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  <front>
    <article-meta>
      <title-group>
        <article-title>An account of leadership attributes: lived experience of leaders in nursing education</article-title>
      </title-group>
      <contrib-group content-type="author">
        <contrib contrib-type="person">
          <name>
            <given-names>Annie Rosita</given-names>
          </name>
          <email>annierosita1@gmail.com</email>
          <xref ref-type="aff" rid="aff-1"/>
        </contrib>
      </contrib-group>
      <aff id="aff-1">
        <institution>Lecturer, Fatima College of Health Sciences</institution>
        <country>India</country>
      </aff>
      <history>
        <date date-type="received" iso-8601-date="2020-08-12">
          <day>12</day>
          <month>08</month>
          <year>2020</year>
        </date>
        <date data-type="published" iso-8601-date="2020-08-12">
          <day>12</day>
          <month>08</month>
          <year>2020</year>
        </date>
      </history>
    </article-meta>
  </front>
  <body>
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    <p>
      <bold>www.ijamscr.com</bold>
    </p>
    <sec id="sec-1">
      <title>An account of leadership attributes: lived experience of leaders in nursing education</title>
      <sec id="sec-1_1">
        <title>Annie Rosita, MSc Nursing, RN RM, PhD Scholar</title>
        <p>
          <italic>Lecturer, Fatima College of Health Sciences  </italic>
        </p>
        <p>
          <bold>*Corresponding Author:</bold>
          <bold>Annie Rosita</bold>
        </p>
        <p>
          <bold>Email id: </bold>
          <bold>annierosita1</bold>
          <bold>@gmail.com</bold>
        </p>
        <sec id="sec-1_1_1"/>
        <sec id="sec-1_1_2">
          <title>ABSTRACT</title>
          <p>Nurses have a vital role to partner and lead in transformation of health care. The leaders in the nursing education hold a pivotal position that influences both the current nursing practice and the advancement of the profession. Despite the influential roles that they hold, little is known about their experience and perception of their leadership role, its significance and its meaning to them. This study intends to explore the lived experience of leaders currently practicing as leaders in the academics and also to identify the important attributes for the leaders in nursing education. Ethnographical and narrative phenomenological approach was followed for the study. Participants were asked to reflect on their experiences elaborately on various attributes of leadership, which signified being Supportive, Credible, Resourceful, Facilitator, Charismatic, Acting as per the mission of the institution etc. The analysis also informs of various experiences, which definitely would inform the administrators to consider prospering Academic Nursing.</p>
          <p><bold>Keywords:</bold> Leadership Attributes, Nursing Education, Lived Experience</p>
        </sec>
        <sec id="sec-1_1_3"/>
        <sec id="sec-1_1_4">
          <title>Introduction</title>
          <p>Nursing leadership have been defined as ‘Leadership is walking the fine line between what your organizational needs are versus what the personal needs of may be your employees and your peers ’. (Dyess, 2016). A good nurse leader is someone who can inspire others to work together in the pursuit of a common goal”. (Meliniotis, 2015). “Leadership can be defined as a multifaceted process of identifying a goal or target, motivating other people to act and providing support and motivation to achieve mutually negotiated goals” ( Porter –O’Grady,2003).</p>
          <p>Academic leadership is generally viewed as the act of building the community of scholars and the future leaders in any field, which is achieved through faculty empowerment. Review of literature revealed that there are very few studies that have explored the Nursing leaders in nursing education about their lived experience, the significance of the role to them and the meaning of the role or the position. Also those studies were from the west, involving countries like Canada, England, Australia and United States. So far the aspect of studying the experiences and perceptions of the leaders in education in the Middle East, has not been attempted. </p>
          <p>A systematic review of the literature was undertaken using the cumulative index to nursing and allied health literature (CINAHL), EBSCOhost and Google scholar databases to get an in-depth knowledge about the topic and aspect focussed in the current study. The key terms used to search and extract data are leadership in nursing, perceptions of leadership, deanship, educational leadership and evaluation of leadership. An extensive review of literature revealed that this topic was very minimally researched.</p>
