Category: Leadership

Alpha Males, Psychopaths and Greedy Bastards,

Alpha Males, Psychopaths, Greedy Bastards.

In October 2016, during the United States presidential campaign, the Washington Post released a recording of Donald Trump made in 2005. Trump was heard to be making comments about women:

“I moved on her and I failed, I admit it. I did try and f*ck her, she was married…I moved on her like a bitch…you know I’m automatically attracted to beautiful – I just start kissing them…its like a magnet…grab them by the pussy. You can do anything” (BBC 2016).

Nigel Farage told Fox news that the remarks were ‘ugly’ but something “if we are honest that men do… this is alpha male boasting”. (BBC 2016).

The alpha male trope, its behaviours and traits, might be widespread (Ludeman and Erlandson 2006) especially among ‘alpha males’, those in the 1% and the plutocracy. Teller (2017) critiqued a Fox news article which argued that women’s success in the Boardroom are dooming their marriages, because they are “groomed to be leaders rather than wives…they become too much like men…too competitive…too masculine…too alpha”. Teller criticised the piece for its uncritical acceptance of an American trope – the leader as alpha male, which has ‘wormed its way’ deeply into the American subconscious. It is part of the American mythos in which great men accomplish great deeds with little help from anyone else and draws from a rich vein of rugged individualism as expressed by such as Ayn Rand (1957, 1964). It is in line with the ‘Great Man’ theory of leadership in which leaders are born not made, and great leaders will arise when there is great need, “Cometh the Hour, cometh the man”. Thomas Carlyle (1840) was an early exponent of ‘Great Man Theory’ in the 1840s stating: “The history of the world is but the biography of great men”.

In 2004, Ludeman and Erlandson painted a positive picture of Alpha males, arguing that the modern corporation is characterised by their presence, that indeed it would be difficult to think of the corporation without them. They also devised an instrument to develop ‘alpha profiles’, based on 1,507 individuals all of whom worked full time in the business world, 64% were male with an average age of 41 in 106 countries and in various industries. A significant finding was that alpha risks are closely related to alpha strengths, in general the greater the strengths, the greater the risks, see table below (Ludeman and Erlandson 2006).

The stereotype, or trope, exists probably not as result of biologically determined characteristics or superior innate traits. Rather it is probably the case that the ‘innate traits’ of ‘Great Man Theory’ are used as justification for aggressive, competitive, loud, selfish and often sexually dominant male behaviour. This justification harks back to Thomas Carlyle’s description; draws upon quasi pseudo-scientific principles of evolutionary biology’s ‘survival of the fittest’, and the individualistic rhetoric of neoliberal political economy (Goodman 2017) which is based on an erroneous utility maximising rational actor theory, i.e. ‘homo economicus’ (Persky 1995). It also has roots in the ‘objectivist epistemology’ of Ayn Rand (2007a, 2007b) whose 1947 and 1954 novels have gained current popularity among some of the most powerful people in the United States, and those who aspire to be the most powerful in the United Kingdom (Freedland 2017). Rand’s emphasis on, and the neoliberal rhetoric of, ‘freedom’ is a rallying cry used to mask the reality of exploitation (Monbiot 2017).

Not only is it a myth used by the erstwhile ‘masters of the universe’ in the City of London to justify their dominance, it is sexist and misogynist as it is ignorant of socially constructed gender roles; it is unscientific without any grounding in the natural sciences, it is anthropomorphic of animal behaviour, and it is simplistically individualistic as it shifts the explanations for status and power differentials away from issues of social structure onto biological inevitability and individual psychological characteristics. It is uncritically reflexive in its adoption of the ‘liberal human self’ ontology. It does so to avoid discussing, acknowledging and unmasking unequal social relationships based on class, gender or ethnicity.

Alpha male behaviour is a choice exercised by ‘those who can’ based on their privileged backgrounds and attributes, which are often white, male, heteronormative, educated and so called ‘elite’, over ‘those who have not been able to’. The latter have to overcome class, ethnic and gender barriers not faced by their privately educated competitors. The alpha male also ignores or dismisses our capacity for empathy, without which it truly is an alpha dog eat beta dog world. This alpha male ideology and actual behaviour assumes selfishness and self-interest are main driving forces for successful capitalist societies. The inequality it helps to sustain are, in this world view, necessary for success. Alpha males may also share some characteristics attributed to psychopaths.

What are ‘Alpha Males’?

