Leadership Experiences of Modern Matrons in an Acute NHS Trust
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This study explores and understands the leadership experiences of modern matrons within an acute NHS Trust. The findings suggest that exposure to a range of leadership styles should be included in preparation and CPD for the modern matron role.
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To explore and understand the leadership experiences of modern
matrons, within an acute NHS Trust
NIGEL LAWRENCE R S C N B S C ( H O N S ) ,MSC 1 and JANET RICHARDSON B S C ( H O N S ) ,P H D ,C P S Y C H O L ,R N , D N , P G C E
2
1Lead Nurse for Children and Safeguarding, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK and
2Professor of Health Service Research (Honorary Consultant in Public Health–NHS Plymouth) , Faculty of Health
Education and Society, Plymouth University, Plymouth, UK
Background
Following public consultation,the National Health
Service(NHS) Plan (Departmentof Health (DoH)
2000) identified the need to appoint modern matrons to
provide an authoritative,visible and accessible clinical
figure to lead wards and departments; the intention of
the role wasto improve quality ofcare,the patient
experienceand to help restorepublic confidencein
healthcare.The matron role was re-introducedto
address nursesÕ apparent powerlessness when faced wit
clinical concerns. Three main responsibilities of the role
Correspondence
Nigel Lawrence
Directorate Offices
Centre for WomenÕs Health
RD and E NHS Foundation Trust
Exeter EX2 5DW
UK
E-mail: nigellawrence@nhs.net
L A W R E N C E N .& R I C H A R D S O N J .(2012) Journal of Nursing Management
To explore and understand the leadership experiences of modern matrons,
within an acute NHS Trust
Aim The aim of this study was to explore and understand the leadership
experiences of modern matrons.
Background Modern matrons were re-introduced to the National Health Service
in 2002, and effective leadership has been identified as being essential for the ro
be successful. However, there is minimal evidence of how modern matrons
experience effective leadership.
Methods The study used a descriptive generic qualitative methodology; one-to-on
semi-structured interviews were conducted with nine matrons. This was
subjected to an inductive thematic analysis.
Results Three themes were found to influence modern matronÕs leadership
experiences: leadership behaviours, negative influences and leadership investme
They did not follow one leadership style but adapted this to their situation.
Various factors appeared to restrict their leadership effectiveness.
Conclusions The findings suggest that exposure to a range of leadership styles
should be included in preparation and CPD for the modern matron role and a mor
consistent job description and job purpose should be developed.
Implications for nursing management Leadership styles such as transformational
leadership alone do not meet the complex demands of nursing leaders, and
therefore there is a requirement for greater flexibility in leadership development
all health care professionals.
Keywords:credibility, investment, leadership style, transformational leadership
Accepted for publication: 3 April 2012
Journal of Nursing Management, 2012
DOI: 10.1111/j.1365-2834.2012.01432.x
ª 2012 BlackwellPublishing Ltd 1
matrons, within an acute NHS Trust
NIGEL LAWRENCE R S C N B S C ( H O N S ) ,MSC 1 and JANET RICHARDSON B S C ( H O N S ) ,P H D ,C P S Y C H O L ,R N , D N , P G C E
2
1Lead Nurse for Children and Safeguarding, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK and
2Professor of Health Service Research (Honorary Consultant in Public Health–NHS Plymouth) , Faculty of Health
Education and Society, Plymouth University, Plymouth, UK
Background
Following public consultation,the National Health
Service(NHS) Plan (Departmentof Health (DoH)
2000) identified the need to appoint modern matrons to
provide an authoritative,visible and accessible clinical
figure to lead wards and departments; the intention of
the role wasto improve quality ofcare,the patient
experienceand to help restorepublic confidencein
healthcare.The matron role was re-introducedto
address nursesÕ apparent powerlessness when faced wit
clinical concerns. Three main responsibilities of the role
Correspondence
Nigel Lawrence
Directorate Offices
Centre for WomenÕs Health
RD and E NHS Foundation Trust
Exeter EX2 5DW
UK
E-mail: nigellawrence@nhs.net
L A W R E N C E N .& R I C H A R D S O N J .(2012) Journal of Nursing Management
To explore and understand the leadership experiences of modern matrons,
within an acute NHS Trust
Aim The aim of this study was to explore and understand the leadership
experiences of modern matrons.
Background Modern matrons were re-introduced to the National Health Service
in 2002, and effective leadership has been identified as being essential for the ro
be successful. However, there is minimal evidence of how modern matrons
experience effective leadership.
Methods The study used a descriptive generic qualitative methodology; one-to-on
semi-structured interviews were conducted with nine matrons. This was
subjected to an inductive thematic analysis.
Results Three themes were found to influence modern matronÕs leadership
experiences: leadership behaviours, negative influences and leadership investme
They did not follow one leadership style but adapted this to their situation.
Various factors appeared to restrict their leadership effectiveness.
Conclusions The findings suggest that exposure to a range of leadership styles
should be included in preparation and CPD for the modern matron role and a mor
consistent job description and job purpose should be developed.
Implications for nursing management Leadership styles such as transformational
leadership alone do not meet the complex demands of nursing leaders, and
therefore there is a requirement for greater flexibility in leadership development
all health care professionals.
Keywords:credibility, investment, leadership style, transformational leadership
Accepted for publication: 3 April 2012
Journal of Nursing Management, 2012
DOI: 10.1111/j.1365-2834.2012.01432.x
ª 2012 BlackwellPublishing Ltd 1
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were proposed by the Departmentof Health (DoH
2001). These were: (1) to provide leadership to clinical
staff to secure and assurethe higheststandardsof
clinicalcare,(2) ensure the availability of appropriate
administrative support services in their ward groups, (3)
to provide a visible,accessible and authoritative pres-
ence in ward settings to whom patients and their fam-
ilies can turn for assistance, advice and support.
The modern matron role was further defined in 2002
by the introduction of the 10 key responsibilities (DoH
2002). However,on introducing the role,individual
Trusts were given the opportunity to define the matronÕs
role according to their local needs. Consequently, there
has been variation in how the role is provided between
and even within Trusts (Gould 2008). Since 2002,
modern matron numbers have increased rapidly, and by
2008 there were 5538 modern matrons on NHS wards
(Mooney 2008). The role has evolved and become
increasingly complex asnew targetsand challenges
have been introduced.In particular,there has been an
increasing emphasison the modern matronÕsrole in
responseto environmentalcleanlinessand infection
control (DoH 2004a,b, Shuttleworth2004, Gould
2008).
Evaluation of role
Severalsmall qualitativestudieshave evaluated the
matron role. Some studies suggest the role is successful
in demonstratingthat through effectiveleadership,
matrons are enabling the improvement of patient care,
for example in areasof infection control(Kemp &
Morris 2003, Hill & Hadfield 2005, Keeley et al. 2005,
Dealey et al. 2007, Gould 2008, Smith 2008a,b).
However,the matronsÕability to promote high stan-
dards of cleanliness and infection control may be being
compromised due to limitationsof domestic services
(Gould 2008).
Agnew (2005)assertsthat matronshave replaced
nursing directors as the visible public face of nursing. In
contrast, Barbour and Dodd (2007) suggest that the role
is differentto other seniornursing and management
roles because itensures continuous directcontactbe-
tween patients and middle managers.This mightex-
plain why any power and authority the matrons have is
negotiated,and located in the credibility ofthe indi-
vidual, ratherthan the authority ofthe matron role
(Keeley et al. 2005).
The largestand most comprehensive study ofthe
modern matron initiative was carried out by Read et al.
(2004).This mixed-methods study found that modern
matronsgiven theappropriatesupport,and with a
focused clinical role have great potential for improving
patientcare.However,in many casesorganizational
supportwas limited and the modern matrons had to
rely on their own leadership qualities to achieve their
goals.
Although a policy document from the Royal College
of Midwives (2002) supports the concept of the modern
matron, no studies were found that evaluated the role in
midwifery.
Organizational and personal factors
The majority of published studiessuggestthat the
implementation of the role has been successful.How-
ever, several studies have identified factors that appear
to reduce the effectiveness of the role.These issues in-
clude unrealistic organizational expectations, increasing
administrativetasks and the absenceof budgetary
control(Gould 2008,Koteyko & Nerlich 2008).This
results in competing operational and clinical aspects of
the role,which has led to a hybrid managementrole
that has potentialfor tension and conflict(Savage &
Scott 2004, Dealey et al. 2007). These factors have re-
duced the matronsÕvisibility, and therefore lower their
organizationalauthority and credibility (Read et al.
2004,Koteyko & Nerlich 2008).Furthermore,many
matronsreport feeling under-prepared forthe role,
being unaware oftheir own developmentneeds,and
having a deficitin business managementskills (Read
et al. 2004, Gould 2008, Koteyko & Nerlich 2008).
Leadership and the modern matron
Previous studies appear to suggest that leadership is a
major factor in influencing the matronsÕeffectiveness
(Cole 2002, Barbour & Dodd 2007, Dealey et al. 2007,
Smith 2008b).When highlighting the importance of
effective leadership,many studies advocate a transfor-
mational leadership style for matrons (Hill & Hadfield
2005, Keeley et al. 2005, Scott et al. 2005, Dealey et al.
2007, Clark 2008, Koteyko & Nerlich 2008). However,
attributes and actions associated with transformational
leadership may notbe adequate or broad enough to
meetthe demands ofsenior nursing roles within the
NHS (McIntosh & Tolson 2008).
Severalstudies,(Scott et al.2005,Barbour & Dodd
2007, Gould 2008, Smith 2008b)reported thatthe
modern matrons demonstrated leadership ÔqualitiesÕ an
ÔresponsibilitiesÕ,but provide little evidence regarding
how these attributeswere demonstrated.Read et al.
(2004) implied that the matrons within their study had
to rely on their own leadership qualities to achieve their
N. Lawrence and J. Richardson
ª 2012 BlackwellPublishing Ltd
2 Journal of Nursing Management
2001). These were: (1) to provide leadership to clinical
staff to secure and assurethe higheststandardsof
clinicalcare,(2) ensure the availability of appropriate
administrative support services in their ward groups, (3)
to provide a visible,accessible and authoritative pres-
ence in ward settings to whom patients and their fam-
ilies can turn for assistance, advice and support.