          <p>In the functioning of the educational institution, and the quality of it, is greatly influenced by its leadership. Nurses in every level and other arena are expected to demonstrate leadership qualities. American organisation of nurse executives ( AONE) (2011) has stated the competencies for nurse executives and the nurse educators as five domains, (i) Communication and relationship building, ( ii) Knowledge of the health care environment, (iii) Leadership skills. (iv)  Professionalism and business skills. The National League for Nursing’s excellence in nursing education model (2006) delineates the eight core elements in nursing education that is needed to excel in nursing education.  The core competency for leaders in the academia are given as task statements as (i) Articulate and promote a vision for nursing education. (ii) Function as steward for nursing, nursing organisation and nursing education. (iii) Embrace professional values in the context of higher education (iv) Develop and nurture relationships (Patterson 2015).</p>
          <p>The role of nursing leadership encompasses those attributes that are related to strategic management, operational management, human resource management, academic management, quality of teaching and learning, research performance, community engagement and external stakeholder relationships (Harkins 1998, Bright and Richards 2001, Montez et al, 2003). These roles are influenced by the leaders’ personal attributes like passion, vision, courage, integrity, credibility, adaptability, perseverance, good communication skills, open mindedness, inspiration and commitment.(Harkins 1998,Bright and Richards 2001).</p>
          <p>The objective of this study is to determine the attributes of academic leadership that are perceived to be necessary for the leaders in nursing education to be successful and to explore the essence of their experience to function as a successful nursing leader.</p>
        </sec>
        <sec id="sec-1_1_5">
          <title>THeoretical underpinning</title>
          <p>The combination of ethnographical and interpretive phenomenological approach was consulted for this study. The advantage being, both interpretive phenomenology and ethnographical approach has the exploratory approach in common. The researcher is considered as the data collection instrument and also both methodology insists the researcher to take a self-conscious approach to the research. The two methodologies use interviews with open ended questions and have narrative description as the raw data. The advantage of combining the ethnographical and phenomenological methodology is that, while the interpretive phenomenology tries to explore and bring out meaning of the narrations explicitly. The ethnographical approach brings out the individual and shared views, values of the predominant culture and to describe the cultural knowledge of the participants. Rapport (2000). </p>
          <p><bold><italic>Interpretive phenomenology:</italic></bold> It highlights necessarily the need to study the human experience by focusing on the study subjects. In this study, it’s the leader’s subjective experience. By adopting this methodology, the researcher will be able to understand the deeper meaning and the significance of the experience and also the nature of experience that is narrated by the participants. Patterson (2015) adds that the process develops through three different stages: fore-understanding, interrogation and the reflection. As per the stages that are given, the researcher starts the study with a brief understanding of the concept that is wished to be understood and explored. After which, the phenomenon is explored employing the interview and obtaining a narrative description. And once the texts are transcribed, the emerging themes can be analysed.</p>
          <p><bold><italic>Ethnography</italic></bold><italic>:</italic> This methodology was adopted as the researcher intended to explore the routine and daily lives of the nurse leader in the educational university. The study also takes into numerous factors at a time by allowing the leaders to express their cultural influence on their leadership role, the language, the rituals and the relationships that they build in their workplace, with the culture as the common thread, as supported by (Hammersley 1992). Agar ( 1980) states that people do not always do what they say they do , so employing the ethnographic data collection would help the researcher to bring out the inner meaning and to express the significance of their day to day dealings.</p>
          <p>The researcher adopts the combination of the methodology by consulting the ethnography and the interpretive phenomenology, so to obtain the closer and the deeper understanding and interpretation of the concept that is researched and the experiences of the nurse leaders.</p>
        </sec>
        <sec id="sec-1_1_6">
          <title>METHODOLOGY</title>
          <p>The ethnographical and narrative phenomenological approach was followed in combination. (Thompson 2000) states that personal testimonies can be used to collect data in depth while dealing with the qualitative studies. Rapport (2000) recommends the use of ethnographical and interpretive phenomenological combination of methodologies by stating that, while exploring the phenomenon under study in terms of the participant group, their cultural background and the day to day experiences can be considered while including the ethnographical approach. </p>
          <p>The study used individual interview for extracting and exploring the lived experiences of the leaders in academic field of nursing.</p>
          <p>The questions asked during the interview were:</p>
          <list list-type="order">
            <list-item>
              <p>What is your experience of being a leader in the nursing education program?</p>
            </list-item>
