www.nursingtimes.net / Vol 109 No 42 / Nursing Times 23.10.13 15

Keywords: Confidence/Newly qualified/Leadership This article has been double-blind peer reviewed

Nursing PracticeResearch review

Leadership

Authors Mary Morley is director of therapies, South West London and St Georges Mental Health Trust, London; Lisa Bayliss-Pratt is director of nursing, Health Education England; Liz Bagley is education quality and performance manager, West Midlands Deanery, Birmingham; Steven Alderson is national medical directors clinical fellow, Health Education England.Abstract Morley M et al (2013) Confidence in leadership among the newly qualified. Nursing Times; 109: 42, 15-16.The Francis report highlighted the importance of strong leadership from health professionals but it is unclear how prepared those who are newly qualified feel to take on a leadership role. We aimed to assess the confidence of newly qualified health professionals working in the West Midlands in the different competencies of the NHS Leadership Framework. Most respondents felt confident in their abilities to demonstrate personal qualities and work with others, but less so at managing or improving services or setting direction.

The Francis report (Francis, 2013) stated how important it is for nurses and other professionals to exhibit strong leadership skills to ensure patients are always put first. How-ever, how prepared those professionals who are newly qualified feel about taking on such roles is unclear. As a result of this, we aimed to ascertain how confident newly qualified staff working in the West Mid-lands felt in their leadership abilities. We used the NHS Leadership Competency Framework (Fig 1) to measure confidence in: Demonstrating personal qualities; Working with others; Managing services;

5 key points 1 The Francis report states that all nurses need strong leadership skills

2It is unclear whether newly qualified professionals feel able to adopt a leadership role

3Most newly qualified health professionals feel confident in demonstrating personal qualities and in working with others

4They are less confident in managing and improving services and setting direction

5Although professionals may not feel confident in their abilities, they may be competent leaders

Improving services; Setting direction (NHS Leadership

Academy, 2013).Newly qualified health professionals

working in NHS trusts in the West Mid-lands were invited by their preceptors to complete an electronic survey asking them to rate their confidence across the frame-works five leadership competencies and the various components of each.

ResultsOf the 59 responses received, 41 were com-pleted by nurses and 18 by allied health professionals. Respondents qualifications included undergraduate diplomas (n=16), undergraduate degrees (n=29), postgrad-uate diplomas (n=13) and masters degrees (n=1); 43 worked in acute trusts, 11 in pri-mary care, three in mental health trusts, and two in other workplaces.

Overall, most respondents (57%) said they were confident in their ability to dem-onstrate personal qualities, with nearly 20% rating themselves as very confident. The remainder felt somewhat confident (21%) or not at all confident (3%). Simi-larly, most respondents reported that they were confident (60%) or very confident (25%) in their abilities to work with others.

When asked about their ability to manage services, only 9% rated themselves as very confident. Most felt they were confident (53%) or somewhat confident (32%); just 5% selected not at all confi-dent. In terms of the different components of managing services, respondents were least confident in using data about perfor-mance to identify improvements, under-standing what resources are available and in contributing to service plans (Table 1).

In rating confidence in the ability to

In this article... How confidence was assessed among a group of newly qualified professionals

Where respondents lack confidence in their leadership

Newly qualified health professionals do not always feel confident about their leadership abilities and may feel unsure of their leadership role

Confidence in leadership among the newly qualified

fig 1. NHS LeAdeRSHIp CoMpeTeNCy FRAMeWoRK

16 Nursing Times 23.10.13 / Vol 109 No 42 / www.nursingtimes.net

their personal qualities or working with others but felt less so at managing or improving services, or setting direction. These findings may not be surprising. While the demonstration of personal quali-ties and team-working are well established in health professionals training (McNair, 2005), the importance of newly qualified staff managing and improving services and setting direction is less so. Neverthe-less, both the Francis (2013) and Keogh (2013) reports highlight the importance of listening to the views of the most junior health professionals and engaging them in improving services their energy must be tapped and not sapped (Keogh, 2013).

It is important to acknowledge that while newly qualified professionals may lack confidence in their own abilities, objective measures and reports of others may show them to be competent.

improve services, 12% of respondents were very confident, 38% confident, 30% somewhat confident and 7% not at all confident. They were least confident in expressing the need to change processes, putting forward suggestions to improve service quality and questioning established practices that do not add value (Table 1).

On setting direction, 10% rated them-selves very confident, 39% confident, 39% somewhat confident and 13% not at all confident. They felt most confident consulting with others, but lacked confi-dence in their decisions about the future direction of the service, gathering and ana-lysing data and making recommendations for improvements.

discussionMost respondents reported being confident or very confident about demonstrating

Table 1. ReSpoNdeNTS CoNFIdeNCe LeveLSNot at all

confident (%)Somewhat

confident (%)Confident

(%)very confident

(%)

Managing services

Contributing to service plans 12 37 46 5

Receiving and incorporating feedback from others 2 24 59 15

Understanding what resources are available 6 42 47 5

Organising resources 7 29 58 6

Supporting others in delivering high-quality services 0 25 61 14

Supporting team members 8 28 56 8

Using information/data to identify improvements 8 44 41 7

Developing and learning from experience 0 27 59 14

Improving services

Putting the safety of patients/service users at the heart of thinking 0 14 61 25

Taking action to report or rectify shortfalls in patient safety 4 20 59 17

Gathering feedback from patients, carers and service users 5 34 39 22

Using feedback to contribute to healthcare improvements 7 39 44 10

Questioning established practices that do not add value 14 42 37 7

Putting forward creative suggestions to improve service quality 8 49 37 7

Expressing need to change processes and systems 19 42 27 12

Acknowledging impact on people and services 0 37 49 14

Setting direction

Understanding factors determining why changes are made 9 41 42 8

Understanding recent legislation/accountability frameworks 12 47 36 5

Gathering and analysing data about aspects of service 15 47 32 6

Using evidence to suggest changes that will improve services 12 41 39 8

Consulting with others 1 19 53 27

Contributing to decisions about the future direction of the service 19 44 29 8

Assessing effects of change on service delivery/patient outcomes 15 32 44 9

Making recommendations for future improvements 19 42 34 5

This is a small study; further research using a larger sample might give a clearer indication of where newly qualified pro-fessionals lack confidence. This could also help to determine whether such profes-sionals lack confidence, competence or both and whether the solution is offering more preparation for leadership or simply working on building confidence. NT

ReferencesFrancis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: Stationery Office. tinyurl.com/HMSO-Francis2Keogh B (2013) Review into the Quality of Care and Treatment Provided in 14 Hospital Trusts in England: Overview Report. tinyurl.com/NHS-KeoghMcNair RP (2005) The case for educating health care students in professionalism as the core content of interprofessional education. Medical Education; 39: 5, 456-464.NHS Leadership Academy (2013) Leadership Framework. tinyurl.com/NHS-LFramework NH

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