The modern matron role was further defined in 2002
by the introduction of the 10 key responsibilities (DoH
2002). However,on introducing the role,individual
Trusts were given the opportunity to define the matronÕs
role according to their local needs. Consequently, there
has been variation in how the role is provided between
and even within Trusts (Gould 2008). Since 2002,
modern matron numbers have increased rapidly, and by
2008 there were 5538 modern matrons on NHS wards
(Mooney 2008). The role has evolved and become
increasingly complex asnew targetsand challenges
have been introduced.In particular,there has been an
increasing emphasison the modern matronÕsrole in
responseto environmentalcleanlinessand infection
control (DoH 2004a,b, Shuttleworth2004, Gould
2008).
Evaluation of role
Severalsmall qualitativestudieshave evaluated the
matron role. Some studies suggest the role is successful
in demonstratingthat through effectiveleadership,
matrons are enabling the improvement of patient care,
for example in areasof infection control(Kemp &
Morris 2003, Hill & Hadfield 2005, Keeley et al. 2005,
Dealey et al. 2007, Gould 2008, Smith 2008a,b).
However,the matronsÕability to promote high stan-
dards of cleanliness and infection control may be being
compromised due to limitationsof domestic services
(Gould 2008).
Agnew (2005)assertsthat matronshave replaced
nursing directors as the visible public face of nursing. In
contrast, Barbour and Dodd (2007) suggest that the role
is differentto other seniornursing and management
roles because itensures continuous directcontactbe-
tween patients and middle managers.This mightex-
plain why any power and authority the matrons have is
negotiated,and located in the credibility ofthe indi-
vidual, ratherthan the authority ofthe matron role
(Keeley et al. 2005).
The largestand most comprehensive study ofthe
modern matron initiative was carried out by Read et al.
(2004).This mixed-methods study found that modern
matronsgiven theappropriatesupport,and with a
focused clinical role have great potential for improving
patientcare.However,in many casesorganizational
supportwas limited and the modern matrons had to
rely on their own leadership qualities to achieve their
goals.
Although a policy document from the Royal College
of Midwives (2002) supports the concept of the modern
matron, no studies were found that evaluated the role in
midwifery.
Organizational and personal factors
The majority of published studiessuggestthat the
implementation of the role has been successful.How-
ever, several studies have identified factors that appear
to reduce the effectiveness of the role.These issues in-
clude unrealistic organizational expectations, increasing
administrativetasks and the absenceof budgetary
control(Gould 2008,Koteyko & Nerlich 2008).This
results in competing operational and clinical aspects of
the role,which has led to a hybrid managementrole
that has potentialfor tension and conflict(Savage &
Scott 2004, Dealey et al. 2007). These factors have re-
duced the matronsÕvisibility, and therefore lower their
organizationalauthority and credibility (Read et al.
2004,Koteyko & Nerlich 2008).Furthermore,many
matronsreport feeling under-prepared forthe role,
being unaware oftheir own developmentneeds,and
having a deficitin business managementskills (Read
et al. 2004, Gould 2008, Koteyko & Nerlich 2008).
Leadership and the modern matron
Previous studies appear to suggest that leadership is a
major factor in influencing the matronsÕeffectiveness
(Cole 2002, Barbour & Dodd 2007, Dealey et al. 2007,
Smith 2008b).When highlighting the importance of
effective leadership,many studies advocate a transfor-
mational leadership style for matrons (Hill & Hadfield
2005, Keeley et al. 2005, Scott et al. 2005, Dealey et al.
2007, Clark 2008, Koteyko & Nerlich 2008). However,
attributes and actions associated with transformational
leadership may notbe adequate or broad enough to
meetthe demands ofsenior nursing roles within the
NHS (McIntosh & Tolson 2008).
Severalstudies,(Scott et al.2005,Barbour & Dodd
2007, Gould 2008, Smith 2008b)reported thatthe
modern matrons demonstrated leadership ÔqualitiesÕ an
ÔresponsibilitiesÕ,but provide little evidence regarding
how these attributeswere demonstrated.Read et al.
(2004) implied that the matrons within their study had
to rely on their own leadership qualities to achieve their
N. Lawrence and J. Richardson
ª 2012 BlackwellPublishing Ltd
2 Journal of Nursing Management
goals, particularlythrough using interpersonaland
communication skills.Smith (2008b) identified several
factorsthat clearly reduced thematronsÕleadership
capabilities, such as role conflict, a lack of role clarity,
role overload, competing priorities and blurred
boundaries with other roles.
Whilst studies have attempted to evaluate the leader-
ship role of modern matrons, there is limited literature
regarding the leadership experience of nurses in this role.
The study
Aims
The aim of this study was to explore and understand the
leadership experiencesof modern matronswithin an
acute NHS Trust, and explore from their perception the
organizational and personal factors that influence their
leadership experiences.
Methods
A descriptive generic qualitative methodology approach
(Cohen & Crabtree 2008)was used to explore and
understand the leadership experiences ofmodern ma-
trons. Semi-structured interviewswere used fordata
collection.Interviews were conducted away from the
participantÕswork area, were audio-recordedand
transcribed verbatim for analysis.The interview guide
was based on issuesarising from the literature and
prompts to encourage participants to talk about their
leadershipexperiences.Two pilot interviewswere
carried outto test the interview guide and revisions
made accordingly (Table 1).
Study participants
Participants were modern matrons in one acute NHS
Trust. All modern matrons within the Trust were given
an information leafletand invited to participate.The
lead researcher (NL) attended severalmodern matron
meetings to introduce the study and invite participation.
There are 20 matrons in the Trust and the intention was
to interview up to nine modern matrons or untildata
saturation was achieved (this included one senior mid-
wife). There were no male senior matrons in post at the
time of the selection process.This provided a cross-
section ofmodern matrons from allspecialties across
one NHS Trust, with various levels of experience within
the role,and with whom the interviewer (NL) had no
professional or personal relationship.
Data analysis
To provide a clear systematicapproach,data were
analysed using the thematic analysis process described
by Braun and Clarke (2006).Thematic analysiswas
selected because of its flexibility,due to its theoretical
freedom that allows it the ability to be applied across a
range of theoreticaland epistemologicalapproaches.
This theoreticalfreedom offered theopportunity to
produce a rich and detailed,yet complex analysis of
data (Braun & Clarke 2006). Transcripts were read and
re-read to gain familiarity with the data and to generate
initial themes.
To assistthe identification ofinitial codes a visual
thematic map was created to provide a visualrepre-
sentation of this early process (Braun & Clarke 2006).
Two transcripts were analysed by a second researcher
(JR) and following conferring on themesa coding
strategy was then agreed to apply to all the transcripts
(Green et al. 2007).
The individual participants were given serial numbers
(SM 1–SM 9), and allthe lines in the transcripts were
numbered.This provided the opportunity to cross-ref-
erence,and allowed easier identification ofimportant
sections within the data to return to during the iterative
analytical process (Hardy & Bryman 2004, Denscombe
2007).
Following this process the themes were returned to
the participants in the form of a thematic diagram for
them to confirm or deny the accuracy ofthe analysis
(Guba & Lincoln 1989). This form of member-checking
offered the participants the opportunity to comment on
the themes,and the seven who responded,were all
positive and agreed with the themes.
Rigour was also maintained through reflexivity by
keeping a research journal to promote a transparent and
visible process throughout the study (Cooper & Endacott
2007).All theoretical,methodologicaland analytical
decisions taken were recorded, allowing key entries and
Table 1
Interview question guide for modern matrons
Previous experience
Preparation for matron role
Specific responsibilities of current role
The 10 key roles for matrons
Understanding of leadership
Previous leadership experience and training
Leadership experience within current role
Examples of effective leadership
Personalfactors that influence their leadership experiences
Organisationalfactors that influence their leadership experiences
Support required to develop leadership performance
What next for individualmatron?
Anything further they would like to add?
Leadership experiences of modern matrons
ª 2012 BlackwellPublishing Ltd
Journal of Nursing Management 3
communication skills.Smith (2008b) identified several
factorsthat clearly reduced thematronsÕleadership
capabilities, such as role conflict, a lack of role clarity,
role overload, competing priorities and blurred
boundaries with other roles.
Whilst studies have attempted to evaluate the leader-
ship role of modern matrons, there is limited literature
regarding the leadership experience of nurses in this role.
The study
Aims
The aim of this study was to explore and understand the
leadership experiencesof modern matronswithin an
acute NHS Trust, and explore from their perception the
organizational and personal factors that influence their
leadership experiences.
Methods
A descriptive generic qualitative methodology approach
(Cohen & Crabtree 2008)was used to explore and
understand the leadership experiences ofmodern ma-
trons. Semi-structured interviewswere used fordata
collection.Interviews were conducted away from the
participantÕswork area, were audio-recordedand
transcribed verbatim for analysis.The interview guide
was based on issuesarising from the literature and
prompts to encourage participants to talk about their
leadershipexperiences.Two pilot interviewswere
carried outto test the interview guide and revisions
made accordingly (Table 1).
Study participants
Participants were modern matrons in one acute NHS
Trust. All modern matrons within the Trust were given
an information leafletand invited to participate.The
lead researcher (NL) attended severalmodern matron
meetings to introduce the study and invite participation.
There are 20 matrons in the Trust and the intention was
to interview up to nine modern matrons or untildata
saturation was achieved (this included one senior mid-
wife). There were no male senior matrons in post at the
time of the selection process.This provided a cross-
section ofmodern matrons from allspecialties across
one NHS Trust, with various levels of experience within
the role,and with whom the interviewer (NL) had no
professional or personal relationship.
Data analysis
To provide a clear systematicapproach,data were
analysed using the thematic analysis process described
by Braun and Clarke (2006).Thematic analysiswas
selected because of its flexibility,due to its theoretical
freedom that allows it the ability to be applied across a
range of theoreticaland epistemologicalapproaches.
