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

Abstract

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