A case study of frontline nurse leadership informed by complex responsive processes of relating.

Aims and Objectives: To understand the social construction of frontline nurse leadership and how power operates at this level.
Background: It is argued that frontline nurse leaders are central to the negotiation of care. Evidence suggests they feel ill-equipped to lead and lack confidence in their ability to do so. Disempowerment has been proposed as a barrier to effective ward leadership. There is a lack of studies about daily frontline leadership practice.
Design: Single instrumental case study with embedded cases.
Methods: A purposive sample of one acute National Health Service Trust, with a convenience sample of embedded cases, was selected. Multiple methods of data collection were used including semi-structured interviews, nonparticipant observations, field notes and documentary evidence. Thematic analysis using constant comparison and categorisation of data within, between and across cases was used to generate a theory of ward leadership in its organisational context. COREQ Checklist compliant.
Results: These findings suggest the frontline nurse leaders' power is a dynamic and situation-dependent phenomenon that shapes and is shaped by ongoing interactions between stakeholders in the NHS. In these interactions, power ebbs and flows. These leaders, like all actors involved, were paradoxically both powerful and powerless at the same time.
Conclusion: This study offers a new contribution to the discussion about the power of ward leaders and problematises the theoretical assumptions that perpetuate calls for increased power.
Relevance to Practice: In their efforts to resolve the spontaneous dilemmas that arise in practice, frontline nurse leaders would benefit from regularly participating in communities of reflexive practice.
(© 2020 John Wiley & Sons Ltd.)