LAUSR

There are two issues arising from the title of the paper by Kantanen et al. that I would like to highlight. The first is that ‘leadership’ and ‘management’ are two distinct sets of skills and abilities that usually need to be considered in a separate light. A competent manager may not always lead very well, and a good leader may not display skills of management and prefer to leave operational details to someone else. We have probably all worked with people who possess one or both (or neither) sets of skills. However, examining these qualities together in this study suggests that they can be defined, and are indeed measurable, using a questionnaire that will cover both health and social care contexts. This is an assumption that may need to be treated with some caution. My own recent work with Directors of Nursing in the UK, using a qualitative approach, suggested that leadership and management functions can sometimes lead to a unique clash of pressures for those most senior of nurses in healthcare organisations (Jones et al., 2016; Kelly et al., 2016). As the pressure grows to deliver high-quality care in increasingly costconstrained environments, there is in turn a pressure on Nurse Directors to balance the conflict that may exist between high quality, rising demand and reduced or static resources. This, for some, is unsustainable and can lead to a high turnover of Nurse Directors and stress levels that can become unacceptably high. This Finnish study did not enquire into stress directly, but this would have been an interesting additional insight. It is also important to consider whether a mixed method approach might have been more revealing than relying on a self-reported questionnaire. That said, the paper does suggest the need for more training and support to develop both