title: Leading nurses in dire straits: head nurses' navigation between nursing and leadership roles.
abstract: OBJECTIVE
  The present study reports selected findings from a doctoral study exploring the negotiation between nursing and leadership in hospital head nurses' leadership practice.
  
  
  BACKGROUND
  The importance of bringing a nursing background into leadership is currently under debate. In spite of several studies of nursing and clinical leadership, it is still unclear how nurses' navigate between nursing and leadership roles.
  
  
  METHODS
  An 11-month-long ethnographic study of 12 head nurses' work: five worked at a first line level and seven at a department level.
  
  
  RESULTS
  At the first line level, leadership practices were characterized by an inherent conflict between closeness and distance to clinical practice; at the department level practises were characterized by 'recognition games'. On both levels, three interactive roles were identified, that of clinician, manager and a hybrid role.
  
  
  CONCLUSIONS
  Where clinician or manager roles were assumed, negotiation between roles was absent, leading to reactive, adaptive and isolated practices. The hybrid role was associated with dialectical negotiation of roles leading to stable and proactive practices.
  
  
  CONCLUSIONS
  Nursing leadership practises depend on leaders' negotiation of the conflicting identities of nurse and leader. Successful nursing leaders navigate between nursing and leadership roles while nourishing a double identity.
authors.affiliation: Postdoc, Clinical Nursing Research Unit, Aalborg Hospital Science and Innovation Center, Aarhus University Hospital, Aalborg.
authors.forename: Erik E
authors.initials: EE
authors.lastname: Sørensen
authors.forename: Charlotte
authors.initials: C
authors.lastname: Delmar
authors.forename: Birthe D
authors.initials: BD
authors.lastname: Pedersen
mesh_terms: D000884:Anthropology, Cultural; D003718:Denmark; D006801:Humans; D007406:Interview, Psychological; D007857:Leadership; D017146:Models, Organizational; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D009745:Nursing, Supervisory / Q000458:organization & administration*