The term comes from studies of animal behaviour (ethology), e.g. in chimps (de Waal 1982) and wolves (Mech 1999). It denotes the animal of the highest rank who achieves this status often through physical prowess. They often get to eat first and mate first, and in some species they are the only one allowed to mate. Sexual conquest is thus an important aspect of alpha behaviour. Animal behaviour, for some, provides models and explanations for human behaviour on the basis that we are evolved animals only differing from, say, primates because of our higher cognitive functions. It is thus tempting to extrapolate from primate behaviour to human behaviour on the basis that behaviour in human social groups are affected by evolutionary, and genetic, processes. We watch animal behaviour and are tempted to anthropomorphise and apply to humans. E.O Wilson’s ‘Sociobiology’ was term akin to ethology in that it was an attempt to explain social behaviour in humans such as altruism, nurturance, aggression,  by appealing to underlying evolutionary mechanisms and thus the theory has more than a whiff of biological determinism about it.

In humans, we label alpha behaviour often as that which is about ‘getting the girl’ due to confidence, charisma and competitiveness. Women are supposed to like this display and ‘swoon’ in the presence of an alpha. Whether this is true in sexual politics I leave to women to decide. However alpha characteristics, if seen as the basis for sexual success, can also be seen to be the basis of success in business and politics.

Ludeman and Erlandson (2004) describe the Alpha as ‘highly intelligent, confident, and successful (who) represent about 70% of all senior executives in the United States’. They are not happy unless they are the ‘top dogs’ – they are supposedly natural leaders, they get stressed when tough decisions don’t rest in their hands; they get a thrill when in charge. Ludeman and Erlandson also identify four breeds of Alpha: commanders, executors, strategists and visionaries. Alphas have ‘unique strengths as well as destructive ‘flip sides’.

Strengths and Weaknesses of Alpha leadership style.

It might be an interesting exercise to compare the traits with descriptions of psychopathy/sociopathy which according to Hirstein (2013) are:

  • Uncaring, Shallow Emotions, Overconfidence, Narrowing of Attention.
  • Irresponsibility, Insincere speech, Selfishness, Inability to plan for the future and Violence.
Alpha Attribute Value to Organisation Risk to Organisation
Self-Confident and Opinionated. Overconfident Acts decisively has good intuition Is closed minded, domineering and intimidating.
Highly Intelligent Sees beyond the obvious, takes creative leaps Dismisses or demeans colleagues who disagree with him. Uncaring
Action orientated Produces results Is impatient, resists process changes that might improve results. Narrowing of attention.
High performance expectations for himself and others. Uncaring Sets and achieves high goals Is constantly dissatisfied, fails to appreciate and motivate others. Uncaring
Direct communication Style.


Moves people to action Generates fear and gossip filled culture of compliance. Uncaring
Highly disciplined. Is extraordinarily productive, finds time and energy for a high level of work and fitness Has unreasonable expectations of self and others, misses signs of burnout
Unemotional. Shallow emotions. Is laser focused and objective. Narrowing of attention Is difficult to connect with, doesn’t inspire teams..

(Ludeman and Erlandson 2004).  Words in italics are from Hirstein’s description of psychopathy.

Juni (2010) suggests 3 major types of psychopathy: Superego deficit, aggression driven and sadism while also acknowledging controversy over definition (Scott 2014). He does suggest that people with psychopathy have ‘pro social’ values who often pragmatically get by through complying with social rules and norms. They are able to manage relationships at an adequate, though superficial level. Interestingly they are able to advance in their careers through their interpersonal skills. In discussing ‘superego deficit’ Juni suggests that due to extreme emotional hurt or deprivation in childhood, ‘superego internalization’ is lacking. This means children fail to develop their own checks on what is acceptable and how they should treat others, and then rely on external repercussions to govern behaviour. They have a basic learned incapacity for interpersonal trust, meaning they never really learn to appreciate others and will essentially be ‘users’ as they exploit relationships for their own good. Others are expendable and exchangeable. Another aspect of this is ‘blunted affect’ in which the child has learned to distance itself from all forms of emotion. Past experiences of emotion were painful they learn to choke off feelings. There is a superficial veneer of emotion but internally they have renounced affect. These might be useful traits to have in leading certain corporations.

What would a Venn diagram look like?

Silvio Berlusconi displayed, or thought he did, alpha traits bringing Italian politics into the bordello by treating Italian voters like paying customers being screwed by the puttana of politics. Trump’s ‘pussy grabbing’ comments similarly betray a sense of unearned entitlement, objectifying women merely as playthings for his own narcissistic amusement. His dismissal of this as ‘locker room banter’ was an insult to many ‘locker rooms’ and in doing so he tried to use a veil of ‘irony’ to cover actual misogyny.

Those that consider themselves as alphas may earn more, compete more or attain higher social status than their beta brothers; they think of themselves perhaps as ‘Heroes, Rogues and Lovers’ (Dabbs 2000). Dabbs used this as a book title and discussed the role of testosterone, a hormone linked with alpha theory, further giving justification within our biology. He also linked it with violent crime and sexual assaults!



