Understanding avoidant leadership in health care: findings from a secondary analysis of two qualitative studies

Understanding avoidant leadership in health care: findings from asecondary analysis of two qualitative studies

DEBRA JACKSON R N , P h D1, MARIE HUTCHINSON R N , P h D

2, KATH PETERS R N , P h D3, LAURETTA LUCK

R N , P h D4 and DEBORAH SALTMAN A M , M B B S , M D , M R C G P , F R A C G P

5

1Professor, University of Technology, Sydney, Faculty of Nursing, Midwifery and Health, Sydney, 2Senior Lecturer,Southern Cross University, School of Nursing, Department of Health and Human Sciences, Lismore, 3SeniorLecturer, University of Western Sydney, Family & Community Health Research Group, 4Senior Lecturer, Universityof Western Sydney, Family and Community Health Research Group and 5Professor, University of Technology,Sydney, Faculty of Nursing, Midwifery and Health, Sydney, New South Wales, Australia

Introduction and background

Optimal clinical environments rely on open and trans-

parent processes through which concerns can be raised,

fully investigated and appropriately responded to. Most

health-care facilities have a reporting line identifying

the appropriate persons to whom concerns can be

taken, and though nurses are urged to report matters

Correspondence

Debra Jackson

University of Technology, Sydney

Faculty of Nursing, Midwifery

and Health

Sydney

New South Wales

Australia

E-mail: [email protected]

J A C K S O N D . , H U T C H I N S O N M . , P E T E R S K . , L U C K L . & S A L T M A N D . (2012) Journal of Nursing

Management

Understanding avoidant leadership in health care: findings from a secondaryanalysis of two qualitative studies

Aim To illuminate ways that avoidant leadership can be enacted in contemporaryclinical settings.

Background Avoidance is identified in relation to laissez-faire leadership and

passive avoidant leadership. However, the nature and characteristics of avoidance

and how it can be enacted in a clinical environment are not detailed.

Methods This paper applied secondary analysis to data from two qualitative

studies.

Results We have identified three forms of avoidant leader response: placating

avoidance, where leaders affirmed concerns but abstained from action; equivocal

avoidance, where leaders were ambivalent in their response; and hostile avoidance,

where the failure of leaders to address concerns escalated hostility towards the

complainant.

Conclusions Through secondary analysis of two existing sets of data, we have shed

new light on avoidant leaderships and how it can be enacted in contemporary

clinical settings. Further work needs to be undertaken to better understand this

leadership style.

Implications for nursing management We recommend that organizations ensure

that all nurse leaders are aware of how best to respond to concerns of wrongdoing

and that mechanisms are created to ensure timely feedback is provided about the

actions taken.

Keywords: avoidant leadership, health care, leadership, secondary analysis

Accepted for publication: 16 January 2012

Journal of Nursing Management, 2012

DOI: 10.1111/j.1365-2834.2012.01395.xª 2012 Blackwell Publishing Ltd 1

of concern to their managers, little is known about

nurses� experiences of doing so. This important element

of professional behaviour has not been adequately

scrutinized in the literature. However, there is evidence

to suggest that concerns raised by nurses and other

health-care professionals may not always be dealt with

appropriately by those with whom such matters are

raised (Firth-Cozens et al. 2003, Attree 2007, Hutch-

inson et al. 2008). In this paper, we reanalyse data

drawn from two qualitative studies and use this as a

lens to explore leader responses to concerns raised by

nurses, and conceptualize the responses as avoidant

leadership.

Avoidant leadership is a term that is seen in the

literature but is seldom defined. Typically, nursing

scholars and researchers have focused upon transfor-

mational and transactional leadership styles with little

attention directed to understanding avoidant leader-

ship. Avoidance is identified in relation to laissez-faire

leadership and passive avoidant leadership (Horwitz

et al. 2008, Cummings et al. 2010). However, although

there is reference to avoidance, the nature and charac-

teristics of avoidance and how they can be enacted in a

clinical environment are not detailed. There has been

little attempt to examine in detail the nature or conse-

quences of avoidant leadership in the nursing work-

place, or to determine the contextual factors that

moderate the capacity to engage in various styles of

leadership. For the purposes of this paper, we define

avoidant leadership as occurring where leaders do not

act responsively, efficaciously or decisively to effect

positive change.

