Expert Panel: How to train nursing leaders - bridging the divide between nurses who provide direct patient care and nurse managers in order to improve health care systems.

By Maggie Sullivan Moderator | 05 Nov, 2012

Leadership in nursing in general, and specifically leadership that serves as a bridge between clinical practice and administration, is a pivotal topic during times of global shifts in disease and in health care.

Join us from November 5 - 9 for this virtual panel discussion to address questions on what leadership means in nursing, whether nurse leadership can be taught, and how nurse leadership can impact health systems.

Our panelists include:
     * Inge Corless, RN, PHD FAAN, Professor in the Graduate Program in Nursing at the MGH Institute of Health Professions.
     * Patrice Nicholas, DNSc, RN, ANP, FAAN, Professor at the MGH Institute of Health Professions and Director of Global Health and Academic Partnerships at Brigham and Women’s Hospital in the Division of Global Health Equity and in the Center for Nursing Excellence.
     * Gini Williams, leader of the International Council of Nurses’ TB project
     * Angela McBride, Distinguished Professor and University Dean Emerita at Indiana University School of Nursing

Please join our panel in discussing the following key questions:
     * What does it mean to be a nurse-leader, or to exhibit leadership in nursing? Would this idea of leadership in nursing vary between low/middle income countries and high-income countries?
     * Is leadership in clinical/bedside nursing different from leadership in nurse management/administration?
     * How are health care systems affected by either the presence of absence of nurse-leaders? How might health care systems be different if there was more leadership in nursing?
     * Why does it seem there is greater focus on nurses being leaders in their profession, rather than pharmacist-leaders, physician-leaders, dentist-leaders, etc? Is there a dearth of nurse-leaders, or does the field of nursing somehow require a greater demonstration of leadership?
     * How does one teach leadership? If a student does not come to nursing already possessing qualities of leadership, how can this be developed over the course of her/his nursing education? And how does one continue to develop leadership skills in nursing after graduation?

As always, we look forward to hearing your thoughts during this Expert Panel!

Replies

 

Maggie Sullivan Moderator Replied at 7:50 AM, 5 Nov 2012

Bio for Dr. Inge Corless:

Inge B. Corless, RN, PHD FAAN, is a Professor in the Graduate Program in Nursing at the MGH Institute of Health Professions at the Massachusetts General Hospital. She received her Diploma in Nursing from the Bellevue Schools of Nursing, a Bachelor's Degree in Nursing from Boston University, an M.A. in Sociology from the University of Rhode Island and a Ph.D. from the Robert Wood Johnson Clinical Scholar at the University of California-San Francisco. Dr. Corless is a Fellow in the American Academy of Nursing. Dr. Corless joined the Institute faculty in 1993 after teaching at the University of North Carolina-Chapel Hill, The University of Michigan, and Russell Sage College in Troy, New York. Dr. Corless also has served as the Program Director of St. Peter's Hospice in Albany New York during its' formative years. Prior to that she practiced as a staff nurse at Sloan-Kettering Memorial Hospital, and in the Emergency Ward at Bellevue Hospital both in New York. She has also served as a short-term consultant of WHO at the Western Pacific Regional Office in Manila. At the MGH Institute Dr. Corless has co-directed an HIV/AIDS track and has made courses available via a distance-learning format. Dr. Corless also teaches the Living with Death, Living with Grief course. A member of the UCSF HIV/AIDS nursing research network, Dr. Corless is also a member of the Partners-Fenway-Shattuck Center for AIDS research.

Maggie Sullivan Moderator Replied at 7:51 AM, 5 Nov 2012

Bio for Dr. Patrice Nicholas:

Patrice K. Nicholas, DNSc, RN, ANP, FAAN, completed a Bachelor of Science in Nursing at Fitchburg State College, a Master of Science in Nursing at Boston University and Doctorate of Nursing Science degree at Boston University. Dr. Nicholas also completed a postdoctoral fellowship at Harvard University School of Public Health focusing her research on HIV/AIDS and quality of life in chronic illness. During her fellowship, she completed a Master of Public Health degree in International Health at the Harvard School of Public Health. Dr. Nicholas is professor at the MGH Institute of Health Professions at Massachusetts General Hospital School of Nursing and is director of Global Health and Academic Partnerships at Brigham and Women’s Hospital in the Division of Global Health Equity and in the Center for Nursing Excellence. In May 2010, she received a Doctor of Humane Letters degree Honoris Causa.

She completed a Certificate of Advanced Study in Primary Care in the Adult Nurse Practitioner Program at the MGH Institute of Health Professions. Her professional certifications include ANCC Clinical Nurse Specialist in Medical Surgical Nursing and American Academy of Nurse Practitioners as an Adult Nurse Practitioner.

Dr. Nicholas’ professional experiences include serving as director of Global Health and Academic Partnerships at Brigham and Women’s Hospital, Professor at the Massachusetts General Hospital (MGH) Institute of Health Professions, Fulbright Senior Scholar of University of KwaZulu-Natal in South Africa, Advanced Practice Nurse, and as Region 15 Coordinator for Sigma Theta Tau International, with responsibilities for chapters in Africa, western Europe, eastern Canada, and the northeastern U.S. She is an Associate Clinical Scientist at the Cantor Center of the Dana Farber Cancer Institute. Dr. Nicholas has served as visiting professor at the University of KwaZulu-Natal, St. Luke’s Hospital in Tokyo, and Catholic University in Belgium. She has also served as an external reviewer for the University of Swaziland.

She holds membership and executive positions in numerous professional organizations including Sigma Theta Tau International (Board of Directors), National Organization of Nurse Practitioner Faculties, American Public Health Association, Eastern Nursing Research Society, the Association of Nurses in AIDS Care, Fulbright Association, and Massachusetts Association of Registered Nurses/American Nurses Association. Dr. Nicholas has also served on three Fulbright Senior Review panels for the U.S. Department of State and the Council for International Exchange of Scholars in Washington, D.C., and in Durban, South Africa. Dr. Nicholas is a fellow of the American Academy of Nursing. She has conducted numerous research studies related to quality of life in HIV/AIDS and neuropathy-related symptoms in HIV.

Maggie Sullivan Moderator Replied at 7:51 AM, 5 Nov 2012

Bio for Gini Williams:

Gini Williams has been running the International Council of Nurses’ TB project since 2008. She is a committed advocate for the recognition and investment in nursing as a means to improve the care delivered to people affected by TB particularly in low and middle income countries. The ICN's TB Project is funded via the Lilly MDR-TB Programme and has been working in 16 countries with a high incidence of TB and DR-TB.