Alpha males may conceive of their actions as originating in and being determined by and thus excused by evolution, often implicitly invoking the reptilian brain and the force of genes upon behaviour and traits. Many alphas from the world of politics, business and economics are not steeped in ethology or would be aware of its origins. However an appeal to evolution is nonetheless often present. Thus they have an essentialist understanding of the human. What is missed is that evolution has further acted upon the human brain and we now have the limbic brain and the neocortex which together, it is argued, constructs the ‘Triune Brain’ (MacLean 1990). In other words the reptilian territorial selfish brain has the empathic, communitarian brain and higher cognitive functioning brain to balance any primordial tendencies. Alpha also misses what epigenetics tells us, i.e. that it is the interplay between environment and genes and cultural life that influence behaviour. We are not as genetically predisposed to do anything, as much as we like to think we do. Appeals to some form of biological determinism for behaviour, is just stupid.

A modern exponent of essentialist determinist nonsense in the field of psychology is John Grey. His book ‘Men are from Mars, Women are from Venus’ exaggerates the differences and lends credence to theories based solely on biology. He recently explained the behaviour of ‘alpha males’ as resulting from testosterone. Men, he suggests, are hard wired for violence and polygamy. This relates to the workings of the reptilian brain. However, as already noted we also have the capacity to be ‘soft wired’ to be empathic and communitarian. Susan Gerhardt (2011) argues it is culture and child rearing practices that results on changes in brain function towards or away from empathy, violence and selfishness. This is based on neuro-scientific research, such as that carried out by Baron Cohen (2011). Hard wiring is a misleading term as it suggests a form of determinacy, reducing the possibilities for change.

Research now suggests that we are soft wired with ‘mirror neurons’, which results in our ability to experience another’s plight as if we were experiencing it ourselves (Rifkin 2009), we can then empathise with others. We are not hard wired for aggression, violence, utility maximisation and self-interest but soft wired for sociability, acceptance, affection and companionship. However, we have built up social institutions and economic structures as if the former were true. These selfish structures are going global. These structures are also designed and run by alpha males for alpha males and justified by appeals to human nature and the inevitability of violence, aggression, utility maximisation and self-interest as the engines for creative social development that capitalism has wrought.

Self Interest?


Alpha’s justifications imply an ‘essential’, often selfish human nature.  The idea of an essential human nature has a long track record. However, an essentialist view of human nature, if human nature indeed exists, does not necessarily mean that it includes a drive for naked self-interest and aggressive competition.  The modern confusion can be traced to some Enlightenment philosophers (e.g.  John Stuart Mill 1836,  Adam Smith 1776) and their modern interpreters, overplaying the selfishness and utility maximising aspect of behaviour. Thomas Hobbes in Leviathan placed self-interest on the throne of human motivation. Adam Smith’s utility maximising rational actor merely reflected what was emerging under industrial capitalism rather than what could be in other more empathic civilizations (Rifkin 2009).

Human nature to Alphas, is ‘naturally selfish’. We were naturally rational actors seeking our own self-interest to maximise our utility in the market. This we now know to be nonsense. Economics cannot be seen to work in isolation from society, culture, politics and power. Its mathematical models have proved to be false by the Great Financial crash of 2008 and by everyday experience.

Self-interest has not been seen as the only drive for humanity. Alongside this drive is the ‘Will to Power’ associated with Friedrich Nietzsche, the ‘Pleasure Principle’ associated with EpicurusJeremy Bentham and with Sigmund Freud (Snyder, Lopez and Pedrotti 2007) and the ‘Will to Meaning’ associated with Frankl (1946/2006). Thus the quests for Power, Pleasure and Meaning are alternatives to economic self-interest as drivers for human action. Erich Fromm and Manfred Max Neef have also discussed fundamental human needs which could be thought of as drivers for human action. Self-interest for material gain does not feature anywhere near as prominent in their theories.


Miller (1999) argues that a different view of human agency acknowledges the power of other motives, such as public spiritedness, empathy, commitment, and justice.


Yet given this, somewhat admittedly white, colonialist and patriarchal divergence of views on what motivates us in contemporary societies, it could be argued that hegemonic neoliberal imaginary (Hall 2011) especially in the United States and the United kingdom since the 1970’s, rests on the idea of the rational actor, the ‘free, possessive, individual’, using his economic self-interest for ‘life liberty and the pursuit of happiness’.


One aspect of rational self-interest is that of “principal-agent” theory: agents will perform best under high-powered financial incentives to align their interests with those of the principal (a business school thesis – Layard 2009). For example employees and managers (agents) will work for the same goals of employers and shareholders (principals) and not in their own self interest, if the goals are aligned, e.g. profits are shared. However, Daniel Pink argues that above a certain level of material reward, what motivates us is Mastery, Autonomy and Purpose. Financial rewards start to become hindrances rather than benefits. Not that this insight affects the level of, and justification for, the ‘High Pay’ of many ‘fat cat’ CEOs.


