Paradigms of Canadian nurse managers: lenses for viewing leadership and management.

To an extent unprecedented in history, healthcare is a complex and human enterprise. Generating the complexity are stakeholders with more diverse perspectives, needs, and agendas, and greater knowledge and vested interest than ever before. Given their pivotal position between the direct-care environment and external stakeholders, nurse managers can no longer rely on the hierarchy, authority, and linear thinking afforded by traditional management; in order to accomplish they must lead people by working through them. Ironically, when needed most, there is a lack of consensus in the literature about what leadership is. In this paper I describe the paradigms for leadership and management held by six Canadian nurse managers who participated in a phenomenological study of leadership. Thinking leaders worked through people to enhance their growth, potential, and accomplishment, participants did so by creating and sustaining inclusive environments, influencing people, and acting in a manner that reflected and supported integrity. Participants thought managers did not focus on people; instead, they carried out routine, procedure-driven tasks to run departmental business. Included in this paper are suggestions about how participants' paradigms might benefit the nursing profession, consumers of care, and healthcare organizations. Although organizations are markedly interested in the development of managers and leaders as decision makers behind accomplishment (Beyers, 1991), managed or pushed organizations will fall behind those that are "led and stretched" (Batten, 1989, p. 3). According to Bennis and Nanus (1985), whereas managers are concerned about efficiency as it relates to set routines, leaders try to be effective by doing what is right. These authors also posited that although management alone may have sufficed in our more predictable past, today's intricate world is not well served by management's linear thinking; its lack of attention to people's diversity; and its dangerous assumptions that problems, goals, alternatives, and consequences are always clear, known, and/or certain, and that necessary information is always on hand and reliable. Perhaps to an extent unprecedented in history healthcare is a human enterprise. Within its dynamic context myriad stakeholders with increasingly diverse perspectives, needs, and agendas, and growing levels of knowledge and vested interest, are involved in unpredictable and uniquely complex situations with uncertain outcomes. These factors orchestrate the intangible mist that healthcare organizations must contend with today. These factors also render traditional how-to manuals obsolete and suggest, instead, that contemporary decision makers in healthcare must be leaders who are comfortable with ambiguity, deftly sensitive and responsive to complexity, and continually looking for ways to work with people to enhance organizational success. Ironically, when we need it most, leadership retains its enigmatic and complex nature (Beyers, 1991); perhaps that is why management is the prevalent practice in organizations (Bennis & Nanus, 1985). Results of one project identified insufficient nursing leadership as a major cause of dissatisfaction among registered nurses (Registered Nurses Association of British Columbia (RNABC), 1989). Hence, our need to grapple with the elusive nature of leadership. In this paper I share the paradigms for leadership and management held by six Canadian nurse managers, and suggest how their paradigms might benefit the nursing profession, and healthcare consumers and organizations.