Nursing Research

Paths to nursing leadership

TERESE BONDAS P hD , RN

Senior Lecturer, University College of Borås, School of Health Sciences, Borås, Sweden

Introduction

Nursing leadership is exposed to various organiza-

tional, economical, scientific and political demands. It is

concerned with the care of vulnerable human beings

and human encounters in health, pain and agony, and

close to matters of life and death. Nursing leadership

occurs in an environment that has become more and

more technological and complicated (Bondas 2003). It

seems to be an eternal task for the nurse leader to create

a balance between a caring patient, family friendly,

employee attractive as well as an economical effective

and smoothly operated health care organization. The

patients need to know that they will get the best poss-

ible known care, receive up to date information, and

also participate in care according to their ability. They

want to know who is responsible for their care (Ehrat

2001). Brandi (1998) metaphorically described nurse

executives on the managed care battlefield. However,

professional nurses are seldom in need of �commando-

management� but, instead, they need possibilities and

support to practice and develop nursing (Mahoney

2001, Bondas 2003).

The matters concerning the educational requirements

for health care leadership positions, and the rights to

administrative authority, have not been settled since the

Correspondence

Terese Bondas

University College of Borås

School of Health Sciences

S-501 90 Borås

Sweden

E-mail: [email protected]

BONDAS T . (2006) Journal of Nursing Management 14, 332–339

Paths to nursing leadership

Aim The aim was to explore why nurses enter nursing leadership and apply for a management position in health care. The study is part of a research programme in

nursing leadership and evidence-based care.

Background Nursing has not invested enough in the development of nursing lead-

ership for the development of patient care. There is scarce research on nurses� motives and reasons for committing themselves to a career in nursing leadership.

Method A strategic sample of 68 Finnish nurse leaders completed a semistructured

questionnaire. Analytic induction was applied in an attempt to generate a theory.

Findings A theory, Paths to Nursing Leadership, is proposed for further research.

Four different paths were found according to variations between the nurse leaders� education, primary commitment and situational factors. They are called the Path of

Ideals, the Path of Chance, the Career Path and the Temporary Path.

Conclusion Situational factors and role models of good but also bad nursing lead-

ership besides motivational and educational factors have played a significant role

when Finnish nurses have entered nursing leadership. The educational requirements

for nurse leaders and recruitment to nursing management positions need serious

attention in order to develop a competent nursing leadership.

Keywords: analytic induction, nursing career, nursing leadership, nursing management,

qualitative approaches

Accepted for publication: 14 September 2005

Journal of Nursing Management, 2006, 14, 332–339

332 ª 2006 Blackwell Publishing Ltd

days of Florence Nightingale (Gould et al. 2001,

Mahoney 2001). Duffield and Franks (2001), in their

review, describe a lack of formal preparation for the

transition and development of clinical nurses into

management positions. Many first-line nurse managers

lack appropriate educational qualifications to do their

jobs effectively. In Finland, 1-year educational pro-

grammes in administration have been arranged for

nurses since the 1950s. These programmes ended when

the university education in nursing science began in

1979. It was then possible to earn a master’s and a

doctoral degree. In the last few years, the university

colleges have arranged courses in health care adminis-

tration that vary regionally between 20 and 40 weeks,

but there are no separate degrees awarded. A back-

ground in nursing has been an important factor, and

still is a necessity for leadership positions at the ward

level in public health care organizations (Sinkkonen &

Kinnunen 1999, Academy of Finland 2003).

An effective clinical leadership requires competence

in research and knowledge of nursing care (Atsalos &

Greenwood 2001, Cook & Leathard 2004). It is also

seen as important that nurse leaders develop an under-

standing of a multiprofessional and transcultural care.

The nurse leaders need to have a clear understanding of

the priorities and the key stakeholders whom they serve.

Cooperation and communion within, and outside the

organization is desirable when it has an impact on the

prerequisites for care and valuing nursing (Duffield &

Franks 2001, Bondas 2003, Jones & Cheek 2003). A

pledge to identify and nurture a strong nursing leader-

ship has been set out. The purpose of this study is

therefore to explore why nurses enter leadership and

apply for a management position.