John Stuart Mill (1836) argued:

[Political economy] does not treat the whole of man’s nature as modified by the social state, nor of the whole conduct of man in society. It is concerned with him solely as a being who desires to possess wealth, and who is capable of judging the comparative efficacy of means for obtaining that end.


Similarly, Adam Smith (1776) wrote:

It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.


Smith (1759) however does express in ‘The Theory of Moral Sentiments’ that self interest alone is not the sole motivator, men can act out of regard for others:

“How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortunes of others, and render their happiness necessary to him, though he derives nothing from it, except the pleasure of seeing it. Of this kind is pity or compassion, the emotion we feel for the misery of others, when we either see it, or are made to conceive it in a very lively manner. That we often derive sorrow from the sorrows of others, is a matter of fact too obvious to require any instances to prove it; for this sentiment, like all the other original passions of human nature, is by no means confined to the virtuous or the humane, though they perhaps may feel it with the most exquisite sensibility. The greatest ruffian, the most hardened violator of the laws of society, is not altogether without it” .


This exposition of rational self-interest demonstrates that Smith accepted that what makes us human is not only based on unrestrained self-interest.


Ayn Rand (1943, 1957) in her novels and lectures taught ‘objectivism’ based on a belief that:


man exists for his own sake, that the pursuit of his own happiness is his highest moral purpose, that he must not sacrifice himself to others, nor sacrifice others to himself”.


Rand insisted on the ‘virtue of selfishness’ and the ‘morality of rational self-interest’ which is congruent with the neoliberal creed of individual responsibility. This sounds close to Adam Smith’s rational self-interest of the market, whereas Smith described the invisible hand, Rand moralises it.


Yet Becker (2007) argues that moral leadership is exercised not solely based on rational self-interest, that business decisions are not made only on the economic conditions of the market. The World Business Council for Sustainable Development (WBCSD) is also an example of business principles being enunciated which go beyond the simple search for maximum profit.


However, the theory of self-interest allied to material reward remains strong as a description of ‘natural’ human behaviour. If it is ‘natural’ then human happiness is gained if self-interest is given its head. Self interest as ‘human nature’ can be seen therefore as the major drive which should be harnessed both for prosperity and happiness.



Alphas as Self-Interested Greedy Bastards


Graham Scambler, following on from Margaret Archer’s theory of ‘modes of reflexivity’, argues that we have entered an era where plutocrats and oligarchs (Alphas) have captured the levers of the State to rule as ‘Greedy Bastards’.


He constructed an ideal-typical sub-type of Archer’s ‘autonomous reflexive’ called the focused autonomous reflexive. Those who make up the ruling oligarchy, or the ‘greedy bastards’, are also ‘focused autonomous reflexives’. Scambler argues they have the following characteristics:


“Total commitment:  The focused autonomous reflexive exhibits an overriding engagement with accumulating capital and personal wealth/income. Nothing less will suffice: that is, any deficit in commitment will result in absolute or relative failure.


NIETZSCHIAN Instinct: Born of a Hobbesian notion of the natural human state, they betray a ruthless determination to cut whatever corners are necessary to gain an advantage over rivals. they are the ‘blond beasts’ of ‘noble morality’ whose values are constructed by themselves to serve their own interests.


Fundamentalist ideology: Commitment is not only total and Nietzschian but fundamentalist: it does not admit of compromise. It is an ideology – that is, a standpoint emerging from a coherent set of vested interests – that brooks no alternative.


Cognitive Insurance: While cognitive dissonance is a state to which none of us is immune, they are  able to take out sufficient insurance to draw its sting. Thus accusations of greed and responsibility for others’ suffering are rarely internalized. Such epistemological and ontological security is the exception rather than the rule in this era of financial capitalism.


Tunnel Vision: A concomitant of a total, Nietzschian and fundamentalist commitment is the sidelining of other matters and a reflex and frequently gendered delegation of these to others.


Lifeworld Detachment There is simply no time for the ordinary business of day-to-day decision-making. In this way focused autonomous reflexives rely on and reproduce structures not only of gender but of class, ethnicity, ageing and so on. Their Lifeworld detachment presupposes others’ non-detachment, i.e. other people service the everyday requirements of life”.

Graham Scambler’s typology requires empirical verification and is not meant to describe any one person in totality. Without studying the lives of the 0.01% and their ‘players’ (often to be found in the 1%), this cannot be verified. However, may we see indicators of their world views in their speeches and writings?


Societies have ‘myths’ – stories to explain phenomena and to bind the people together. Self Interest in free markets is an old story, an ‘anti-myth’, as it divides peoples based on negativity, rather than binds. It sorts a people into ‘winners and losers’, ‘top cornflakes‘, ‘skivers or strivers‘ and the ‘left behind‘. It is not based in the actuality of human experience or within philosophy over history, but has been imposed in the West as a guiding ideology especially since the Reagan-Thatcher Duopoly. The Autonomous Reflexives both in the political class and the corporate class of the 0.01%, have imposed: “there is no alternative” and ridden roughshod over other values and stories. Facts, evidence and reason have not worked against their neoliberalism to date. However we may be witnessing the challenge of Authoritarian Populism, which will either destroy or appropriate neoliberalism, as a new ‘anti-myth’. What we need now is a new story, to bridge this ‘myth gap’ (Evans 2017).


