9.1 Introduction

This chapter will focus on the challenges of leadership and the importance of the leader’s well‐being. In recent years, leaders in healthcare have experienced extreme challenges, and this chapter will explore the risks and effects of leading during a crisis. Much research has been published during and after the COVID‐19 pandemic, building on the dearth of knowledge in this area pre‐pandemic, and this has brought suggestions of strategies for leading. It has also identified gaps in preparation and a realisation that while both our healthcare systems and individuals within may cope with short episodes of high impact, the long‐term and unpredictable nature of COVID‐19 caused an immense strain and uncertainty and continues to do so.

The COVID‐19 pandemic has introduced a new range of vocabulary and in some countries, nurse leaders have had to quickly grasp their meaning to explain and relate their importance to patients and staff, such as “lockdown,” “self‐isolation,” “pandemic,” “endemic” and the language of political leaders who use military metaphors of war. Using this terminology may have been an attempt to unify communities and to ensure the seriousness of the situation was realised. However, it also had the effect of instilling fear for control and compliance. For nurses working with patients’ day to day, fear was another issue to deal with in caring for patients with health needs while also in great fear of being infected themselves. Linguistic creativity is often used in times of serious social crisis and is not new (Flusberg et al. 2018). However, as a nurse leader during a crisis, care and the application of emotional intelligence is needed to be aware of the impact of how information is communicated, how it is received and the reaction to messages from perceived healthcare leaders and their followers.

The image of nursing during the pandemic has varied, from “angelic tropes” to “vexatious protestors” as explored by Bennett et al. (2020) at the height of the pandemic and again as the COVID‐19 pandemic waned (James et al. 2023). This is challenging for nurse leaders as historically nursing has been viewed as symbolic of servitude and the nature and needs of the profession have changed. Nurse leaders are more than able, skilled and knowledgeable to have an influencing voice in the decisions of healthcare policy; yet for some, this remains a challenge. Looking forward, nurse leaders have considerable power to continue to lobby for the profession, using learning from challenges to build the presence of nursing on the global stage.

9.2 Leading During Challenging Times

There is a crack in everything. That’s how the light gets in.

Leonard Cohen (2014, p. 366)

While the experience of nurses during the pandemic has often been traumatic and challenging, there are undoubtedly opportunities to learn and prepare for the future. In order to do that, there is a need for transparency and open discussions which confront difficult issues. It can be argued that decisions had to be made and the “command and control” approach of many governments was needed. Difficult decisions and rapid actions were required, often stepping into the unknown of what the future held. Nurse leaders, alongside other health professionals, were required to act on many of these decisions and make decisions on the clinical floor, and there is much written now on the issues of moral injury and moral distress; the emotional response following events that contradict or violate a person’s ethical or moral stance (Litz et al. 2009). Frei and Morriss (2020) and Thompson and Kusy (2021) agree that teams who are able to maintain unity and interconnection demonstrate honesty and trust, authenticity and empathy, and these are often set and directed by the nurse leader in a clinical context. Worline and Dutton (2017) suggest social connection and altruism are linked to compassion and empathy and having core professional values can improve unity in teams. More than ever, during challenging times, a compassionate and congruent leader can encourage cohesion and empathy within a team, ensuring that even during the most difficult times, a team can feel trusted, listened to and supported. Allowing the expression of emotions and indeed, being courageous by demonstrating their own emotions, clinical leaders can place value on the experiences and impact of their co‐workers and provide reassurance (Thompson and Kusy 2021).

9.3 Examples of Leading Through Crises

Learning from leadership examples outside of healthcare can allow us to gain a wide perspective on how people manage adversity well. There will be examples perhaps locally and within your organisation that can inspire and motivate, and it is good to share these examples for staff. Meanwhile we can look wider, and below are some examples of leaders and their approaches to crisis leadership, which have provided positive cases for effective leadership approaches.

1. Decisive action with displayed compassion: Jacinda Ardern ‐ former Prime Minister, New Zealand.
   

   Applying an approach of decisive action, clear communication and expression of humanity, Jacinda Ardern limited deaths related to COVID‐19 to far fewer than many countries and eased lockdown controls earlier. With prior experience in dealing with tragic events, she demonstrated openly her sensitivity and compassion, bringing people together and making swift policy changes to gun laws.

   
   
2. Giving followers direction and roles recognising their value, instilling trust: Earnest Shackleton ‐ Explorer and Captain of Endurance.
   

   In 1915 Endurance, Shackleton’s ship, became stuck in the ice on an exploration to the Antarctic. Shackleton realised that he and his crew would have to wait out the brutal weather conditions trapped in ice. To keep the crew’s morale high he insisted each man maintain duties, keeping daily routines and tasks, establishing order and keeping his men focused in uncertain times that were filled with danger. Shackleton responded to changing circumstances. When the ship was no longer habitable, crushed by the ice, he instructed his men to build a camp on the ice. Moving the crew on, not really knowing the outcome, he reached an uninhabited island. Knowing that no one knew if they were alive and therefore with no chance of rescue, he identified a group of men to accompany him in one of the three lifeboats 800 miles to find help. Four months and three unsuccessful rescue attempts later, Shackleton arrived back to rescue the rest of his team. They were all alive.