Assuming the mantle of leadership: issues and challenges for directors of nursing

Abstract

This ethnographic study investigated leadership from the perspective of directors of nursing (DONs) in proprietary nursing homes. Data from interviews and extensive participant observation with 10 DONs were analyzed using open coding and content analysis. The study drew on a priori concepts from transformational leadership theory to describe the role, DON approaches to leadership, and factors that facilitate or impede leadership in nursing homes. This article reports findings from a larger study related to conditions existing when participants entered the DON position. Antecedent conditions influenced organizational expectations of incoming DONs and shaped participants' leadership experiences. DONs filling long-standing vacancies had to reestablish the influence and authority of the role. Those replacing unsuccessful DONs confronted serious regulatory, care, and morale issues. In contrast, DONs with successful predecessors experienced organizational support and had confidence in their abilities to lead.