Aim

The aim of this paper is to illuminate ways that avoi-

dant leadership can be enacted in contemporary clinical

settings. The experiences of clinical nurses raising

concerns about workplace wrongdoing were used as an

exploratory lens to better understand and detail the

leader behaviours that comprise avoidant leadership.

Methods and data collection

This paper presents the findings of a secondary data

analysis employing data collected from two distinct

studies that shared the feature of exploring nurses�experiences of workplace wrongdoing. Study 1 exam-

ined nurses� experiential accounts of whistle blowing

and study 2 sought to reveal the experiences of nurses�exposed to bullying in their workplace. The studies

shared many methodological features (Table 1). Both

studies were underpinned by the tenets of qualitative

research that acknowledged the personal meanings of

subjective experiences of participants as revealed

through their accounts of the phenomena of interest

(Streubert Speziale & Carpenter 2010). In-depth qual-

itative interviews were conducted in both studies and

lasted between 40 and 120 minutes. Findings from both

of these primary studies have been published elsewhere

(Hutchinson et al. 2005, 2006a,b, 2010a,b,c, Jackson

et al. 2010a,b, 2011).

Initially, the qualitative data used here was generated

through two distinct inquiries that focused on similar

topics using comparable research methods. Analytical

integration of qualitative data sets from these two

studies allowed for further investigation from which a

synthesized account of the concept avoidant leadership

emerged. For this current paper, both sets of qualitative

data were reanalysed to answer questions related to the

role and responses of clinical leaders in the initial

management of workplace wrongdoing, specifically,

�How did leaders demonstrate avoidant leadership

when these nurses raised matters of concern?� In this

approach, the contribution of each data set was of equal

value, and both data sets were reanalysed to provide a

richer explanatory account of avoidant behaviours in

clinical leaders.

Analysis

Analysis of the data followed the tenets of thematic

analysis. In this case, the abstracted themes were re-

vealed using the same approach used when analysing

interviews successively (Miles & Huberman 1994,

Boyatzis 1998). First, each data set were separately

read and re-read. The researchers re-immersed

themselves in the transcripts seeking data that focused

on the participant�s descriptions of the manager�sresponses to the event. The data sets were decontex-

tualized or reduced and recontextualized (Boyatzis

1998). Data reduction included analysing and coding

each data set independently, so two sets of tentative

codes were developed. An iterative process ensued

and themes were developed using both data sets.

There was deliberate flexibility during development of

themes and they were revised based on emergent

codes, ideas and new description. This process en-

abled the identification of commonalities and over-

arching themes. Emerging from the independent

analyses of these data sets was a similar thematic

thread that had resonance with both data sets – the

avoidant responses of nurse managers to concerns

raised.

D. Jackson et al.

ª 2012 Blackwell Publishing Ltd2 Journal of Nursing Management

Secondary analysis of data

Secondary data analysis enables researchers to ask new

questions of extant data sets (Corti 2007, du Plessis &

Human 2009). While data mining and secondary

analysis of quantitative data is well-represented in the

literature, (Thompson 2000, Doolan & Froelicher

2009) there is very limited discourse detailing accepted

processes and methods that can be used to re-explore

existing qualitative data, and little in the literature that

guides qualitative researchers when more than one data

set is analysed. Typically, qualitative interviews seek to

gather data about experiences or personal meanings in

order to answer a research question. These interviews

also capture contextual information and stories related

to the research focus. There is implicitly a wealth of

information that is often under-explored and under-

utilized (Corti 2007). This under-explored data can

yield new insights that may not be revealed unless a

different question is asked of the data and a fresh lens is

applied. Secondary analysis of data sets can answer new

questions that are compatible with the original aims of

the project. Secondary analysis of rich qualitative data

also provides an opportunity to further the ethical

principle of justice, as participants� contributions and

stories are more fully explored and reported. Further, it

has been argued that undertaking secondary analysis of

narrative data about highly sensitive topics has the

ethical benefit of avoiding further potential distress to

vulnerable participants (Fielding 2004).