Previous research

There is scarce research on nurses� motives and reasons

for committing themselves to a career in nursing lead-

ership. Nursing leadership has an effect on both the

quality of care and on the organizational culture. There

is, however, a shift away from the core of nursing, the

provision of patient care (Duffield & Franks 2001).

McKenna et al. (2004) in their study of community

nursing, conclude that the traditional subservient cul-

ture of nursing is blamed for the perceived inability to

nurture strong leaders and there is a reliance on lead-

ership from General Practitioners (GPs). Community

nursing participants felt that they are either pushed into

management positions or that those nurses who become

leaders leave practice. Allen (1998) studied perceptions

and beliefs about leadership development by inter-

viewing 12 nursing leaders. Five important factors were

self-confidence, innate leader qualities, a progression of

experiences and successes including education, influence

of significant people who expressed confidence in, and

encouraged the nursing leaders, and finally personal life

factors such as family reasons with a daytime job or

finding a less strenuous position. For future nurse

leaders, they recommend reinforcing self-confidence,

acting as role models and mentors, creating opportun-

ities for progressive experiences and successes and fos-

tering continuous learning. All 12 participants

described a sense of self-confidence that had developed

since childhood with additional attributes of risk-taking

and education. Natural leadership tendencies and easily

getting involved were described by eight participants,

but only two nurse leaders described a desire to change

and improve nursing.

Purpose

The purpose of this qualitative study, which is a part of

a wider study in nursing leadership and evidence-based

care, is to explore, from the nurse leaders� perspective, their experiences of entering nursing leadership and

applying for a management position in health care.

Data collection

Data were collected using a semistructured self-reported

questionnaires developed by the researcher, based on a

pilot study and previous research. It has eight open-

ended questions that are focused on becoming a nurse

leader, and content relevant to nursing leadership and

administration. In this study, only the questions that

concern entering nursing leadership, and applying for a

management position in health care, are highlighted.

Demographic data about age, position, years of work-

ing life and education were also collected. A self-report

measure was chosen in an effort to avoid the problems

that could come with the structured interview where the

researcher’s presence might hinder the participants to

articulate the ways in which they conceptualize and

understand their own world (Johnson 2004).

Ethical considerations

The researcher tried to avoid exploitation of partici-

pants, acknowledging their vulnerability and respect for

them as persons. Ethical principles were applied. These

principles included the protection of human rights: the

rights to be informed of the study, the right to freely

decide whether to participate or not, the right to

Nursing leadership

ª 2006 Blackwell Publishing Ltd, Journal of Nursing Management, 14, 332–339 333

withdraw and informed consent (Orb et al. 2000). Each

participant was given an information sheet, in addition

to a verbal explanation and a possibility to ask ques-

tions about the study. Anonymity, meaning that par-

ticipants� identities were not revealed, was applied.

Participants

A strategic sample of 68 Finnish nurse leaders, from

both rural and urban parts of the country took part in

this qualitative study. The selection of the participants

was directed by the principle that the informants taken

together should give a broad picture of the area under

study. The participants answered the questionnaire at

the beginning of leadership courses held at four uni-

versity colleges, one university and one hospital. The

courses in which the participants were enrolled were

short continuation courses for nurse leaders or leader-

ship courses that were part of a master’s education. The

nurse leaders joined the courses with or without finan-

cial or other support from the organization where they

were employed.

The participants were all active in leadership posi-

tions as ward sisters or nurse executives in different

private and public health care organizations. Only five

of them were men, and this reflects the percentage of

men (7%) in nursing in Finnish health care organiza-

tions (Tehy 2005). Participants� educational back-

ground varied, all had a nursing background. A few

(5%) had completed master programmes, and 71% of

the informants had participated in various courses in

leadership and administration that had not led to a

degree. Additionally, 24% of the participating nurse

leaders did not report administrative education at all,

besides their nursing education. Participants� experi-

ence, as leaders, varied between 3 months and 26 years.

The age of participants was ranging from 25 to

55 years. The health care organizations where they

were employed had between 4 and 500 staff positions.

Only 5% of the nurse leaders were in positions with

authority, equal to chief doctors. The great majority,

95%, occupied middle management positions and

answered to the chief doctors. The unit leaders reported

to the nurse executives.