She has been active in the field of TB since 1993 and worked as a TB Nurse specialist herself in London for five years. In the mid 1990s she went to Tomsk with the British NGO Medical Emergency Relief International (Merlin). It was here, while she was working with nurses to strengthen the outpatient service and community support for patients with TB, that she realized the enormous challenges faced by nurses in delivering good quality patient care and that training was only part of the story. On her return to the UK she completed an MSc in Medical Anthropology and after a year in the post of Northeast London TB Network Manager, she joined City University as a Lecturer in TB and Public Health. She first joined the Nurses and Allied Professional Section of the Union in 1994 and was chair from 2001 to 2002. She chaired TB Alert’s Advisory Board from 1999 to 2002 and was a trustee from 2002 until 2006. In 2003 she was seconded to Head the newly formed Nursing Division of the International Union Against Tuberculosis and Lung Disease and joined the ICN after the birth of her second son. Earlier this year, she joined the steering group for the UK Coalition to StopTB.

Gini Williams Replied at 9:10 AM, 5 Nov 2012

It is great to be part of this important discussion. Here are some initial thoughts on today's question. I look forward to hearing further views, comments and questions from around the world.
1. What does it mean to be a nurse-leader, or to exhibit leadership in nursing? Would this idea of leadership in nursing vary between low/middle income countries (LMIC) versus high-income countries like the U.S.?
There are different levels of leadership in nursing and certainly not all nurse leaders are as noticeable as you would expect them to be. I know a nurse in Kenya who is a Clinical Director of a huge project serving over 20,000 people in the slums of Eastern Nairobi. To meet her, small, quiet and unassuming as she is, you would never know the challenges she has overcome to bring truly patient-centred care to people with TB and HIV who are living in the most difficult circumstances.
Nurse leaders start small and learn every step of the way. Alice Njoroge, the nurse I refer to above, was a newly trained staff nurse once and she too had leaders she looked up to who became her mentors just as she has become a mentor to others. I believe that it begins with a determination to do the best you can with the patients in your care which means being an effective patient advocate. Patient advocacy is a crucial part of a nurse’s role but is not necessarily recognised as such by other disciplines and sometimes by nurses themselves who have learnt from experience that it is easier to go with the flow. Patient advocacy can mean making sure a person’s food is left where they can reach it to getting involved in a discussion about a change in ward routine that may have a negative impact on one or more patients.
Patient advocacy requires you to speak up with clarity, confidence and knowledge and often take a risk. The risk may vary – you may make yourself unpopular with colleagues or start to be seen as a trouble-maker; people may disagree and the potential for conflict with others may arise. To a leader, the most important thing is the patient and the ability to provide the best care possible for them in the safest way. This outweighs the risks as the risks to the patient if nothing is done, feel greater. Leaders do not just identify a problem they decide to do something about it and can justify what needs doing.
Once nurses take on leadership positions, such as ward or clinic managers, nursing directors, or government level positions, the need to behave as a role model - leading by example -becomes more important. Simply holding a position of leadership does not make a nurse a good leader, it is the way they work when in that position that counts. Nurse leaders need to be constantly learning and developing personally and professionally. They need to use their position to ensure that nurses throughout the facility or service they are involved with, have the skills, tools and capacity to deliver the best quality care possible in the safest possible environment. This means knowing what is happening on the ground, listening to and understanding nurses concerns and bringing these into the wider political and strategic discussions.
I do not think that this idea of leadership should very between high- and middle-/low-income countries and certainly in my experience it does not. There may be fewer nurses in leadership positions in LMICs but the qualities required are the same. If anything the challenges are greater so the leadership needs to be stronger.

Maggie Sullivan Moderator Replied at 10:05 AM, 5 Nov 2012

Response from Dr. Inge Corless:

Being a nurse-leader and exhibiting leadership in nursing are not mutually exclusive and one would hope that appointed and elected nurse leaders would exhibit leadership. On the other hand, one can be a nurse leader and not exhibit leadership skills and one can certainly exhibit leadership skills without being a designated nurse leader. In the latter instance it is likely that the nurse who exhibits leadership skills will in fact become a nurse leader. Joseph Simone, MD (2012) in a recent article “Leadership Lessons from Abraham Lincoln” refers to the book by Doris Kearns Goodwin, Team of Rivals: The political Genius of Abraham Lincoln”. The attributes that Simone highlights for leadership include:

Capacity to Listen to Different Points of View

Ability to Learn on the Job

Awareness of own Weaknesses (and compensating for them)

Ability to Control Emotions

Know how to Relax and Replenish

Go out into the Field and Manage Directly

Strength to Adhere to Fundamental Goals

Ability to Communicate Goals and Vision

It is clear that these attributes apply more to the formal or designated leader but also have implications for the informal leader.

As to the question of whether leadership varies between economically diverse countries, the response is yes and no. Leaders in LMIC countries may have fewer resources at their disposal including finances, infrastructure, and human resources and these may have an impact depending on the issue to be resolved. The larger difference that may affect how leadership is demonstrated is one of culture and what is considered appropriate behavior in a given culture. Culture may frame how leadership is enacted.

Simone, J.V. (2012). Leadership Lessons from Abraham Lincoln. Oncology Times, Oct. 25, pp 20, 22.

Elizabeth Glaser Moderator Emeritus Replied at 10:08 AM, 5 Nov 2012

Hi Inge , Patrice and Gini, and Maggie,

I would like to ask a question and also add a few comments.
In the past few years programs have popped up which provide certificates or degrees in clinical nurse leadership, or nursing leadership , and I was wondering if any for you could comment on the value or benefit of offering such a specific concentration?

Comments 1. I very much value the experience of all of the members of panels today - it seem hardly a coincidence that a number of nurse leaders here and that we know in other venues such as Anne Sliney and Sheila Davis, are associated with work in HIV/AIDS. I was wondering if any of you could comment on how working in HIV /AIDS care led to your positions today and how that might be relevant to forming the nurse leaders of the future. .
2.The most powerful means of learning from the experience of nurse leaders in lower and middle income settings,would be to hear their voice directly, how can such men and women be included on the panel?