            <list-item>
              <p>What is the significant experience that has prepared you to transition to the role of nursing leader?</p>
            </list-item>
            <list-item>
              <p>What is your personal perception about your leadership attributes, which you consider as vital and has helped you to be successful in the leadership position and role.</p>
            </list-item>
            <list-item>
              <p>What do you consider as to explore the perception of leadership attributes that is ideal to possess to function as a successful nursing leader?</p>
            </list-item>
            <list-item>
              <p>Did you experience any difficult times, and how did you deal with it successfully?</p>
            </list-item>
          </list>
          <p>Two of the Nursing institutions in United Arab Emirates was considered as the setting of the study. The participants were the leaders in the nursing program who was currently holding the leadership position at the time of study and also someone who were holding the leadership position in the educational institutes in UAE. A purposive sampling was adopted for the study, which consisted of 10 participants. This study focuses on the lived experience of being the senior academic nursing faculty who are currently in the responsible position of leading the nursing program and responsible for the major aspect of the operation in the nursing education of the institution. The study aims to capture their experience in professional lives, being in the position and functioning so far. The study also lays emphasis on their perception of the leadership attributes which they think is vital, have contributed for them to be identified for this position and entrusted the leadership role. </p>
          <p>The interview was transcribed from the digital recording. The themes were identified and analyzed by identifying the repeated statements and phrases about an idea, which revealed the attributes of successful leader and the experience of the leader in nursing education and their perception about the success in their role. The researcher also has incorporated the stages formulated by Ritchie and Spencer (1994). This framework was opted to be consulted because it provides very clear steps in analyzing the breadth of the data derived from the interview. Using this framework, the data was subjected to vital five stages which are (i)familiarization (ii)identification of the thematic framework; (iii)indexing (iv)charting and mapping (v)interpretation.</p>
          <p>The familiarization of the data was done by adopting the method of listening to the digitally recorded discussions, transcribing the data, and repeatedly reading the transcribed data. The second stage involves identifying the theme in regard to the data that is obtained. This was achieved by grouping the phrases and the ideas together and differentiating into main theme and the sub themes. The third stage was indexing, which was done by sorting out the data in the transcripts using the identified theme and sub themes. The fourth stage is the charting and mapping where the data is arranged together according to the framework that is used for analysis. The last stage is the interpretation where the complete data set that is sorted, grouped, mapped and are interpreted to find the significance and the meaning of the data, whereby trying to answer the research question and meet the objective of the study.</p>
        </sec>
        <sec id="sec-1_1_7">
          <title>ANALYSIS AND RESULT </title>
          <p>The aim of the study was to explore the leadership attributes that is essential for the nursing leadership in the Nursing education.  Interview yielded attributes that they perceive as vital for any leader in the nursing education program. The most commonly mentioned attributes which includes both personal qualities and the attributes related to the position held is listed in Table: 1. </p>
          <p>
            <bold>Table: 1 Attributes of successful leader.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>S:No</bold>
                </td>
                <td>
                  <bold>Attributes</bold>
                </td>
                <td colspan="2"/>
              </tr>
              <tr>
                <td>1</td>
                <td colspan="2">Supportive</td>
              </tr>
              <tr>
                <td>2</td>
                <td colspan="2">Credible</td>
              </tr>
              <tr>
                <td>3</td>
                <td colspan="2">Resourceful</td>
              </tr>
              <tr>
                <td>4</td>
                <td colspan="2">Facilitator</td>
              </tr>
              <tr>
                <td>5</td>
                <td colspan="2">Charismatic</td>
              </tr>
              <tr>
                <td>6</td>
                <td colspan="2">Acting as per the mission of the institution.</td>
              </tr>
              <tr>
                <td>7</td>
                <td colspan="2">Innovator</td>
              </tr>
              <tr>
                <td>8</td>
                <td colspan="2">Creator</td>
              </tr>
              <tr>
                <td>9</td>
                <td colspan="2">Good listener</td>
              </tr>
              <tr>
                <td>10</td>