This theoreticalfreedom offered theopportunity to
produce a rich and detailed,yet complex analysis of
data (Braun & Clarke 2006). Transcripts were read and
re-read to gain familiarity with the data and to generate
initial themes.
To assistthe identification ofinitial codes a visual
thematic map was created to provide a visualrepre-
sentation of this early process (Braun & Clarke 2006).
Two transcripts were analysed by a second researcher
(JR) and following conferring on themesa coding
strategy was then agreed to apply to all the transcripts
(Green et al. 2007).
The individual participants were given serial numbers
(SM 1–SM 9), and allthe lines in the transcripts were
numbered.This provided the opportunity to cross-ref-
erence,and allowed easier identification ofimportant
sections within the data to return to during the iterative
analytical process (Hardy & Bryman 2004, Denscombe
2007).
Following this process the themes were returned to
the participants in the form of a thematic diagram for
them to confirm or deny the accuracy ofthe analysis
(Guba & Lincoln 1989). This form of member-checking
offered the participants the opportunity to comment on
the themes,and the seven who responded,were all
positive and agreed with the themes.
Rigour was also maintained through reflexivity by
keeping a research journal to promote a transparent and
visible process throughout the study (Cooper & Endacott
2007).All theoretical,methodologicaland analytical
decisions taken were recorded, allowing key entries and
Table 1
Interview question guide for modern matrons
Previous experience
Preparation for matron role
Specific responsibilities of current role
The 10 key roles for matrons
Understanding of leadership
Previous leadership experience and training
Leadership experience within current role
Examples of effective leadership
Personalfactors that influence their leadership experiences
Organisationalfactors that influence their leadership experiences
Support required to develop leadership performance
What next for individualmatron?
Anything further they would like to add?
Leadership experiences of modern matrons
ª 2012 BlackwellPublishing Ltd
Journal of Nursing Management 3
critical issues to be discussed with the second researcher
(Baker 2006, Koch 2006, Rolfe 2006) Figure 1.
Results
The analysis revealed three themes:leadership behav-
iours, negative influences and leadership investment. A
further theme that appeared as a constant main-thread
throughout the transcripts was leadership credibility.
Leadership behaviours
When describing their leadership experiences,the par-
ticipants highlighted examples ofusing the attributes
associated with transformationalleadership such as
creating a vision,collaboration,approachability and
empowerment.However,when referring to their lead-
ership styles they appeared to not favour one style over
another. The participants all suggested that they would
adapt their style according to the situation they were in.
ÔYou can never sort of stop learning different ways
to alter your style.And as I say, mine changes
according to the situationÕ.(SM 7. 12:601;
Participant Code. Page number: Line number).
The participants emphasized the flexibility of leader-
ship styles by providing real-life examples ofpositive
behaviours that are associated with various leadership
approaches. These behaviours appeared strongly to fo-
cus on their personalvalues,beliefsand principles,
supported by their passion and compassion.
The participants appeared to place greater value on
the ÔdoingÕrole as opposed to the ÔcreativeÕcomponent
of leadership,and consistently referred to the impor-
tance of being recognized as a positive role model. They
used the term Ôwalking the walkÕ, to describe their role
modelling behaviours,which they believe emphasizes
their commitment to the values and beliefs that support
their credibility as a leader to patients, and their nursing
teams in the clinical area:
ÔCredibility isabout doing what you say and
walking the walk, and sometimes being brave, and
doing differentÕ. (SM 6. 5:238)
When describing theirrole modelling experiences
there was a consistent reference to describing leadership
behaviours/attributes that have been identified as being
consistentwith the ability to motivate individuals to
work in collaboration towards a common goal.This
included positivedecision-making,honesty,courage,
respect, consistency and heightened interpersonal skills.
Another aspect of leadership the participants referred to
was their commitmentto the empowermentof the
nurses within their teams.
ÔLeadership…is about empowering the ward ma-
trons, finding out what it is they want to achieve,
where they see their ward going,where they see
their own careers going, and empowering them to
get thereÕ. (SM 3. 5:236)
The participants were able to describe how they be-
lieved they demonstrated and maintained their integrity,
and thereforeenhancetheir credibility within their
teams. The most frequent references to positive actions
were based around giving praise,celebrating success
and admitting mistakes.
ÔThe other thing Itry to do as well is actually
praise them when they do something really well
and give feedback,and I think thatÕsreally
importantÕ. (SM 4. 6:302)
Numerous exampleswere provided of how the
participants valued positive interpersonal skills,
including the importance ofbeing seen to apologize
when wrong.They were able to articulate how they
demonstratedthese within their daily roles. From
Credibility
Role Models Positive Influences Negative Influences Future Leaders
Role Model
Walk the Walk
Adaptable Leadership Style
Emotional Intelligence
Enable/Empower
Admit mistakes
Celebrate success
Positive Role Models
Protected time
Coaching
Clinical Supervision
Team work
Interpersonal skills
Approachable
Management V
Leadership
Preparation for role
Task culture
Negative Role Models
Isolation
Competing priorities
Administrative challenges
Talent spot
Non-hierarchy process
Share
Praise
Coach
Potential for investment
not based on position
Figure 1
Thematic map showing emerging themes and sub-themes: returned to the participants.
N. Lawrence and J. Richardson
ª 2012 BlackwellPublishing Ltd
4 Journal of Nursing Management
(Baker 2006, Koch 2006, Rolfe 2006) Figure 1.
Results
The analysis revealed three themes:leadership behav-
iours, negative influences and leadership investment. A
further theme that appeared as a constant main-thread
throughout the transcripts was leadership credibility.
Leadership behaviours
When describing their leadership experiences,the par-
ticipants highlighted examples ofusing the attributes
associated with transformationalleadership such as
creating a vision,collaboration,approachability and
empowerment.However,when referring to their lead-
ership styles they appeared to not favour one style over
another. The participants all suggested that they would
adapt their style according to the situation they were in.
ÔYou can never sort of stop learning different ways
to alter your style.And as I say, mine changes
according to the situationÕ.(SM 7. 12:601;
Participant Code. Page number: Line number).
The participants emphasized the flexibility of leader-
ship styles by providing real-life examples ofpositive
behaviours that are associated with various leadership
approaches. These behaviours appeared strongly to fo-
cus on their personalvalues,beliefsand principles,
supported by their passion and compassion.
The participants appeared to place greater value on
the ÔdoingÕrole as opposed to the ÔcreativeÕcomponent
of leadership,and consistently referred to the impor-
tance of being recognized as a positive role model. They
used the term Ôwalking the walkÕ, to describe their role
modelling behaviours,which they believe emphasizes
their commitment to the values and beliefs that support
their credibility as a leader to patients, and their nursing
teams in the clinical area:
ÔCredibility isabout doing what you say and
walking the walk, and sometimes being brave, and
doing differentÕ. (SM 6. 5:238)
When describing theirrole modelling experiences
there was a consistent reference to describing leadership
behaviours/attributes that have been identified as being
consistentwith the ability to motivate individuals to
work in collaboration towards a common goal.This
included positivedecision-making,honesty,courage,
respect, consistency and heightened interpersonal skills.
Another aspect of leadership the participants referred to
was their commitmentto the empowermentof the
nurses within their teams.
ÔLeadership…is about empowering the ward ma-
trons, finding out what it is they want to achieve,
where they see their ward going,where they see
their own careers going, and empowering them to
get thereÕ. (SM 3. 5:236)
The participants were able to describe how they be-
lieved they demonstrated and maintained their integrity,
and thereforeenhancetheir credibility within their
teams. The most frequent references to positive actions
were based around giving praise,celebrating success
and admitting mistakes.
ÔThe other thing Itry to do as well is actually
praise them when they do something really well
and give feedback,and I think thatÕsreally
importantÕ. (SM 4. 6:302)
Numerous exampleswere provided of how the
participants valued positive interpersonal skills,
including the importance ofbeing seen to apologize
when wrong.They were able to articulate how they
demonstratedthese within their daily roles. From
Credibility
Role Models Positive Influences Negative Influences Future Leaders
Role Model
Walk the Walk
Adaptable Leadership Style
Emotional Intelligence
Enable/Empower
Admit mistakes
Celebrate success
Positive Role Models
Protected time
Coaching
Clinical Supervision
Team work
Interpersonal skills
Approachable
Management V
Leadership
Preparation for role
Task culture
Negative Role Models
Isolation
Competing priorities
Administrative challenges
Talent spot
Non-hierarchy process
Share
Praise
Coach
Potential for investment
not based on position
Figure 1
Thematic map showing emerging themes and sub-themes: returned to the participants.
N. Lawrence and J. Richardson
ª 2012 BlackwellPublishing Ltd
4 Journal of Nursing Management
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analysing the participantÕs experiences itappears that
they are describing emotionalintelligence.All partici-
pants provided examples of heightened self-awareness,
and empathetic awareness of the needs of others.
ÔI think I am very self-aware,as in,IÕm also very
aware ofother people and how theyÕre feelingÕ.
(SM 4. 12:636)
ÔItÕsempathising with them too.Understanding
and seeing it from their point of viewÕ.
(SM 8. 5:259)
Negative influences
During the interviews allthe participants were able to
describe variousnegative factorsthat they perceived
restricted their ability to lead effectively. These included
workload, restricted time,professionalisolation and
lack of preparation fortheir role. In addition, the
majority suggested an apparent conflict, with competing
priorities betweenthe leadershipand management
components of their role.
Whilst discussing theirleadership experiences,the
participants repeatedly referred to how they believed
that their daily workload was too busy.
ÔYou canÕtactually see the woods for the treesÕ.
(SM 2. 4:210)
Some of them suggested thatthe time constraints
during their busy day were restricting their ability to
provide visible leadership within the clinicalenviron-
ment. This they believed limited their effectiveness, re-
duced their credibility and subsequently caused them to
feel frustrated.
