Nurses' views of shared leadership in ICU: a case study

Fifty-five years of managerial shared leadership research: A review of an empirical field

Managerial shared leadership is a practice that goes beyond traditional ways of organising leadership functions. It is an organisational phenomenon where a few individuals share responsibility for the tasks of a managerial position. This paper reviews 67 empirical papers published in scientific journals. The review covers 55 years (1965–2019). The aim is to contribute knowledge about managerial shared leadership as a research field and offer some relevant theoretical concepts. No review to date has specifically focused on managerial shared leadership, and this paper intends to close this knowledge gap. The paper details the start of managerial shared leadership as a research field, presents a bibliometric analysis and the methodological approaches used, and describes the structural characteristics of managerial shared leadership. The paper includes a thematic content analysis of necessary and enabling antecedents and outcomes. Historically, the imprecise use of concepts has hampered managerial shared leadership’s development into a cohesive research field, so this paper develops and uses theoretical concepts to form a theoretical construct for the entire field. This construct is briefly discussed in relation to general shared leadership theory and critical leadership studies. In practice, managerial shared leadership may provide leadership solutions where there is an imbalance between demands and resources while managing complex situations.

Identifying the context, mechanisms and outcomes underlying collective leadership in teams: building a realist programme theory

BACKGROUND

There is accumulating evidence for the value of collective and shared approaches to leadership. However, relatively little research has explored collective leadership in healthcare and thus, there is a lack understanding of the mechanisms that promote or inhibit the practice of collective leadership in healthcare teams. This study describes the development of an initial programme theory (IPT) to provide insight into the mechanisms underpinning the enactment of collective leadership.

METHODS

This IPT was informed by a multiple-method data collection process. The first stage involved a realist synthesis of the literature on collective leadership interventions in healthcare settings (n = 21 studies). Next, we presented initial findings to receive feedback from a realist research peer support group. Interviews with members of teams identified as working collectively (n = 23) were then conducted and finally, we consulted with an expert panel (n = 5). Context-mechanism-outcome configurations (CMOCs) were extrapolated to build and iteratively refine the programme theory and finalise it for testing.

RESULTS

Twelve CMOCs were extrapolated from these data to form the initial programme theory and seven were prioritised by the expert panel for focused testing. Contextual conditions that emerged included team training on-site, use of collaborative/co-design strategies, dedicated time for team reflection on performance, organisational and senior management support, inclusive communication and decision-making processes and strong supportive interpersonal relationships within teams. Mechanisms reported include motivation, empowerment, role clarity, feeling supported and valued and psychological safety which led to outcomes including improvements in quality and safety, staff and patient satisfaction, enhanced team working, and greater willingness to share and adopt leadership roles and responsibilities.

CONCLUSIONS

This study has identified preliminary support for the contexts, mechanisms and outcomes underpinning the practice of collective leadership. However, it must be noted that while they may appear linear in presentation, in reality they are independent and interlinked and generative of additional configurations. This paper contributes to the nascent literature through addressing an identified gap in knowledge by penetrating below the surface level inputs and outputs of an intervention to understand why it works or doesn't work, and for whom it may work.

Interventions to develop collectivistic leadership in healthcare settings: a systematic review

Background

Collective or shared leadership approaches have been associated with team performance outcomes in several sectors. Based on this evidence, there have been calls for more inclusive approaches to leadership in healthcare settings, but guidance on how to achieve collective leadership is lacking. This study synthesised knowledge of interventions to introduce collectivistic leadership in healthcare settings.

Methods

The databases of PubMed, PsychInfo, ABI Inform, Cochrane and CINAHL and three grey literature databases were searched. Studies from any country were included if they reported on the development and evaluation and/or implementation of training/interventions to develop collectivistic leadership and reported individual and/or team-level outcomes. Results were synthesised using a narrative approach.

Results

The searches yielded 4448 records of which 21 met the eligibility criteria and were reviewed. Studies used a variety of interventions; eleven employed a team training approach, four described co-leadership, three explored service improvement, two detailed co-design approaches and one described an individual team development intervention. Most demonstrated moderate to good success in enabling collectivistic leadership, with benefits reported in staff engagement, satisfaction, and team performance.

Conclusions

Whilst collectivistic leadership interventions have demonstrated positive outcomes, there is a need for more rigor and consistency in the evaluation of interventions aimed at developing collectivistic leadership approaches in health settings.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3883-x) contains supplementary material, which is available to authorized users.