3. I spent the first years of my work at Boston Healthcare for the Homeless and then at the Nursing clinics Pine Street Inn. I was struck by the nursing model of care we used at PSI , we were able to outline the difference between that and a medical model when we formulated care. Many of the people who passed through those little clinics have gone on to become leaders - Eileen Stuart-Shor , for example, and I wonder if it was because working within such a model allowed us not only to provide very good care in a resourced constrained setting but also made us more clear on our role, our philosophy and our value as nurses.

thanks very much,

Elizabeth

Angela McBride Replied at 10:40 AM, 5 Nov 2012

For me the divide between clinical practice and administration goes away if you define leadership as not one and the same with administration. For me leadership implies that the individual inspires and catalyzes others to achieve shared mission and values in a context that keeps changing, thus constantly requiring us to think of new ways to meet mission when, for example, the very meanings of health and aging are evolving. I am a proponent of all nurses orchestrating a career for leadership. This careerist view implies that you get prepared to make contributions, eventually moving to take more responsibility for developing the setting and health care. In this view, the clinician and the administrator both are meeting organizational mission, but the administrator is already at the career stage where she or he is additionally concerned with developing organizational infrastructure and people, whereas the clinician may be more focused on own practice. Basically, this is the view I espoused in my 2011 book entitled The Growth and Development of Nurse Leaders (Springer).

Angela McBride Replied at 10:43 AM, 5 Nov 2012

By the way, here is a copy of my bio:
Angela Barron McBride is Distinguished Professor and University Dean Emerita at Indiana University School of Nursing; she is also a member of the Indiana University Health Board, and chairs the board’s Committee on Quality and Patient Safety. Dr. McBride is known for her contributions to women’s health, particularly the psychology of parenthood, and to psychiatric-mental health nursing. She served as president of Sigma Theta Tau International (1987 1989) and of the American Academy of Nursing (1993 1995). In 1995, she was elected to membership in the Institute of Medicine, and in 2006, she was named a “Living Legend” by the American Academy of Nursing. For the last dozen years, she has directed the leadership conference that is part of the John A. Hartford Foundation’s Building Academic Geriatric Nursing Capacity Program; she also chairs the national advisory committee for the Robert Wood Johnson Foundation’s Nurse Faculty Scholars Program. Her latest book entitled The Growth and Development of Nurse Leaders won the 2011PROSE Award for the category “Nursing and Allied Health” (Prose Awards are the premier awards for outstanding professional and scholarly publishing in the United States). In 2012, she received Indiana University’s President’s Medal for “sustained academic excellence.”

Patrice Nicholas Replied at 10:55 AM, 5 Nov 2012

Hi Maggie and Colleagues on GHD!
Patrice Nicholas here and I am delighted to join the panel for this topic! I am fortunate to serve as director of Global Health and Academic Partnerships at Brigham and Women's Hospital and Professor at the MGH Institute of Health Professions.

Yes, leadership in nursing in general, and specifically as a bridge between clinical practice and administration, is a pivotal topic during times of global shifts in disease and in health care. What does leadership in nursing mean? Leadership in nursing occurs in global settings in clinical practice in hospitals, rural settings, education--and all nurses can be leaders even if new to practice. One of the most important things is be mentored by other nurse leaders. I know that part of what GHD accomplishes so well is to link nurse leaders with nurses who are interested in global nursing! This is a great model since nurses and nursing students can learn about global nursing needs from practicing clinical nurses and expert nurse leaders. It is a great example of building a community.

If not already naturally a leader, can a nurse be taught leadership? I believe that some are natural leaders, but every nurse can learn to be a leader. Mentorship is an important aspect of learning how to be a leader. Also involvement in professional organizations is key. For example, the Vision of the International Honor Society of Nursing, Sigma Theta Tau
is " to create a global community of nurses who lead in using knowledge, scholarship, service and learning to improve the health of the world’s people". Also organizations like to Association of Nurses in AIDS Care provide a forum to address the HIV epidemic worldwide.
Membership in professional organizations is key to advancing one's leadership skills.

How does leadership in nursing, or the lack thereof, affect health care systems?
It is widely known that one of the major reasons for the world not accomplishing all of the United Nations Millenium Development Goals (promulgated in 2000) aimed to be achieved by 2015 is the lack of support and adequate numbers of nurses globally. In Africa, the shortage of nurses is directly linked with slower progress in achieving the MDGs and this was cited in the MDG Report on Africa (2007).
http://web.undp.org/africa/mdg/report.pdf
http://www.un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf
Thank you! Patrice

Attached resources:

Gini Williams Replied at 11:26 AM, 5 Nov 2012

Hi Elizabeth

Many thanks for your questions.
1. Personally I have not been working with HIV/AIDS directly although it has been a big part of my work as my field of expertise is TB. I am not sure if the specialism itself makes a difference but I am sure that one route into a leadership position is through specialising in a field which you care deeply about. Being involved in a speciality gives you the opportunity to develop expertise and speak with authority in one area having concentrated your efforts regarding research, training and practice development. There is no doubt that experiences in one fieldd can be transferred to another so it is not necessarily as isolating as it may seem.
2. I agree that we should get more voices from LMICs and have forwarded details of this discussion to the different Nurses Organisations, nurse leaders and trainers we work with to encourage their input.
3. Having a positive experience of working according to a nursing model is very important. I had the opportunity to develop a nurse-led service for people affected by TB in a hospital in West London at an early stage in my career. The Consultant Physician was very comfortable with the different roles of doctor and nurse and it was possible to set up seamless service spanning the hospital and community gaining access to physicians when needed but otherwise managing all other aspects of patient care. Having experienced this early on I was more inclined to fight for it later when, with much more experience, I was working with a very different Consultant Physician who was continually 'pulling rank'.

Gini

Lynda Wilson Replied at 1:26 PM, 5 Nov 2012

Dear colleagues,
I am energized by this discussion of global nursing leadership development...such an important topic and agenda! I wanted to share a program that we offer every 2 years as one of the activities of our PAHO/WHO Collaborating Center on International Nursing here at the University of Alabama at Birmingham (UAB) School of Nursing. The program started in 2006, and has evolved into a 2 week program on International Nursing and Health Care Leadership and Management. The program is open to nurses in Latin America and in Zambia (since our collaborating center focuses on these countries). Last July we had a total of 26 participants including nurses, clinical officers, and pharmacists from Zambia, Mexico, Chile, Brazil, and Costa Rica. Faculty in the School of Nursing lead classes and seminars on various aspects of nursing leadership, and we open the course as an elective to our undergraduate and graduate nursing students (the course is entitled "Global Perspectives on Nursing Leadership."). We base the classes on the model of leadership development that guided the International Council of Nurses' Leadership for Change program (as outlined in the book "Nursing Leadership" by Sally Shaw. Program participants use SWOT analyses to identify strengths, weaknesses, opportunities, and threats to their leadership development. They work with school of nursing faculty in a "coaching" relationship to develop individual leadership development plans to guide their ongoing professional development. We have used the coaching framework that has been developed by the Coaching the Global Village program (see http://coachingtheglobalvillage.org). We will offer the program again in 2014. I am keeping track of all of the discussions to incorporate as a discussion topic for our next program! Thanks for the great input!