Data analysis

In this qualitative study, analytic induction was applied

to examine a number of cases to determine the char-

acteristics of a specific phenomenon (Johnson 2004).

The method is influenced by the constant comparative

method for grounded theory (Glaser & Strauss 1967).

Analytic induction is a set of methodological procedures

that attempt to systematically generate theory grounded

in the empirical world, and to focus on the variations of

a phenomenon, and not on its quantity. Analytic

induction consists of four phases. In the first phase,

access was gained to the primary phenomenon of

interest, i.e. nursing leadership and evidence-based care,

by using questionnaires. In the second phase, the phe-

nomenon was defined as the following research ques-

tion: why do nurses enter nursing leadership and apply

for a management position? Moreover, variations were

identified by reading and re-reading the data. An

in-depth comparative analysis was performed within

and between the data from different participants,

looking for both common and differing characteristics.

Variations were then categorized in terms of shared

characteristics and differences in cases. In the third

phase, a provisional list of case features, common to

each delineated category, was identified. Any deviant

cases that lacked case features, common to the cases

initially put in the same category, were re-examined. If

there were differences, the categories or case features

were modified to accommodate the findings. The case

features, shared by more than one category, and case

features unique to a category were examined. Shared

case features were regarded as necessary, but not suffi-

cient, for generating a category. In contrast, unique case

features were sufficient. In the fourth phase, a taxon-

omy of categories was constructed, and case features

elucidated to facilitate the theoretical development, best

explaining the collected data. This taxonomy was then

presented in a matrix. A matrix is essentially the cros-

sing of two lists, set up as rows and columns, and dis-

played as a table (Miles & Huberman 1994). Each row

and column was labelled, with rows representing the

unit of analysis. The columns represent the character-

istics that were found pertinent to the research ques-

tions. The matrix thus provided visibility to the process

of data analysis and enabled the theory generation.

Findings

The findings show that there were variations in the way

the nurse leaders had entered leadership and considered

applying for a management position. There were dif-

ferent patterns called Paths to Nursing Leadership

positions. The path was chosen as a metaphor to depict

the nurse leaders� descriptions. The path is not a simple

and smooth way forward; it is thickset but unique in the

area. The person has to make some efforts to move, and

other people may be involved as pathfinders and guides.

There are seldom any clear signs to where the path leads

T. Bondas

334 ª 2006 Blackwell Publishing Ltd, Journal of Nursing Management, 14, 332–339

and how long it takes. Metaphorically speaking, the

nurses carry a rucksack containing their life experien-

ces. There are three characteristics that form four dif-

ferent paths (see Table 1), which are called: (1) the Path

of Ideals, (2) the Path of Chance, (3) the Career Path

and (4) the Temporary Path. In the table, the columns

represent the paths and the rows the discriminating

characteristics.

The first Path of Ideals (n ¼ 16, 23; 5%), is an active

choice, made by the nurse her/himself dominated by

many altruistically oriented hopes and visions. The

nurse has educated her/himself and reflected on her/his

conscious choice. The other active path is called the

Career Path (n ¼ 11, 16; 2%), and it is directed by the

nurses� wishes to be more comfortable at work and

powerful as a leader, an egotistically oriented career,

instead of remaining a bedside nurse. Destiny has left its

mark on the third path, a Path of Chance (n ¼ 37, 54;

4%), where other persons or circumstances pave the

way to leadership. The person may be guided, but is

more or less passive. Sometimes, the nurse may even be

pushed. As more primary data were examined and

compared, it was evident that there were deviant cases,

and these were reassigned to constitute the Temporary

Path (n ¼ 4, 5; 9%). This path is kept open, and soon

may be abandoned and re-entered in substitute posi-

tions. The four paths are presented below.

The Path of Ideals

The Path of Ideals is characterized by a personal drive,

and there is a conscious choice to become a nurse lea-

der. It is characterized by seeking new knowledge and

education. There is, metaphorically, a kind of exam-

ination at the start of the path. The nurses went through

this examination mostly as a process inside themselves

before they even dared to consider the choice. The

questions that were included in the examination were:

Who am I? What do I want? What am I willing to do?