                <td colspan="2">Knowledgeable</td>
              </tr>
              <tr>
                <td>11</td>
                <td colspan="2">Evidence based </td>
              </tr>
              <tr>
                <td>12</td>
                <td colspan="2">Share responsibility</td>
              </tr>
              <tr>
                <td>13</td>
                <td colspan="2">Culture conscious</td>
              </tr>
              <tr>
                <td>14</td>
                <td colspan="2">Transparent</td>
              </tr>
              <tr>
                <td>15</td>
                <td colspan="2">Open minded to accommodate suggestions</td>
              </tr>
              <tr>
                <td>16</td>
                <td colspan="2">Conflict resolver.</td>
              </tr>
              <tr>
                <td>17</td>
                <td colspan="2">Team builder</td>
              </tr>
              <tr>
                <td>18</td>
                <td colspan="2">Dynamic</td>
              </tr>
              <tr>
                <td>19</td>
                <td colspan="2">Role model</td>
              </tr>
              <tr>
                <td>20</td>
                <td colspan="2">Visionary</td>
              </tr>
              <tr>
                <td>21</td>
                <td colspan="2">Able to handle stress</td>
              </tr>
              <tr>
                <td>22</td>
                <td colspan="2">Delegator</td>
              </tr>
              <tr>
                <td>23</td>
                <td colspan="2">Able to function with deadlines.</td>
              </tr>
              <tr>
                <td>24</td>
                <td colspan="2">Bold &amp; courageous</td>
              </tr>
              <tr>
                <td>25</td>
                <td colspan="2">Hard working</td>
              </tr>
              <tr>
                <td>26</td>
                <td colspan="2">Quality oriented</td>
              </tr>
              <tr>
                <td>27</td>
                <td colspan="2">People management skills</td>
              </tr>
              <tr>
                <td>28</td>
                <td colspan="2">Practice inclusiveness</td>
              </tr>
              <tr>
                <td>29</td>
                <td colspan="2">Organized</td>
              </tr>
              <tr>
                <td>30</td>
                <td colspan="2">Self-Dignity</td>
              </tr>
              <tr>
                <td>31</td>
                <td colspan="2">Trusting relationship</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table :2 Themes and subthemes emerged from the discussions</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Categories/    Themes</bold>
                </td>
                <td>
                  <bold>Sub categories</bold>
                </td>
              </tr>
              <tr>
                <td>Subservient Leadership</td>
                <td>Challenging</td>
              </tr>
              <tr>
                <td>Role Preparedness</td>
                <td>Previous experience</td>
              </tr>
              <tr>
                <td rowspan="8">Professionalism</td>
                <td>Image of Nursing professionSelf-respect</td>
              </tr>
              <tr>
                <td/>
                <td>Personal growth.</td>
              </tr>
              <tr>
                <td rowspan="6">Institutional Status</td>
                <td>Faculty Shortage</td>
              </tr>
              <tr>
                <td/>
                <td>Accreditation</td>
              </tr>
              <tr>
                <td/>
                <td>Government policy</td>
              </tr>
              <tr>
                <td/>
                <td>High turnover of top-level Managers</td>
              </tr>
              <tr>
                <td rowspan="2">Cultural competence</td>
                <td>Multicultural</td>
              </tr>
            </table>
          </table-wrap>
          <p>As expressed by the leaders, it very important to influence the direction of the program and to be successful in the nursing program. For this, they are required to have knowledge about the profession and about the operation of academic nursing program. Other expressions of the participants, nominating the attributes are as follows:</p>
          <p>
            <italic>“The important quality of the leader is that they should be supportive to the staff and should be aware of them their strength and use their strength appropriately”</italic>
          </p>
          <p>“<italic>The leader should be knowledgeable </italic><italic>about the management strategies and also people management skills. T</italic><italic>his is very important because the leader should be able to know how to talk and manage with people to get the work done and also keep them in the constructive mode”</italic></p>
          <p>
            <italic>“ ..</italic>
            <italic>Should</italic>
            <italic> be charismatic because that will iron out any conflicts if arises”</italic>
          </p>
          <p>
            <italic>“Being supportive is a very important character for the leader, whatever the situation is, just the feeling that the leader will support me will make the staff to function effectively”</italic>