Lynda Law Wilson, RN, PhD, FAAN, Professor
Assistant Dean for International Affairs and
Deputy Director, PAHO/WHO Collaborating Center on International Nursing
School of Nursing, University of Alabama at Birmingham
NB 420, 1720 2nd Avenue South
Birmingham, Alabama   35294-1210
Office Phone: (205) 934 6787 Cell Phone: (205) 306 1556 FAX:  (205) 996 7183 email: 

Inge Corless Moderator Replied at 8:25 AM, 6 Nov 2012

It's great to have responses from such distinguished colleagues. Angela McBride has a wealth of information to share on this topic as do others. The question we were to prepare a response for today was: Is leadership in clinical/bedside nursing different from leadership in nurse management/administration? If so, how? I recognize that we we have already begun our discussion on this. The attributes that I mentioned previously from the Simone article apply equally to both situations as does the ability to foster the development of one's colleagues. The specific knowledge and skills may differ, but the goal is growth and development of colleagues and achievment of the mission.

Angela McBride Replied at 10:06 AM, 6 Nov 2012

My original thoughts didn't speak to whether leadership can be taught. My answer is a resounding YES. I don't think that leadership means one personality type or having an administrative position. It means learning from entry into profession that you are expected to exert leadership (say it often enough and message is integrated into person's thinking). This means knowing that it is your job to inspire or energize others to work together for common purpose (some organizational goal that reflects values of institution) always aware that we need to get ready for the conditions of a quickly changing world. You can do this from many different positions. Part of the original question to us asked about certificates that prepare leaders. I am not keen on saying that certain degrees or certain certificates prepare leaders, but I think that we should emphasize preparation for leadership in every academic degree and program. There should be leadership development for every career stage and leadership goals for every individual development plan. The undergraduate might become a student representative to a committee, thus learning important lessons about governance. The new staff nurse might become a Magnet Hospital champion for his unit. The administrator might think about engaging in a formal leadership program, e.g., Robert Wood Johnson Foundation's Executive Nurse Program or Wharton Program.

Angela McBride Replied at 10:17 AM, 6 Nov 2012

Is leadership in clinical/bedside nursing different from leadership in nurse management/administration? If so, how? I tend to think that the differences are a matter of degree not kind. The bedside nurse needs to be a boundary spanner to get coordinated care for her patient; managers need to be boundary spanner to involve all of the appropriate stakeholders in policy formation. The bedside nurse needs to be aware of resources in thinking through whether follow-up care is affordable and there are individuals to provide needed supports. The administrator needs to be aware of resources (human and otherwise) in planning needed organizational changes. The bedside nurse needs to be aware of strengths and limitations of workers on his unit, so overall team can accomplish what needs doing; the manager needs to be aware of strengths and limitations of workers on all her units so a range of needs in different settings can be addressed. The bedside nurse and manager both need to be capable of having crucial conversations around tough topics and responsive to feedback they receive, though the focus of these conversations and the nature of feedback will vary with responsibilities.

Patrice Nicholas Replied at 2:17 PM, 6 Nov 2012

Hi All,
Such a great discussion by all!
Lynda WIlson, many thanks for sharing the information about your terrific program with GHD too!
For today's question from Maggie Sullivan:
• Is leadership in clinical/bedside nursing different from leadership in nurse management/administration?
I think that leadership in clinical nursing has many similarities to leadership in nursing administration. Emerging leaders at the bedside can often develop a career trajectory into nursing administration/leadership with the skills that they developed at the bedside.
But of course, mentorship is so important to develop leaders both in clinical settings and in administration/management.
Elizabeth, your post about having a commitment to a specific area (like HIV/AIDS) and developing one's leadership skills is really important. For example, there are many of us who are interested in HIV care and leadership roles too.
Best Regards, Patrice

Tess Panizales, DNP, MSN, RN Replied at 3:36 PM, 6 Nov 2012

This is a great discussion, and one of my favorite -

Leadership and management has been thought by some as inherent to an
individual, while other authors would argue that leadership is inherent but
management is learned. One can be a manager but may not have leadership
skills. A leader can learn management skills.

What does leadership in nursing mean? Leadership is a very important role
that a nurse can play. You can be a leader in any situation that arises
within a clinical setting or in the public health service arena.
Leadership does not entail a humanistic and creative approach to be able
to make things happen. One must have honesty, commitment and and
integrity. A leader does not have to at the forefront but one who is at
the back as well providing support, guidance and mentorship. He or she can
be the voice that is unheard but it may be that leaders hand and shoulder
that lifts the spirit of the team.

Some of our nurses in the clinical, academia or public health does not
realized that in one or the other they are or have been leaders in their
areas of expertise and career.

If not already naturally a leader, can a nurse be taught leadership? If
not inherent, I believe you can help mentor or nurture someone to be a
leader, only if the determination and sincerity to be one exist.

How does leadership in nursing, or the lack thereof, affect health care
systems? In order for nursing to grow and be heard - we need leaders to
help champion our professions cause. Nurses are champions in leading the
way for patient and community health care advocacy.

Thanks Maggie and the expert panel.

