The money or the nurse?

Research is needed into the development of nursing sensitive measurement tools. Because we remain uncomfortable about fitting human care into an empirical framework it is crucial that nurses learn the skills to develop appropriate processes that will ensure nursing's survival in this post modern era. Economics demand measurement, dollar values and numbers. Nurse leaders need to develop an understanding of these factors in order to balance nursing and administration.

Nurses need to be aware that education does not stop upon completion of their degrees but continues for the duration of their careers. Nurses need to be educated to have the confidence and competence that will take them from the classroom to the boardroom. We may need to be more innovative and creative about how we are educated and how we develop our practices within an economic framework, but our focus should remain on nursing. This may help put more nurses into decision-making levels in government and private organisations. Nurses need to learn how to avoid the trap of the “tyranny of niceness” that some authors believe is keeping nurses from confronting the difficult issues that are inherent in health care today.

Advocacy must be for ourselves as health care professionals as well as for others. As a profession we need to promote the core values amongst ourselves first, and then take them to the wider community. Only if nurses are consistent and persevere in the promotion and ongoing development of their values based system of practice will outside forces, governments and economists, be influenced. Leadership for today and tomorrow needs to be developed, promoted and practised. To do this we need to understand our own leadership style and ask whether this style is suited to today's health care scene. As workplaces today consist of people from different generations, cultural backgrounds and value systems it is imperative that those in leadership positions, or who aspire to those positions, develop an understanding of leadership itself, reflect on their own style and then alter or develop that style as necessary.

Leadership through advocacy is a model suited to health care today. As nurse leaders we could be seen to be the last line of defence of our profession. We must be aware of the wishes of the creators of our nursing values and, through advocacy, bring that information to the attention of all nurses. This process can only be successful in an environment where collaboration and trust exist. Trust needs to be earned not given. Trust is an interactive process that cannot take place behind closed doors.

All instruments play an essential part in delivering the complete sound of an orchestra. Its music is incomplete and would not meet the composer's requirements unless all the different instruments are involved in delivering the music. Imitations and substitutions of synthesised music may be cheaper but is it real music? As nurse leaders we need to promote harmony between the different aspects of our profession. Nurse leaders need to ensure clinical practice models protect the profession from the advent of unskilled workers and technicians. Nurse leaders should develop the unity of purpose required to ensure the music of caring is played the way we want to hear it and reaches the heart of the audience intact.

The world of nursing leadership is challenging and complex and requires diverse expertise and skills. Nurse leaders need excellent interpersonal capabilities combined with critical thinking skills and knowledge. There is no 'best' place to deliver nursing care. The venues may be different and change over time but the music remains the same. As the health care scene moves from the acute setting into the community and patient homes, nurse leaders will be called on to develop programs to support nursing practice in these vastly different areas.

Leadership through advocacy requires nurse leaders to have a voice in the issues that effect nursing and the broader health care arena be it in economics, politics or social policy. It calls on all nurse leaders to become self-aware and develop the skills required to promote nursing through empowering others. But it is this leadership style that may best help us to address the complex issues inherent in the question - “The Money or The Nurse?” Nurse leaders are challenged by it but through this challenge let it be seen that nurses dare to care in a corporate world.