title: Challenges faced by public health nursing leaders in hyperturbulent times.
abstract: OBJECTIVE
  This study discusses the challenges and characteristics of effective public health nursing leaders in local health departments and barriers to effective leadership during the hyperturbulent conditions of 2008-2010.
  
  
  METHODS
  Participants were drawn from a purposive sample of seven directors of nursing (DON) in six county LHDs in two states for this qualitative study using inductive methods.
  
  
  METHODS
  Semistructured telephone interviews were conducted, using open-ended questions. Data analysis consisted of coding, pattern identification, and theme development, assisted by the use of ATLAS.ti™. Credibility was achieved through intercoder agreement and resonance of the findings with participants.
  
  
  RESULTS
  Two underlying challenges emerged: leadership dissonance and leading through ambiguity. Three key effective leadership attributes identified were as follows: collaborative change management, life-long learning, and being visionary. DONs identified extrinsic and intrinsic barriers to leadership effectiveness and leading change in public health systems and PHN practice.
  
  
  CONCLUSIONS
  Results suggest ways to support PHN leaders in order to overcome barriers to effective leadership such as defined leadership competencies, continuing education, and mentorship opportunities.
authors.affiliation: Public Health - Seattle & King County, Seattle, Washington.
authors.forename: David J
authors.initials: DJ
authors.lastname: Reyes
authors.forename: Betty
authors.initials: B
authors.lastname: Bekemeier
authors.forename: L Michele
authors.initials: LM
authors.lastname: Issel
mesh_terms: D006801:Humans; D007857:Leadership; D009718:Nurse Administrators; D015403:Nursing Evaluation Research; D011635:Public Health Administration; D011637:Public Health Nursing / Q000458:organization & administration*; D036301:Qualitative Research; D014481:United States
keywords: leadership; nursing; public health; public health nursing; public health systems