Leadership Development: Supporting Nursing in a Changing Primary Health Care Environment

Abstract
New organisations to provide primary health care in New Zealand are evolving in response to changes in policy, funding and contracting arrangements. The premise of this paper is that involvement of nurses in the decision-making of health organisations is essential to maximise the contribution of nurses and thereby promote positive client outcomes. It is argued that development of key leadership skills will enable nurses to become more critically aware of underlying power structures in the health system and to move towards being acknowledged as interdependent health professionals in the Primary Health Organisations (PHOs). The particular competencies discussed are those proposed by Van Maurik (1997) namely ability to understand and manage organisational politics, work facilitatively with people and circumstances, and build a feeling of purpose.  

Keywords
Nursing leadership, primary health care nursing, resourcing, primary health organisations 

Introduction
The health reforms in New Zealand, from the 1980s onwards, introduced a competitive, free market model, which resulted in a fragmented approach to nursing leadership and decreased nursing involvement in decision making (Ministry of Health, 1998). There is now a move away from competition towards collaboration to promote health (King, 2001). Emphasis on leadership competencies will assist nurses to develop the skills required to regain ground and take their place as equal and valued health professionals, working interdependently with other members of the primary health team in the forthcoming Primary Health Organisations (PHOs). While other health professional groups also face leadership issues, nurses represent the largest workforce in health (Ministry of Health, 1998) and therefore have the greatest potential for improving health outcomes.