As described earlier in this chapter, interviewees were able to identify key behaviours at the individual level to encourage effective leadership, namely empathy, communication, and leading by example. However, at the group level they were aware that clinicians’ perceptions of them might inhibit their effectiveness as leaders.
When asked about clinical midwives’ perceptions of them, interviewees suggested that clinicians tend to label anyone in a formal leadership role as ‘management’:
“And the trouble is, management is always seen by clinicians in a manager – a
negative light. They’re the ones that… ‘They’re the ones who won’t let us do
things’, yeah” – Susan, LSA MO.
Like Karen, other interviewees contrasted the perception of clinicians with their own self- identification:
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“I don’t think everyone perceives me as a midwife, because I have had – for
example, we do the ward assurance audits, where we have to go into another area.
So I currently have cancer and rehab ward that I visit on a monthly basis… And I talk
to staff up there, and they’ll say, ‘Oh, you’re a midwife. But you’re a matron, so you
don’t deliver babies any more’. And I say, well, no, I don’t actually get my hands on,
delivering babies any more, but I support staff that are, you know, hands on, I
actually do get involved in a lot of antenatal work, dealing with issues with women,
so I do have to have that grounding, I do have to understand what is expected of a
midwife during that actual antenatal period, and the postnatal – because I pick up
all the community stuff. So I think… sometimes they do struggle in thinking that all
I’m doing is filling forms in and reading emails” – Deborah, matron.
The interviewees believed staff perceptions were generally, at an individual level, based on their experiences. For example, Lesley spoke about the perception of clinicians she had taught during her years as a midwifery lecturer:
“I think the band 6s are far more likely to see me as a midwife than the band 7s…
Because an awful lot of them would know – have known me as a midwife teacher.
And I – I like to kind of sit, and wander around, and chat to them”.
Pauline hoped she would be thought of as both leader and manager, but with important and valuable clinical knowledge:
“They see you as a manager with knowledge, so they would see you as – as
[laughing] – whether they’re right or wrong – because you’re at this level – they
think that you’ve got a wealth of knowledge, do you know what I mean? You’ve
gone through the practical side of things and so you – you’ve gained all those skills
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that’s what I’m saying, that’s how – or, ‘Go to Pauline, because Pauline will know
that, Pauline will know that’, and that’s fine. So they see you as a manager and a
leader, but they also think you’ve got a wealth of knowledge and expertise” –
Pauline, matron.
While the interviewees were not comfortable with the idea of being perceived as managers, they were able to sympathise with this view, and offered various reasons why it might happen. Deborah reflected on a clinician view of HoMs as managers:
“I can see why they do think that… I think it’s difficult because the head of
midwifery role is not standardised across the whole country, and there is… There is
this tendency, now, to lump it in with the general manager, lead nurse, general-
covers-everything role… And I think that hasn’t helped that professional element of
it, because it then does become more, you know, pure management role”.
Natalie, meanwhile, suggested the importance of socialisation in clinicians forming particular views about leaders and managers:
“What I find so frustrating is, a lot of those midwives [with negative attitudes], I
knew as students. And they didn’t leave here [behaving like that] – so there’s a lot
of peer pressure. And I do think peer pressure – having to conform or get out”.
The interviewees were unsurprised by the negative attitude attached to being a ‘manager’. Pauline believed public perception was a driver in this:
“I am a manager, and I do see myself as a manager, but – but a midwifery
manager. But yes, from the public’s realm, they see us as a manager”.
Susan suggested a negative view might be linked to clinicians’ reluctance to move into clinical leadership roles:
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“And actually, why would you want to put yourself into that position where
actually, you work longer hours than ever, but you’re not paid for them – so the
staff on the shop floor take home a heck of a lot more than you”.
In the first data chapter, there was a strong sense of ‘I am still a midwife’ in the interviewees’ narratives, which were analysed from an individualistic perspective. However, when looking at identity maintenance from a group perspective, analysis has shown a far more complex picture. Identity maintenance in this chapter has been closely related to the interviewees’ interaction with fellow midwives, and they appear aware that others’ perception may not be as positive as their own.
‘The Cream of Nursing’
Of all the observational experiences I had during the band 8 leadership programme, I think this one stuck most firmly. The participants were mid-way through a two-day element of the programme, and a session was being presented which involved a former chief executive of an NHS trust. Within the first minute of his presentation, he made two remarks that would elicit huge amounts of conversation at coffee time. First, he commented on the fact that this was the most nerve-wracking presentation he had given, being to a roomful of midwives; he described midwives as ‘daunting’ and ‘intimidating’.
Then, a couple of sentences later, he referred to midwives as ‘the cream of nursing’. I was extremely offended by this title: I had never been a nurse, although I obviously had nursing skills as part of my midwifery role. I also felt it offended nurses – I didn’t think they would appreciate the idea that midwives are somehow ‘better’ than them! I wondered, though, if it was just me that felt his remark was irritating in its lack of understanding – particularly as many of the course participants trained in the days when you had to do nursing prior to midwifery training.
At coffee, all became clear… I was not alone. There was a lively discussion among the participants, and I realised just how many of them had picked up on his remarks. First, they really did not like the idea that they were daunting or intimidating. And second, the idea of being the cream of nursing utterly negated their midwifery identity.
I referred to this observation during the interviews, which is what led to discussions around the NHS perception of midwives in relation to nursing.
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