Setting the agenda for nurse leadership in India: what is missing

Abstract

BackgroundCurrent policy priorities to strengthen the nursing sector in India have focused on increasing the number of nurses in the health system. However, the nursing sector is afflicted by other, significant problems including the low status of nurses in the hierarchy of health care professionals, low salaries, and out-dated systems of professional governance, all affecting nurses’ leadership potential and ability to perform. Stronger nurse leadership has the potential to support the achievement of health system goals, especially for strengthening of primary health care, which has been recognised and addressed in several other country contexts. This research study explores the process of policy agenda-setting for nurse leadership in India, and aims to identify the structural and systemic constraints in setting the agenda for policy reforms on the issue.MethodsOur methods included policy document review and expert interviews. We identified policy reforms proposed by different government appointed committees on issues concerning nurses’ leadership and its progress. Experts’ accounts were used to understand lack of progress in several nursing reform proposals and analysed using deductive thematic analysis for ‘legitimacy’, ‘feasibility’ and ‘support’, in line with Hall’s agenda setting model.ResultsThe absence of quantifiable evidence on the nurse leadership crisis and treatment of nursing reforms as a ‘second class’ issue were found to negatively influence perceptions of the legitimacy of nurse leadership reform. Feasibility is affected by the lack of representation of nurses in key positions and the absence of a nurse-specific institution, which is seen as essential for creating visibility of the issues facing the profession, their processing and planning for policy solutions. Finally, participants noted the lack of strong support from nurses themselves for these policy reforms, which they attributed to social disempowerment, and lack of professional autonomy.ConclusionsThe study emphasises that the nursing empowerment needs institutional reforms to facilitate nurse’s distributed leadership across the health system and to enable their collective advocacy that questions the status quo and the structures that uphold it.

The association of leadership styles and nurses well-being: a cross-sectional study in healthcare settings

“…Varghese et al . [ 35 ] reported that the absence of quantifiable evidence on the nurse leadership crisis and the treatment of nursing reforms as a “second class” issue were found to negatively influence perceptions of the validity of nurse leadership reform. The present investigation confirms that nurses have a poor mental health which can affect patient safety, quality of care, and the profitability of the organizations [ 23 ].…”

Nurse Practitioners – India’s Answer to Addressing Access to Healthcare

“…Additionally, though nurses have exhibited competence in leadership required for strengthening of health care in various other country, lack of opportunities or representation in India causes discouragement. The strong opposition by doctors opposing inclusion of nurses in the Medical Termination of Pregnancy (Amendment) Bill in 2014 reflects the attitude towards the nursing cadre [10,11]. However, evidences across the globe highlight the benefits gained through the advancement of nursing cadre through nurse practitioners degree.…”

Building an initial realist theory of partnering across National Health Service providers

“…This examination of organisational perspectives and theories surrounding the integration of these elements leads to the understanding that different partnering types are likely to interact with some elements more than others ( Figure 6). For example, a partnership synergy theory suggests that certain characteristics are intrinsic to partnerships, namely leadership, administration and management, governance and efficiency; and these elements are similar to the domains of financial and contractual mechanisms, leadership and governance and service and care model design from the framework herein (Lasker et al, 2001). As such, one could argue that partnering interventions largely exerts their forces of change through changes to service and care model design, leadership, governance and financial and contractual mechanisms, and that subsequent changes to IT systems, culture and workforce occur as knock-on effects.…”