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Core competencies and challenges among nurses transitioning into positions of leadership – a Caribbean perspective

Oscar Noel Ocho (School of Nursing, The University of the West Indies at St Augustine, Saint Augustine, Trinidad and Tobago)
Erica Wheeler (Pan American Health Organization Trinidad and Tobago, Port of Spain, Trinidad and Tobago)
Janet Rigby (Nova Scotia Health Authority, Centre for Clinical Research, Halifax, Canada)
Gail Tomblin Murphy (Director WHO/PAHO Collaborating Centre, Dalhousie University, Nova Scotia Health Authority, Centre for Clinical Research, Halifax, Canada)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 4 August 2021

Issue publication date: 31 August 2021




Nurses are a significant part of the professional workforce, but leaders may be promoted without the requisite competencies. This study aims to explore the perspectives of nurse managers about the core competencies necessary for promotion as leaders in health.


This was a mixed-methods study that targeted nurses (N = 126) who were promoted in four Caribbean countries over the past five years. A 30-item questionnaire was used for quantitative data collection and analyzed using SPSS version 25. Interviews yielded the qualitative data, which were analyzed using open coding and thematic analysis. Ethical approvals were received from ethics committees at the university and country level.


Most participants were female (n = 112), had 15 or more years’ experience (n = 71) and an associate degree/diploma in nursing (n = 62). Leadership was the most important competency required of nurse leaders in spite of their position within the organization, followed by team building and motivation. Challenges to the transitioning into leadership positions included the prevailing culture and a lack of a systematic approach to building capacity in leadership. There was also between-group statistical significance, as determined by one-way ANOVA for delegation, motivation and leadership as core competencies based on occupations roles.

Research limitations/implications

Notwithstanding the importance of the findings from this research, there were some limitations. While the researchers considered implementing this study in eight Caribbean countries, approvals were received for only four countries. This will affect the ability to generalize the findings to the wider Caribbean countries. One of the strengths of this research was the use of mixed methods for data collection. However, the qualitative component of the findings may be limited by the number of focus groups conducted, notwithstanding the richness of the data collected.

Practical implications

The findings can be used as a framework from which the health system in developing countries can begin to examine practical solutions to developing 21st century leadership competencies in nursing. While there may be remanence of the colonial past in the way systems function, the complexity of health systems requires leadership that is rooted in competence that is multidimensional.


This paper provides an important contribution to the literature on leadership and competencies from the perspective of low- to middle-income resource settings. The qualitative component of the research added richness to the nuances and understanding of the phenomenon of competencies for nurse leaders.



Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University of the West Indies, St Augustine, Trinidad and Tobago (August 29, 2017/CEC 271/08/17).

Conflict of interest: No potential conflict of interest was reported by the authors.

Informed consent: Informed consent was obtained from all individual participants included in the study.

Consent to publish: Not applicable.

Source of funding: This research project was funded through a US$30,000.00(TT) School of Graduate Studies and Research grant – CRP.3.MAR17.36. The funds were used to pay the salary for a research assistant.


Ocho, O.N., Wheeler, E., Rigby, J. and Tomblin Murphy, G. (2021), "Core competencies and challenges among nurses transitioning into positions of leadership – a Caribbean perspective", Leadership in Health Services, Vol. 34 No. 3, pp. 333-347.



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