A poor ‘quality of mind’ 

Alpha males lack a sociological imagination, a quality of mind that links biography and history and the relationship between the two in society. They are unable to link their personal stories to the structures of society at the time they live in. For them, continuing unemployment is simply a personal failure not a result of changing labour market structures; obesity is a personal and moral weakness unrelated to increasing fossil fuel dependence (car use) and the availability of cheap calorie rich foods and our ‘lock in’ to high carbon systems; the lack of female representation at the top is down to female unsuitability to leadership in market employment conditions rather than market conditions being designed by alpha males for alpha males; black people are poor because they lack a work ethic not because of institutional and cultural racism; countries are underdeveloped because they lack a capitalist ethic rather than as a result of past and current imperialism.

They seek always to blame the individual, emphasise personal responsibility and ignore power relationships and structures, which are rigged in one’s favour. Once one accepts the notion that success may be down to a combination of luck, individual effort and abilities, privileges and certain socio-economic conditions, then it becomes untenable to justify huge disparities in reward as being solely based on one’s work ethic and abilities. Empathy is a luxury for the weak in this context, for to empathise would mean examining the real reasons for success and failure in one’s ‘peers’ and the need to gain an understanding of the hopes and ambitions and the barriers to fulfilling such in an unjust world.



Alpha males behave in that way because we let them do so and because they have the power to do so. It is often a self-justificatory myth for boorishness and exploitation of the weak members of society. It has no scientific basis. It is theoretically vacuous, empirically wrong and philosophically infantile. We are not ruled by our hormones, our genes or our reptilian brains. However, alpha males have big sticks and they make the rules, but they can be forced to put the sticks down.  We can refashion society in a way that reflects more communitarian ethics and behaviour when we first counter their propaganda based on a singular value ‘freedom’. Freedom is a word that powerful people use to shut down thought (Monbiot 2017). What they mean of course is freedom to do what they please, what they count , free from red tape, regulations of market stultifying laws.

Freedom from: Trade Unions; paying Tax; environmental protection legislation.

Freedom to: design sophisticated financial products that crashed the system in 2008; to buy and develop property that only plutocrats can own; lobby and receive from the state for a hand out on land they own; to ignore and bypass democracy….

Do Alphas exist?

Now it may be that the alpha male is a straw man, that in reality powerful men do not exhibit traits of dog eat dog über competitive, devil take the hindmost, who dares wins mentality. Step forward Donald Trump, Steve Bannon, Rex Tillerson, Alan Greenspan, Senator Rand Paul, Uber’s Travis Kalenick, Facebook’s Peter Thiel, Boris ‘Top Cornflake’ Johnson, Sajid Javid MP,  Alan Sugar… Kim Jong Un, Putin, Assad, Modi, Orban, Erdogan, Duterte….

Do alphas exist in real life? If an alpha is a highly rewarded individual, at the top of the social stratum and who justifies that position by reference to their own individual endeavour then we may suggest that the erstwhile masters of the universe may qualify as alphas.  Toynbee and Walker (2008) interviewed City ‘High Fliers’ in an attempt to understand their justifications for their salaries and bonuses. Their responses certainly indicate their attitudes as alphas, they objectively are high status and they control the reward structure. No doubt their access to females is unlimited. Competition and charisma would be prized characteristics among this group. It was clear from their responses that they saw that their success was down to them and their individual effort. Initially the reasons given for success was globalisation (a structural reason) but as Toynbee and Walker continued it became clear that personal moral reasons were the basis for success. They thought of themselves as ‘better’: “we work harder and aspire the most”, fairness is not a valid question, “it’s a fact of modern life that there is a disparity…people say its unfair when they don’t do anything to change their circumstances”, “people don’t want to achieve”, “you won’t find a teacher who works as hard as we do” (p27).

Empathy at the socio-political or corporate level is hard to find. Aspects of neoliberal capitalism and globalisation is pitting all against all as nations try to out compete each other in a race to the bottom in terms of wage reductions, pension reductions, flexible working (i.e. rotational unemployment) and extensions of working lives. Somehow we have accepted that working longer for less in a less certain world is a good thing because not to do so risks losing jobs to India and China (Jones 2011). The structures of globalisation are such that competition not cooperation rules social lives. We are now working for the economy rather than for the community. It is not the alpha males in Greece who have to bend the knee to austerity, they still have their yachts and villas. The existence of the odd rich alpha victim to globalised capitalism only serves to show that the system they operate takes no prisoners. Many of those who go down keep the riches they earned when in power.

