The lived experience of clinical development unit (nursing) leadership in Western Sydney, Australia.

Abstract

A network of nine Clinical Development Units (Nursing) (CDU(N)) were recently created in the Western Sydney Area Health Service. These units are designed to develop patient-focused nursing practice through group process and action research, based on principles of transformational leadership. Although there is documented evidence from Australia and the United Kingdom (UK) that CDUs and Nursing Development Units (NDUs) are very successful in improving both patient and staff satisfaction, there is also growing evidence that the stressors experienced by nurse leaders are threatening the survival of some of these units. This study set out to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership when these stressors were likely to impinge. Hermeneutic phenomenology was employed in order to identify how these experiences changed over time. Two rounds of interviews were conducted: approximately 4--6 months after the launch and, again, 12 months later. The Clinical Development Unit (Nursing) philosophy provided a framework on which these very motivated leaders began to enhance nursing accountability in their units through reflective practice and participatory governance. While reinforcing many previously published positive and negative aspects of Clinical Development Units and Nursing Development Units, this paper also highlights how the expectations and experiences of these leaders changed over time with unanticipated pressures of work, a high turnover of clinical leaders, a perceived diminution of management support and unrealistic self-expectations. A significant theme that emerged as these stressors began to impinge was the leaders' own need for leadership in order to sustain their confidence and motivation. Insights harvested from this study have since been incorporated into a revised leadership preparation programme and support mechanisms for the leaders of eight new Clinical Development Units (Nursing) in the Western Sydney Area Health Service.