Malawi’s Director of Nursing & Midwifery Vision for Nursing Leadership

By June 20, 2019Uncategorized

Tulipoka Soko outlines leadership principles to help nurses improve child health delivery services

Leadership in nursing requires changes that can be challenging for us as nurses to make. While we have  to acknowledge the challenges, we must initiate these changes to fulfill our roles as key healthcare providers. We need these changes. Our patients need these changes. So what do we need to do? 

The Mary K Center for Global Nursing Development has asked Tulipoka Soko, Malawi’s Director of Nursing and Midwifery Services, Ministry of Health and Population to share her vision for leadership as it pertains to her expertise in child health delivery services. She recently presented this information at a conference on Building Children’s Nursing for Africa 2019, held in Cape Town, South Africa.   The conference was sponsored by the Department of  Pediatrics and Child Health at the University of Cape Town, with over 120 delegates from 13 countries in attendance.

The principles she described transfer across nursing disciplines, so we can all benefit from her insights. Here are the highlights from Soko’s presentation.

Weak Leadership = Weak Outcomes

Within the discipline of child health delivery services, nurses typically have not been mentored by senior nurses, who could be their role models.   In addition, nurses are not offered in-service educational opportunities on leadership.  Both trends show that there has not been a vision for nurses and midwives as leaders, giving a general impression of disrespect for the profession as a whole.

Most likely this disrespect is the result of a lack of appreciation for nurses’ responsibilities.  To put it simply, other healthcare providers in different roles see their jobs as more important. This attitude prevents coordination and collaboration for best possible outcomes during service delivery, and everyone loses. The dynamic also fosters a lack of confidence in some nurses to articulate clearly their ideas, so that the best ideas are presented at appropriate times for the patient’s benefit.   

The problem with this cycle is that the ineffectiveness of nursing leadership becomes the biggest barrier to making timely and sustained improvements in policy, education and practice.  Ironically, policy makers, regulators, educators and practitioners cite ineffective nursing leadership for child health delivery services as the #1 barrier to improvements in all these areas.  It is a vicious circle that we as nurses need to take hold of and start making changes.  We can’t expect others to do for us what we need to do for ourselves.    

What Does It Mean to be a Good Nursing Leader?

Margaret Wheatley, leadership expert, defines leadership beautifully and succinctly saying, it is  “Anyone who sees an issue or opportunity and chooses to do something about it (2009).” Applying this to nurses and midwives, a good leader leads and inspires others to work together in pursuit of a common vision and goal – quality patient care. 

Leading our community in quality patient care is accomplished only by developing the skills required for true leadership.  The first step is for nurses to see ourselves as leaders, care givers and educators.  With that as a basis, our skill set has to include the following behaviors:

  • Speak with wisdom and authority
  • Develop excellent oral and written communication skills to ensure the staff understands expectations.
  • Resolve conflicts towards a common goal.
  • Set the pace for childcare nurses to gain more respect and to be the best they can be for their patients. 

The leadership model has to be exhibited and extended so that all members of the healthcare team can work optimally for best patient outcomes.   The World Health Organization (WHO) states that most countries are struggling to educate and train enough health professionals.   

Malawi and other countries in the region face a high disease burden, coupled with a shortage of health workers.  Working together in teams, then, is the smartest way forward.  Essential team members in children’s wards include:  pediatricians, medical doctors, clinical officers, physiotherapists, pharmacists, laboratory technicians, social workers and support staff. 

How Does a Team of Leaders Function?

In general, every member of a team of leaders has to display certain behaviors:

  • Show familiarity with and assign value to each other’s role and scope of practice.
  • Share actively the needed information for decision-making.
  • Develop a shared vision and goals.
  • Be honest with each other.
  • Demonstrate that there is mutual trust, respect and value of the input from the other team members.

To be more specific, nurses and midwives in the child health delivery can increase their leadership by:

  • Conducting nurse-led rounds, allowing nurses to take on more responsibility, information and authority with other practitioners.  These rounds include presentations regarding patient care provision.
  • Formulating ward policies, protocols and guidelines to support patient care.  In one instance, a nurse took the initiative to write a proposal to a company to seek support of providing nutritious food like porridge to the children in the ward.  This is leadership.
  • Becoming a role model, leading by example.
  • Working proactively and making strategic decisions.
  • Seeing ourselves as a change agent, remaining assertive.
  • Focusing on results-oriented progress.

We all know the challenges we face, from a micro and a macro perspective.  For example, funding is not adequate to buy enough drugs, materials and supplies in the wards.  The disease burden mounts higher, making our wards congested.  But these challenges will not go away by becoming weaker leaders.  Instead, we need to gear up to become stronger leaders to make changes at every level. 

What Can We Do Next?

It is not nurses alone who suffer when they exhibit weak leadership:  everyone does.   We don’t need to tolerate a lower level of leadership among nurses any more.  Instead, we can reinforce the value of effective leading to fulfill key goals, such as:

  • Connecting all professionals to work towards innovation and professional growth
  • Increasing access to care for all
  • Providing for efficient use of resources
  • Improving nursing education, advancing nursing practice that empowers nurses to improve the quality of care

Effective leadership in child-health nursing, or any type of nursing, has never been more needed – and more supported – than it is now.  Let’s make the most of it and start the change here. 


We are deeply grateful to be able to share Tulipoka Soko’s practical wisdom.  Please pull out an idea or two that you can start doing today.  For further reference, her full presentation can be found in our Resources section CLICK HERE.

Soko continues to lead by example as she lobbies and advocates for training more child health nurses.  She also provides strategic direction to set up standards, supervision, and specialist career path for nurses.   


Lisa D. Cole, MA, RN

Director of the Mary K Center for Global Nursing Development

MBF/Medical Benevolence Foundation


PS. If you have any follow up questions or suggestions, please email us at [email protected] and we will do our best to address them.