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Promoting nursing leadership: the story so far …

Ricarda Klein

Jacqueline Filkins
Honorary President
European Nurse Directors Association

A quick literature search relating to nursing leadership yields much material. Many research findings highlight the need for good leadership, but few studies have attempted to define the role of nurse directors and to measure its impact on patient outcomes, nurse retention, effectiveness and overall quality of care.(1) A crescendo of new roles and responsibilities for nurse directors began to emerge in the 1990s, which led to the creation of ENDA.

Establishment and development
In 1992 a small group of nurse directors from Switzerland, Germany, England, Belgium and Finland met with one overarching aim – to build a support network among nurse directors in Europe to further the art and science of nursing leadership. The first goal was to engage other European colleagues by organising a congress. A name for the association was agreed and reflected the fact that it was, at that time, for nurses who worked at directorate/strategic decision-making level within hospital settings.

One of the early decisions was that ENDA would organise a biennial congress. Since the first meeting in Switzerland, congresses have taken place all over Europe, attracting audiences of up to 400 nurse leaders. The congress for 2007 will take place in Reykjavik, Iceland. The Annual General Meeting of ENDA takes place during the congress and action plans are agreed for the following year. It is a democratic association whereby each European country is encouraged to nominate a delegate member to ENDA and its Standing Committee.

It is also stipulated that members should, wherever possible, maintain strong links with their own national nursing association in order to strengthen networking and influence strategies. This also allows ENDA to avoid the pitfalls of “group think” – as first described by Janis and quoted by Iles – as it expects its members to discuss group deliberations with experts from other groups.(2) Three overarching objectives were agreed at the 1995 congress and have, so far, stood the test of time (they were last reviewed February 2006):

  • To strengthen the nursing contribution to policymaking in the context of healthcare management in Europe.
  • To further the development of the art and science of nursing leadership through research, nursing education, policy and practice development .
  • To establish formal links between nurse leaders (and/or other healthcare decision-makers) and their organisations across Europe and in so doing create a communication network of experts.

Achieving our objectives
The expanding EU, demographic changes in population and issues relating to nursing recruitment, retention and education all have an impact on the work of healthcare managers. Nurse directors especially have to ensure that standards are met (or exceeded) within tightening financial allocations and, at times, a fluctuating workforce. There are two ways that ENDA ensures that actions are formalised, communicated and acted upon:

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  • It makes the most effective use of the time spent at congress in order to formalise action plans, whose progress is evaluated at the annual board meeting.
  • It makes extensive use of IT for networking and communicating.

One action was to undertake a SWOT analysis of the roles and responsibilities of nurse directors, the results of which formed a benchmark for ENDA and its constituent membership.(3) The results were presented in 2001 and have contributed to strengthening the understanding that wherever nurse directors might be working they face similar challenges and, most importantly, opportunities for enhancing patient care.

This greater understanding of issues relating to nursing within Europe created an awareness that in order to be involved at the heart of policymaking there was a need to connect with the European Federation of Nurses Associations (EFN). This was achieved, and ENDA is now a member of the European Specialist Nursing Organisations (ESNO), a feeder arm of the EFN.

Learning, sharing and making changes
ENDA members give their time freely to act as consultants or facilitators to other colleagues or their associated organisations in order to learn, share expertise and facilitate changes in practice where needed. We respond to invitations to contribute to workshops and conferences at national and European level and encourage networking at all levels and with the multiprofessional team. The themes of each congress address contemporary healthcare issues, with the emphasis on nursing contribution and solutions. “Tomorrow’s Nurse – Taking the Lead” is the theme for the congress in 2007, and speakers will be addressing issues relating to:

  • Continuous professional development: its impact on quality of care and as a motivational tool for nursing, including recruitment and retention.
  • Nursing education: future needs in relation to a pan- European context.
  • Nurse migration: European nurse leaders need a forum where all issues relating to migration can be explored in order to understand and be prepared for the likely increased movement of health professionals within Europe.

In addition to the preparation of the congress, which is in the hands of the Icelandic Nursing Association, ENDA has agreed two key points. First, it has amended the membership criteria. To address nursing leadership issues comprehensively, ENDA welcomes all nurses who have leadership responsibilities. This can include ward managers (succession planning), educationalists, researchers and more. It is hoped that underrepresented sectors, such as psychiatry and primary care, will join forces to better represent the voice of nursing in all sectors to the benefit of patients. Secondly, it has agreed to work with the European Nutrition for Health Alliance to address issues relating to malnutrition and to build an agenda for action at European level. This has already led to ENDA being invited to contribute to a parliamentary workshop on developing a policy in the UK to tackle malnutrition for older people in the community. Other initiatives on this topic are developing across Europe.

The future
The bigger picture sees ENDA being increasingly asked to contribute to both European and national development of policies that affect patient care and to continue to learn from each other. Possible links with other organisations are being explored to support and enhance its activities.

ENDA congress
3–5 October 2007
Reykjavik, Iceland


  1. Filkins J. Director of nursing and quality: a gilt-edged bond for the Trust? J Nurs Manag 1997;5;301-9.
  2. Janis IL. Group think. In: Iles V. Really managing health care. Ham C, Heginbotham C, editors. Buckingham (UK): Open University Press; 1997. p. 20-1.
  3. Filkins J. Nurse Directors’ jobs – a European perspective. J Nurs Manag 2003;11;44-7.