title: The challenges of leading change in health-care delivery from the front-line.
abstract: OBJECTIVE
  The public sector is facing turbulent times and this challenges nurses, who are expected to serve both patient interests and the efficiency drives of their organisations. In the context of implementing person-centred health policy, this paper explores the evolving role of front-line nurses as leaders and champions of change.
  
  
  BACKGROUND
  Nurses can be seen to have some autonomy in health-care delivery. However, they are subject to systems of social control. In implementing person-centred policy, nurses can be seen to be doing the best they can within a constrained environment.
  
  
  METHODS
  A survey of nursing practice in person-centred health-policy implementation is presented.
  
  
  RESULTS
  Despite much being written about managing health-professional resistance to policy implementation, there is a gap between what is being asked of nurses and the resources made available to them to deliver. In this milieu, nurses are utilising their discretion and leading from the front-line in championing change.
  
  
  CONCLUSIONS
  Empowering nurses who seek to lead patient involvement could be the key to unlocking health-care improvement.
  
  
  CONCLUSIONS
  Health services tend to be over-managed and under-led and there is a need to harness the potential of front-line nurses by facilitating leadership development through appropriate organisational support.
authors.affiliation: Health Policy & Management, Dublin Institute of Technology, Dublin, Ireland.
authors.forename: Vivienne
authors.initials: V
authors.lastname: Byers
mesh_terms: D000328:Adult; D005260:Female; D006291:Health Policy / Q000639:trends; D006801:Humans; D007494:Ireland; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009718:Nurse Administrators / Q000523:psychology* / Q000592:standards; D024802:Nurse's Role / Q000523:psychology*; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards; D010465:Perception; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: change champions; front-line nurses; health policy; leadership; person-centred