Conducting the orchestra in aged care: the leadership role of the registered nurse

Conducting the orchestra in aged care: the leadership role of the registered nurse

The registered nurse (RN) position in the residential aged care setting is a role that encompasses the position of care coordinator, staff liaison and educator and one that orchestrates the direction of care of residents. This research is grounded in interpretive phenomenology. The philosophical and methodological grounding and structure of the research draws on the tenets of Hans George Gadamer’s premise of hermeneutic phenomenology. This premise guides the research in an exploration of the ‘what is’ of the leadership role of the RN working in residential aged care environments. Interviews were conducted with registered and enrolled nurses and unregulated health care workers and equated to the thirteen clinical care staff participants from across two states in Australia in four aged care settings.

The study suggests that the leadership role of the RN was identified as a fine balance between the leading, sometimes following and at other times the silent observer available and willing to intervene or converse when the time was seen as right. The study identified that RN leadership was a multidimensional phenomenon. Two key areas appeared in the leadership role, identified as the understanding of the leadership role and the application of leadership in practice. The realisation of how the understanding and the application of the RN leadership role were perceived and received by aged care staff was important. The RN sets the scene, coordinates the care and engages other staff in the unified practice of caring under the auspices of their leadership role.

The implications for the residential aged care sector is seen in the leadership enacted by the RN, the missed opportunities or the capacity of the RNs employed in the sector to both have a voice, an understanding and an ability to practically apply the leadership required. It was the difference or indifference seen, heard and expressed through the clinical care staff participants that created the dissonance or consonance in leadership expressed by those working in the setting. The research has identified clinical leadership as a key component in the understanding and application of leadership by the RN in the residential aged care setting. To enable this in practice the RN requires education for leadership in practice, rather than leadership by style or characteristic.