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. 2016 Apr 5:9:153-61.
doi: 10.2147/JMDH.S100640. eCollection 2016.

Stuck between a rock and a hard place: the work situation for nurses as leaders in municipal health care

Etty R Nilsen  1 , Anja H Olafsen  1 , Anne Grethe Steinsvåg  2 , Hallgeir Halvari  1 , Ellen K Grov  3
Affiliations

Stuck between a rock and a hard place: the work situation for nurses as leaders in municipal health care

Etty R Nilsen et al. J Multidiscip Healthc. .

Abstract

Background: The paper aims to present how nursing leaders in the municipal health care perceive the interaction with and support from their superiors and peers. The paper further aims to identify the leaders' vulnerability and strength at work in the current situation of shortage of manpower and other resources in the health care sector. This is seen through the lens of self-determination theory.

Methods: Qualitative interviews were conducted with nine nursing leaders in nursing homes and home-care services, which, in part, capture the municipal health care service in a time of reform.

Results: The nursing leaders are highly independent regarding their role as leaders. They act with strength and power in their position as superiors for their own staff, but they lack support and feel left alone by their leader, the municipal health director. The relation between the nursing leaders and their superiors is characterized by controlling structures and lack of autonomy support. As a consequence, the nursing leaders' relations with subordinates and particularly peers, contribute to satisfy their needs for competence and relatedness, and, to some extent, autonomy. However, this cannot substitute for the lack of support from the superior level.

Conclusion: The paper maintains a need to increase the consciousness of the value of horizontal support and interaction with peers and subordinates for the municipal nursing leader. Also, the need for increased focus on "the missing link" upward between the municipal health director and the nursing leader is revealed. The impact of extensive controlling structures and lack of autonomy support from superiors might lead to reduced motivation and well-being.

Keywords: leadership; motivation; municipal health care service; nursing leader.

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Managing performance in a squeeze.
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References

    1. The Norwegian Ministry of Health and Care Services . Meld. St. nr. 47 2008–2009 Samhandlingsreformen [Report to the Storting (White Paper) Coordination reform] Oslo: Norwegian Ministry of Health and Care Services; 2009.
    1. Vabø M. Home care in transition: The complex dynamic of competing drivers of change in Norway. J Health Organ Manag. 2009;23(3):346–358. - PubMed
    1. Deci EL, Ryan RM. Handbook of Self-Determination Research. Rochester: University of Rochester Press; 2002.
    1. McNulty T. Reengineering as knowledge management – A case of change in UK healthcare. Manage Learn. 2002;33(4):439–458.
    1. Lotsberg DØ. Ledelsesteori – hva slags ledere passer i kommunene [Management theory – what type of managers are suitable for the municipalities]? In: Baldersheim H, Rose L, editors. Det kommunale laboratorium Teoretiske perspektiver på lokal politikk og organisering [The municipal laboratory Theoretical perspectives on local politics and organizing] Bergen: Fagbokforlaget; 2000. pp. 137–161. Norwegian.