ÔOne of the mostfrustrating aspects of the role,
that IÕm never feeling like IÕm finishing something,
or doing something wellÕ. (SM 5. 8:377)
There also wasan issue with regard to a lack of
clarity around the modern matron role, and unrealistic
organizationalexpectations,that they often feltthat
they were considered as being Ôall things to all peopleÕ.
The participants described differing experiences with
regard to whether they had felt prepared to take on the
modern matron role.None had received role-specific
preparation before being appointed within the Trust.
However,they had allhad the opportunity to attend
modern matron study days once in post. This absence of
specific preparation for the role seemed to suggest that
some of the participantsare unclearabout their job
purpose, and there was a perception that this confusion
extended to the organization as a whole.Many of the
participants believed thatthis promoted a culture of
unrealistic expectations of the role.
Ô…in terms of preparation…I sort of learned as I
went alongÕ. (SM 7. 1:37)
ÔFrom the organizationÕs pointof view…I donÕt
think that the Trust was aware of what they
wanted from these people (modern matrons)…so
there was no preparation, or in-house training or
coachingÕ. (SM 3. 2:70)
When describing theirrole the participantsall re-
ferred to the leadership and management components,
and although they recognized a relationship between
the two,they were clear that the two terms described
different functions.
ÔTo me leading is about…havinga vision,
and leading a service forward,but managing is
how I am going to do it, how we are going to do
itÕ. (SM 1. 2:76)
Although some of the participants identified the po-
sitive impact managerial attributes could have on their
role, it became apparentthat the majority considered
managementas a poor relation to leadership;when
referring to managerialattributesit was often in a
negative tone,and mostof the participants suggested
that their operationalmanagementrole was compro-
mising their ability to lead their teams effectively.
ÔLeadership…itÕsmuch more positive,itÕsmuch
more engaging.Management,itÕssetting the
targets and finance,and business,and dullstuffÕ.
(SM 6. 6:303)
Some of the participants openly discussed their neg-
ativity towards ÔmanagementÕand ÔmanagersÕ.
ÔIthink having the ÔmanagementÕand ÔmanagerÕ
title mixed in with nursing sometimesgives
the wrong message to patients and staffÕ.
(SM 4. 1:28)
Leadership investment
When discussing leadership developmentwithin the
Trust,there was a shared commitment to the needs of
their teams, and emphasison the importanceof
identifying and investing in thepotentialof future
leaders.They were motivatedtowards their own
developmentneeds,but there was disagreementwith
how these could be met.Two main sub-themesare
Leadership experiences of modern matrons
ª 2012 BlackwellPublishing Ltd
Journal of Nursing Management 5
they are describing emotionalintelligence.All partici-
pants provided examples of heightened self-awareness,
and empathetic awareness of the needs of others.
ÔI think I am very self-aware,as in,IÕm also very
aware ofother people and how theyÕre feelingÕ.
(SM 4. 12:636)
ÔItÕsempathising with them too.Understanding
and seeing it from their point of viewÕ.
(SM 8. 5:259)
Negative influences
During the interviews allthe participants were able to
describe variousnegative factorsthat they perceived
restricted their ability to lead effectively. These included
workload, restricted time,professionalisolation and
lack of preparation fortheir role. In addition, the
majority suggested an apparent conflict, with competing
priorities betweenthe leadershipand management
components of their role.
Whilst discussing theirleadership experiences,the
participants repeatedly referred to how they believed
that their daily workload was too busy.
ÔYou canÕtactually see the woods for the treesÕ.
(SM 2. 4:210)
Some of them suggested thatthe time constraints
during their busy day were restricting their ability to
provide visible leadership within the clinicalenviron-
ment. This they believed limited their effectiveness, re-
duced their credibility and subsequently caused them to
feel frustrated.
ÔOne of the mostfrustrating aspects of the role,
that IÕm never feeling like IÕm finishing something,
or doing something wellÕ. (SM 5. 8:377)
There also wasan issue with regard to a lack of
clarity around the modern matron role, and unrealistic
organizationalexpectations,that they often feltthat
they were considered as being Ôall things to all peopleÕ.
The participants described differing experiences with
regard to whether they had felt prepared to take on the
modern matron role.None had received role-specific
preparation before being appointed within the Trust.
However,they had allhad the opportunity to attend
modern matron study days once in post. This absence of
specific preparation for the role seemed to suggest that
some of the participantsare unclearabout their job
purpose, and there was a perception that this confusion
extended to the organization as a whole.Many of the
participants believed thatthis promoted a culture of
unrealistic expectations of the role.
Ô…in terms of preparation…I sort of learned as I
went alongÕ. (SM 7. 1:37)
ÔFrom the organizationÕs pointof view…I donÕt
think that the Trust was aware of what they
wanted from these people (modern matrons)…so
there was no preparation, or in-house training or
coachingÕ. (SM 3. 2:70)
When describing theirrole the participantsall re-
ferred to the leadership and management components,
and although they recognized a relationship between
the two,they were clear that the two terms described
different functions.
ÔTo me leading is about…havinga vision,
and leading a service forward,but managing is
how I am going to do it, how we are going to do
itÕ. (SM 1. 2:76)
Although some of the participants identified the po-
sitive impact managerial attributes could have on their
role, it became apparentthat the majority considered
managementas a poor relation to leadership;when
referring to managerialattributesit was often in a
negative tone,and mostof the participants suggested
that their operationalmanagementrole was compro-
mising their ability to lead their teams effectively.
ÔLeadership…itÕsmuch more positive,itÕsmuch
more engaging.Management,itÕssetting the
targets and finance,and business,and dullstuffÕ.
(SM 6. 6:303)
Some of the participants openly discussed their neg-
ativity towards ÔmanagementÕand ÔmanagersÕ.
ÔIthink having the ÔmanagementÕand ÔmanagerÕ
title mixed in with nursing sometimesgives
the wrong message to patients and staffÕ.
(SM 4. 1:28)
Leadership investment
When discussing leadership developmentwithin the
Trust,there was a shared commitment to the needs of
their teams, and emphasison the importanceof
identifying and investing in thepotentialof future
leaders.They were motivatedtowards their own
developmentneeds,but there was disagreementwith
how these could be met.Two main sub-themesare
Leadership experiences of modern matrons
ª 2012 BlackwellPublishing Ltd
Journal of Nursing Management 5
highlighted,leadershippotential, and support and
development.
Although participants had a commitmentand
awareness oftheir own developmentneeds,mostap-
peared to have a greatermotivation to ensure other
nurses within the Trust had the opportunity to realize
their potential.The idea of talent spotting at an early
stage in someoneÕs career,and investing in their po-
tential was viewed as essential for succession planning,
and for demonstratingthe participantsÕleadership
credibility.
ÔItÕs early identification of people that have leader-
ship promise and I think thereÕs something that we
can do a lot better at is talent-spotting early onÕ.
(SM 6. 8:383)
It was interesting to note that all participants believed
that investmentin leadership developmentshould be
based on potentialand talent,and not focus on posi-
tion, seniority or on a hierarchical system.
When discussing their own leadership development
some ofthe participants appeared to suggestthat as
individuals progressed upwards in their careers,their
developmentalrequirements were not such a high pri-
ority within the organization.
ÔIthink you getto a certain grade,and I think
thereÕsvery little afterthat to support you, or
to give you anything to sortof work towardsÕ.
(SM 2. 11:564)
For their own professional development some of the
matrons were currently studying at a post graduate le-
vel, however, others were not convinced by its value to
their current role.
ÔItÕs great to have your Masters, but…IÕm not sure
whetherthis givesyou the right skills to be a
manager or leaderÕ. (SM 2. 11:571)
Clinical supervision,coaching and mentorship were
proposedas supportiveframeworksfor leadership
development, and would have been viewed as beneficial
when they were first promoted to the modern matron
role. Interestingly,many of the participants tended to
use all three terms interchangeably, which may indicate
that they view all of them as being synonymous. All of
the participantswere able to describe the positive
impactthese processes could provide,with particular
regard to developing their interpersonal skills that they
considered essential for leadership credibility.
ÔThe sortof transformationalside…is empower-
ing, coaching, investing the time, and itÕs time well
rewardedÕ. (SM 5. 5:259)
ÔIÕve learnt far more by being coached and learning
from others and being reflective…coaching
costs so little and can be delivered so easilyÕ.
(SM 6. 8:397)
Leadership credibility
Credibility was a consistent thread that ran throughout
the interviewswhen the participantsdiscussed their
leadership experiences.Often they would assess whe-
ther they judged something as being successful, or not,
with regard to the effect it had on their own or another
individualÕs credibility. Within the three themes a con-
sistent implication was that to support their leadership
credibility the matrons should display certain behav-
iours thatcan be associated with effective leadership,
such as, Ôwalking the walkÕ, empowerment, celebrating
success, coaching, mentorship and integrity.
Discussion
Leadership behaviours
Previous research of modern matrons and other senior
nursing posts has recommended transformational lead-
ership to support the effectiveness of the role, and few
other leadership styles appear to have been considered
(Read et al. 2004, Dealey et al.2007, Clark 2008,
Koteyko & Nerlich 2008). However, in this study
participants described behaviours that are attributed to
different leadership models (Adair 2005, Stanley 2008).
It appears that one leadership style does not necessarily
meet all nursing leadersÕ needs, a finding consistent with
concernsregardingthe perceivedover-relianceon
transformational leadership as the single recommended
model (McIntosh & Tolson 2008).
Our findings suggest that being seen as a positive role
model is important for leadership credibility. This daily
role-modellingbehaviourdescribed asÔwalkingthe
walkÕ,emphasizes positive actions that team members
can imitate.Certain leadership characteristics,such as
problem-solving, honesty, courage, respect, consistency
and heightened interpersonal skills were highly valued.
This has important implications for allleaders to con-
sider; as these attributes are consistent with the ability
to motivate individuals to work in collaboration with
other team memberstowardsa shared vision (Adair
2005).
