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references. Firstly, he traced the renaissance of clinical nursing leadership across the UK, the USA and Australia between 1992 and 1997. Cook used in-depth interviews with clinical nurse leaders in the United Kingdom and supplemented his data by study tours to the remaining countries. The study findings indicated that these countries used leadership styles such as transactional, transformational connective and renaissance, and that styles are not necessarily country-specific but are aligned to individual settings. He critically reviewed leadership themes within nursing that were derived from the aforementioned countries.

Firth (2002), from the United Kingdom perspective, explains that various titles such as ward sister, nurse, charge nurse, or ward manager are used to describe the clinical leader of nursing in practice settings. She continues that despite the variation in name, the role of clinical leadership combines clinical and administrative knowledge. Her qualitative study included interviewing and observing 12 ward managers. Findings included that the ward managers found the combination of having to develop staff and improve the quality of services provided can be problematic.

Similarly, Williams, McGee and Bates (2001) when researching senior nursing roles in the United Kingdom, found that ward managers reported difficulties balancing the managerial and clinical practice of their roles. Duffield et al. (2001) study specific to Australia is representative of the evolution of the traditional ward sister into the present model that combines both administration duties with clinical leadership. Nurse managers and charge nurses were observed to examine how much time they spent devoted to direct patient care as opposed to unit related management.

Doherty (2003) and again Porter O’Grady (2003) offer opinion led commentary. Doherty states that: “At the beginning of the 21st century ward sisters and charge nurses are viewed as having a pivotal role in health care, perhaps with little clarity about what this means in practice” (p. 35). Porter O’Grady suggests that in the future, nurse leaders need to be self and socially aware and invest in relationship management. Commentaries such as these and research into role definition accompany information on what is leadership and what is


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