Finding the tools for the job

Steve Kelsey uncovers some of the key challenges facing ward sisters and calls for a more structured development to support the role.

Social support in the workplace: nurse leader implications

The state of the science as it relates to the stress-mediating role of social support in the health care work environment is explored. The ability to build a nursing leadership workforce is dependent upon a type of social support mechanism that mediates the inherent stress that comes along with managerial positions. Independent of the inevitable work-related stress associated with the nurse manager role, social support provided to current and aspiring nurse leaders is assumed to assist with coping and thriving in the work environment.

Investing relational energy: the hallmark of resonant leadership

Recent research has shown that hospital restructuring that included staff layoff has adversely affected the role, health and well-being of nurses who remained employed. Further research found that nurses working in environments that reflected resonant (emotionally intelligent) leadership reported the least negative effects to their healt and well-being following hospital restructuring. What remained unclear was the mechanism by which this mitigation occurred. The purpose of this paper is to explore additional findings from this leadership research and discuss one explanation unique to the academic literature for the mitigation variable--the investment of relational energy by resonant nursing leadership to build relationships with nurses and manage emotion in the workplace.

Predictors of nurse managers' health in Canadian restructured healthcare settings

Although nursing leadership roles have been greatly transformed as a result of dramatic changes within healthcare over the past decade, there is little research on the nature of nurse manager work life in current work environments. The purpose of this study was to test a theoretical model derived from Kanter's theory of organizational empowerment: linking nurse managers' perceptions of structural and psychological empowerment to burnout, job satisfaction and physical and mental health. A descriptive, correlational design was used in a sample of 286 first-line (n=202) and middle-level (n=84) hospital-based nurse managers obtained from a provincial registry. Ironically, managers reported high levels of burnout, but good mental and physical health. Middle managers were more empowered and satisfied with their jobs than first-line managers. In both groups, approximately 45% of the variance in job satisfaction and 18-52% of the variance in physical and mental health was explained by empowerment and burnout. Empowered work environments were associated with lower nurse manager burnout and better physical and mental health. The results suggest that creating work environments that provide access to empowerment structures may be a fruitful strategy for creating healthy work environments for nurse managers.

Building confident organizations by filling buckets, building infrastructures, and shining the flashlight

Leaders have the ability to create confidence or fear in the organization. Kanter (2004) writes that confidence is the "...sweet spot between arrogance and despair" (p. 8). Overconfidence causes people to overshoot, and to assume they are invulnerable. Under-confidence is just as harmful because it leads to under-investing in people, under-innovating, and eventually leads to the disenfranchisement of staff and poor morale. If we take Kanter's advice, we will build an infrastructure that creates confidence in everyone and the organization. But we will not stop there. We will focus "flashlights" on people and activities that are inspiring to others.

Nurse manager who was rude to staff and lied about his qualifications

John was employed as a nurse manager at Bloomsday Nursing Home, a position he had held for 3 years. The home was a former residential home, which was converted into a nursing care. It was felt at interview that he would be an ideal manager as his curriculum vitae (CV) contained excellent references and a past employment history which demonstrated he had worked successfully at a similar level in another nursing facility.

Evaluation of a clinical leadership initiative

AIM

To evaluate a clinical leadership initiative in mental health and care of older people settings.

METHOD

Clinical leaders (n=15), clinical nurse managers (n=6), and mentors (n=4) involved in the initiative received three questionnaires assessing perceived change, occupational stress and burnout. A nurse, a support worker and a doctor or therapist with whom the clinical leaders worked, each received the perceived change questionnaire (n=45). A comparative group of senior nurses (n=6) who were not part of the initiative received all three questionnaires. A comparative group of clinical nurse managers (n=3) not involved in the initiative received the perceived change questionnaire.

RESULTS

Major improvements in direct care management, communication processes, decision-making, clinical nursing care, reporting and evaluation practices, and support strategies and processes at ward level were indicated. The evaluation also identified evidence of stress, potential burnout and job dissatisfaction.

CONCLUSION

A customised design was negotiated between the evaluators and the NHS trust, and recommendations were made for wider introduction of the initiative, with enhanced planning, an integrated evaluation process and a systematic approach to job redesign.

Notes from the floor

Notes From the Floor describes the experiences and learning of a nurse executive who chooses to return to direct patient care. The nurse executive wants to learn how the planning and initiatives she is directing actually translate to the patients' care. This article describes 6 days of her experience and reflections on that experience. It concludes with a summary of her learning and actions she is taking as a result of that learning.

Creating a caring practice environment through self-renewal

The soul of nursing is seeking the good of self and others through compassionate caring. Healing and caring for oneself is vital to have the energy to compassionately care for others. Nurse leaders have the moral responsibility to facilitate self-care, renewal, and healing in the organizational culture to foster caring and trusting relationships. Nurses who have a strong sense of self and caring will provide holistic patient care grounded in caring values.

Visits of children to patients being cared for in adult ICUs: policies, guidelines and recommendations

Little is known about the frequency of children visiting their nearest relatives in adult ICUs or if there are any policies/guidelines or recommendations regarding these. The aims of this multi-centre descriptive study were to survey Swedish ICUs policies/guidelines or recommendations, and examine the reasons given both for and against restricting child visits; if parents/guardians sought advice in connection with such visits, and if any differences in demographic data could be ascertained. Fifty-six Lead Nurse Managers (LNM), representing as many general adult ICUs, participated by answering a questionnaire. Only one ICU had written policy/guidelines concerning child visits; most ICUs (70%) had no policies/guidelines at all. All LNMs reported that their ICU was positive to child visits, but only two actively encouraged these. Nineteen (34%) of the ICUs restricted child visits. More than 50% of the LNMs reported that only about half of their patients ever had visits from children. Seventy percent of the ICUs had no restrictions on visiting hours, but 30% imposed some form of restriction. Twenty LNMs reported that 75% of the parents/guardians of children 0-6 years old asked for advice about child visits. However, those responsible for children >12 years of age seldom asked for any advice at all.

Quality Focus of the First Line Nurse Manager and Relationship to Unit Outcomes

The purpose of this article was to examine the relationship between the quality focus of the first line nurse manager and patient satisfaction, job satisfaction of the nursing personnel, unit effectiveness, staff perceptions of quality, and nursing personnel turnover. Of the unit outcomes that were tested, quality focus was found to be a significant predictor variable only for staff nurse job satisfaction (R2 = 0.218). Managers need to be aware of their vision for quality of patient care and how this translates into expectations for nursing care quality and overall quality of the organization.