Student Nurses’ Perceptions of the Nurse Manager as a ‘servant Leader’

South Africa focuses on service delivery at primary health care (PHC) clinics. A ‘servant leader’ could guide student nurses towards service delivery at PHC clinics. The purpose of this study was to describe the role of nurse managers acting as servant leaders of student nurses at some PHC clinics in the Johannesburg, South Africa, area. A quantitative, exploratory and descriptive design was followed. The accessible population comprised 302 thirdand fourth-year diploma and degree student nurses enrolled at a university in Johannesburg and its affiliated nursing college who were allocated to PHC clinics for learning experience. A survey was conducted by means of a structured questionnaire which was returned by 288 (95%) respondents. The findings indicated that student nurses perceived shortcomings in the nurse managers as ‘servant leaders’ regarding empowerment, compassion and role modelling. Nurse managers should be briefed with regard to empowering student nurses, showing compassion and role modelling during interaction with them as well as building relationships of trust between them and the student nurses. KEyWORDS: healthcare manager, primary health care, servant leader, student nurse INTRODUCTION AND BACKGROUND INFORMATION In the repertoire of leadership styles, the concept of ‘servant leadership’ is growing in popularity (Walumbwa, Hartnell & Oke, 2010:517). Greenleaf (1904–1990) is the scholar who reintroduced this leadership concept (Greenleaf, 1991:7–8). He stated that a ‘great leader first serves, that begins with the natural feeling that one wants to serve, where a conscious choice brings one to aspire to lead’ (Greenleaf, 1977:21–28). Servant leaders lead through their visible attitudes and actions, seeking to involve others in AJNM_14(1)2012.indd 76 8/14/2012 7:36:48 AM STUDENT NURSES’ PERCEPTIONS OF THE NURSE MANAGER AS A ‘SERVANT LEADER’ 77 decision making (Gersh, 2006:3). Certain aspects, such as empowerment, compassion, role modelling and the building of a reciprocal relationship based on trust, are all functional characteristics of a servant leader (Russell & Stone, 2002:2). Servant leaders are required to focus on the development of other people and to consider identifying their followers’ strengths and meeting clients’ needs as being more important than their own interests (Washington, Sutton & Field, 2006:1). Servant leadership is also relevant in the primary health care (PHC) clinical area where student nurses are placed for their clinical training. The PHC nurse manager in charge of the clinic has the ultimate educational accountability to ensure student teaching and learning in practice. The nurse manager within this context is thus in the position to act as a servant leader. In organisational settings, such as a PHC clinic, nurse managers could act as servant leaders by doing the following: devoting themselves to serving the needs of their followers (students); focusing on meeting the learning needs of those they lead; developing followers to bring out the best in them; coaching students and encouraging their self expression; facilitating personal growth in followers; and listening to what followers have to say in an effort to build a sense of community. By doing these things, nurse managers as servant leaders are effective by encouraging and facilitating their followers (students) to reach their full potential during their training, allowing them to perform at their best, which ultimately is better for the organisation as a whole (Washington et al., 2006:1). At a PHC clinic, the educational focus is on the development of the student nurse as a servant leader to deliver health care services to the community. The primary motivation of servant leadership in nursing is to improve service delivery (Walumbwa et al., 2010:517). The PHC nurse manager in charge of the clinic should act thus as a servant leader to guide students towards effective PHC service delivery. LITERATURE REVIEW Servant leadership, as a recognised style of leadership, appears to be insufficiently supported by empirical research (Dennis & Borcanea, 2005:7). Research about servant leadership has focused mainly on servant leadership in relation to other leadership models and on the characteristics of a servant leader (Washington et al., 2006:1). South Africa has a wide network of district health care service clinics staffed by health workers from various disciplines. Servant leadership should address the needs of all the team members, and should ensure that other people’s highest priority needs are being served. It also refers to training students, enabling them to manage a clinic and to lead the activities at such a facility. AJNM_14(1)2012.indd 77 8/14/2012 7:36:48 AM K. Jooste and E. Jordaan 78 During an address by the late Minister of Health, Dr Manto Tshabalala-Msimang (2006), at an International nursing conference with the theme of ‘We lead together’, she expressed four salient concepts that could be directly linked to servant leadership. She appealed to senior nurses to embrace junior nurses and to guide them to develop into effective and responsible nursing practitioners. This statement indirectly indicates the importance of the characteristics of empowerment and compassion. She also emphasised that competent leaders are the most important resource to tackle challenges through role modelling and the facilitation of change. Thirdly, she mentioned the importance of leadership for improving nursing. She indicated that, if junior nurses were to be involved in the planning and implementation of programmes, their leadership attributes and clinical skills should be identified in order to develop these attributes and skills. Fourthly, she mentioned the importance of empowering followers. Beukes (2005:347) states that nurse managers should recognise student nurses as human beings by including them in nursing actions and by not ignoring them. One of the most important duties of a role model, in this case the nurse manager at a PHC clinic, is to provide leadership to her followers, including student nurses. Shaw (2007:91) believes that leaders have an instrumental role to play as trainers in an attempt to change and shape their followers’ motives, values and aspirations. PROBLEM STATEMENT During clinical supervision of student nurses at various PHC clinics, the researchers observed different kinds of leadership styles being practised by nurse managers. However, all these styles appeared to focus on self-interest instead of contributing towards the development of students into future leaders. This observation was substantiated by the students who expressed similar perceptions. It was unclear to what extent nurse managers were guiding the students in their capacity as servant managers.