There are three broad approaches to secondary

analysis of research data. The first, triangulation, in-

volves exploring complementarity between the results

from one data set to enhance, illustrate, or clarify the

results from another (Morse 1991). The second,

combing, involves one data set being subsumed into

another and the blended data being analysed. The third

approach is integration in which the individual

integrity of both data sets is retained while their inter-

dependence is analysed, allowing researchers to gain

richer perspectives and add scope or breadth to what is

understood about a concept (Creswell & Plano Clark

2010). Integration can occur at a number of stages. In

the analysis presented in this paper, analytical integra-

tion of two qualitative data sets occurred at the point of

secondary analysis and interpretation.

Participants

All participants were nurses who were currently work-

ing, or who had worked, in a health service in Australia.

The combined sample size was 44, comprising 18 from

study 1 and 26 from study 2 and had years of nursing

experience ranging from 2 to 40 years. Participants had

wide clinical experience and were drawn from critical-

care areas, mental health, aged care, medical/surgical

and community settings.

Ethics

Both studies received ethics approval from relevant

human ethics committees. Participants were asked for

their consent to use their data for research purposes and

subsequent publications. Owing to the highly sensitive

nature of the data, however, it was important that the

participants� data were anonymized before data analysis

commenced. Only the researchers who undertook

original data collection knew identifying details of the

Table 1Methodological features of the two studies

Methodology Data collection Inclusion criteriaRecruitmentprocedures Participants

Year datawas collected

Study 1 Qualitative Digitally recorded andtranscribed

Nurses with first handlived experience ofwhistle blowing, eitheras a whistle blower,the subject of awhistle-blowingcomplaint, or as abystander to awhistle-blowing event

Self-selecting participantsto respond to a mediainvitation

18 enrolled andregistered nurses

2009

Study 2 Qualitative Digitally recorded andtranscribedsemi-structured,open-endedinterviews

Nurses with first-handlived experience ofbullying either as thesubject of bullying oras a bystander tobullying

Self-selecting participantsto respond to a mediainvitation

26 enrolled andregistered nurses

2006

Avoidant leadership in health care

ª 2012 Blackwell Publishing LtdJournal of Nursing Management 3

participants or the health services involved in the

events. To further ensure the protection of the partici-

pants and the health services, the data sets were read

closely for potentially identifying information and this

was removed.

Rigor

Trustworthiness of this secondary analysis is supported

because both of the original studies were underpinned

by the same research tradition, and the focus of the data

sets is compatible with the current research question (du

Plessis & Human 2009). This enabled a coherent ap-

proach to data analysis. Confirmability of the emerging

codes and themes was supported by the participants�similarities, (Thompson 2000) the depth of description

in both sets of data, and the concurrence between

researchers during data analysis. Credibility was

established because the themes were revealed in both

data sets.

Findings

Participants described a range of serious concerns they

had attempted to raise, and these included diverse

matters such as inappropriate use of narcotics, abusive

and threatening behaviours within work teams, unsafe

patient acuity levels, hostile workplace behaviours

that compromised patient care and unsafe clinical

practices. When raising concerns participants reported

unexpected leader responses. These nurses had felt they

were fulfilling their obligations to follow organi-

zational processes in reporting concerns or wrongdo-

ings appropriately and in many cases had expected to

garner support and validation of their concerns. How-

ever, from our analysis, we have identified three forms

of avoidant leader response: placating avoidance, where

leaders affirmed concerns but abstained from action;

equivocal avoidance, where leaders were ambivalent

and inefficacious in their response; and hostile avoid-

ance, where the failure of leaders to address concerns

escalated hostility towards the complainant. These

forms of avoidant response are explored more fully

below.

Placating avoidance: �she would not tolerate thatin our ward�

In exhibiting a placating response, participants reported

their managers initially appearing to be receptive to

concerns, and pledging to take some sort of action.

