L e a d e r s
hip The RNs expressed their leadership role as supervising the HCAs for medical issues as these perform most of the assessment of patients’ needs, nursing actions and evaluations on a daily basis. Mutual trust was there- fore necessary, as the HCAs consti- tuted the eyes, ears, nose and hands of the RNs. RN: ‘It seems the HCAs have really good observation by sight: so there is a lot of trusting the staff.’ The RNs described that they worked in a context of medical and nursing responsibility but without the formal tools to execute this fully, as they were not formal managers of the HCAs. RN: ‘It seems that the people in charge can’t recruit enough staff. We are not responsible for recruitment. It is at another level.’ The interviewed RNs’ leadership was described as executing various strategies such as formal and infor- mal meetings, written instructions, evaluation of signature sheets, and through an extensive education pro- gramme. This requires developed strategies of communication between the RNs and other people involved in the patient’s care. The overall main tools for communica- tion were cell phones and written instructions. Personal meetings with HCAs were also considered valuable for the exchange of information. RN: ‘They can call on the telephone, or they can knock at my door, or every morn- ing we meet in our home care groups. And they know that they shall inform about it [changes in foot status].’