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that the clinical supervision model has limited impact on the growth of leadership ability but did allow dialogue to problem solve. Sullivan et al. (2003) based on qualitative findings from senior nurses in management inclusive of nurse managers recommend that leadership programmes be structured around such evidence. Krugman and Smith (2003) summarise it is essential to continue to evaluate the effectiveness of clinical leadership programmes. Connelly et al. (2003) recommends real life scenario-based education to be utilised when educating charge nurses. Thorpe and Loo (2003) from a Canadian perspective explore the emerging role of what they termed first line nurse managers or those that oversee the daily running of nursing units. Their study involved a triangulation of investigators utilising interviews and a Delphi study as well as qualitative and quantitative data. They recommend that these first line nurse managers be provided with training and development as well as a “supportive work environment” (p. 329). Thorpe and Loo conclude that any future education should be based on the unique needs of these nurses. Other writers argue that the professional development of those in the role needs to be formal and structured commencing with education on leadership management, finance and quality management (Williams, 2004). Cook and Leathard (2004) expanding on Cook’s (2001) research which identified the five previously described key attribute, argue that present preparation for clinical leadership is incomplete. Their reasons include absence of agreed definition or descriptors of clinical leaders, clinical leaders having voluntary programmes which are uni-professional, and that these programmes are “…disconnected from wider organisational development strategies” (p. 442).

2.8. Conclusion

The literature review from 1993 to 2004 was the foundation for this study. It was the link between my observation and consideration of the impact the change of health care delivery in the nineties had on clinical leadership in nursing, my beliefs on the evolution of this role and my research objective. The indicative approach to the literature review was purposeful in contesting these beliefs that the research activity had been restricted to theoretical framework derived from non nursing/leadership management theories and this was not only driving education for clinical leaders but describing expected behaviours. It linked to


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