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CHAPTER 1. SETTING THE CONTEXT

Can you love or respect the people and assist their/our inquiry without imposition of your will Can you intervene in the most vital matters and yield to events taking their course Can you attain deep knowing and know you do not understand Conceive, give birth and nourish without retaining ownership

Trust action without knowing outcome Guide by being guided Exercise stewardship without control.

(Interpretation of words attributed to Lao Tzu, c. 550 BC in Wadsworth, 2001, p. 420)

1.1. Introduction

This thesis defines the project I began in October 2005 when I set out to explore clinical leadership in nursing within a District Health Board (DHB) in New Zealand. This exploration was to be achieved through a study based on the principles of action research (research which is cyclic, qualitative and participatory). My objective for undertaking this study was twofold: to inform the ongoing evolution of the role; and to improve the support afforded the role. Research surrounding clinical leadership in nursing has been generated from various parts of the globe, including the United Kingdom, Spain, Singapore, Israel, America and Australia (Oroviogoicoehea, 1996; Cook, 2001; Duffield, Wood, Franks, & Brisley, 2001; Firth, 2002; Connelly, Yoder, & Miner-Williams, 2003; Stanley, 2004; Mills, 2005; Stanley, 2006). There has also been a minimal amount of New Zealand research carried out including but not limited to Drummond (2002), Kan (2002) and Williams (2004). White (2004), although not concentrating solely on leadership, outlined the loss of nursing leadership positions in New Zealand when the health reforms of the nineties were introduced. These reforms saw a change in the relationship the government had with the public service, including health. Simply put, the market model was applied to the delivery of health services throughout the country (Upton, 1991).

Nursing leadership at executive and clinical level was not exempt from such a model. White (2004) explains that in the early 1990s many hospitals chose not to employ a

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