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    The experiences of becoming and being a nurse leader in Aotearoa New Zealand in the 21st century : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, at Massey University, Manawatū, Aotearoa New Zealand
    (Massey University, 2025-11-27) Kerr, Dianne
    The Experiences of Becoming and Being a Nurse Leader in Aotearoa New Zealand in the 21st century This thesis explores the experiences of current registered nurses who have attained leadership positions in Aotearoa New Zealand (NZ). A feminist deconstruction of gender framework serves as a lens to examine how masculine and feminine binaries affect the experiences of nurse leaders in a neoliberal environment that has commodified and devalued the act of caring. Particular attention was paid to the different challenges experienced by Māori nurses as the indigenous people of a post-colonialist Aotearoa. The research employed a qualitative design using an exploratory, descriptive survey, grounded in a pragmatic philosophical approach. It was conducted in two phases: an online questionnaire followed by two rounds of interviews. In total 49 participants completed the questionnaire and 13 participants were interviewed. All participants held NZ nurse registration and had been in leadership roles in healthcare for at least three years, during which time they were responsible for overseeing staff. Respondents represented diverse practice backgrounds and localities. The findings indicate that most participants achieved leadership roles primarily through chance and personal determination. In many cases, pursuing post-graduate education or serendipitous opportunities broadened their perspectives on nursing. The nurse leaders in this study realised they could have a significantly greater impact on the quality of care they wished to provide by stepping into leadership positions. However, they faced challenges related to nursing's strong association with femininity and often experienced subordination to the male-dominated fields of medicine and management. There is ample evidence linking empowered nurse leadership to effective care; however, nursing input in healthcare decisions is often overlooked due to the prevailing assumption that traditionally feminine traits do not significantly contribute to patient outcomes. Despite the proven value and significance of nurse leadership, this research indicates that leadership is not adequately planned for or supported in a way that reflects the size of the nursing workforce. Post-graduate education has been shown to raise nurse consciousness, yet NZ healthcare systems and academic institutions fail to invest in or value the critical thinking and awareness needed for nurse leaders to function and contribute effectively in the current neoliberalist environment. This research suggests that preparation for leadership in nursing should focus on helping nurses gain an awareness of their identity within a gendered profession before developing their leadership skills. Highlighting nurses who have succeeded in roles beyond bedside care and providing mentorship and networking opportunities for emerging leaders will cultivate future nurse leaders who can advance the profession. Key findings: • gendered socialisation continues to impact the career trajectories of nurse leaders, • neoliberalist environments create challenges for nursing autonomous practice • ongoing issues of colonialism, racism and sexism influence the career pathways of nurses in Aotearoa
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    Managers who mediate : exploring perceptions of managerial mediation : a thesis presented in partial fulfilment of the Masters in Business Studies, Massey University, Palmerston North
    (Massey University, 2019) Gordon, Megan Ruth
    Managers worldwide are increasingly expected to take on conflict management responsibilities, and to use early interventions such as informal mediation to address interpersonal conflicts which arise in the workplace in order to prevent them from escalating (Arnold, 2007; Khan, 2012; O’Donnell, 2009; Poitras, Hill, Hamel, & Pelletier, 2015; Teague & Roche, 2012; WorkSafe, 2017). Previous studies have examined this facet of the managerial role from the perspective of employees who have had disputes mediated by their direct supervisor (Poitras et al., 2015), and from the perspective of senior managers and human resource (HR) personnel (Teague & Roche, 2012). While it is acknowledged that the manager-mediator role is a complex one, little is known about how managers themselves perceive their role as informal mediators, nor about how they navigate its complexities. This qualitative study draws on semi-structured interviews with eleven nurse manager-mediators in order to explore their perceptions of managerial mediation. Specifically, the study sought to find out what skills they consider important for effective managerial mediation, and how their managerial role influences their ability to conduct this aspect of their responsibilities. Thematic analysis was used to analyse the interviews. The findings of this study highlight an important link between management style and mediation skills, indicating that collaborative, people-centred management approaches create an environment in which managerial mediation can take place. In addition, the findings indicate that importance specific mediation skills are essential for conducting effective managerial mediation. In exploring how the role of the manager influences the ability to conduct managerial mediation, the study illuminates the central role of trust in fostering employees’ perception of fairness during managerial mediation processes. Furthermore, the study emphasises the overarching role played by organisational policies and values in encouraging and supporting managerial mediation. In light of these findings, the study recommends that managers require training in specific management and communication skills, as well as in mediation skills, if they are to be able to undertake informal managerial mediation processes. It also recommends that managerial mediation needs to be seen as part of a conflict management system which is supported by senior management and HR personnel, as well as by organisational policies and values.
