Traditionally, the role of leadership among nurses was assumed by nursing executives. The nurse executives used to come from high social class and not the bedside nurses. There was a predetermined criterion for selecting nurse executives and key in the criteria were education qualification, the social status, he /she was to be accepted by the dominant and upper class and had to particularly be among those working in the health services in the capacity of doctors and administrators (Wolper, 2010). It was earlier observed that leadership belonged to those in the health institution management but the nurses developed their own theory of hospital management. Just like other executives in the corporate world, nurse executives have turned out to be males and this phenomenon has made it to be labelled as partial men positions. Like any other managerial position, nurse executives face numerous challenges which are explained below.
The first challenge is the gap between the management and the service: the management experiences problems posed by the division between the nurses at the bedside and the nurse executive. This is a largely due to the traditional pervasive culture associated with the nurses at the bedside. Due to his/her responsibilities and his/her position, the nurse executive is symbolically and functionally delinked from the nurses at the bedside since he/she is not bound to handle patients. This act has been interpreted by the nurses at the bedside to label them as irrelevant and nonessential. This hampers smooth management in hospitals due to this weak relationship. Restructuring of the health services as witnessed in the UK eliminated the nurses from the role of making decisions. This rendered the nurse executives powerless and ineffective. These actions results in the marginalization of the nurse executives in terms of workforce, management, and education requirements since there are nurses at bedside who may have qualifications higher than the nurse executive.
Nurse executives also face the challenge of resocialization. The mental set that nurse executives are supposed to be men has served to widen the separation gap between the nurse executives and the nurses at the bedside who perceive nurse executives as elitist.
Consequently, there is the challenge of leadership and management which are considered two discrete factors. Leadership in nursing is always the function of the management which has often been over managed and under led which subjects it to the vulnerability of managerialism. Lack of leadership in nursing has created the notion that nurses are inadvertently bystanders. The exclusion of nurses from the decisions making despite their numbers has posed challenges to the powers of the nurse executives. There have been difficulties associated with the distinction between leadership and management particularly among the nurse executives; this is due to the fact that nurses are well versed with managerialism framework and not leadership modes.
Institutional perceptions: the nurses executive have been perceived as the agents of administration and not the executive of the organization, this tag has threatened their reputation in the health institutions hence eroding their relevance in the organization which makes it difficult for them to render their duties effectively. The leadership of nurse executives has been doubted since there is no management role that is developed along the line of nursing profession and their leadership attributes are often considered misplaced. Leadership is considered as a management function which is unfit for nurses to hold. This deletes the confidence people have on the nurse executives since they may not be considered legitimately in leadership (Fedoruk & Pincombe, 2000).
Fedoruk, M & Pincombe, J. (2000). The nurse executive: challenges for the 21st century, Journal of Nursing Management, 8(1), 13–20.
Wolper, F.L. (2010). Health care administration: managing organized delivery systems (5th ed). New York, NY: Jones & Bartlett Learning.