skills as well as being able to undertake quality assessment. As the CNLs in this research attested, these skills are necessary to demonstrate being accountable for how nursing services impact on the health dollar. This added fiscal responsibility can be traced back to the country’s health reforms of the 1990s. This era marked a significant change in the delivery of health care. DHBs were to operate based on a cost competitive market model and as a result of this change in operation, senior nurse positions like the Director of Nursing and the then Charge Nurse were reviewed.
Whilst the change to the delivery to health care has altered so too has the patient profile that access services within the DHBs. CNLs, in conjunction with their nursing teams, increasingly care for aging communities and increasing complex social situations of some patients. These changing patient profiles have seen physical infrastructure altered to include standard notification within hospitals that verbal or physical abuse will not be tolerated from the public. In addition, CNLs in remote rural settings lead and educate their teams on personal safety.
Findings from the Phase One interviews with the CNL revealed themes relating to the role, attributes, skills and knowledge requirements of the Clinical Nurse Leader. Some of the themes were representative of struggle and uncertainty, others were not. Some were directly opposite to each other (e.g. exciting/enjoyable compared to hard work/emotionally draining) demonstrating both the tensions and triumphs of being in the role. 24 themes were identified; this large number of themes is a standalone representation as to the complexity of the CNL role.
In Phase Two the action research group was established. The 24 themes were presented as a list at the second meeting to start the group action and reflection. Four of the nine meetings concentrated on the reality of practice and the tension caused by the leadership plus management mix within the role. The role was one of leadership, management and patient care. The group agreed that a supportive role alongside the CNL would be useful, for example an associate, as the present ability to achieve all that the organisation expected of the role was constrained. This constraint, or the reality of practising in the role, could be