Director of Nursing and the then Charge Nurse role was often devolved into Clinical Nurse Specialist or Resource Manager positions. Executive level appointments of nurses to lead the profession are now back in place, with DHBs continuing to function within a market model responsible for distributing allocated resources to its population. Some 15 years after the reforms, having evolved from such significant changes, the title used at this DHB to lead clinical areas is Clinical Nurse Leader (CNL), and at the executive level it is the Director of Nursing. The CNL role carries formal accountabilities within this DHB as a health care provider structure.
The CNL is the nurse responsible for the leadership and management of one defined clinical or geographical area within the DHB setting. This could be, but is not limited to, an acute ward, clinic or a mobile community service. Clinical Nurse Leaders work across a myriad of specialities within primary, secondary and tertiary settings. Their patient population may require intervention of a medical/surgical nature, for example within a hospital, or a primary follow up within their homes. They can function in relative isolation, for example as a district nurse based in a remote rural setting, or within the confines of a ward, unit, clinic, theatre or department within a hospital. They lead nursing teams of various sizes and are responsible and accountable for the entire seven day week, 24 hours of the day, although most are usually physically present for only five days. The CNL, in whatever environ, is responsible for the maintenance of not only clinical standards, but also the implementation of relevant organisational policy whilst being mindful of the budgetary responsibilities. They are in charge of nursing staff in their setting and attend to this same staff by appraising their clinical performance on a regular basis. Cumulatively there are expectations of the role from the patients, the nursing staff, the multidisciplinary team, the organisation and the profession of nursing.
The DHB where the research was undertaken is one of 21 District Health Boards that service a New Zealand population of just over four million people. District Health Boards are charged with giving effect to governmental health policy and responding to the health needs of their defined population (New Zealand Public Health and Disability Act, 2000).