Perceived Leadership Qualities of Public Health Nursing Leaders: Challenges in Advancing Public Health Nursing

Background: Public health nursing (PHN) leaders, specifically directors of nursing (DON), in local health departments (LHDs) continue to face leadership challenges related to maintaining and developing qualified public health nurses. The HRSA funded Keeping RNs to Improve and Strengthen Population Health (KRISP) project seeks to support the directors in addressing leadership challenges such as these. However, little empirical information exists describing their realities and experiences upon which to base interventions. The aim of this study was to ascertain perceptions and challenges of effective leadership for LHD directors of nursing. Methodology: An exploratory study using semi-structured interviews was conducted with a purposive sample of seven nursing directors in six county LHDs in two states. Participants provided individual, tape-recorded semi-structured telephone interviews. Questions included probes about their experiences leading nurses, characteristics of persuasive leadership, barriers to effective leadership, and roles and responsibilities in their LHD and the community. Inductive methods were used to analyze and code the data, and to identify salient patterns and themes. Credibility of the data was achieved through inter-coder reliability and resonance of the findings with study participants. Results: Data analysis yielded five primary domains: Accountable PHN Practice, Co-existent Accountabilities, Effectiveness Barriers, Influential Leadership, and Life-long Learning. These domains were represented across all seven PHN leaders, with variations in the sub-category distribution. Conclusions: The PHN leaders' ability to achieve KRISP goals is constrained by system and organizational barriers. Study implications suggest opportunities to identify leadership gaps, support, and develop public health nursing leadership.