To an extent unprecedented in history, healthcare is a complex and human enterprise. Generating the complexity are stakeholders with more diverse perspectives, needs, and agendas, and greater knowledge and vested interest than ever before. Given their pivotal position between the direct-care environment and external stakeholders, nurse managers can no longer rely on the hierarchy, authority, and linear thinking afforded by traditional management; in order to accomplish they must lead people by working through them. Ironically, when needed most, there is a lack of consensus in the literature about what leadership is. In this paper I describe the paradigms for leadership and management held by six Canadian nurse managers who participated in a phenomenological study of leadership. Thinking leaders worked through people to enhance their growth, potential, and accomplishment, participants did so by creating and sustaining inclusive environments, influencing people, and acting in a manner that reflected and supported integrity. Participants thought managers did not focus on people; instead, they carried out routine, procedure-driven tasks to run departmental business. Included in this paper are suggestions about how participants' paradigms might benefit the nursing profession, consumers of care, and healthcare organizations.
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