Participant B6 reported a very positive initial reaction;

�She [manager] was great. She said oh, no, she would

not tolerate that in our ward�. After this initial com-

plaint, when met with this response, participants would

leave their manager�s offices feeling optimistic, positive,

validated that their concerns had been treated seriously

and respectfully, and with the expectation of some sort

of corrective action.

However, as time passed, with no apparent action or

changes in the situation, participants felt increasingly let

down and disappointed. In these cases, participants

would have to repeatedly raise the concerns, each time

feeling a little more disillusioned, with the original

optimism and hope that a solution could be reached

fading. As time passed with repeated attempts to raise

their concerns being unsuccessful, these participants

began to take the view that they were simply being

placated – that is, being told what their managers

thought they wanted to hear rather than being taken

seriously.

I had gone back to my manager quite a number of

times, which really wasn�t any help. I really felt

like she understood what I was talking about and

what I was saying. She really made me feel like she

did understand and that it [issue] was a problem

that we were going to have to deal with it, but

nothing ever happened (W18)

On some occasions the placating responses took the

form of a type of counselling session where the partic-

ipant was encouraged to adapt and accept the matters

that had concerned them. Participants reported being

counselled that they could come to accept a situation; it

was simply a matter of time.

Well, I have talked to the NUM [nurse unit

manager]… you know, and… she said that those

people are like that and �you will get over this with

time� (B5)

Equivocal avoidance: �you don�t know what�sgoing to happen�

The equivocal avoidant response was evident when

complaints and concerns were met with ambivalence or

ambiguous responses. Where the placating response

created an initial cause for optimism, the equivocal re-

sponse was one in which there was a perception that the

response was evasive or ambivalent.

What was interesting is what was done with

nurses� reports [of bullying]. Unfortunately, the

person [manager] said… �well I just file them�.

D. Jackson et al.


Don�t you do anything about it? �No, I just file

them� (B4)

This lack of decisive response was experienced as

perplexing to participants, who had believed that in

raising concerns with managers they were acting in

accordance with professional obligations, and within

clinical and organisational protocols.

… I�ve addressed it [clinical problem] with the

NUM, twice, put in formal complaints and I�ve

taken that over to the DON. Nothing�s happened.

It really annoys me because you think, well they

tell you that you should be taking these things

further but nothing happens. Um, nuh, and you

just think why, why bother, why bother (B9)

The failure to appropriately acknowledge concerns

raised by nurses was seen as evidence of equivocal lea-

der behaviour. This behaviour was noted and com-

mented on, even in managers that were regarded with

some fondness and affection.

There were complaints. There were complaints to

the NUM, but I think the NUM used to feel a bit

intimidated by her as well. So there would never

be anything followed up. I think it was easier just

to ignore it. I think maybe she didn�t want to be-

lieve it. She always I think she was always pos-,

tried to be a positive person. She was a lovely

NUM and, um, or is a lovely NUM, she�s out of

the Department for a little while now but she is a

lovely person, but I think it was just too easy to

ignore it because it would mean probably having

to deal with it. She didn�t want to have to deal

with it (B12)

Many health-care organizations undergo habitual

and repeated organizational change. This can involve

frequent changes of managers, and the appointment of

managers to acting positions. In these situations, where

managers seemed to be simply disinterested and eva-

sive, participants were of the opinion that some of

these leaders had a lack of commitment to the work-

place.

I feel that if we had strong leaders in this division

sort of, in one place for a number of years, that

would have certainly helped stop the bullying

occurring. I think it�s very hard when everyone is

in acting positions… I think in the past we�ve had

Chief Executive Officers using the position as a

stepping stone to go somewhere else. We�ve got a

person in there as the Director XX, looking out

for her own profile to go somewhere else. She

doesn�t seem to be doing anything about the bul-

lying and about other things that are coming up,

she really doesn�t. She tends to whitewash any

responsibilities to go away without doing any-

thing about it (B3)

Some leaders adopted a �wait-and-see� attitude,

requiring further episodes of suboptimal clinical prac-

tice before any action would be taken. Aside from the

equivocal nature of this response, it could also indicate

the leaders themselves were anxious or nervous about

raising concerns higher up the managerial ladder be-

cause to do so could potentially expose them as being

inadequate. Participant B11 arranged a meeting with

her manager to raise some matters of concern. The

managerial response comprised, �let me know if it

happens again�.Ongoing delay and the postponement of probable

effective action was another way that these avoidant

leaders were able to defer and neutralize potentially

useful actions and render them ineffective.