What do I have to give up? What kind of effect do I

have on others? What will happen if I became a nurse

leader? And most of all, am I capable of leadership? In

this study, there were nurses who cautiously looked

upon themselves as capable leaders after their self-

examination.

The Path of Ideals is mirrored by the following quote:

�there is an idealist living inside me�. The ideal was

described as creating a culture, where patients regain

their health and will to live, and a place where the

relatives are welcomed and where the staff has been

given the prerequisites for an excellent nursing care.

�My basic attitude has always been to help the patients

and alleviate pain and agony, and is important to create

a good culture. When I studied nursing science, I

understood even more that this is the right thing�. There was a will to transfer nursing knowledge, and change

nursing care according to their ideals. �I wanted to

influence the nursing philosophy and care, and always

remind us that we are there for the patients and not the

opposite�. There was also a bit of egoism involved, the

wish to have a unit of their own which they could

develop to a dream unit. But, this egoism is connected

to the well being of the patients, and humbleness. They

saw the dream unit as a favourable environment where

the staff could grow and feel proud of being nurses.

These nurse leaders felt that they had the courage to put

a spirit into the organization. Sometimes, they took a

huge step over borders when they have to accomplish

what they believed was right. �I decided to find ways to

develop the application of nursing science theories in

our nursing practice, with or without the support of

others�. They knew that this work would neither run

smooth nor be easy. These nurse leaders described the

meaning of spreading enthusiasm, taking care, listening,

being honest and worthy of thrust. They emphasized the

courage to engage others in their vision. There was

evidence of an inner knowledge of things that matter in

delivering nursing care. The nurses had arrived at this

knowledge through formal education but also through

their experiences, not only as nurses and leaders but

also as patients or relatives on other units. Their pre-

vious experiences in nursing care are described as an

Table 1 Characteristics of the four Paths to Nursing Leadership

The Path of Ideals The Career Path The Path of Chance The Temporary Path

Education Education/knowledge-seeking Education Often missing Usually missing Primary commitment

Develop nursing care/create a dream unit/save the world from the effects of bad nursing leadership

Personal development/leave bedside nursing

Unclear/satisfying others� will

Laissez-faire trial

Influencing factors

Good and bad leader's examples Models gained from other leaders/idealization of leadership

The only position available/working conditions

Substitute

Nursing leadership

ª 2006 Blackwell Publishing Ltd, Journal of Nursing Management, 14, 332–339 335

important source for their choice to apply for a nursing

leadership position.

These nurse leaders had observed both good and bad

examples of other nurse leaders that had made an impact

on their decision. These nurse leaders then wanted to

bring about the same liability, respect and professional

competence that they had experienced in their leaders.

These nurse leaders acted as apprentices, and tried to

follow the example. But, they did not describe a mentor

relationship, or a direct dialogue. Leaders who were

described as driving forces were admired. They were

regarded as a source for inspiration and role models for

future nurse leaders. �The nurse executive is a leader who

is close to us and she listens but also gives constructive

critique. She became a good example for me�. Head

nurses were mentioned by seven participants (10%) and

five mentioned nurse executives (7%).

Negative examples were also mentioned. These nurse

leaders were persons that had such an impact that they

were feared. These were the leaders that the participants

did not want to resemble. Some nurse leaders (13%)

even described that they chose to become leaders

because they wanted to save the world from bad lead-

ership. These negative leaders were described as dis-

tanced: they abused their position, were greedy for

power and seemed uninterested in the fate of the people

who came in their way. Inconsistent and moody, even

wicked leader behaviour had awoken bitterness in staff

and caused a dull and tense atmosphere. The partici-

pants had experiences of being violated, treated non-

chalantly and being ranked and placed last in the list of

precedence, worthless as persons but useful as tools. �Do

nurse leaders have to be so uninterested in their staff,

and burst with self-importance’? These leaders had been

authoritative. They have tried to coerce, and manipu-

late their staff. There was a description of a head nurse

that had made a fool out of the nurse, critiquing and

mocking her in front of others. There had also been

leaders that did not act when people at their unit were

badly treated. These leaders� behaviour had a strong

impact on the participants� choice to become a leader.