There was also evidenceof commitmentto the
empowerment of the nurses within the teams through
encouraging positive collaborative and team building
practices.The benefitto individuals and employers
N. Lawrence and J. Richardson
ª 2012 BlackwellPublishing Ltd
6 Journal of Nursing Management
development.
Although participants had a commitmentand
awareness oftheir own developmentneeds,mostap-
peared to have a greatermotivation to ensure other
nurses within the Trust had the opportunity to realize
their potential.The idea of talent spotting at an early
stage in someoneÕs career,and investing in their po-
tential was viewed as essential for succession planning,
and for demonstratingthe participantsÕleadership
credibility.
ÔItÕs early identification of people that have leader-
ship promise and I think thereÕs something that we
can do a lot better at is talent-spotting early onÕ.
(SM 6. 8:383)
It was interesting to note that all participants believed
that investmentin leadership developmentshould be
based on potentialand talent,and not focus on posi-
tion, seniority or on a hierarchical system.
When discussing their own leadership development
some ofthe participants appeared to suggestthat as
individuals progressed upwards in their careers,their
developmentalrequirements were not such a high pri-
ority within the organization.
ÔIthink you getto a certain grade,and I think
thereÕsvery little afterthat to support you, or
to give you anything to sortof work towardsÕ.
(SM 2. 11:564)
For their own professional development some of the
matrons were currently studying at a post graduate le-
vel, however, others were not convinced by its value to
their current role.
ÔItÕs great to have your Masters, but…IÕm not sure
whetherthis givesyou the right skills to be a
manager or leaderÕ. (SM 2. 11:571)
Clinical supervision,coaching and mentorship were
proposedas supportiveframeworksfor leadership
development, and would have been viewed as beneficial
when they were first promoted to the modern matron
role. Interestingly,many of the participants tended to
use all three terms interchangeably, which may indicate
that they view all of them as being synonymous. All of
the participantswere able to describe the positive
impactthese processes could provide,with particular
regard to developing their interpersonal skills that they
considered essential for leadership credibility.
ÔThe sortof transformationalside…is empower-
ing, coaching, investing the time, and itÕs time well
rewardedÕ. (SM 5. 5:259)
ÔIÕve learnt far more by being coached and learning
from others and being reflective…coaching
costs so little and can be delivered so easilyÕ.
(SM 6. 8:397)
Leadership credibility
Credibility was a consistent thread that ran throughout
the interviewswhen the participantsdiscussed their
leadership experiences.Often they would assess whe-
ther they judged something as being successful, or not,
with regard to the effect it had on their own or another
individualÕs credibility. Within the three themes a con-
sistent implication was that to support their leadership
credibility the matrons should display certain behav-
iours thatcan be associated with effective leadership,
such as, Ôwalking the walkÕ, empowerment, celebrating
success, coaching, mentorship and integrity.
Discussion
Leadership behaviours
Previous research of modern matrons and other senior
nursing posts has recommended transformational lead-
ership to support the effectiveness of the role, and few
other leadership styles appear to have been considered
(Read et al. 2004, Dealey et al.2007, Clark 2008,
Koteyko & Nerlich 2008). However, in this study
participants described behaviours that are attributed to
different leadership models (Adair 2005, Stanley 2008).
It appears that one leadership style does not necessarily
meet all nursing leadersÕ needs, a finding consistent with
concernsregardingthe perceivedover-relianceon
transformational leadership as the single recommended
model (McIntosh & Tolson 2008).
Our findings suggest that being seen as a positive role
model is important for leadership credibility. This daily
role-modellingbehaviourdescribed asÔwalkingthe
walkÕ,emphasizes positive actions that team members
can imitate.Certain leadership characteristics,such as
problem-solving, honesty, courage, respect, consistency
and heightened interpersonal skills were highly valued.
This has important implications for allleaders to con-
sider; as these attributes are consistent with the ability
to motivate individuals to work in collaboration with
other team memberstowardsa shared vision (Adair
2005).
There was also evidenceof commitmentto the
empowerment of the nurses within the teams through
encouraging positive collaborative and team building
practices.The benefitto individuals and employers
N. Lawrence and J. Richardson
ª 2012 BlackwellPublishing Ltd
6 Journal of Nursing Management
through utilizing such practices is evident,as there is
an association between fostering a culture of partner-
ship working, and information and power sharing
(Murphy 2005, Stanley 2008). Therefore, nursing
leaders can positively influence their teamÕsrole
satisfaction,staff retention and commitmentto their
organization.
The study identified examplesof negativerole
modelling;it is importantthat leadersrecognize the
potentialfor negative behaviours to be imitated.Con-
sequentlypeople in leadership positionsshould be
aware of the power they hold with regard to influencing
their teams,and should endeavour to use their power
effectively and ethically (Gallagher & Tschudin 2010).
This is particularly relevant, for example, in the context
of clinicalpractice supervision for junior and student
nurses.The ability to enhance an individualÕs integrity
through giving praise, celebrating success and admitting
mistakes appears accurate. Leaders who apologize and
ensure that individual team memberÕs achievements and
contributions are valued can foster a team culture of
acceptance, value and pride, and this creates feelings of
trust and caring (Bally 2007, Tomey 2009).
Negative influences
This study identified workload and timeconstraint
issues, which appearedto reduce the leadership
effectiveness,and thereforethe credibility of the
matrons.Previous modern matron and senior nursing
studieshighlightsimilar concerns(Read et al.2004,
Booth et al. 2006, Gould 2008, Smith 2008a,b). There
were consistent references to feelings of frustration, due
to their perceived inability to lead wardseffectively
because ofhigh acuity levels,and resources thatare
continually stretched.This has important implications
for all organizations;Parker et al. (2009) have
described similar work environments thatresulted in
seniornursesfeeling undervalued,and frustrated by
their perceived inability to influence the quality of care
they provided.
The limited formal preparationfor the modern
matron role, led to matrons relying on skills developed
whilst in other roles, and organizations.Previous
research also highlights this absence of preparation for
the modern matron role (Read et al. 2004, Gould 2008,
Smith 2008a,b).This is relevantfor all health-care
organizations, as lack of management training can lead
to issues of inefficiency (Paliadelis et al. 2007, Douglas
2008, Platt & Foster 2008). This study suggests that the
majority of the participants had a business management
deficit, particularly with regard to human resource
management,finance and information technology,
which McCallin and Frankson (2010) suggestis a
frequent issue for many nurses in senior positions.
There appeared to be a negative attitude towards the
managerialcomponents of the matron role,and Ôman-
agementÕ in general, whereas ÔleadershipÕ was embrac
The reasons for this are unclear,however,Buchanan
and Considine (2002) believe that many senior nurses
perceive that work which provides efficiency and cost
savings is more valued by the organization than quality
and patientexperience (cited by Parkeret al. 2009).
Therefore, the matrons may consider that their work is
undervalued when efficiencyis given primacyover
quality of care (Hegney et al. 2006). It is also interesting
to note that research has suggested that little attention
has been paid to managementin recent years,and
everyone has become enamoured with leadership.No
one aspires to being a good manager anymore;every-
body wants to be a greatcredible leader (Gosling &
Mintzberg 2003).
Leadership investment
There was a commitmentto ÔtalentspottingÕfuture
nurse leaders,and an emphasison an individualÕs
potential, rather than their position within the
organization thatshould be the deciding factor when
considering investment.Taking a lead in the develop-
ment of future nurse leaders, and succession planning is
highlighted as an essentialrequirement for allnursing
leaders (Read et al. 2004, Bonczek & Woodard 2006).
This has particular relevance for allnurse leaders as
research also indicates that the development of the next
generation of nurse leaders is often overlooked (Porter
et al. 2006).
Although committed to leadership development,the
matrons believed this was not a priority for the orga-
nization.When considering their developmentalneeds
many of the participants indicated that it was business
managementprocesseswhere they had a knowledge
deficit.McCallin and Frankson (2010)highlightthat
this can be addressed by enrolling on the appropriate
postgraduate modules.However,there was scepticism
regarding the perceived benefitsof postgraduate and
formal education, and the reasons for this were unclear.
When consideringworkload issues and time con-
straints, it is possible that they viewed the commitment
required for professional development as an additional
source ofsignificantstress,as opposed to individual
growth (Timmins & Nicholl 2005).
The use of clinicalsupervision,coaching and men-
torship were all highlighted as beneficial to provide the
Leadership experiences of modern matrons
ª 2012 BlackwellPublishing Ltd
Journal of Nursing Management 7
an association between fostering a culture of partner-
ship working, and information and power sharing
(Murphy 2005, Stanley 2008). Therefore, nursing
leaders can positively influence their teamÕsrole
satisfaction,staff retention and commitmentto their
organization.
The study identified examplesof negativerole
modelling;it is importantthat leadersrecognize the
potentialfor negative behaviours to be imitated.Con-
sequentlypeople in leadership positionsshould be
aware of the power they hold with regard to influencing
their teams,and should endeavour to use their power
effectively and ethically (Gallagher & Tschudin 2010).
This is particularly relevant, for example, in the context
of clinicalpractice supervision for junior and student
nurses.The ability to enhance an individualÕs integrity
through giving praise, celebrating success and admitting
mistakes appears accurate. Leaders who apologize and
ensure that individual team memberÕs achievements and
contributions are valued can foster a team culture of
acceptance, value and pride, and this creates feelings of
trust and caring (Bally 2007, Tomey 2009).
Negative influences
This study identified workload and timeconstraint
issues, which appearedto reduce the leadership
effectiveness,and thereforethe credibility of the
matrons.Previous modern matron and senior nursing
studieshighlightsimilar concerns(Read et al.2004,
Booth et al. 2006, Gould 2008, Smith 2008a,b). There
were consistent references to feelings of frustration, due
to their perceived inability to lead wardseffectively
because ofhigh acuity levels,and resources thatare
continually stretched.This has important implications
for all organizations;Parker et al. (2009) have
described similar work environments thatresulted in
seniornursesfeeling undervalued,and frustrated by
their perceived inability to influence the quality of care
they provided.