The lack of an empathic civilisation and the rule by global elites is not natural or inevitable but we somehow believe it to be so. Meanwhile the alpha looks on, secure on his yacht or in his gated community in ‘Richistan’ (Frank 2007), laughing at the poor people while justifying his ‘right’ by ‘might’.

Because he can.     Because he’s ‘worth it’.



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Nursing and the NHS – wtf is going on?

I cannot take credit for this, it is Roy Lilley, and although I was about to write about it,  I thought, nah, Roy has done it better: 


Talk to the DH and they will tell you there are more nurses than there are daffodils smiling in the spring sunshine.


An extra 2,400 hospital nurses have been hired since Francis and over 3,300 more nurses working on wards since May 2010.  The bit that is missing is; ‘more’ doesn’t mean ‘enough’ and enough doesn’t mean enough of the ‘right sort’.


The RCN says; The NHS has lost nearly 4,000 senior nursing posts since 2010.  The ‘missing’ nurses include ward sisters, community matrons and specialist nurses.  They’ve gone because they cost more; drop them and you save loadsamoney… quicker.


According to the latest data, November 2013; the NHS was short of 1,199 full time equivalent registered nurses compared with April 2010.  The RCN says; ‘… hidden within wider nursing workforce cuts is a significant loss and devaluation of skills and experience’… just under 4,000 FTE nursing staff working in senior positions.  Band 7 and 8 have been disproportionately targeted for workforce cuts.  It looks like nursing is being de-skilled. (Must look graph).


If the evidence of my in-box is to be believed nursing is not just being de-skilled, it is being denuded.  Time and time again I hear stories of nurse patient ratios of 9,10,11,12,even 18 and often quickly beefed up for the benefit of the CQC.


“Let each person tell the truth from their own experience.”  Florence Nightingale.


Funnily enough, I am writing this on a plane where the cabin-crew to passenger ratio is a matter of law.  I see no reason why the nurse to patient ratio shouldn’t be a matter of law.


The Chief Nurse doesn’t agree.  She’s faffing-about with her half-dozen C’s and ignores the risk that one nurse looking after a dozen or more vulnerable patients is a risk to the Six C’s.  She speaks, unthinking, with her master’s voice…  I hope she’s ready to explain the inevitable.. the next Mid-Staffs.


“The very first requirement in a hospital is that it should do the sick no harm.”  Flo Nightingale again.


There’s a wilful blindness to what’s going on; on the wards and at the ‘high-end’ of nursing; nurse specialists.  If the RCN is right (and this H&SCIC FoI confirms) it is a madness that their numbers are reducing.


Nurse Clinical Specialists are highly skilled and there is overwhelming evidence that better skilled nurses are better for patients, and reduce admissions, re-admissions and waiting times, free-up consultant’s, improve access to care, educate and share knowledge with other health and social care professionals and support patients in the community.


“Were there none who were discontented with what they have, the world would never reach anything better.”   

Fabulous Flo again.


Yup, I’m discontent Flo!  There are only 2 types of post-reg’ training programmes; Specialist Community Public Health Nurses and a Specialist Practice Qualification and for all practical purposes, degree entry-level.  We know they work (chronic heart failure for example and in Stoma nursing) so the default position should be; all patients, with long term conditions, should have access to a specialist nurse… but here we go again… there are not enough of them.


A new, free web-resource for Specialist Nurses caught my eye; help with job plans, annual reports and service summaries and I particularly liked the ‘Speaking up for my Service’ section.  I hope they and their managers do. 


“How little can be done under the spirit of fear.” More Flo truth-to-power-talk.


Nursing is the Swiss Army knife of the NHS; versatile, multi-purpose, portable, one-stop.  Nurses build, work and fix services, flex them and extend their reach and cover.  But, we patronise them and squabble over their numbers. 


“Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done?” Yes, Flo again… in full flow!


It looks to me very like nursing is in a muddle, confused, a jumble.  No one seems to have a clue what is ‘the right thing’, the right numbers or the right training.  Nursing, the biggest group in the NHS workforce, lacks direction… leadership.  Buried in directorates, managed by administrators shoved around by everyone’s agenda.   A Chief Nursing Officer (Carbuncle) and a Director of Nursing (DH), all chiefs but what about the Indians.


Events, technology, finance, balance sheets, bed-sheets, need and resources pull nursing in different directions.  The profession needs to stop, catch its breath and think about its voice, role and purpose.

I wonder what Flo would say? 