Elhassan Elhassan Replied at 5:36 AM, 7 Nov 2012

Thanks, Maggie Sullivan for storming such vital discussion. The issue of Leadership is spearheaded in all recent advances and development including the science-based initiative, approach or concept. All academic bodies and institutes are very much concerned with Leadership.
As a professional working in health service, research and teaching in a low resource country, Sudan the concept of Leadership has been negotiated and discussed in frank language about ten years or little more. Now there is a big concern and interest in Leadership, the fact that the knowledge and rapid growth of ideas, which considered to me as plethora, because every constitution or institution even governments are badly in need of Leadership. It is obvious that quality assurance and control are to extreme degree dependent on Leadership. In Sudan, experts in health sector and medical education are aware of the value of leadership and how it is vital.
I came to be in touch with the term long time ago when things and nomination were not clear cut. The combination between Leadership and innovation was the starting point when the University of Gezira was yet born and growing, so telling my story and our experience. The innovative idea of that University was based mainly on solid ground of potent Leadership which struggled very much to establish the quite new idea of innovative medical education as one the first schools of such kind in the world. Amazingly enough the idea has contained within its folds the importance of midwifery and nursing since it was born, which was considered at that time as fallacy or fantasy and it was very odd to use such terms like nursing and midwifery school inside faculty of Medicine !. This story is dated back to early 1980s. Morals and spirituals were very much resisting, but gradually and after more than 20 years the term come true that was Leadership which produced the vital importance of nurse and midwife. This is of course primary loader which put nurses and midwives as potential Leaders. The story may be rather long, but nursing and midwifery with other medical non doctoral professions are now in a place to lead and manage. One added factor is that the nurse and the midwife have got historical power and potency. They were and still strongly empowered. They are not only leaders, but in fact leading the teaching process in there so many faculties. They mainly females and now sharing decision making and leading together with the staff. The way is quite open for them to proceed to post graduate studies and higher degrees in their profession and careers. Now we are having some of them in Europe to build more capacity in the profession. They are highly empowered.
This atmosphere is the ideal one for getting them towards Leadership by the impact of the progress in the profession. The naturally gifted and personally talented leader is easy to be picked up among such environment. Not every body can be a leader. The leader is the one who can make the job done in silence and peace, makes achievements friendly, knows how to utilize facilities, innovates and puts dreams real. Leadership is framework that is based on science and talent. It is different from administration which is not necessarily Leadership. The leadership includes administrative competence shouldered by influence and not authority. The intermingled activity between practice and administration is important part of Leadership, the fact that the Leader should always be among his or her staff during work, by near or by remote. That is to improve health care system.

Inge Corless Moderator Replied at 8:48 AM, 7 Nov 2012

The nursing perspective is different from that of other professions. Our focus is on the patient, family, community- in illness, prevention of disease or maladies, and in health promotion. When I think about those affected by Tropical Storm/HurricaIne Sandy in NYC and NJ, I wonder who is assessing people who have various illnesses; who is considering the potential for disease outbreaks; who is identifying those people without resources. Electricity and heat can remedy part of the problem but lack of housing poses more severe issues. And what of the stress this whole experience has for those affected? I understand that State Nurses Associations are sending nurses to the affected areas. This is a time when we need nurse leadership and the nursing perspective in disaster response. Health care systems and disaster planning would be enriched by the presence of more nurse-leaders as would the persons in the affected areas.

Brittney Sullivan Replied at 9:39 AM, 7 Nov 2012

This has been a great discussion to follow!
Hearing what current leaders in nursing have to say about the trajectory of future nurse leaders is wonderful - I was at Angela McBride's lecture at BC last week (which was fantastic!) and gained so much wisdom about how to be a leader at every stage of your career. Both having, and being, a mentor I think is fundamental to fostering leadership. Having mentors (whether formal or informal) who can "show you the ropes" and push you to take on more challenges and who encourage you to achieve more is vital to the success of leaders. That being said, I think leaders are born when they start doing the same for others - invigorating and catalyzing others towards change or a greater good is what leadership in nursing is about.

Inge - thank you for bringing to light the aftermath of Sandy and what it means for nurses. ABC's 20/20 highlighted NICU nurses from NYU Langone Medical Center who became "heros" for doing their job and transporting 20 critically ill neonates down 9 flights of stairs in the dark to other hospitals. The full story (and video) can be seen here: http://abcnews.go.com/Health/nicu-nurses-saved-babies-remember-harrowing-triu.... I think this is a great story about nurse leaders - patients came first, yet they led the way by keeping calm in the face of adversity.

Looking forward to hearing more comments!
Brittney

Patrice Nicholas Replied at 11:55 AM, 7 Nov 2012

This has been a great discussion and thanks to Dr. McBride, Corless and Williams as well as the discussants!
Today's question is:
• How are health care systems affected by either the presence of absence of nurse-leaders? How might health care systems be different if there was more leadership in nursing?
This question is so compelling in that the absence of nurse leaders in any organization or health care system diminishes outcomes for patients and populations. It is well known that achieving the MDGs is limited by a lack of available professional nurses worldwide.
And Sheila Tlou, PhD, RN served as Minister of Health in Botswana bringing HIV/AIDS and the important work of nursing in HIV prevention, treatment and care to the forefront. Botswana achieved great progress in limiting the spread of HIV during Dr. Tlou's tenure. She has also co-edited an impressive volume with some of the leading experts in HIV: Dr. Max Essex, Dr. Phyllis Kanki, Dr. Richard Marlink, and Dr. Souleymane Dboup. Dr. Tlou is also a past recipient of the Florence Nightingale Medal from the International Committee of the Red Cross for her work on advancing women's rights in the era of HIV/AIDS. She has past appointments to a special UN task force on girls, women, and HIV/AIDS in southern Africa, as well as serving as a consultant to UNAIDS, and the UN Commission on the Status of Women and the World Health
Organization.
Just one exemplar of the importance of nursing leadership in health systems and the importance of nurses at the forefront!
Thank you, Patrice

Inge Corless Moderator Replied at 11:57 AM, 7 Nov 2012

Brittany, Your comment about mentorship is right to the point. I've been reading an article about Mitt Romney by Nicholas Lemann (Transaction Man) in the New Yorker (Oct.1, 2012) pp 38-51 in which he mentions how the Morman Church prepared him (Romney) for leadership. The expecation was that the young men would be leaders. Forgetting the sexist aspects, the boys were given opportunities with greater responsibility from the time they were children. I think that's a model we can use with our young nursing students, nurses, and faculty.

Tess Panizales, DNP, MSN, RN Replied at 12:05 PM, 7 Nov 2012

Totally in agreement with mentoring for nursing leadership and management!

Angela McBride Replied at 1:53 PM, 7 Nov 2012

How are health care systems affected by either the presence or absence of nurse-leaders? I go to the IOM study of 2004 entitled Keeping Patients Safe to answer the first question. That entire volume focuses on nurses as the key to safe hospital environements, and the pages plead for nurses to become transformational leaders--meaning among other things that they take responsibility for the design of clinical environments and the design of caregiving systems. So my answer is that clinical facilities peopled by individuals at all levels who see themselves as responsible for the design of environments and systems that maximize quality and safety, would be truly transformative.

How might health care systems be different if there was more leadership in nursing?
Nurses would be front and center in the development of a culture of safety and mechanisms to ensure best practices. They would be involved in interprofessional leadership at every level, from co-leading unit-based quality-improvement efforts to serving on the board of the clinical facility. The more this involvement comes to pass, the more the behavior of nurses would change too. All nurses would understand the mission, values and goals of the institution, and frame what they are doing more in terms of achieving said mission, values and goals. I mention this because the emphasis would be less on "pay attention to me because nursing is important" and more on "I can help this institution achieve its ends here's how I can do it." In the United States, we are finally moving away from "nurses as expenses" to "nursing can help you realize maximum reimbursement for services rendered" now that insurers and the government are moving to award maximum reimbursement to those clinical facilities that have achieved maximum quality.