There were descriptions of high ideals in the begin-

ning that sadly led to disappointment and bitterness,

along with the experience of not being at the right place

at the right time with the right staff. There was not

enough support, or possibilities for being developed

were not recognized. There were experiences of not

being understood, and not being recognized as a leader

as they would have wanted. The work was not what

they thought it would be. There is the nurse executive

that admitted that she would have performed better at

the ward level. The road of disappointment seemed to

be open if there were not enough nourishment or

development from their leadership but it was scary and

almost impossible to see where the path out would be or

where it would lead. The thought of quitting and going

back to nursing is described as very hard; there were

feelings of shame of their careers sliding downwards

and fear of not being a competent nurse anymore.

The Career Path

There is also a more self-anchored and self-centred

Career Path, with interests and ambitions, when nurses

explicitly want to become leaders. This path implied

more power in decision-making, working hours that

were more self-decided, working daytime and moving

more freely in the organization. These leaders also

wrote about leaving behind a nursing workload that

was too heavy, not interesting enough and did not offer

them fulfilment. They felt that they had more to give

than staff nursing could offer. An important feature in

the Career Path is that leader positions will provide

benefits, such as higher wages and a possibility to

increase one’s visibility in the organization. Self-con-

fidence was emphasized, and also a need for challenges

in work.

They described that they were leaders early in child-

hood: �My personality is dominant. I have an instinct to

lead, to stand at the barricades�. These nurses described that they had early become informal leaders on the unit

and they had felt as if they were the leaders of the unit

long before they were appointed. They connected this

with a leadership vacuum, or a leader who had prob-

lems in the relations to the staff. And, they had instead

been appointed as a remedy to the discontent towards

the present leadership. They experienced themselves as

brave initiators with an ambition to keep the whole

organization in their hands. They wanted to influence

the direction of the organization. They thought they

could handle all kinds of people, and they thought they

were able to use their body language to emphasize their

message. Knowledge-seeking was not emphasized by

these nurse leaders who, instead, described how their

staff should develop.

The Path of Chance

The Path of Chance is passive and capricious, and

leadership just comes into the nurse’s life. The nurse

was passive, the choice was made by others and there

was no need to take responsibility. These nurse leaders

did not regard their leadership as influential but a task

to be accomplished. They did not write of ambitions,

T. Bondas

336 ª 2006 Blackwell Publishing Ltd, Journal of Nursing Management, 14, 332–339

either their own or the organization’s. The descriptions

of 31% of the participants started with the words �I had never thought of becoming a leader�. In addition, 24%

of the participants wrote indirectly that they had not

planned to become a leader. However, the choice to

become a nurse could be vividly described from dreams

emanating from lifelong experiences in relation to their

own, or a family member’s illness and care. Paediatric

and psychiatric care, and midwifery seemed to be spe-

cial. They described how they overcame many obstacles

to become a nurse. These descriptions are recalled, and

intertwined with descriptions of their way from a nurse

to a leader, because these nurses had never even thought

of becoming a leader when they had entered nursing.

The nurse leaders on this path not only remained

passive, but also described how somebody else made

this decision for them. They metaphorically became

�shovelled in� and directed by others. This is not men-

tioned generally, but it was always a question of a

specific unit that needed this person as its leader. These

nurse leaders described how somebody had to take this

task, and nobody else could. They also described that

they had never thought of themselves a leaders. At least,

it seems that they did not want to admit this but,

modestly and cautiously, came forward as the able

nurse leader. There were other nurse leaders that had

taken them under their wings, and even persuaded them

into taking the step, and some of these were mentioned

by name. There are 10 reports (15%) of this kind of

encouragements. There were persons that have believed

in these nurses and thought that they would be suitable.

Additionally, colleagues are mentioned by 9%, teachers

by 7%, parents by 6%, friends by 3% and their own

husband by 3% of the participants.

There is also a kind of laissez faire in the Path of

Chance. Five participants (7%) described that they

became leaders because it was the only position that

was available at that time. �I applied by chance for a

head nurse position, and I got it�. It seemed that they

then tried to apologize, and did not even want the

leadership position. However, there was a lack of

registered nurses. These nurses had, for example, the

right clinical specialization for the unit, and some of

these nurses thought it was quite natural to apply for a

leadership position when they had worked for some

years as nurses. This experience is destiny and chance

when the nurse leaders themselves emphasized that they

had never thought of being a leader and did not wish for

it: �I drifted into leadership�. It was very hard for these

persons to create and experience a leader identity. There

are descriptions of maturity and engagement developing

gradually through experiences and reflections, and they

finally had become one with their work, assuming a

nurse leader identity. �Now, after 10 years of leadership

experience, I think I have a wish to be a nurse leader�.