The limited formal preparationfor the modern
matron role, led to matrons relying on skills developed
whilst in other roles, and organizations.Previous
research also highlights this absence of preparation for
the modern matron role (Read et al. 2004, Gould 2008,
Smith 2008a,b).This is relevantfor all health-care
organizations, as lack of management training can lead
to issues of inefficiency (Paliadelis et al. 2007, Douglas
2008, Platt & Foster 2008). This study suggests that the
majority of the participants had a business management
deficit, particularly with regard to human resource
management,finance and information technology,
which McCallin and Frankson (2010) suggestis a
frequent issue for many nurses in senior positions.
There appeared to be a negative attitude towards the
managerialcomponents of the matron role,and Ôman-
agementÕ in general, whereas ÔleadershipÕ was embrac
The reasons for this are unclear,however,Buchanan
and Considine (2002) believe that many senior nurses
perceive that work which provides efficiency and cost
savings is more valued by the organization than quality
and patientexperience (cited by Parkeret al. 2009).
Therefore, the matrons may consider that their work is
undervalued when efficiencyis given primacyover
quality of care (Hegney et al. 2006). It is also interesting
to note that research has suggested that little attention
has been paid to managementin recent years,and
everyone has become enamoured with leadership.No
one aspires to being a good manager anymore;every-
body wants to be a greatcredible leader (Gosling &
Mintzberg 2003).
Leadership investment
There was a commitmentto ÔtalentspottingÕfuture
nurse leaders,and an emphasison an individualÕs
potential, rather than their position within the
organization thatshould be the deciding factor when
considering investment.Taking a lead in the develop-
ment of future nurse leaders, and succession planning is
highlighted as an essentialrequirement for allnursing
leaders (Read et al. 2004, Bonczek & Woodard 2006).
This has particular relevance for allnurse leaders as
research also indicates that the development of the next
generation of nurse leaders is often overlooked (Porter
et al. 2006).
Although committed to leadership development,the
matrons believed this was not a priority for the orga-
nization.When considering their developmentalneeds
many of the participants indicated that it was business
managementprocesseswhere they had a knowledge
deficit.McCallin and Frankson (2010)highlightthat
this can be addressed by enrolling on the appropriate
postgraduate modules.However,there was scepticism
regarding the perceived benefitsof postgraduate and
formal education, and the reasons for this were unclear.
When consideringworkload issues and time con-
straints, it is possible that they viewed the commitment
required for professional development as an additional
source ofsignificantstress,as opposed to individual
growth (Timmins & Nicholl 2005).
The use of clinicalsupervision,coaching and men-
torship were all highlighted as beneficial to provide the
Leadership experiences of modern matrons
ª 2012 BlackwellPublishing Ltd
Journal of Nursing Management 7
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opportunity for leadersto create and influencethe
clinical environmentwhere nursing leadershipand
practice can flourish (Jones2006, Allan et al. 2008,
Frankel 2008). However, there appeared to be a lack of
understanding regarding the processes.For example,
there was a tendency to describe allthree terms inter-
changeably, which may indicate that they were viewed
as synonymous (Driscoll & Cooper 2005, Fielden et al.
2009). It is essential for all nurse leaders to have a clear
understanding ofthe principlesof coaching,clinical
supervision and mentorship,as they all have unique
attributes, and their appropriateness for an individualÕs
development will depend on various factors, such as the
nurseÕs seniority, and their personal development needs
(Fielden et al. 2009).
Leadership credibility
Credibility can be described asthe quality of being
believed,and trustworthy (The free dictionary 2011).
The majority of the participants appeared to measure
or justify their own or another leaderÕs effectiveness by
referringto how credible the leaderÕsbehaviouris
judged. This is consistent with research highlighting the
importanceof, and relationship between,leadership
effectiveness and credibility (Parry & Proctor-Thomson
2002, Murphy 2005, Apker et al. 2006) and other
studieshave indicated theimportanceof leadership
credibility in ensuringthe successof the modern
matron role (Read et al. 2004, Gould 2008, Smith
2008a).
Strengths and limitations of the study
Strengths
The main strength of this study was the commitment
and enthusiasm ofthe participants and depth ofdis-
cussion in the interviews.The methodologicalap-
proach, using a second researcher, audit trail, reflexivity
and member checks assured transparency and rigour.
Limitations
This study was carried out in only one NHS Trust due
to the constraintsassociated with a small-scale MSc
study. Only nine of the 20 modern matrons within the
Trust were interviewed,although data saturation was
achieved,and their experiences of leadership appeared
to be consistentand similar.However,it cannotbe
assumed that this would have been the case if the other
11 modern matronshad been interviewed.Further-
more,all of the modern matrons interviewed were fe-
male, and their experiencesmay not reflect the
leadership experiencesof male modern matrons.In
addition, the researcherÕs inexperience as an interviewe
was apparent,particularly during the listening to the
audio recordings of the interviews, where, in retrospect
opportunities to prompt or challenge were not always
followed through.
Recommendations from the study
As there is a lack of role clarity regarding the modern
matron role within the Trust,the role should be re-
viewed to provideclarity of role and job purpose.
Further research could supportthis by seeking the
understanding of other professionalsÕexperience of the
leadership role of modern matrons.
A Trust-wide review of leadership development and
succession planning should be carried out to consider
opportunitiesto support modern matronsand other
potential leaders.
Subsequently,in 2012 the Director ofNursing and
PatientCare in this Trust will be leading a service
improvement programme to review and develop clinical
nursing leadership throughoutthe Trust, which will
include the modern matron role. This will form part of
a wider senior management and leadership review of all
senior Trust roles as part of a strategicredesign
programme.
Conclusion
This study explored the leadership experiences of senior
matrons within one NHS Trust.The findings suggest
that effective leadership is essentialfor the role to be
successful.The matrons placed greatemphasison
adapting their leadership style, and demonstrated their
leadership credibility through Ôwalking the walkÕ within
the clinicalarea.Various negative influences such as
lack of role clarity and workload issues appeared to
restricttheir leadership opportunities.All were com-
mitted to developing other leaderÕs potential,and ap-
peared to put the learning needs of their team members
above their own.
Modern senior nursing roles are complex and there-
fore requireleaderswith the ability to adapt their
leadership styleto meet the various challenges.Al-
though transformational leadership is an effective style,
it is unlikely that used in isolation it can meet all of the
demandsplaced on modern seniornursing leaders.
Therefore a more flexible approach to leadership
development is indicated.
N. Lawrence and J. Richardson
ª 2012 BlackwellPublishing Ltd
8 Journal of Nursing Management
clinical environmentwhere nursing leadershipand
practice can flourish (Jones2006, Allan et al. 2008,
Frankel 2008). However, there appeared to be a lack of
understanding regarding the processes.For example,
there was a tendency to describe allthree terms inter-
changeably, which may indicate that they were viewed
as synonymous (Driscoll & Cooper 2005, Fielden et al.
2009). It is essential for all nurse leaders to have a clear
understanding ofthe principlesof coaching,clinical
supervision and mentorship,as they all have unique
attributes, and their appropriateness for an individualÕs
development will depend on various factors, such as the
nurseÕs seniority, and their personal development needs
(Fielden et al. 2009).
Leadership credibility
Credibility can be described asthe quality of being
believed,and trustworthy (The free dictionary 2011).
The majority of the participants appeared to measure
or justify their own or another leaderÕs effectiveness by
referringto how credible the leaderÕsbehaviouris
judged. This is consistent with research highlighting the
importanceof, and relationship between,leadership
effectiveness and credibility (Parry & Proctor-Thomson
2002, Murphy 2005, Apker et al. 2006) and other
studieshave indicated theimportanceof leadership
credibility in ensuringthe successof the modern
matron role (Read et al. 2004, Gould 2008, Smith
2008a).
Strengths and limitations of the study
Strengths
The main strength of this study was the commitment
and enthusiasm ofthe participants and depth ofdis-
cussion in the interviews.The methodologicalap-
proach, using a second researcher, audit trail, reflexivity
and member checks assured transparency and rigour.
Limitations
This study was carried out in only one NHS Trust due
to the constraintsassociated with a small-scale MSc
study. Only nine of the 20 modern matrons within the
Trust were interviewed,although data saturation was
achieved,and their experiences of leadership appeared
to be consistentand similar.However,it cannotbe
assumed that this would have been the case if the other
11 modern matronshad been interviewed.Further-
more,all of the modern matrons interviewed were fe-
male, and their experiencesmay not reflect the
leadership experiencesof male modern matrons.In
addition, the researcherÕs inexperience as an interviewe
was apparent,particularly during the listening to the
audio recordings of the interviews, where, in retrospect
opportunities to prompt or challenge were not always
followed through.
Recommendations from the study
As there is a lack of role clarity regarding the modern
matron role within the Trust,the role should be re-
viewed to provideclarity of role and job purpose.
Further research could supportthis by seeking the
understanding of other professionalsÕexperience of the
leadership role of modern matrons.
A Trust-wide review of leadership development and
succession planning should be carried out to consider
opportunitiesto support modern matronsand other
potential leaders.
Subsequently,in 2012 the Director ofNursing and
PatientCare in this Trust will be leading a service
improvement programme to review and develop clinical
nursing leadership throughoutthe Trust, which will
include the modern matron role. This will form part of
a wider senior management and leadership review of all
senior Trust roles as part of a strategicredesign
programme.
Conclusion
This study explored the leadership experiences of senior
matrons within one NHS Trust.The findings suggest
that effective leadership is essentialfor the role to be
successful.The matrons placed greatemphasison
adapting their leadership style, and demonstrated their
leadership credibility through Ôwalking the walkÕ within
the clinicalarea.Various negative influences such as
lack of role clarity and workload issues appeared to
restricttheir leadership opportunities.All were com-
mitted to developing other leaderÕs potential,and ap-
peared to put the learning needs of their team members
above their own.
Modern senior nursing roles are complex and there-
fore requireleaderswith the ability to adapt their
leadership styleto meet the various challenges.Al-
though transformational leadership is an effective style,
it is unlikely that used in isolation it can meet all of the
demandsplaced on modern seniornursing leaders.