She keeps saying oh we�re going to have a

meeting – a fact-finding meeting – but they never

have the meetings. So you�re sort of on tenter-

hooks all the time – you don�t know what�s going

to happen (W3)

Failure to establish the full facts of a situation meant

that further investigative or corrective action could be

delayed indefinitely. In addition to delaying measures

such as meetings that could help reveal the full facts of a

situation, the endless postponements meant that par-

ticipants remained in a state of anticipatory apprehen-

sion and unease as described by participant W3 above.

Hostile avoidance: �then it got out of control�

Although they themselves viewed their complaints as

being expressions of genuine concern about a matter they

perceived as unethical, wrong or dangerous, participants

who experienced a hostile response described a sense that

their actions were construed to have malicious intents.

This positioning effectively reframed their actions and

meant they were perceived as being unsupportive and

treacherous to their managers. Perhaps in response to

this, managerial threats and counterattacks were com-

monly described among the hostile responses to com-

plaints. W3 raised her concerns about a patient care issue

to her NUM. Her concerns were dismissed by the NUM,

so W3, on advice, then acted in accordance with her

organizational communication line and spoke to the

deputy director of nursing in charge of the area.



…I spoke to the deputy director of nursing [about

concerns] and then it got out of control… I got a

letter saying that I had accused her [the NUM] of

being negligent, which I never did. I never said she

was negligent… Then after that I was sort of given

the warning that, you know, I was doing the

wrong thing and that I had no right to do this.

Then she started saying – the NUM started saying

that I was canvassing against her and undermining

her (W3)

As with the case of participant W3 above, who was

subjected to a range of counter-accusations, several

other participants also reported being subjected to

retaliatory action for raising concerns. These took the

form of counter-complaints, accusations or allegations

directed against them.

Some participants reported the hostile acts of their

leaders being taken up by others, paving the way for a

flow-on effect that became established throughout the

work environment. This meant the informants them-

selves came to be positioned as being the problem rather

than the issue they had attempted to raise in the first

place. Once matters got to this point, it was as if the

original issue of concern had never occurred and did not

exist. Instead the participants were themselves posi-

tioned as �problems� who needed to be �managed�. This

positioning then justified the initiation of various mea-

sures designed to restore and maintain the organisa-

tional status quo.

�I went and saw my boss who assured me that by

the time I come back from holidays things would

be sorted out and I could come to her… On my

first day back from holidays I got called into

[manager�s] office. Now her words, as I remember

them, were I see you�ve had a good holiday and

your head space is now in the right area. Before

you went on holidays we feel that you were

slightly stressed and your head space wasn�t in the

correct area and now we can see that it is. How-

ever, we�d like to keep it that way for you so we�removing you out of the ward� (W7)

Once becoming the recipient of managerial or colle-

gial aggression and hostility, participants found it very

difficult to turn back the clock to the previous friendly

or less hostile state.

Discussion

Few studies have explored in any detail counter-

productive styles of nursing leadership and little has

been written about the nature of avoidant leader

behaviours, their impact upon employees and the po-

tential risks created for the public. Attention in the

nursing literature has largely focused upon the positive

aspects of executive level leadership styles while over-

looking forms of leadership that foster negative out-

comes. As a consequence, little is known about

avoidant nurse leader behaviours or the individual and

organizational factors that might influence leaders to

employ this type of response. This paper drew on two

qualitative studies to generate new knowledge into

various ways avoidant leadership has been enacted in

the current clinical environment.

Contemporary leadership theorizing suggests leader-

ship occurs across a spectrum of styles (Daly et al.

