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Peer-to-peer shadowing as a technique for the development of nurse middle managers clinical leadership: An explorative study

Pieterbas Lalleman (School of Nursing, University of Applied Sciences Utrecht, Utrecht, The Netherlands)
Joanne Bouma (Zorg algemeen, Nij Smellinge Hospital, Drachten, The Netherlands)
Gerhard Smid (Open University of the Netherlands, Heerlen, The Netherlands and Sioo, Interuniversity Centre for Organization Studies and Change Management, Utrecht, The Netherlands)
Jananee Rasiah (Faculty of Nursing, University of Alberta, Edmonton, Canada)
Marieke Schuurmans (School of Nursing, University of Applied Sciences Utrecht, Utrecht, The Netherlands and Utrecht University, Utrecht, The Netherlands)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 12 October 2017

Issue publication date: 19 October 2017




The purpose of this study was to explore the experiences and impact of peer-to-peer shadowing as a technique to develop nurse middle managers’ clinical leadership practices.


A qualitative descriptive study was conducted to gain insight into the experiences of nurse middle managers using semi-structured interviews. Data were analysed into codes using constant comparison and similar codes were grouped under sub-themes and then into four broader themes.


Peer-to-peer shadowing facilitates collective reflection-in-action and enhances an “investigate stance” while acting. Nurse middle managers begin to curb the caring disposition that unreflectively urges them to act, to answer the call for help in the here and now, focus on ad hoc “doings”, and make quick judgements. Seeing a shadowee act produces, via a process of social comparison, a behavioural repertoire of postponing reactions and refraining from judging. Balancing the act of stepping in and doing something or just observing as well as giving or withholding feedback are important practices that are difficult to develop.


Peer-to-peer shadowing facilitates curbing the caring disposition, which is essential for clinical leadership development through unlocking a behavioural repertoire that is not easy to reveal because it is, unreflectively, closely knit to the professional background of the nurse managers. Unlike most leadership development programmes, that are quite introspective and detached from context, peer-to-peer shadowing does have the potential to promote collective learning while acting, which is an important process.



The authors thank the nurse managers who participated in this study and their organizations. The study is part of a PhD study. The authors gratefully acknowledge the financial support provided by The Dutch Department of Education, Culture and Science managed by the Foundation Innovation Alliance (SIA-RAAK-International, 2010-2-005 INT).


Lalleman, P., Bouma, J., Smid, G., Rasiah, J. and Schuurmans, M. (2017), "Peer-to-peer shadowing as a technique for the development of nurse middle managers clinical leadership: An explorative study", Leadership in Health Services, Vol. 30 No. 4, pp. 475-490.



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