Therefore a more flexible approach to leadership
development is indicated.
N. Lawrence and J. Richardson
ª 2012 BlackwellPublishing Ltd
8 Journal of Nursing Management
Acknowledgements
The authors would like to acknowledge the NHS Trust for
supporting this study,and the participants for their enthusi-
asm, and for giving their time to the interviews.
This research study was submitted to and granted ethics
approvalby the University of Plymouth in March 2010 and
the NHS NationalResearch Ethics Service (South West)in
May 2010. Authorization from theTrustÕsResearch and
Development Department was also obtained.
Source of funding
A small research grantwas awarded by the TrustÕs
Research and DevelopmentService to supportthe re-
search study.
Ethical approval
Ethical approval for the study was provided by the NHS
National Research Ethics Service (South West) in May
2010 and authorization from the TrustÕs Research and
Development Department was also obtained.All par-
ticipants were assured that their data would be treated
confidentially and any quotes would be anonymized.
References
Adair J. (2005) How to Grow Leaders. Kogan Page, London.
Agnew T. (2005) Are directors of nursing being eclipsed by the
modern matron? Nursing Standard 19 (44), 14–16.
Allan H.T., Smith P.A.& Lorentzon M. (2008) Leadership for
learning: a literature study of leadership for learning in clinical
practice. Journal of Nursing Management 16, 545–555.
Apker J., Propp K.M., Zabava Ford W.S. & Hofmeister N. (2006)
Collaboration, credibility, compassion, and coordination: pro-
fessionalnurse communication skillsets in health care team
interactions. Journal of Professional Nursing 22 (3), 80–189.
Baker L. (2006) Ten common pitfalls to avoid when conducting
qualitativeresearch.British Journal of Midwifery 14 (9),
530–531.
Bally J.M.J. (2007) The role of nursing leadership in creating a
mentoring culture in acute care environments.Nursing Eco-
nomics 25 (3), 143–149.
Barbour M. & Dodd F. (2007) Comparing roles:senior nurses
and modern matrons. Nursing Management 14 (2), 30–34.
Bonczek M.E. & Woodard E.K. (2006) WhoÕll replace you when
youÕre gone? Nursing Management, 31–35.
Booth J., Hutchinson C., Beech C. & Robertson K. (2006) New
nursing roles:the experience ofScotlandÕs consultantnurse/
midwives. Journal of Nursing Management 14, 83–89.
Braun V. & Clarke V. (2006) Using thematicanalysis in
psychology. Qualitative Research in Psychology 3, 77–101.
Buchanan J.& Considine (2002) Stop telling us to cope! NSW
nurses explain why they are leaving the profession. A report for
the NSW nurses association,Sydney.Australian Centre for
Industrial Relations Research and Training. University of
Sydney, 1–54.
Clark L. (2008)Clinical leadership:values,beliefs,and vision.
Nursing Management 15 (7), 30–35.
Cohen D.J. & Crabtree B.F. (2008) Evaluative criteria for quali-
tative research in health care:controversies and recommenda-
tions. Annals of Family Medicine 6 (4), 331–339.
Cole A. (2002) Modern matrons: take me to your leader. Health
Service Journal 112 (5833), 24–29.
Cooper S. & Endacott R.(2007) Generic qualitative research:a
design for qualitative research in emergency care.Emergency
Medicine Journal 24, 816–819.
Dealey C., Moss H., Marshall J. & Elcoat C. (2007) Auditing the
impactof implementing the modern matron role in an acute
teaching trust. Journal of Nursing Management 15, 22–33.
Denscombe M.(2007)The Good Research Guide:For Small-
Scale Social Research Projects, 3rd edn. Open University Press,
Berkshire.
Department of Health (2000) The NHS Plan: A Plan for Invest-
ment, a Plan for Reform. The Stationery Office, London.
Departmentof Health (2001) Implementingthe NHS Plan:
Modern Matrons.Health Service Circular.2001/2010.DoH,
London.
Departmentof Health (2002)Modern Matrons in the NHS:A
Progress Report. DoH, London.
Departmentof Health (2004a)A MatronÕs Charter:An Action
Plan for Cleaner Hospitals. DoH, London.
Department of Health (2004b) Towards Cleaner Hospitals and
Lower Rates of Infection. DoH, London.
Douglas M. (2008) Management roles in nursing: current issues,
perspectives,and responses.Journal of Nursing Management
16, 1765–1767.
Driscoll J. & Cooper R. (2005) Coaching for clinicians. Nursing
Management 12 (1), 18–23.
Fielden S.L., Davidson M.J. & Sutherland V.J. (2009) Innovations
in coaching and mentoring:implications for nurse leadership
development. Health Services Management Research 22, 92–99.
FrankelA. (2008) What leadership styles should Senior Nurses
develop? Nursing Times 104 (35), 3–24.
Gallagher A.& Tschudin V. (2010) Educating for ethicallead-
ership. Nurse Education Today 30 (2010), 224–227.
Gosling J. & Mintzberg H. (2003) The five minds of a manager.
Harvard Business Review 81 (11), 54–63.
Gould D. (2008) The matronÕs role in acute national health ser-
vice trusts. Journal of Nursing Management 16, 804–812.
Green J., Willis K.,Hughes E. et al. (2007) Generating best evi-
dencefrom qualitativeresearch:the role of data analysis.
Australian and New Zealand Journal of Public Health 31 (6),
545–550.
Guba E.G. & Lincoln Y. (1989) Fourth Generation Evaluation.
Sage, Newbury Park, CA.
Hardy M. & Bryman A. (2004).Handbook of Data Analysis.
Sage Publications, London.
Hegney D.,Plank A. & Parker V. (2006) Intrinsic and extrinsic
work values, their impact on job satisfaction in nursing. Journal
of Nursing Management 14, 271–281.
Hill D. & Hadfield J. (2005)The role of modern matrons in
infection control. Nursing Standard 19 (23), 42–44.
Jones A. (2006) Clinical supervision: what do we know and what
do we need to know? A review and commentary Journalof
Nursing Management 4, 577–585.
Keeley O., Goodman C. & Bark P. (2005) The modern matronÕs
role in influencing safe practice. Clinical Risk 11, 93–98.
Leadership experiences of modern matrons
ª 2012 BlackwellPublishing Ltd
Journal of Nursing Management 9
The authors would like to acknowledge the NHS Trust for
supporting this study,and the participants for their enthusi-
asm, and for giving their time to the interviews.
This research study was submitted to and granted ethics
approvalby the University of Plymouth in March 2010 and
the NHS NationalResearch Ethics Service (South West)in
May 2010. Authorization from theTrustÕsResearch and
Development Department was also obtained.
Source of funding
A small research grantwas awarded by the TrustÕs
Research and DevelopmentService to supportthe re-
search study.
Ethical approval
Ethical approval for the study was provided by the NHS
National Research Ethics Service (South West) in May
2010 and authorization from the TrustÕs Research and
Development Department was also obtained.All par-
ticipants were assured that their data would be treated
confidentially and any quotes would be anonymized.
References
Adair J. (2005) How to Grow Leaders. Kogan Page, London.
Agnew T. (2005) Are directors of nursing being eclipsed by the
modern matron? Nursing Standard 19 (44), 14–16.
Allan H.T., Smith P.A.& Lorentzon M. (2008) Leadership for
learning: a literature study of leadership for learning in clinical
practice. Journal of Nursing Management 16, 545–555.
Apker J., Propp K.M., Zabava Ford W.S. & Hofmeister N. (2006)
Collaboration, credibility, compassion, and coordination: pro-
fessionalnurse communication skillsets in health care team
interactions. Journal of Professional Nursing 22 (3), 80–189.
Baker L. (2006) Ten common pitfalls to avoid when conducting
qualitativeresearch.British Journal of Midwifery 14 (9),
530–531.
Bally J.M.J. (2007) The role of nursing leadership in creating a
mentoring culture in acute care environments.Nursing Eco-
nomics 25 (3), 143–149.
Barbour M. & Dodd F. (2007) Comparing roles:senior nurses
and modern matrons. Nursing Management 14 (2), 30–34.
Bonczek M.E. & Woodard E.K. (2006) WhoÕll replace you when
youÕre gone? Nursing Management, 31–35.
Booth J., Hutchinson C., Beech C. & Robertson K. (2006) New
nursing roles:the experience ofScotlandÕs consultantnurse/
midwives. Journal of Nursing Management 14, 83–89.
Braun V. & Clarke V. (2006) Using thematicanalysis in
psychology. Qualitative Research in Psychology 3, 77–101.
Buchanan J.& Considine (2002) Stop telling us to cope! NSW
nurses explain why they are leaving the profession. A report for
the NSW nurses association,Sydney.Australian Centre for
Industrial Relations Research and Training. University of
Sydney, 1–54.
Clark L. (2008)Clinical leadership:values,beliefs,and vision.
Nursing Management 15 (7), 30–35.
Cohen D.J. & Crabtree B.F. (2008) Evaluative criteria for quali-
tative research in health care:controversies and recommenda-
tions. Annals of Family Medicine 6 (4), 331–339.
Cole A. (2002) Modern matrons: take me to your leader. Health
Service Journal 112 (5833), 24–29.
Cooper S. & Endacott R.(2007) Generic qualitative research:a
design for qualitative research in emergency care.Emergency
Medicine Journal 24, 816–819.
Dealey C., Moss H., Marshall J. & Elcoat C. (2007) Auditing the
impactof implementing the modern matron role in an acute
teaching trust. Journal of Nursing Management 15, 22–33.
Denscombe M.(2007)The Good Research Guide:For Small-
Scale Social Research Projects, 3rd edn. Open University Press,
Berkshire.
Department of Health (2000) The NHS Plan: A Plan for Invest-
ment, a Plan for Reform. The Stationery Office, London.
Departmentof Health (2001) Implementingthe NHS Plan:
Modern Matrons.Health Service Circular.2001/2010.DoH,
London.
Departmentof Health (2002)Modern Matrons in the NHS:A
Progress Report. DoH, London.