2004), with leaders engaging in various forms of lead-

ership reflecting their self-efficacy (Hannah et al. 2008)

and the situational context. Avoidant leadership has

largely been characterized as laissez-faire or passive

(Bass & Avolio 1994) and considered to be enacted

through ignorance or limited skills. Our findings high-

light additional features of avoidant leadership. On the

surface avoidant leadership may appear to be passive or

of harmless intent. However, our findings reveal it to be

a process that can mask a form of repeated harmful

behaviour that can suppress dissent or avoid bringing

attention to matters of concern. Our findings reveal the

ways in which avoidant nurse leader responses can

erode the ethical character of the workplace and

undermine the perceptions held by nurses as to the

trustworthiness of their employer.

A range of processes for reporting sentinel events and

near misses have been implemented in health-care

organizations. These systems have been modelled upon

those used in aviation and military contexts and are

founded upon the premise that organizations should

learn from errors and failures (Singer et al. 2008). There

are, however, powerful disincentives for reporting

within organizations. The climate or culture within an

organization can greatly influence the success or failure

of safety systems. Factors such as scepticism, lack of

trust and fear of reprisal have been identified to erode

the capacity of staff to report concerns (Barach 2000).

Nurse leaders are central to providing the guidance

necessary to ensure the quality of service delivery and

facilitating safe and productive workplace relationships.

At both the executive and nursing-unit level leadership

plays an important role in fostering trust (Edmondson

2004). Research confirms that trust in unit managers

bolsters the ability of nurses to systematically pursue

changes in their work practices and ensure patient

safety (Vogus & Sutcliffe 2007). Trust-enhancing

D. Jackson et al.


behaviours from leaders include consistency, follow-up,

listening, mutual respect and honesty (Zauderer 2002).

While trust in leaders is a keystone to the success

of organizations learning from untoward incidents,

developing trust can be a complex and problematic

process (Firth-Cozens 2004). When an employee places

trust in their leaders, as did the nurses in our studies by

reporting their concerns about wrongdoing, they make

themselves vulnerable to the subsequent behaviours and

actions of their manager that are beyond their control.

It has been proposed that this acceptance of vulnera-

bility is a characteristic of trust which is based on po-

sitive expectations of the intentions and behaviours of

those in whom the trust has been placed (Rousseau

et al. 1998). The narratives presented here illustrate the

trust and positive expectations nurses held about their

nurse leaders and employing health-care organizations,

and how the breach of trust enacted through avoidant

leader behaviours had serious implications for these

individual nurses. By placing trust in avoidant leaders,

nurses inadvertently placed themselves in a position of

potential further personal risk.

When problems occur, organizations can learn from

them, alternatively they may ignore or cover-up mis-

takes and errors (Singer et al. 2008). The narratives of

our respondents draw attention to the way in which

hostile avoidant leader behaviours may be enacted to

protect organizational interests, or be employed strate-

gically in certain situations to protect the interests of

others within the organization. In these types of in-

stances, by raising concern about perceived wrongdo-

ing, nurses in our study may have been viewed as

engaging in actions that were counter-productive or not

in the best interests of the organization (Johnstone

2004). This type of culture has been attributed to the

unacceptably high rates of errors in the delivery of

health care (Institute of Medicine 2000). Rather than

framing avoidant leadership behaviour as relatively

harmless, we suggest it should instead be viewed as a

serious concern in light of its capacity to erode trust

within organizations and disempower those who raise

concerns.

The climate of health-care organizations, character-

ized by frequent restructures, continual change and an

increasing focus upon fiscal efficiency, may form a

counter-current in which enacting forms of positive

leadership becomes problematic. The logic of modern

managerialism creates a paradox for nurse leaders, one

in which they are accountable to sustain both efficiency

and caring (Jackson & Borbasi 2009). Little is known

about the emotional labour involved in leading in this

context, or how this climate may influence the capacity

to enact various leadership styles. It is feasible that

avoidance may become a survival strategy, employed by

leaders in the face of increasing demands and dimin-

ishing resources, that creates emotional dissonance and

depersonalization (Gardner et al. 2009). Similarly,

informally constituted structures of legitimacy within

organizations may create pressures to engage in or tol-

erate avoidant behaviours that serve to protect organi-

zational interests (Gordon et al. 2009). As a result,

leaders may �fall in line� with prevailing organizational

norms and, over time, they may even begin to ratio-

nalize avoidance, regardless of the consequences, as a

routine or acceptable feature of managing within this

context.