          </p>
          <p>“<italic>In my experience I have understood that the 5 important skill set that is expected from the leader I the UAE is to be a (i) Good communicator</italic><italic>, (</italic><italic>ii) need to have a thirst to move towards excellence</italic><italic>, (</italic><italic>iii</italic><italic>) multitasking</italic><italic> ability</italic><italic>, (</italic><italic>iv) innovator”</italic><italic>.</italic></p>
          <p>“<italic>Some of my personal qualities that has helped me to perform my role as a leader is that ,I’m a good listener, I consult with people expert in the field and also study the feasibility “.</italic></p>
          <p>The other attributes are categorized as per the themes and are presented in the form of narrative statements and the exemplars.  </p>
          <p>The discussions yielded six themes and fifteen subthemes as listed in Table: 2. These overarching themes include subservient leadership, Role preparedness, professionalism, Institutional status, Responsibility without authority and Cultural back ground. Through the participants’ discussion analysis, various sub themes are obtained which is based on the overarching themes. </p>
          <sec id="sec-1_1_7_1">
            <title>Subservient leadership</title>
            <p>Four among the ten mentioned that they don’t feel comfortable to be creative as they need to deal with many questioning. Their innovations sometimes are not taken positively and being escalated, where they constantly have the fear of losing the lob. </p>
            <p>
              <italic>“</italic>
              <italic>....</italic>
              <italic>subordination is the expected attribute</italic>
              <italic> mainly</italic>
              <italic>,”.</italic>
            </p>
            <p>
              <italic> “The leader in the academic field is meant to be creative but afraid to be so due to repercussions...”</italic>
            </p>
            <p>It was mentioned that dealing with the staff, that are equal to their position and getting the work done is very challenging to handle, </p>
          </sec>
          <sec id="sec-1_1_7_2">
            <title>Role preparedness</title>
            <p>Some participants, mentioned positively about their previous experiences. They shared that they were working as the leader in the clinical setting that they think that experience is helping them to perform well in the current role. But one of the senior leader mentions that, the same experience hinders their performance.</p>
            <p><italic>“ In my previous work place I was working as the unit manager in an intensive care unit, where i had to deal with staff who had more than 10 years’ experience than me, i think the experience that i have dealing with people have helped me a great deal I think</italic>”</p>
            <p>
              <italic>“Being a successful leader also depends on the personality of the leader and his leadership qualities or attributes than </italic>
              <italic>just </italic>
              <italic>the qualification”</italic>
            </p>
            <p>
              <italic> “I hold PhD in education and I think this has prepared me for this role well”</italic>
            </p>
          </sec>
          <sec id="sec-1_1_7_3">
            <title>Professionalism </title>
          </sec>
          <sec id="sec-1_1_7_4">
            <title>Self-respect </title>
            <p>In regard to the Self-respect, it was mentioned that they have a huge boost up of self-respect as they were able to foresee any concerns that might arise and resolve it early on.</p>
            <p>“<italic>The real leader does not wait for the problem or issue to be handed over to him to find solution, he offers himself to the situation, explores far and wide and tries to resolve the concerning issue. I’m able to do that as I have experience in this field and I’m able to manage well</italic>”</p>
          </sec>
          <sec id="sec-1_1_7_5">
            <title>Personal growth</title>
            <p>
              <italic>It was mentioned by the participants “I have chances to attend many workshops and conferences which enhances and strengthens me in my role. I also get to attend many refresher courses”</italic>
            </p>
          </sec>
          <sec id="sec-1_1_7_6">
            <title>
              <bold>
                <italic> “This is a growing institution with a dynamic </italic>
              </bold>
              <bold>
                <italic>environment,</italic>
              </bold>
              <bold>
                <italic> this in a way makes us stronger even more.”</italic>
              </bold>
            </title>
          </sec>
          <sec id="sec-1_1_7_7">
            <title>Institutional status</title>
            <p>
              <italic>During the interview, it was brought up that some of the conditions including the logistics that prevail, influence the role of nursing leadership.</italic>
            </p>
          </sec>
          <sec id="sec-1_1_7_8">
            <title>Faculty shortage</title>
            <p>
              <italic>“It</italic>
              <italic> was very stressful</italic>
              <italic> for me as a leader,</italic>
              <italic> as I had to handle the budget issues. I also had a lot of issues in regard to manpower and also IT related concerns which took lots of my time.”</italic>