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    Senior nurse administrators as decision makers in an era of environmental change : a thesis presented in partial fulfilment of the requirements for the degree of Masters in Business Studies at Massey University
    (Massey University, 1982) Moulson, Monica Jean
    The purpose of this thesis is to examine the activities of senior nurse administrators as decision makers responsible for planning and policy issues in large hospitals. The focus is on the effect environmental change has on these decision makers. Nineteen-seventy-nine marked the end of a decade of considerable change for nurses, nursing and the health services of New Zealand. In 1979 there were 46 nurses in appointed positions as chief, supervising principal or principal nurse of major regional or hospital nursing services in New Zealand. This total population was selected for the research study. There was a 63% response rate to a mailed questionnaire sent in November 1979. The effect of having a very small research population is reflected in the quality of data. However, there is some very interesting material from which inferences can be made in light of the model developed by the researcher. Seventy-nine per cent of the nurses participating in the study have been appointed to their present position from 1970 onwards and so have not had experience as an executive decision maker prior to the transitional era of the 1970's. Fifty-two per cent of these respondents have been nursing for more than 30 years and so have had long term exposure to working within bureaucracies. Fifty-six per cent of respondents have completed or partially completed university degrees and diplomas during the decade of the 1970's. Nursing qualifications do not reflect a move towards acquiring comprehensive registrations which became a possibility in this decade. There is evidence of some changes in organisational structure and decision making strategies. Forty-one per cent of the respondents are no longer responsible to medical administrators for their decision making, 17% are part of executive management teams, and 19% report that they receive important information for decision making by means of group discussion. There is also evidence of these nurses acknowledging formal organisation group structures. If these nurses are active participant members in these groups, then it can be conjectured that not only will the organisation, but maybe these groups will also be buffers to the effects of environmental change. The use of economic aspects of health services as indicators of information, that is considered as important by these decision makers, is a means of ascertaining subjective material. It is clearly demonstrated that finance and manpower have major effects on these nurses' decision making processes when compared with other input economic aspects of health services. Output aspects that are seen to be interlinked with finance and manpower, e.g. effectiveness of services, evaluation of quality of care, etc, are also seen to have considerable or very considerable effects on their decision making processes. The results of this research study demonstrate that these nurses are responding to environmental change with some individual, geographical and organisational differences being evident.
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    Making sense of the Director of Nursing structural positioning in New Zealand public hospitals (2006-2012) : a thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Massey University
    (Massey University, 2013) Hughes, Kerri-ann
    This dissertation reports on research examining and analyzing nursing leadership structures in New Zealand public hospitals, and in particular, the Director of Nursing (DoN) structural positioning. Leadership in hospital nursing is critical if the profession is to meet the challenges facing health services in the 21st century. The research has been undertaken using case study methodology and focuses on how organizational decision-making structures have impacted on nursing leadership in public hospitals. ‘Sense-making’ has been used as a theoretical construct to understand both the formal and informal structures that influence organizational decision-making. Phase one of the research involved examining twenty District Health Board (DHB) organizational and nursing charts. In phase two and three, the Directors of Nursing (DoNs) and the Chief Executive Officers (CEOs) were surveyed using a series of demographic and qualitative questions to draw out understanding of the Director of Nursing (DoN) role. The research has found that the constructs of power and authority influence the decision making processes at the executive level of the DHB. An analysis of the data indicates that the current structural positioning of the DoN is hindered by the existing dual accountability line reporting structures in DHBs and this is a barrier to alignment with Magnet hospital principles which provide evidence of effective patient outcomes. The focus primarily adopted by District Health Boards on professional line reporting only for nursing is not conducive to achieving effective and safe patient outcomes as it removes authority from the DoN and yet places unrealisticexpectations on accountability of how the DoN can achieve effective and safe patient outcomes within the public hospital setting.
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    BSMC : is there room for me? : an exploration of nursing leadership in primary health care : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Auckland, New Zealand
    (Massey University, 2012) Calverley, Rachael
    The unpredictability of health in a dynamic climate can result in a multiplicity of challenges. Indeed unpredictability has been referred to as the essence of creativity. Strong leadership in healthcare and importantly nursing is crucial to seeking solutions to organizational change especially when decision making will impact on the population’s health. By influencing policy objectives through leadership, nurses have the opportunity to develop strategies that make a difference to future complex problems. With the implementation of the Governments Better Sooner More Convenient (BSMC) policy agenda and principles underway from 2008 onwards, to reframe primary health care services, a series of key principles emerged including: a more personalized primary health care system with services moved closer to home; reduction in demand on hospitals and a package of services centred on integrated family health centres, with nurses taking a key role in shifting services from the secondary to primary care needs of patient support. From seventy health collective submissions positioning themselves to address these principles, nine were selected to move through to the next stage of development. The applications from all of the successful organizations referred to the need for improved multi-professional working and/or the importance of the nursing workforce to the BSMC agenda. Importantly, it would appear that a high quality nursing leadership function within the BSMC health collectives developing BSMC service configurations would be required to meet their goals. The purpose of this study was to explore with nurse leaders how they were able to contribute to these evolving primary health care collectives and changes that influenced the development of new or reviewed services, in addition to gaining insight into their challenges and opportunities as nurse leaders. The literature suggests a move away from the post heroic model of leadership and refers more frequently to coalitions of experts or leaders as a collective intelligence. These emerging characteristics represent a distributed leadership model that is leadership shared across varying people, professions and roles. It is this distributed model of leadership that provided a conceptual framework and a clear point of reference for this study. A qualitative approach derived from an interpretive perspective was the methodology chosen for this research. Eight out of nine potential nurse leaders involved in each of the regional health collectives participated in telephone interviews and communicated with the researcher via email networks. Theme identification was the essential task for the analysis process. Four key themes were identified with subthemes: politicization (power to influence), infrastructure (teams and education/training), coalitions of leaders (communication and relationships) and resilience (battling and visibility). The findings suggest on-going challenges to nurses leading in primary health care which include fragmentation among nurses, variable investment in regional nursing infrastructure, interdisciplinary relationship issues and limited training to develop future nurse leaders. Addressing these results requires clinical, strategic and professional nursing leaders to work within fora that are unified, cohesive and collectively agreed on their purpose.