Understanding strategic nurse leadership in public policy: an international study

BackgroundDespite longstanding calls to expand the policy contribution of nursing, research on strategic nurseleadership in policy at a national or international level is under-developed. Understandinginternational experiences of strategic nurse leaders in influencing policy is critical to realisingambitions for nursing’s growth as a policy influential profession.AimsTo investigate strategic nurse leadership approaches, challenges, and contribution to public policy,and to construct a consensus statement exemplifying global perspectives on nurse leadership andpolicy influence.MethodsThis three-phase social constructionist study comprised pre-Delphi interviews (n=8), three roundmodified Policy Delphi (n=40), and post-Delphi interviews (n=10) with strategic nurse leaders from39 countries. Post-Delphi interviews with government nurse leaders explored the resonance andpotential utility of the draft consensus statement constructed during the Delphi. Pre- and post-Delphi interviews were semi-structured, and framework analysed. The Delphi data were analysedusing descriptive statistics and content analysis. Culturally Endorsed Leadership Theory and bases ofsocial power provided theoretical richness to study design and interpretation of findings.FindingsThe findings reveal a disconnection between the rhetoric and reality of policy influence for strategicnurse leaders internationally. Despite international variation marginalisation was identified as theoverarching challenge to policy influence. Strategic nurse leaders offered mitigating approaches,which centred on expanding the capacity, capability, credibility, and connectivity of the profession asa policy actor. Application of the theoretical lenses identified threats to nursing’s legitimate andexpert power and suggested that realisation of nursing’s ambitions for substantive improvement topolicy influence may require wider cultural change.ConclusionThis is the first theoretically informed study to investigate the approaches and challenges of a crosssectoral,international cohort of elite strategic nurse leaders. The synthesis of key points ofinternational agreement into a narrative consensus statement offers a novel contribution to the fieldof strategic nurse leadership in policy.