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The role of front-line managers has become more challenging during the past decade. In today’s turbulent healthcare environment, nurse managers are expected to provide leadership on units that have high staff vacancy and turnover rates, patients with higher acuity levels and higher incidence of chronic diseases, more limited financial resources and support staff and increasingly complex technology and reporting requirements. (p. 204)

General widespread agreement that the role involves conflict is reported in the literature. Firth’s (2002) study involving ward managers, the British equivalent of CNL, described how ward managers found the balancing of clinical and managerial responsibilities “problematic” and a cause of “conflict” (p. 489). This current research also contained content relating to conflict that occurs between the leadership and management aspects of the role both at interview and throughout the action research group work. We now know more about this tension. The administrative responsibilities to type up staff appraisals and progress incident forms are time consuming and take the CNL away from the clinical leadership aspects of the role. The responsibility of a cost centre was not a priority for some CNLs and left them feeling powerless to do anything about it. Patient care and overall responsibility for clinical care were their priorities. The patient should be retained as the focus and the administrative tasks should be devolved out of the role. Solutions to the CNL workload were explored and raised the need to scope the size of the role in each area and to establish the feasibility of an associate Clinical Nurse Leader position being developed. West, Lyon, McBain and Gass (2004) agree that there can be role overload and the role can only progress quality of patient care if role expectations are made clear at the outset. Latterly Mills (2005) describes the extra pressure on the nurse leader roles as one of “role conflict and lack of role clarity in increasingly complex organisations” (p. 20).

The tension caused by the leadership/management functions, as derived from the organisational expectation of the CNL role, remained a constant thread throughout this research. It was one of the 24 themes from the initial interviews, one of the remaining two after the action research group reduced the focus and the one that occupied four of the nine action research meetings. Clinical leaders in nursing impact on quality of patient care


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