The concept of leadership in nursing can be traced back to Florence Nightingale. In the late nineteenth century, she exercised power autocratically and promoted her model of leadership through the role of matron. She called her nurse managers 'specials', and until the 1960s, they were similar to their military counterparts.
Nurses have been taught traditionally to be acquiescent, even submissive, helpers of doctors (Alimo-Metcalfe 1996 22-24), and nursing has been described as 'an oppressed discipline' (Jooste 2004 217-223) that remains the underdog in relation to medicine (Carney 2004).
There have been changes in recent years however caused in part by feminism and demands for female equality, but also by employment legislation that has allowed most nurses to pursue clinical, educational or management career pathways. (Upenieks 2003 456-467)
Nevertheless, as Alimo-Metcalfe (1996) suggest, many nurses working on wards retain a submissive role and do not assert themselves well. Yet this role does not necessarily reflect the relationship between nurses and doctors; as this paper into nurses' use of effective nursing management finds, nurse managers can also inhibit effective nursing management in nurses.
Nurse Managers have demonstrated an array of different skills and abilities compared to regular nursing staff. Skills and qualities required for an effective nurse manager include essential communication skill with nurses who wish to develop professionally (Hersey 1982, Anthony 2005: 146-155). Alimo-Metcalfe (1996) identify several factors that prevent nurses from using nursing management skills, including a knowledge about their personal or professional rights, concern about what others will think about their behaviour, and anxiety caused by lack of confidence and poor self esteem.
Effective nursing management skills education and training can alleviate some of these factors. Indeed, Hersey (1982) suggests that such training can help nurses to develop professional confidence and so collectively enhance the growth and development of the nursing profession. A descriptive paper by Bondas (2006 332-339) supports this view, in which a random sample of 800 nurses were asked to complete a questionnaire that incorporated both the Alderman effective nursing management schedule (Alderman 2001: 49-50) and a personal and professional data form.
Findings from the 500 responses show that gender, age, years of experience and clinical setting do not influence individual effective nursing management levels. However, nurses with higher levels of education and previous effective nursing management training were more assertive. King (1996 3-14) also fined that training can increase levels of nursing management skills; although they suggest that workplace factors primarily promote or inhibit its use.
The hierarchical nature of nursing, Hersey (1982) suggests, means that nurses have not always been encouraged by nurse managers to be assertive. Bondas (2006 332-