This substantive grounded theory has been developed from co-constructed meanings and understandings of participants' experiences. Findings: This research has revealed the ways in which learning from practice is important to clinical nursing leadership development, and has determined how and why this is the case. Learning occurs by engaging with different experiences as they arise. These experiences are called opportunities and they present themselves in the work milieu and have been identified as: recognising the impact of significant others, optimising staff relationships and integrating formal information. These opportunities can be responded to in three different ways. These responses can differ for the individual CNL with each opportunity presented. How CNLs respond depends on the enablers and disablers. These are identified as: having credibility in the speciality, perceptions of autonomy, bringing in the persona and living values and beliefs. From this study there are three responses identified: knowing it already, blending in and activating. The critical method of learning is activating, as it leads to transforming conscious behaviours that is a four stage process: reflecting, discovering, deciding and choosing (RDDC). Reflecting leads to the discovery of behaviours, followed by deciding whether or not to work on those behaviours. A choice is made to use newly learned or altered behaviours and a change occurs, the core of leadership development. This change entails a redirection of the way CNLs engaged with their world. Progressing through the process CNLs move from one level of self-awareness to an increased level of self-awareness. Conclusion: From this study it has become apparent that learning to lead occurs in practice by responding to learning opportunities. This learning involves a complex social process influenced by variables such as enablers and disablers. The findings and generated theory add to the body of knowledge of clinical leadership learning. Efforts to support CNLs in their learning journey need to be aimed at increasing self- awareness through involving them in the transforming conscious behaviours process.