Gini Williams Replied at 6:21 AM, 8 Nov 2012

I cannot help thinking that questions regarding the impact of nursing leaders on health systems and the need to focus on leadership in nursing are inextricably linked. The thing I have encountered over and over again is the frustration nurses face implementing health care policies which they have not been effectively consulted about during the development process and yet form the bulk of the workforce having to implement them. I have no doubt that health systems would be stronger and more effective if all partners involved in implementation were represented fully at a strategic level not least because nurses would be respected and recognised for the contribution they make leading to better morale and staff retention.
It has been evident throughout my 20 year involvement in the TB field, where the focus on the technical aspects of diagnosis and treatment, have received the overwhelming majority of investment at global national and local levels. The quality of patient care and access to diagnostics and treatment, which is predominantly the domain of nurses, has taken second-place and when it is considered as a topic requiring strategic debate, this has usually occurred without the input of nurses.
In a profession overwhelmingly represented by women, sadly leadership is not necessarily expected nor valued among peers or colleagues. Nurses who express their own ideas and concerns are often seen as being difficult and not wanting to do as they are told. Sadly, as a newly qualified nurse, when I questioned something, a nursing colleague has responded “we have always done it this way”.
In addition, a hierarchy exists in health services with nursing taking second-place to medicine and not being seen as a profession in its own right, with its own professional development and regulation systems. There is something we seem to have missed with regard to claiming a space for nursing as a separate discipline. Doctors seem to think they know all they need to about nursing and that mostly nurses just do as they are told – if nurses have a good idea it often requires convincing a doctor it is his or her idea for it to be acted upon. Nurses often work as part of a team and when a team leader is chosen this role most often falls to a doctor. Everyone acknowledges verbally how important nurses are but this importance relates to the fact that they are doing the work not that they have a role in planning it, identifying priorities etc. I am talking globally here – I accept that in a number of countries the situations I am describing may be less common but I still think it is a common experience for many.
I have been battling with this for years and am so frustrated when I see wonderful work being done by nurses in such difficult circumstances around the world which receives little if any acknowledgement at a country let alone an international level. Indeed, I have often conversations with international medical consultants, who provide technical assistance to the same countries where these nurses are working, and who have no idea what the nurses are doing on the ground and the contribution they could make if only they were more effectively engaged at all levels.
I am trying to counter this though the ICN TB Project by supporting more nurses to be active at international events and meetings, to write for academic journals and conduct more research to get more evidence into the literature. For the last few years, thanks to the investment from Eli Lilly in a nurse led project for nurses, I have been doing what many leading experts from USAID, World Bank, and WHO to name a few, told me over and over was impossible to do and I am still having to ‘prove’ it. I don’t see microbiologists, pharmacists or even patient advocacy groups having to jump through the same hoops as nurses to get their voices heard.
Working in international health, I believe we have a duty to shine a light on the work of nurses in countries where the challenges are greatest. This is not to suggest that we do the talking but we must use our international contacts and knowledge of the global health scene to create opportunities for nurses to speak for themselves and enable them to demonstrate what a difference their contribution can make.
I would very much welcome your thoughts and suggestions.

Angela McBride Replied at 9:44 AM, 8 Nov 2012

Why is there a greater focus on nurses being leaders in their profession, rather than pharmacist-leaders, physician-leaders, dentist-leaders, etc? Is there a dearth of nurse-leaders, or does the field of nursing somehow require a greater demonstration of leadership?
I think that you are going to hear more of a drum beat regarding leadership in other professions, given the enormity of the challenges ahead (economic constraints, access issues, demand for quality/safety). There will be more and more of a push for all professions to work at the top of their licenses. I agree, however, that so much of the push for leadership in nursing goes back to the gendered nature of the nursing profession, historically expecting the physician to be more like the father (the head) in a family and the nurse to be more like the mother (the heart) in a family. All of our imagery had physician as captain of ship giving orders and nurse as person carrying out orders and a team player--images not in keeping with notions of leadership. Now that both professions are more diverse and the challenges are so complicated, there's more push for a different kind of leadership, one who can take the skills of all members of the health team and turn them into something greater than the whole, ie., nurse leadership.

Inge Corless Moderator Replied at 11:12 AM, 8 Nov 2012

I had much the same thoughts as Angela when I was thinking about this.I don’t know whether there is a greater emphasis on nurses being leaders in their profession than there is in other disciplines. I think it is assumed that MDs are leaders in health care by virtue of being MDs whether they choose to emphasize that role or not, for many of the reasons Angela noted. My hunch is that the focus on nurses being leaders has more to do with their role as a member of the clinical team and in public policy. In both instances the push is to have nursing’s voice heard. So I think the question can be reframed as how do we have nursing's voice heard in health care and policy. We have always had leaders in the profession. We need leaders FOR the profession although we have had them as well, some of whom have responded to this discussion. But we need more such leaders as there are more areas where nursing leadership would improve the outcomes of policy and health care.
Regarding Gini Williams' hard-fought efforts in TB, my hunch is that everyone wants the "qucik fix" solution (which may take a long time in developing requiring much investment) rather than approaches that require a continued investment of time and resources but are ultimately successful. Such efforts, nursing efforts, will never be a "quick fix" and thus are considered less valuable. We need to demonstrate their value!

Elizabeth Glaser Moderator Emeritus Replied at 11:54 AM, 8 Nov 2012

Having nurses seen as leaders beyond the nursing sphere - that our training
and knowledge means that we can and should be included in implementation,
operations research, planning and policy in health - is essential.

1.Getting research and policy briefs published in venues that are not
nursing specific will help such as NEMC, JAMA, Health Policy and Planning,
AJPH.
Linda AIken has had her research on nurse staffing in these journals so it
is not impossible. However, we need to go beyond that to publish,as primary
authors, on issues that are not nursing specific but are relevant to health
in general. By doing so we will can show that the nursing perspective is
one which may provide reasonable commentary and potential solutions to the
problems we see in domestic and global health.

2. Talking heads - we need to make ourselves available as experts to talk
on policy related to HIV, Public health, health care financing and the
impact of policy changes on issues in domestic and global health. I realize
that many people cringe at being labeled an "expert" and I share that
wariness but that is an important aspect on how we make our voices heard.