When concerns related to health-care delivery and

patient safety are ignored, the literature suggests that

nurses can experience moral distress because of their

inability to effectively advocate for their patients and

therefore ensure the provision of ethical care (Erlen

2001, McCarthy & Deady 2008, Schluter et al. 2008,

Jackson et al. 2010a,b). Furthermore, nurses have been

described as �the canaries down the mine or the frogs in

the health-care ecosystem who provide the first alerts

and early warning signals that all is not well� (Darby-

shire 2011). Disempowered, nurses may give up raising

concerns, or alternatively leave the organisation or the

profession (Austin et al. 2003).

Limitations

In presenting these findings, we acknowledge that we do

not have the perspectives of the leaders themselves. The

nurse leaders may have offered alternative insights and

have provided understandings of the machinations of

organizations that would inform expectations about

when a change or response might occur. In addition, it

should be pointed out that the data reflected extreme

situations and our informants had experienced signifi-

cant events that may have affected their careers and

lives in an on-going way, and may have influenced the

way that events were recalled (e.g. the interpretation of

responses of the leaders may appear to be defensive).

Conclusion and implications for nursingmanagement

Nurses are urged, and in some locations legally

mandated, to report wrongdoing. Though there may be

an assumption that simply reporting a problem to a

manager will result in positive action, this paper has

revealed that managers may not act responsively,

efficaciously or decisively to effect positive change



following reports. Through secondary analysis of two

existing sets of data, we have been able to shed new

light on avoidant leader behaviours demonstrated in

response to concerns raised by nurses. In seeking to

explore organizational wrongdoing in two contexts,

nurses experiences of raising concerns were made

visible, and in particular their attempts to engender

appropriate responses from their nurse leaders.

It is feasible that lines of communication and

accountability within organizations may themselves

hamper or obfuscate leadership actions and responses.

This may limit communication and delay the timeliness

of responses, creating among followers a perception that

their leader is shying away from, or abstaining from

active leadership. Given the negative effect avoidant

leader responses can have upon the perceptions and be-

liefs of employees we recommend that organizations

ensure that all nurse leaders are aware of how best to

respond to concerns of wrongdoing, to be supported in

doing so, and that mechanisms are created to ensure

timely feedback is provided about the actions taken. The

design of reporting systems should be considered from

the perspective of whether they provide the level of

transparency required to sustain trusting relationships

and the capacity to learn from even difficult experiences

without shaming (Firth-Cozens 2004). Consideration

should also be given to developing systems that incor-

porate leadership accountability as a key to fostering safe

organisational cultures (Sammer et al. 2010).

In highlighting the impacts of avoidant styles of

leadership we seek to broaden the debate on nursing

leadership. While avoidant leadership may seem rela-

tively harmless, it has the potential to seriously under-

mine health-care safety and service provision. Further

work needs to be undertaken to better understand this

leadership style. This is important to ensure that orga-

nizations do not elevate to management positions

individuals who lack the capability to respond appro-

priately and who, instead, respond with avoidance

when concerns and risks are raised. In highlighting the

lack of substantive information on avoidant leadership

we have also raised the need for more robust theorizing

and research on nursing leadership and leadership

practice, as understanding these factors is fundamental

to ensuring a viable nursing leadership for the future.

Acknowledgement

We acknowledge the support of the Faculty of Nursing,Midwifery and Health at the University of Technology,Sydney (UTS), and School of Nursing and Midwifery, Uni-versity of Western Sydney.

Source of funding

Funds for study one were from the School of Nursing &

Midwifery at the University of Western Sydney, and for

study two were from the Australian Research Council.

Ethical approval

Ethical Approval was obtained from the relevant In-

stitute Ethics Committee.

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Documents

Understanding avoidant leadership in health care: findings from a secondary analysis of two qualitative studies