Departmentof Health (2004a)A MatronÕs Charter:An Action
Plan for Cleaner Hospitals. DoH, London.
Department of Health (2004b) Towards Cleaner Hospitals and
Lower Rates of Infection. DoH, London.
Douglas M. (2008) Management roles in nursing: current issues,
perspectives,and responses.Journal of Nursing Management
16, 1765–1767.
Driscoll J. & Cooper R. (2005) Coaching for clinicians. Nursing
Management 12 (1), 18–23.
Fielden S.L., Davidson M.J. & Sutherland V.J. (2009) Innovations
in coaching and mentoring:implications for nurse leadership
development. Health Services Management Research 22, 92–99.
FrankelA. (2008) What leadership styles should Senior Nurses
develop? Nursing Times 104 (35), 3–24.
Gallagher A.& Tschudin V. (2010) Educating for ethicallead-
ership. Nurse Education Today 30 (2010), 224–227.
Gosling J. & Mintzberg H. (2003) The five minds of a manager.
Harvard Business Review 81 (11), 54–63.
Gould D. (2008) The matronÕs role in acute national health ser-
vice trusts. Journal of Nursing Management 16, 804–812.
Green J., Willis K.,Hughes E. et al. (2007) Generating best evi-
dencefrom qualitativeresearch:the role of data analysis.
Australian and New Zealand Journal of Public Health 31 (6),
545–550.
Guba E.G. & Lincoln Y. (1989) Fourth Generation Evaluation.
Sage, Newbury Park, CA.
Hardy M. & Bryman A. (2004).Handbook of Data Analysis.
Sage Publications, London.
Hegney D.,Plank A. & Parker V. (2006) Intrinsic and extrinsic
work values, their impact on job satisfaction in nursing. Journal
of Nursing Management 14, 271–281.
Hill D. & Hadfield J. (2005)The role of modern matrons in
infection control. Nursing Standard 19 (23), 42–44.
Jones A. (2006) Clinical supervision: what do we know and what
do we need to know? A review and commentary Journalof
Nursing Management 4, 577–585.
Keeley O., Goodman C. & Bark P. (2005) The modern matronÕs
role in influencing safe practice. Clinical Risk 11, 93–98.
Leadership experiences of modern matrons
ª 2012 BlackwellPublishing Ltd
Journal of Nursing Management 9
Kemp P. & Morris F. (2003) WorthingÕs modern matron expe-
rience: the first year. Nursing Management 10 (8), 19–23.
Koch T. (2006)Establishing rigour in qualitative research:the
decision trail. Journal of Advanced Nursing 53 (1), 91–103.
Koteyko N. & Nerlich B. (2008) Modern matrons and infection
control practices:aspirations and realities.British Journal of
Infection Control 9 (2), 18–22.
McCallin A.M. & Frankson C. (2010)The role of the charge
nurse manager:a descriptiveexploratory study.Journal of
Nursing Management 18, 319–325.
McIntosh J. & Tolson D. (2008) Leadership as part of the nurse
consultant role: banging the drum for patient care. Journalof
Clinical Nursing 18, 219–227.
Mooney H. (2008) Number of modern matrons reaches 5,500.
(Editorial). Nursing Times (Online), Available at: http://www.
nursingtimes.net/whats-new-in-nursing/number-of-modern-
matrons-reaches-5,500, accessed 29 June 2010.
Murphy L. (2005) Transformational leadership: a cascading chain
reaction. Journal of Nursing Management 13, 128–136.
Paliadelis P.,Cruickshank M.& Sheridan A. (2007) Caring for
each other:how do nursing managersÔmanageÕtheir role?
Journal of Nursing Management 5, 830–837.
Parker V., Giles M. & Higgins I. (2009) Challenges confronting
clinicians in acute care.Journal of Nursing Management17,
667–678.
Parry K.W. & Proctor-Thomson S.B. (2002) Perceived integrity of
transformationalleaders in organisationalsettings? Journalof
Business Ethics 35 (2), 75–96.
Platt J.F. & Foster D. (2008) Revitalizing the charge nurse role
through a bespoke development program.Journal of Nursing
Management 16, 853–857.
Porter S., Anderson L., Chetty A. et al. (2006) Operational
competencydevelopmentin E and F grade nursing staff:
preparation for management. Journal of Nursing Management
14 (5), 384–390.
Read S., Ashman M., Scott C. & Savage J. (2004) Evaluation of
the Modern Matron Role in a Sample of NHS Trusts.Royal
College of Nursing Institute/School of Nursing and Midwifery,
University of Sheffield, Sheffield. Report to the Department of
Health October 2004.
Rolfe G. (2006) Validity, trustworthiness, and rigour: quality and
the idea of qualitative research.Journal of Advanced Nursing
53 (3), 304–310.
Royal College of Midwives (2002) Modern Matron in the
Maternity Services: Position Statement. RCM, London.
SavageJ. & Scott C. (2004) The modern matron:a hybrid
managementrole with implications for continuousquality
improvement.Journal of Nursing Management12 (6),
419–426.
ScottC., Savage J.,Ashman M. & Read S. (2005)Evaluating
the role of modern matrons.Nursing Management12 (2),
22–26.
Shuttleworth A.(2004)The role of modern matrons in raising
standardsof infection control.Nursing Standard 100 (26),
26–27.
Smith A. (2008a)Modern matrons:reviewing the role.Part 1.
Nursing Management 15 (4), 20–24.
Smith A. (2008b)Modern matrons:reviewing the role.Part 2.
Nursing Management 15 (5), 18–26.
Stanley D. (2008) Congruent leadership: values in action. Journal
of Nursing Management 16 (5), 519–524.
The free dictionary (2011). (Online) Available at: http://
www.thefreedictionary.com/credibility, accessed 1 April 2011.
Timmins F. & Nicholl H. (2005) Stressors associated with qual-
ified nursesundertaking part-time degree programmes-some
implications for nurse managers to consider. Journal of Nursing
Management 13 (6), 477–482.
Tomey A.M. (2009) Nursing Leadership and Management Effects
Work Environments. Journalof Nursing Management 17 (1),
15–25.
N. Lawrence and J. Richardson
ª 2012 BlackwellPublishing Ltd
10 Journal of Nursing Management
rience: the first year. Nursing Management 10 (8), 19–23.
Koch T. (2006)Establishing rigour in qualitative research:the
decision trail. Journal of Advanced Nursing 53 (1), 91–103.
Koteyko N. & Nerlich B. (2008) Modern matrons and infection
control practices:aspirations and realities.British Journal of
Infection Control 9 (2), 18–22.
McCallin A.M. & Frankson C. (2010)The role of the charge
nurse manager:a descriptiveexploratory study.Journal of
Nursing Management 18, 319–325.
McIntosh J. & Tolson D. (2008) Leadership as part of the nurse
consultant role: banging the drum for patient care. Journalof
Clinical Nursing 18, 219–227.
Mooney H. (2008) Number of modern matrons reaches 5,500.
(Editorial). Nursing Times (Online), Available at: http://www.
nursingtimes.net/whats-new-in-nursing/number-of-modern-
matrons-reaches-5,500, accessed 29 June 2010.
Murphy L. (2005) Transformational leadership: a cascading chain
reaction. Journal of Nursing Management 13, 128–136.
Paliadelis P.,Cruickshank M.& Sheridan A. (2007) Caring for
each other:how do nursing managersÔmanageÕtheir role?
Journal of Nursing Management 5, 830–837.
Parker V., Giles M. & Higgins I. (2009) Challenges confronting
clinicians in acute care.Journal of Nursing Management17,
667–678.
Parry K.W. & Proctor-Thomson S.B. (2002) Perceived integrity of
transformationalleaders in organisationalsettings? Journalof
Business Ethics 35 (2), 75–96.
Platt J.F. & Foster D. (2008) Revitalizing the charge nurse role
through a bespoke development program.Journal of Nursing
Management 16, 853–857.
Porter S., Anderson L., Chetty A. et al. (2006) Operational
competencydevelopmentin E and F grade nursing staff:
preparation for management. Journal of Nursing Management
14 (5), 384–390.
Read S., Ashman M., Scott C. & Savage J. (2004) Evaluation of
the Modern Matron Role in a Sample of NHS Trusts.Royal
College of Nursing Institute/School of Nursing and Midwifery,
University of Sheffield, Sheffield. Report to the Department of
Health October 2004.
Rolfe G. (2006) Validity, trustworthiness, and rigour: quality and
the idea of qualitative research.Journal of Advanced Nursing
53 (3), 304–310.
Royal College of Midwives (2002) Modern Matron in the
Maternity Services: Position Statement. RCM, London.
SavageJ. & Scott C. (2004) The modern matron:a hybrid
managementrole with implications for continuousquality
improvement.Journal of Nursing Management12 (6),
419–426.
ScottC., Savage J.,Ashman M. & Read S. (2005)Evaluating
the role of modern matrons.Nursing Management12 (2),
22–26.
Shuttleworth A.(2004)The role of modern matrons in raising
standardsof infection control.Nursing Standard 100 (26),
26–27.
Smith A. (2008a)Modern matrons:reviewing the role.Part 1.
Nursing Management 15 (4), 20–24.
Smith A. (2008b)Modern matrons:reviewing the role.Part 2.
Nursing Management 15 (5), 18–26.
Stanley D. (2008) Congruent leadership: values in action. Journal
of Nursing Management 16 (5), 519–524.
The free dictionary (2011). (Online) Available at: http://
www.thefreedictionary.com/credibility, accessed 1 April 2011.
Timmins F. & Nicholl H. (2005) Stressors associated with qual-
ified nursesundertaking part-time degree programmes-some
implications for nurse managers to consider. Journal of Nursing
Management 13 (6), 477–482.
Tomey A.M. (2009) Nursing Leadership and Management Effects
Work Environments. Journalof Nursing Management 17 (1),
15–25.
N. Lawrence and J. Richardson
ª 2012 BlackwellPublishing Ltd
10 Journal of Nursing Management
1 out of 10
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