3. Books - while I admire Suzanne Gorden's profiles of nurses and her
advocacy for our profession, we need to be the ones writing the popular
books, to do what Jerome Groopman, Atul Gawande and so many
physicians-writers do so well - blend science , case studies and memoir
into compelling readings which show the breathe and depth of what we do and
the value of the nursing perspective.

Elizabeth

--
*Elizabeth Glaser, MSc, MA, ACRN, RN-BC*
Doctoral candidate, Social Policy
Institute for Global Health and Development
Heller School for Social Policy and Management
Brandeis University
415 South Street, MS 035
Waltham, Massachusetts. USA 02453

Barbara Waldorf Moderator Emeritus Replied at 6:23 PM, 8 Nov 2012

I am very curious about this question - posed by Maggie Sullivan - for this discussion:

Why does it seem there is/needs to be greater focus on nurses being leaders in their profession, rather than pharmacist-leaders, physician-leaders, dentist-leaders, etc? Is there a dearth of nurse-leaders, or does the field of nursing somehow require a greater demonstration of leadership?

I think that the need or emphasis on nurse leaders comes from a historical lack of being able to define our worth and place. Some of this comes from the position of nurses vis a vis the medical field; but at the root, I think it has to do with the origin of nursing as a woman's profession and thus being tied to the status of women in any given society. Despite the extraordinary work that is being done by nurses both locally and internationally, there is still a sense of having to "catch up" and create situations where our voice is valued. I don't think there is a lack of leadership, but a sense of having to push uphill in order to be recognized as such.

Would love to hear other thoughts about this.
Thank you for all the fascinating posts to this discussion.

Barbara Waldorf

Gini Williams Replied at 2:33 AM, 9 Nov 2012

Thank you Inge, you could not have described it better and it certainly reassures me that we are on the right track. People are always looking for the 'quick fix' and with something like TB, which takes a minimum of six months to treat, there is no such thing even though people have spent decades looking for it.
Gini

Gini Williams Replied at 2:38 AM, 9 Nov 2012

Thank you Barbara, this is a very helpful and reassuring comment. Reassuring as it points to an underlying social factor which hampers our efforts and not necessarily our personal shortcomings. It is obviously important for nurses to be reflective about their work but also recognise the wider context and the influence this might have on our personal ability to overcome the challenges we face.

Gini

Gini Williams Replied at 9:09 AM, 9 Nov 2012

This refers back to our earlier discussion on the difference between leadership in nursing practiced at the bedside and in the broader clinical environment and the leadership involved in administrative and other recognised leadership roles. All nurses need certain assertiveness and communication skills which can be taught, in order to advocate appropriately for the needs of patients and the safety of the work environment. There are also important leadership qualities required by many nurses who will be in charge of a ward or clinic fairly soon after completing training.
There was a comment yesterday about us being wary of acknowledging our expertise and certainly it feels risky when participating in national and international strategic discussions but it is important that we are confident in our own expertise wherever we are working and respect the expertise of our colleagues. From the beginning of a nurses’ training there needs to be an emphasis on the need for on-going learning and development throughout his or her career at whichever level that may reach. As mentioned a number of times earlier in this discussion, mentorship is essential throughout a nurse’s career, from student to senior management levels.
As nurses who show an aptitude for leadership (and even some who do not) are promoted to higher clinical and administrative roles, further training is required to ensure a fuller understanding of the roles they inhabit and their opportunities as well as responsibilities to lead. Just as a football team has a captain who has shown leadership qualities so nurses demonstrating leadership skills should be identified and given training to further develop their skills. What nurse leaders should never do is lose sight of the practice environment where nurses actually are providing care. It is still at this level that the major impact should be made and measured in the experience and outcomes for patients, families and communities.

Inge Corless Moderator Replied at 9:38 AM, 9 Nov 2012

The question for today is
How does one teach leadership? If a student does not come to nursing already possessing qualities of leadership, how can this be developed over the course of her/his nursing education? And how does one continue to develop leadership skills in nursing after graduation?
Before responding to today's question I want to address Barbara's comment about having to push uphill to be recognized. It is a very thought-provoking comment that I will likely consider for some time. One response is the suggestion I think by Elizabeth that we get out there with our writing for periodicals like The New Yorker or write newspaper columns, etc. is a good way for us to get our names out there. We also do so by creating innovative programs that are people-serving and cost-saving or at least cost neutral with more beneficial outcomes. We do so by conducting research and using the results to inform policy makers and develop programs. The hardworking clinical nurse, administrator, or academician who shys away from publicity is the wrong model for us. (I'm not suggesting a Kardashian-like approach although we might learn something there). If we want nursing recognized, we need to have nurses recognized as key to policy and the health of the public.
And now to todays' question. We know how to teach leadership skills. This is not the same as being a leader and we may only provide limited opportunities for leadership development in academia for students. The “how to” becomes incorporated by the doing, by the practice of the skills that were learned by having a leadership role and this may happen post graduation. As to the second question, muscles atrophy with non-use. It is important that nurses participate in professional organizations and volunteer for committees and then take on the leadership of such committees and organizations. Students need to be encouraged to do so during their academic program and thereafter.And back to Barbara, we need to demonstrate the advantage of including nurses with our strengths and skills to achieving given outcomes so that it becomes a disadvantage not to have us at the table.

Dédamani Thomas SANWOGOU Replied at 1:44 PM, 9 Nov 2012

Hello Dear all,
I read with interest and attention the intervention of each other. I think the points made in the comments show the importance and relevance of nursing leadership in a context of globalization care.

So I would advise that reflects my geographical and social environment. In the francophone countries of Africa nursing leadership arises in two different ways.

1 - Lack of nursing leaders: all nurses are at the operational level of care. To breast health administrations at district, regional or central, are rarely found nursing positions that allow them to participate in decisions. I take an example: In Togo and Senegal, where all the work in the fight against
TB at district and regional levels is done by nurses, there are no nurse in both NTP coordiantion team. This situation is caused by the low level of nursing education and  absences of nurses specialization  in most countries. Until 2000, almost all francophone countries of West Africa accounted for nurses at a
nurse in the first degree. The few nurses who could pursue specialization no longer recognize nurses, and thus they make no effort to promote the nursing profession.

2 - The lack of leadership skills. Nurses in our region desperately short of skills in leadership, I take the example of professional associations of nurses in Francophone West Africa. Few are those who manage to impose and operate normally. It is necessary to support nursing leadership and nurses selecting the area, who have charisma to equip them to be in different countries leaders who can lead others to assention true professional.

