As a final year student midwife embarking on my leadership module, I must confess I thought to myself…. “Why do I need to learn about leadership, I am only a student, I am not a leader.” When I thought of leaders, I summoned imagery of powerful, authoritarian, senior ranking management, not little old me!

I came to learn, however, that over recent years, effective leadership has become seen as a healthcare priority with evidence of multiple personnel and organisational benefits, and improved health outcomes. Conversely, poor leadership has been consistently documented as a major contributing factor to avoidable maternal and neonatal harm and deaths, as evidenced within the Francis (2013), Ockenden (2022), and Kirkup (2022) reports. Considering the magnitude of the potential of (both good and bad) healthcare leadership, I reflected upon my own leadership development and pondered… “Am I, or could I become a leader, and bring about positive changes that improve healthcare quality and safety?”

I considered an episode of care I provided whilst a third-year student midwife, to a mother who was separated from her baby, due to their admission to the Neonatal Unit with birth complications, whereby I initiated the discussion of colostrum harvesting and bonding hearts with the new mother. “What is wrong with that?” I hear you say. Well notably, this was against the repeated advice and wishes of my practice supervisor, who believed raising these issues so soon after birth would only serve to upset the mother further. I became curious to know… “Why did I take that course of action and did I do the right thing?”

Research states that whilst healthcare professionals are often intrinsically aligned with ethical, value-based behaviour, authentic leadership is achieved through affiliation with one’s own core values. I subsequently undertook Brene Brown’s well known values exploration activities, allowing me to recognise my values as “kind” and “courageous”; something I had not taken time to really appreciate before. John Amaechi’s powerful book “The Promises of the Giants” offers another profound self-awareness challenge, encouraging me to, as he states, ‘recognise my soul in the dark’. He argues that critical, yet compassionate self-awareness and reflection aid meaningful self-improvement. Such deep reflection allowed me to identify that I often feel stressed, am motivated by completing tasks to high standards, tend to want people to like me, and (unfortunately!) rarely respond well to feedback. But, because of my new awareness, I can now implement action to address these, thereby proving Amaechi’s point that self-reflection can lead to improvement. Although Brown and Amaechi promote self-reflection, limitations of such self-awareness activities can be argued to exist. As humans, we may provide perceived socially acceptable answers, or our responses may differ as we become hypercritical or perhaps more self-compassionate depending on the circumstances and situation. Crucially, the perception of ourselves may not match that of others. After all, leading is about how others feel in our presence, so this is important to note. Consequently, the results or answers we discover from such tools may be vague, inaccurate, and conflicting, for example, acting with courage may result in interpersonal hostility and adverse feedback from those we seek to lead. Therefore, perhaps such tools are best interpreted with caution.

In this episode of care I described above, I felt conflicted and initially abided to the instructions from my supervisor to not raise the discussion, which has provoked deeper reflection on my perception of rank and power. As a student, I considered myself of lower hierarchical rank, with less experience and knowledge than my supervisor. I was reluctant to appear disrespectful or to damage our professional relationship; factors I now recognise as consistent with healthcare professionals failing to voice their opinions, which is common in our NHS; a place with entrenched hierarchical structures and, with that, an embedded fear of retribution. However, empowered by my clinical knowledge, and leaning into my values of kindness and courage, I felt justified and motivated to speak up. Indeed, the information and advice I provided was gratefully received by the mother, who explained it gave her a practical and tangible focus which would positively impact her baby and their early bonding despite their separation.

At the time, I felt uncomfortable for disobeying my supervisors wishes, but on reflection, I realise that my actions simply demonstrated my values and emerging leadership qualities. Furthermore, by attending, understanding, empathising, and helping, I demonstrated the four pillars of compassionate leadership, which I have since learned has a profound evidence base within healthcare.

I now recognise that although historically, rank, seniority, and power constituted leadership, contemporary theory recognises that leadership does not always directly correlate with seniority and that leaders can occupy all roles. In turn, it is clear to me that development should be encouraged and nurtured by those in traditional leadership spaces. In other words, true leaders support others, including students to lead.

However, I recognise as a soon-to-be newly qualified midwife, I am starting my leadership development journey, with limited experience to draw upon. The 70:20:10 framework suggests that 70% of learning happens through work-based experiences, rather than the taught theory or self-development time I’ve been fortunate to have to date. But I look forward to the reflections my future experiences will offer.

For now, I will close by encouraging all students to take time to reflect deeply on who they are and what they value; this is the starting point of leadership, and yes, even little old you, can lead.

Author

Vanessa Jagger

Vanessa is a mature student midwife studying at Sheffield Hallam University, with the support of a wonderful husband and 2 beautiful children. Becoming a midwife is a lifetime ambition finally realised.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.