By June Girvin (auth.)
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Consequently, many nursing officers became alienated from practice, reinforcing the already growing gap between management and practice (Jones et al. 1981). Layers of hierarchy were introduced as a result of Salmon nursing officers, senior nursing officers, principal nursing officers, chief nursing officers, divisional nursing officers and so on. Clinical nurses had, on the whole, little or no contact with the more senior levels and questioned their credibility from the start, although their rank and positional authority over nursing appeared to be maintained.
The introduction of Trust boards, requiring a nurse director to sit on the board, drew attention to the need for nurses to be prepared for executive level working and to the gaps in the career pathways and preparation processes that sometimes made these posts difficult to fill. An attempt was made to try to increase the general profession's interest in the nature of and need for leadership in nursing by the publication of the Department of Health's A Strategy for Nursing (1989). This document contained a whole section on 48 Leadership in Nursing leadership and management, proposing seven action targets.
Being a leader nearly always means tackling organisational culture change at some point, or at least working with or around particular cultures. It is important for leaders to remember that understanding the culture in which they work is vital. They often have to begin to change the prevailing culture in order for people to see the need or want to change anything else. People working in organisations are sensitive to the signals emanating from their particular organisation. These signals can come from different parts of the organisation, for example from pay and reward strategies or from promotion patterns, but the signals are strongest when they come from what the mass of the organisation thinks is 'the done thing'.