3 - The lack of professionalism. The few nurses who have emerged in our country, those who are often hinder the emergence of young nurses who wish sophisticated. That they have changed the title and they refuse to recognize nurses, they prefer to be called health technicians, they consider themselves superior to how nurses and hinder their development. I only take my example, I've been several times and I continue to be victims of stroke nurses who are my superiors.

4 - The influence of physicians. How you so well pointed out in your words, history is something. Today
in our country when nurses made a greater degree, it you are almost certain that it will less degree. Preferred a doctor not trained in a field as a nurse specializing in this Demaine. For example, the health system doctors prefer to appoint young without experience as chief district that experienced nurses who have been educated in public health and health service management.

Let me conclude by reiterating the importance of research to show that nurses have their say in the management of health problems and finding solutions scientifically valid. Operational research can contribute to this goal.

It is also interesting than the supporting parts of the world to allow a statement of the globalized profession and a true nursing leadership.


 Excuse me for my english.

Thank you.
 
SANWOGOU Dédamani Thomas
IDE, MD sciences de l'éducation
Secrétaire Exécutif du REEISAOF
Etudiant en master santé internationale
Université Senghor d'Alexandrie.
Tel. 00201142461547 (Egypte) /
0022890312325 (Togo)
mail:

Angela McBride Replied at 2:21 PM, 9 Nov 2012

How does one teach leadership? I think you can teach elements of the skills important to leadership, e.g., self-reflection, how to think about feedback and give it in an ego-enhancing way, problem solving, how to apply for grants, self-presentation (the look of a CV and the elements of a good presentation), how to write clearly. But I think mainly you coach leadership--expanding the person's notion of possibilities, providing tips on how to recoup from failure, recommending experiences and publications that expand one's thinking. Within that mentoring or coaching, you mainly help the person discover her/his strengths and build on them.

If a student does not come to nursing already possessing qualities of leadership, how can this be developed over the course of her/his nursing education? I've said this before, but I think the main thing you can do is to tell the person that she or he is good in certain areas, and encourage them to take advantage of opportunities that build their nascent abilities further--workshops, internships, governance, writing up an innovation to present at a professional meeting, shadowing someone who is already doing what you hope eventually to do.

And how does one continue to develop leadership skills in nursing after graduation? I think mentoring is crucial in life after graduation, particularly at times of major transition--taking first clinical position, taking first academic position, taking first managerial position, going on first interprofessional board. Increasingly, there are formal programs that exist to help at these times of transition. For example, the Robert Wood Johnson Foundation has programs in the United States for executive nurses, tenure-probationary faculty, and mid-careerists interested in health policy. Sigma Theta Tau International is a good example of an international nursing organization committed to leadership development over the course of a nurse's career. I think all of our nursing organizations need to think about how they can develop needed leadership development programs for life after graduation.

Angela McBride Replied at 2:39 PM, 9 Nov 2012

I just want to note that Inge's masterful weaving of others' remarks into her comments is an excellent modeling of an important leadership skill.

Elizabeth Glaser Moderator Emeritus Replied at 3:07 PM, 9 Nov 2012

Agree that Inge's points are very well made , clear, and address all points.
Re leadership - Mentoring may help the mentor as well as the mentee by
promoting an increased mindfulness in one's words and actions.

--
*Elizabeth Glaser, MSc, MA, ACRN, RN-BC*
Doctoral candidate, Social Policy
Institute for Global Health and Development
Heller School for Social Policy and Management
Brandeis University
415 South Street, MS 035
Waltham, Massachusetts. USA 02453

Sally Rankin Replied at 4:52 PM, 9 Nov 2012

I have been following this interesting discussion and wanted to let everyone know about the Afya Bora Consortium which has as one of its primary goals leadership development. Afya Bora is a consortium between 4 SSA and 4 US universities:
■Makerere University, Kampala, Uganda, and Johns Hopkins University
■Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, and the University of California, San Francisco
■University of Botswana, Gaborone, Botswana, and the University of Pennsylvania
■University of Nairobi, Nairobi, Kenya, and the University of Washington

Our SSA nursing and medical colleagues identified the areas in which they are most interested in partnering with US universities and leadership was at the top of the list. UCSF has had one nursing student participate and another one will be leaving soon but the program is open to medical students and residents too. Most participants are from our African partner institutions. For more information go to this website: http://globalresearch.ucsf.edu/train-in-global-health.html.

Sally H. Rankin, RN, PhD, FAAN
Professor and Associate Dean for Global Health and International Programs
N411Y, Box 0606
School of Nursing
University of California-San Francisco
2 Koret Way
San Francisco, CA 94143
415-502-7662
http: //nurseweb.ucsf.edu


-----Original Message-----
From: GHDonline (Elizabeth Glaser) [mailto:]
Sent: Friday, November 09, 2012 12:07 PM
To: Rankin, Sally
Subject: Re: [Global Health Nursing & Midwifery] Expert Panel: How to train nursing leaders - bridging the divide between nurses who provide direct patient care and nurse managers in order to improve health care systems.

Elizabeth Glaser replied to the discussion "Expert Panel: How to train nursing leaders - bridging the divide between nurses who provide direct patient care and nurse managers in order to improve health care systems." in the Global Health Nursing & Midwifery community.

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"Agree that Inge's points are very well made , clear, and address all points.
Re leadership - Mentoring may help the mentor as well as the mentee by
promoting an increased mindfulness in one's words and actions.

On Fri, Nov 9, 2012 at 2:40 PM, GHDonline (Angela McBride) <
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> "I just want to note that Inge's masterful weaving of others' remarks into
> her comments is an excellent modeling of an important leadership skill."
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*Elizabeth Glaser, MSc, MA, ACRN, RN-BC*
Doctoral candidate, Social Policy
Institute for Global Health and Development
Heller School for Social Policy and Management
Brandeis University
415 South Street, MS 035
Waltham, Massachusetts. USA 02453
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Inge Corless Moderator Replied at 9:50 AM, 12 Nov 2012

I'd like to say what a privilege it's been to be on a panel with such distinguished colleagues- all of whom are leaders. The postings of colleagues from Africa enlarge our undertstanding of the issues faced in these countries. And to have Dr. McBride who is an expert on the subject is a special gift. My thanks to each of you- Maggie for organizing this panel, and Patrice, Gini, Elizabeth, Lynda, Tess, Angela, Elhassan, Brittany, Barbara, Dedamani, and Sally for comments that have enriched my understanding of the topic.

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