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Embracing leadership and autonomy in practice

Cheryll Adams
D(Nurs) MSc BSc(Hons) RN RHV Dip Man
Independent Adviser, Nursing, Health Visiting and Community Health Policy and Practice
Honorary Senior Visiting Lecturer
City University

One of the pillars of the new government's vision for the health service of the future was that clinicians should have more autonomy. At the time this was music to my ears; but how is it being played out in practice?

It was my privilege to chair a conference for the children's workforce recently. We had a number of eminent speakers both at policy level and as researchers and leaders, both in the voluntary and statutory sectors. At the end of the two days, delegates left saying that they now understood the way forward, and what their part in it must be. They had been empowered, but also realised that, with the new vision for health their expertise must be cultivated and not suppressed if it was to make a difference. It is my belief that they now felt confident they had permission from policy leaders, not only to demand more autonomy in their workplace, and to influence the direction of their services; but also to offer professional leadership to the process.

How often do you attend professional conferences? They are very empowering as well as helping you understand where your service fits in the 'big picture'. Conferences need not be expensive; indeed, the Nursing in Practice Events are free and bring top-notch clinical speakers to venues up and down the country. Each event also includes a keynote from at least one figure working in policy development in that area. My belief is that all clinical staff should have regular opportunities to attend conferences as they are so empowering.

In the bulletin from the Chief Nursing Officer in March, Dame Sally Davies said, "Getting the right leadership in place is just as important for those nurses providing direct care and wellbeing services. The ability to influence and lead changes to improve services to patients and communities demonstrates the central role nurses need to play." This quote seems to me to offer the clinical workforce permission to exert their autonomy and clinical leadership to enhance the delivery of
high-quality local services.

So what are the opportunities to demonstrate your professional leadership and promote your autonomy? At the current time local commissioning boards are being established for the general practice consortia, and shortly there will also be health and wellbeing commissioning boards to lead the public health activity across the NHS and local authority. It is essential that nurses, midwives and health visitors lobby for professional representation on these boards, so that their professional interests are properly represented. But, equally, those appointed to the boards will require your support. You might want to consider setting up a local community and/or public health nursing strategic group to support any representative on the board. This would be immensely helpful to that person, would provide a forum for discussion and debate of organisational decisions, and allow your service to influence those decisions.

Another powerful way to have a voice is to meet as a professional group to debate any issues of concern, or perhaps a new way forward for delivering aspects of your service. Not only is this professionally helpful as it provides an often quite isolated group of professionals with an opportunity to meet colleagues, but it also offers the opportunity to reach a consensus on an issue. One side of A4 can then be prepared with your professional recommendations and this can be disseminated to managers or perhaps even to the commissioning board. The secret when addressing problems is to come up with a range of pragmatic solutions.

Some of the more adventurous or entrepreneurial of you may like to consider taking a braver step by becoming a partner in your GP employer's practice. This can offer real opportunities to demonstrate your professional autonomy and leadership. Some community practitioners are also helping establish social enterprises or community interest companies to deliver services on behalf of their clients. These offer the ultimate opportunity for autonomy and leadership as you shape the services your new organisation delivers.

Now is a time of opportunity for community nursing and the workforce has a choice. It can act as the autonomous professionals that registered nurses, midwives and health visitors have the power to be, embrace the professional leadership opportunities available, and be part of defining the future. Alternatively, it can allow others to make important decisions on its behalf.