Liderazgo y Gestion en Enfermeria – Leadership and Management in Nursing

Liderazgo y Gestion en Enfermeria – Leadership and Management in Nursing

leadership for the future

This paper is for spanish nurses on a leadership course but has general application:

“Considerable evidence suggests that neocolonialism, in the form of economic globalization as it has evolved since the 1980s, contributes significantly to the poverty and immense global burden of disease experienced by peoples of the developing world, as well as to escalating environmental degradation of alarming proportions. Nursing’s fundamental responsibilities to promote health, prevent disease, and alleviate suffering call for the expression of caring for humanity and environment through political activism at local, national, and international levels to bring about reforms of the current global economic order”. (Falk-Rafael 2006)


The theories and issues so far covered in this module are focused on the individual (micro) and organisational (meso) level of analysis. Nurses are asked to examine their personal resources and the culture of the clinical setting and the hospital environment in which they work. The immediate focus is on patient outcomes: their safety, their recovery, their dignity and their comfort. Many of the policy drivers for critical care rightly ask us all to consider the patient’s journey, to see the issues from their perspectives as well as from our own.


You have been invited to consider whether transformational leadership is a style fit for clinical practice, you have been invited to consider how interpersonal and interprofessional relationships affect your work, you have been invited to consider how we add value in a public sector organisation, you have been invited to consider applying CQI as a process in your work.  


But you have not been invited to take the next step: The macro analysis.


A macro analysis asks you to see beyond the individual, the clinical unit and the hospital. It asks you to consider wider socio-political issues that impinge on public health and well being. Critical care rightly focuses on the seriously ill individual and the skills and competencies developed for nurses reflect that. However, Nursing is an ethical endeavour, your exercise of leadership reflects your ethical positions. The decisions you don’t take may be as important as the decisions you do.  The world view you ascribe to helps to create the world you live in. You have an opportunity for just a moment to raise your eyes above the bedside and think about your vision for the future.


A good deal of discussion in leadership theory is about vision, that leadership is a role, it is a process and can be exercised by anyone.  Being a ‘leader’ is a post holder (chosen, elected , appointed), but a formal post may or may not exercise leadership. So I wish to ask, what are you leading for, for you are all potential leaders regardless of the formal title or post you hold. What is your vision? What are your ethics? What do you care about?


Sarah Parkin (2010) argues that much of leadership education does not clearly see the impending crises of unsustainable economic, business and political practice, has failed to see the wider picture and has failed to ask what is leadership for?


We know we live in a messy world (Peccie 1982, Morrall 2009). The financial crisis that started in 2008 continues prompting the indignados movement.  Spain has a 46.2% under 25 unemployment rate where young educated people argue:


“juventud sin futero, sin casa, sin curro, sin pension, sin meido.” (The Economist 2011).


We know that economic inequality has direct health effects (Marmot 2010, Wilkinson and Pickett 2009). We know what the under 5 mortality rate in many countries is still far above the stated target of the Millennium Development Goals (MDG 4). The WHO (2008) supports the ‘social determinants of health’ approach which links social, political and environment issues with human health. Climate change is the biggest threat to public health and security in this century (Costello et al 2009, BMA 2008, 2011, Goodman and Richardson 2009, Goodman 2011).


These issues, Parkin argues, require leadership as “positive deviancy”. A positive deviant is:


“a person who does the right thing for sustainability, despite being surrounded by the wrong institutional structures, the wrong processes and stubbornly uncooperative people” (2010 p1).


There is an urgent need for healthcare professionals to address the sustainability of current politics, economics and social practices (Goodman 2011). The exact nature of that response is down to individuals. However, without some macro analysis we are in danger of leading ourselves into the dark. This then leads us to ask about out ethical responsibilities on a globalised world.


Nurses’ ethical responsibility in a globalised world?


Globalization results in large capital flows, labour movement and displacement and the increasing dominance of TransNational Corporations (TNCs) on economic, social and political life. The demise of state power for the public good and its alignment with finance capital (Harvey 2010, Crouch 2011) – results in its increasing withdrawal from public services in many European countries. The TNCs and ‘the markets’ are two voices guiding politics. The current Eurozone crisis illustrates how politicians have to create polices that the international financial institutions feel are acceptable to them.  Collier (2008) suggests that we have a bottom billion stuck in poverty, and the WHO acknowledges wide health inequalities. Even for the Rich, threats to survival are not domestic but global. Perspectives are changing from local to global, the ethics of healthcare thus need to be discussed in this context. The WHO’s Millennium Development Goals also set a global policy framework. There is thusa need for another voice to defend global public goods such as health.


Ethical practice (source Austin 2008):


Paul Ricoeur (1992) suggested that ethics are about “aiming at the good life”, and so if this is the case we ought to consider the good for all. If everyone has a right to the opportunity for a good life, what should the Nursing response be? 


Consider the codes of Ethics that govern nursing practice. Where are they and what do they say?


Professional ethics:  International Council of Nurses. Code of Ethics for Nurses.


Acting Ethically as a nurse in a global community requires a need for transformative thinking and leadership as positive deviance. 