            </p>
          </sec>
          <sec id="sec-1_1_7_9">
            <title>Accreditation, </title>
            <p>Getting accreditation and reaccreditation is an important aspect of any institution but it was mentioned </p>
            <p>“<italic>I’m not much aware about th</italic><italic>e</italic><italic> accreditation, but I’m expected to prepare</italic><italic> many </italic><italic>documen</italic><italic>ts</italic><italic> for submission...It takes most of my time every week. An individual with experience for this task needs to be assigned the job identified individual</italic>”</p>
          </sec>
          <sec id="sec-1_1_7_10">
            <title>High turnover of top level managers. </title>
            <p>The instability of the people in the administrative position often leads to instability of the system which in turn affects the smooth functioning of the staff.</p>
            <p>“If the administrator is not in the position for long time and if there are new people every time. It is very difficult to manage...so something that was implemented by one leader is considered no longer good by the next leader and the same thing is done in another way.”</p>
          </sec>
          <sec id="sec-1_1_7_11">
            <title>Cultural competence</title>
            <p>Culture is woven in every functions of the institution. One cannot perform their duties effectively without being oriented and being mindful.</p>
            <p><italic>“....i need to be culturally aware... to understand this place</italic>”</p>
            <p>“<italic>One needs to be very hospitable, to gel with the people of this place, when you meet someone for official purpose also</italic><italic>...</italic><italic> You need to spend some time talking</italic><italic>...</italic><italic> Greeting</italic><italic>...</italic><italic> Wishing them well </italic><italic>etc.</italic><italic> and only then come to the point for discussion. Or else you will be viewed very </italic><italic>rude /</italic><italic>different</italic>” </p>
          </sec>
          <sec id="sec-1_1_7_12">
            <title>Multicultural </title>
            <p>The staff are from different countries and background, so understanding them from their reference is important.</p>
            <p>“<italic>The meaning of loyalty is different in different culture, especially when we are with people belonging to multi culture; you need to understand the environment and the term of reference to function effectively</italic>.”</p>
            <p>“<italic>Due to the multi-cultural environment and also in this place, there is rigidity on creativity or innovation. I fear if I would upset the status quo of this place and culture</italic>”</p>
            <p>The data was obtained from the faculties in the leadership position who belong to two educational institution. The inclusion of faculties from other universities and from other emirates would have enhanced the generalizability of the findings. An expanded and a robust research  including many leaders from the other professional discipline like physiotherapy, paramedics, radiography and medical doctors, would have yielded another dimension of leadership in different settings.</p>
            <p>In the qualitative phenomenological study, there is always a drawback because of understanding the other human being and their perceptions from their point of view. In addition, along with the researcher, one must bear in mind, to differentiate the participants own perception and the social responses elicited by the interview process itself. The researchers personal acquaintance and the present collegial relationship also would have influence on the participants, not to mention about some of their experience and their perceptions. The study also did not take into account the emerging leaders who are in their transitional phase.</p>
          </sec>
        </sec>
        <sec id="sec-1_1_8">
          <title>CONCLUSION</title>
          <p>Academic Nursing can prosper in this field, considering the findings of the study. The findings of the study would inform about the various experiences of the nursing leaders in the educational institution and the attributes needed to function effectively in the role. The results can be utilized by the institutions to recruit personnel with the mentioned attributes and in addition inform the areas where the nursing leaders needed the support from the management to function effectively to their fullest ability.</p>
        </sec>
        <sec id="sec-1_1_9">
          <title>References</title>
          <list list-type="order">
            <list-item>
              <p>Cummings, G., MacGregor, T., Davey, M., Wong, C., Paul, L. and Stafford, E.,. Factors contributing to nursing leadership: a systematic review. <italic>Journal of Health Services Research &amp; Policy</italic>, <italic>13</italic>(4), 2008, 240-248.</p>
            </list-item>
            <list-item>
              <p>Deschamps, C, Rinfret, N, Lagacé, M, &amp; Privé, C 2016, 'Transformational Leadership and Change: How Leaders Influence Their Followers' Motivation Through Organizational Justice', Journal Of Healthcare Management, , CINAHL with Full Text, EBSCOhost, viewed 61(3), 2016, 194-212, 20.</p>
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