The Temporary Path

A path that has similarities to the Path of Chance is the

Temporary Path, described by four persons (5; 9%).

But, the Temporary Path is slightly different. The

Temporary Path is opened when the person applies for

another person’s place. It is a question of trial with a

possibility to withdraw. �I now work as a substitute

assisting ward sister so this is only a period of my life�. These participants described how they had the courage

to try because they thought they had leadership abilities

to organize and took an interest in people.

This seemed to be the only path where there was also

the possibility of returning into nursing. It seemed to be

an acceptable way to try on a new position as a piece of

cloth you metaphorically tried on, wore a while and

then could put away. It was possible to maintain the old

nurse position and not come back again to leadership if

the leadership position did not turn out to be a good

choice.

Being a leader substitute could be bad if one never

had the chance again in the organization. This experi-

ence caused bitterness if the same possibility was not

offered to this person again. It then seemed to be hard

to return from a leader position, and become a staff

nurse again.

Discussion

The findings show that there was seldom a conscious

choice to apply for a nurse leader position compared

with participants� self-initiated comparisons of their

previous inner drive to become a nurse. Four paths were

constructed from the findings, through a method of

analytic induction (Johnson 2004), based on a strategic

sample of 68 Finnish nurse leaders� descriptions.

Credibility or trustworthiness are terms used to describe

the validity of a qualitative study. The credibility

(Johnson 2004) of this qualitative study is enhanced

because the sample was a representative of nurse lead-

ers. However, the findings do reflect solely the Finnish

health care and educational system. The results could be

transferred to any country where: (1) nursing leadership

lacks a direct authority of decision-making in nursing

matters, (2) nurse leaders are subordinate to doctors

and finance personnel and (3) where the educational

requirements for nurse leader positions are unclear. The

four paths were named the Path of Chance, the Path of

Nursing leadership

ª 2006 Blackwell Publishing Ltd, Journal of Nursing Management, 14, 332–339 337

Ideals, the Career Path and the Temporary Path. Nurse

leaders� education, primary commitment and other

influencing factors differed between the paths. The

numbers and percentages are only exploratory in this

study, and further research is needed.

It is to be noted that the problems of education and

development of career paths for nursing leadership

positions have not been solved. Educational require-

ments continue to differ in organizations, and there are

nurses who work as nurse leaders without further

education. Further education, besides a nurse educa-

tion, is missing in both the Path of Chance and the

Temporary Path. Interestingly enough, the Path of

Ideals as well as the Career Path were characterized by

educational efforts, which supports the findings of

Duffield and Franks (2001) and McKenna et al. (2004)

on the importance of recruitment and education in

nursing leadership.

One main difference between the paths seems to be

the commitment. In light of these findings, there is

metaphorically, an existence of an inner customs and a

trial inside the nurse, who reflects on becoming a leader.

The person examines her/himself and, sometimes, there

are others involved in the process such as close relatives

and colleagues. There also seemed to be nurse leaders

who were not leaders for the right reasons. They had

personal issues that they did not recognize, and these

issues remain unresolved when the nurses were to be-

come leaders. These issues seem to include egotism,

narcissism and a need to be in the limelight. At the

career gate, the nurse leaders� reflections on their ability

and their potential to succeed were focused on what

they, as leaders, could get from the organization. In

contrast, on the Path of Ideals, the leader asked what

they could give to the organization. On the Path of

Chance, there was a laissez-faire attitude. On the

Temporary Path, the questions were not always actu-

alized. Allen (1998) identified a sense of self-confidence

as a cornerstone characteristic of leadership develop-

ment. This is not something that is explicitly described

by the nurse leaders in this study, and the reasons could

be cultural and educational. In this study, the role

models of previous leaders were important especially

for the Path of Ideals. When the leadership position was

an active choice, there seemed to be a commitment. This

was either a commitment to themselves and their

working conditions; impressions made by the leadership

position; their own development; or a devotion to the

care of the patients, the staff and the organization. The

will to become a leader seemed, in the light of the

findings from this study, to appear more clearly during

leadership. As a result there is a need for further

research in the process of developing as a leader in the

organizational culture to enable the staff to provide an

evidence-based care and to minister to the patients

(Bondas 2003).