My frame of reference is that healthy lives depend on a healthy socio-economic and physical environment as outlined in the Social Determinants of Health approach (WHO 2008) which has as its outer layer in the model ‘general socioeconomic, cultural and environmental factors’, i.e. social and environmental structures. Thus, I largely agree with Peter Morrall (2009) who argues that patterns of illness and disease are largely determined by issues of social structure and increasingly physical environments. Social structures protect some while damning others to misery and poverty as evidenced in the inequalities in health literature. The affluent even in poor countries and difficult environmental conditions live in ‘safe’ enclaves where they can ensure clean water and a ready supply of food, even in famine stricken countries, money buys food. However, even the affluent will be affected by global changes in certain key environmental limits.


The key power relationships operating at present is the hegemonic stranglehold of advanced consumer capitalism in which the richest 2% own 50% of the world’s wealth (Davies et al 2006). Many do not understand or recognise the notions of limits, while others put undue faith on the resourcefulness of humanity to solve the problems but to do so within the frame of reference of ‘business as usual’ unaware that their selves are interconnected and interdependent within a much wider framework of meaning.


Thus there is a need to transform thinking. Currently leadership is the problem not the solution because we are not asking what we are leading for.


To encourage and transform leadership there is a need to engage in provocative pedagogy whereby we engage in intellectual critique through being challenged with provocative positions. We need a sociological imagination to connect personal troubles with public issues, to fully understand their personal biographies as related to wider social forces at this point in history.


Medical and nursing disciplines cannot be immune from this process. It is not enough to learn how the body works and what to do when it goes wrong. This is navel gazing of the worse kind. Many doctors and nurses have for a long time been pioneers for social action, acting on behalf of the poor, weak and vulnerable. That is their ethic. That has been their historic mission, the problems of this messy little world may not mean a hill of beans to many but without a reawakening of consciousness and a reconnection of self to others, which includes the biosphere, the future looks grim. Peter Morrall (2009) has argued that we as health professionals and/or academics have an ethical responsibility to take individual, collegiate, and organisational action with regard to the social ills which affect human health and happiness.


However, taking a stand is hard. Ethics is hard.Ethics requires thinking. We may be the only sentient being on the planet who can think and reflect on our existence and the search for ‘truth’  It may be that we have a special responsibility to think about our decisions and why we make them. Damon Horowitz has recently argued (2011):


Not only can we think,we must.Hannah Arendt said,“The sad truthis that most evil done in this worldis not done by peoplewho choose to be evil.It arises from not thinking.”That’s what she called the “banality of evil.”And the response to thatis that we demand the exercise of thinkingfrom every sane person


But this may lead to ‘Moral distress’ and Moral responsibility – by understanding the disparities in health if we have responsibility what does that mean? We may provoke moral distress, but then what?



Austin, W. Chapter 3 in Tschudin, V. and Davis, A. (eds) (2008) The Globalisation of Nursing. Radcliffe. Oxford.


British Medical Association (2008). ‘Health professionals taking action on climate change’,


British medical Association (2011). The health and security perspectives of climate change. October 17th


Collier, P. (2008) The Bottom Billion, OUP. Oxford


Costello, A. et al  (2009). Managing the effects of Climate change. Available online at


Crouch, C. (2011) The strange non death of neoliberalism. Polity Press


Davies, J.,  Sandstrom, S., Shorrocks, A., and Wolff, E. (2006) The world distribution of household wealth. December. UNU-WIDER


Economist, The. (2011). Left behind. September 10th.


Falk-Rafael, A. (2006) Globalization and Global Health: Toward Nursing Praxis in the Global Community. Advances in Nursing Science: January/March 2006  29 (1) p 2-14


Goodman B., Richardson J. Climate Change, Sustainability and Health in United Kingdom Higher Education: The Challenges for Nursing in: Jones P., Selby D., Sterling S (2009). Sustainability Education: Perspectives and Practice Across Higher Education. London, Earthscan.


Goodman, B. (2011). The need for a sustainability curriculum in nurse education. Nurse Education Today [online] 14th January 2011


Harvey, D. (2010) The enigma of capital and the crises of capitalism.


Horowitz, D. (2011) Calls for a moral operating system.



Marmot, M. (2010) .Fair society, Healthy Lives. The Marmot Review. Strategic review of health inequalities in England post 2010.


Morrall P (2009a). Sociology and Health. London: Routledge.


Parkin, S. (2010). The Positive deviant. Sustainability leadership in a perverse world. Earthscan . London.


Peccie, A. (1982). One Hundred Pages for the Future: Reflections of the President of the  Club of Rome. Futura books.


Ricoeur, P. (1992) in Austin (2008) op cit.


Tschudin, V. and Davis, A. (eds) (2008) The Globalisation of Nursing. Radcliffe. Oxford.


Wilkinson R and Pickett K (2009).  The Spirit level. Why equality is better for everyone. Penguin. London.


World Health Organisation (2008). Closing the gap in a generation. Health equity through action on the social determinants of health.  WHO.

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