Virginia Henderson (1980), the nursing theorist,

commented over 20 years ago on the historical back-

ground of repressive nursing administration, and pro-

vided recommendations on participatory administration

that still hold true today. Nursing leadership is the key

to maintaining the essence of nursing in a caring cul-

ture, where the nursing leader is not only a manager but

also a leader of evidence-based care (cf. Bondas 2003).

Good leaders lead because they somehow have gained

the privilege and burden of vision and thus are called to

that frontier. When a good leader awakens the depth of

presence in another and encounters the sacredness and

inner world of the other, leadership may be trans-

forming and healing (Hagenow 2001). This is seen in

this study when the participants on the Ideal Path

wished to create a caring culture and an ideal unit.

Although the relationship between the leader and the

staff is very important, the basis for these relations is

not personal but the shared interest in providing

excellent care to patient (cf. Bondas 2003). Manipula-

tion, escaping responsibility and personal favourism are

not part of a caring culture. The Path of Chance is the

most common (54.4%) in the study, and a laissez-faire

mentality is probably not furthering the visionary

leadership and a development of the modern evidence-

based nursing and cooperation (Atsalos & Greenwood

2001, Jones & Cheek 2003). McKenna et al. (2004)

describe similar findings according to which nurses felt

that they were pushed into leadership. The nurse leaders

on the Career Path described how they wanted to put

things in order, stand at the barricades, and be rescuers

in times of crisis to substitute weak leaders. What is it

that they want to save and what happens when the

barricades are not needed any more? Is their working

life empty when the drama ends? Does there have to be

a new drama to eternally show the power of this so-

called strong and energetic leader on the Career Path?

The risk is that s/he only knows how to fight, and not to

cooperate.

A main idea for nursing leadership, a combination of

creating an evidence-based nursing culture with effect-

iveness in health care (Bondas 2003), is seen in the Path

of Ideals. It is ministering to the patients, creating a

culture that strives to provide excellent nursing care. The

responsibility of nursing leadership is to see human

beings as a unique vulnerable persons; not what they

have been, but what they are and could become. It is to

bracket their prejudices and meet the human being as the

T. Bondas

338 ª 2006 Blackwell Publishing Ltd, Journal of Nursing Management, 14, 332–339

person comes before them with her or his own potential.

Nursing leadership is seen as not only walking before,

but also walking with. It is to inspire, motivate and

acknowledge the importance of every encounter with the

patient and the family (Bondas 2003). This is mirrored

in this study in the nursing leadership on the Path of

Ideals.

Conclusions

Four different Paths to Nursing Leadership were found

in this study, the Path of Ideals, the Career Path, the

Path of Chance and the Temporary Path. The Path of

Chance was dominant in this study. Situational factors

and role models of good but also bad nursing leadership

besides motivational and educational factors have

played a significant role when Finnish nurses have

entered nursing leadership. The educational require-

ments for nurse leaders and recruitment to nursing

leadership positions need serious attention in order to

develop a competent nursing leadership. There seems to

be a lack of an education for future nurse leaders pro-

viding a thorough knowledge of nursing care as an

evidence-based practice as well as leadership, organ-

izational and economic issues. Nurse leaders need to

reflect on the meaning and effect of their leadership on

the care and the whole organizational culture because

they are role models who also influence the recruitment

of future leaders. Mentorship and networking with

other nurse leaders could be helpful to maintain a

healthy leadership, and a focus on the development of

care and human dignity.

Health care organizations need nurse leaders, who

preferably enter a combination of the Path of Ideals and

the Career Path, in a career that is not dominated by

egotism and narcissism, but who are able to develop

nursing care and have a positive influence on health care

through their leadership. If the nurse leaders do not

promote nursing knowledge, what is then the meaning

of nursing leadership?

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