The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: An integrative literature review

INTRODUCTION

The number of patients requiring admission into intensive care units (ICUs) is increasing worldwide. Concurrently, recruitment and retention of the ICU nursing workforce is becoming a major challenge due to the high intensity environment, heavy workloads, and decreasing nurse wellbeing. Nurse unit managers play a vital role in promoting and supporting ICU nurse wellbeing, yet little is known about perceptions and experiences of this role.

OBJECTIVES

To examine the perceived and experienced role of the nurse unit manager in supporting the wellbeing of ICU nurses.

REVIEW METHODS

A comprehensive review of the literature was undertaken using Whittemore and Knafl's five stage approach: (i) problem identification, (ii) literature search, (iii) quality appraisal, (iv) data analysis, and (v) presentation of findings.

DATA SOURCES

The following databases were searched for literature published between January 2007 and December 2017: Cumulative Index to Nursing and Allied Health Literature, Cochrane, Informit, Joanna Briggs Institute Library of Systematic Review, ProQuest, PubMed, Scopus, and Wiley online library digital databases. Variations and synonyms of key words included: nurse unit manager, ICU, compassion fatigue, burnout, stress, job satisfaction, bullying, wellbeing, and work environment.

RESULTS

Rigour and trustworthiness of the included studies were assessed using the Critical Appraisal Skills Program qualitative research checklist,⁷¹ a modified Critical Appraisal Skills Program Cohort study checklist for quantitative research,⁷² and the Mixed Methods Appraisal Tool for mixed-method studies.⁷³ The critical review guidelines by Shenton⁷⁴ and Polit and Beck⁷⁵ were also used to make judgements about the worth of the evidence. All of the 11 qualitative studies provided moderate to strong evidence. The overall quality of the quantitative studies was lower, with three of seven studies providing only adequate evidence. The majority of the 19 included studies represented the voices of ICU nurses. Three major themes emerged from the analysis; '1) building professional relationships', '2) leading the way' and '3) satisfying the needs of ICU nurses'.

CONCLUSION

Nurse unit manager behaviours clearly affect the wellbeing of ICU nurses. However, the role of supporting ICU nurses is complex and challenging. More research is needed to investigate the needs of ICU nurses and the facilitators and barriers nurse unit managers face when supporting the wellbeing of nurses in their unit.

Going beyond "two-getherness": Nurse managers' experiences of working together in a leadership model where more than two share the same chair

OBJECTIVE

To explore nurse manager experiences of working in leadership constellations where more than two managers share leadership, and to compare this multilateral sharing form to what is known about experiences of working in joint leadership in pairs.

DESIGN AND SETTING

A qualitative design based on semi-structured interviews with nurse managers in two multilaterally shared leadership constellations at two intensive care units at an emergency hospital in Sweden. Data were analysed using a thematic and comparative approach.

FINDINGS

The comparative analysis identified four aspects that differ decisively from the positive picture in the literature on joint pair leadership: the perception of mandate with reduced decision-making power and reduced access to forums, the way of working with a strict division of tasks and a rotating schedule, a need to cope with the increasing number of internal relations and a feeling of doubt concerning trust.

CONCLUSION

Shared leadership between nurse managers has gone from being a tight collaboration based on a feeling of "two-getherness", to being an organisational solution multilateral in character. In this transformation, a weakening of leadership qualities has occurred. Further research is necessary on how this new organisational solution impacts the nurse managers, their staff and the care provided in healthcare organisations generally.

Exploring nurse leader fatigue: a mixed methods study

AIM

To describe hospital nurse leaders' experiences of fatigue.

BACKGROUND

Fatigue is a critical challenge in nursing. Existing literature focuses on staff nurse fatigue, yet nurse leaders are exposed to high demands that may contribute to fatigue and associated risks to patient, nurse and organisational outcomes.

METHODS

A mixed method approach comprising semi-structured interviews and the Occupational Fatigue Exhaustion Recovery scale with 21 nurse administrators (10 nurse managers and 11 nurse executives) from hospitals in a Midwestern state.

RESULTS

Most nurse leaders experience fatigue; nurse managers reported higher levels of chronic fatigue. Participants identified multiple sources of fatigue including 24 h accountability and intensity of role expectations, and used a combination of wellness, restorative, social support and boundary setting strategies to cope with fatigue. The consequences of nurse leader fatigue include an impact on decision-making, work-life balance and turnover intent.

CONCLUSIONS

The high prevalence of nurse leader fatigue could impact the turnover intent of nurse administrators and quality of care.

IMPLICATIONS FOR NURSING MANAGEMENT

This study highlights the significance and consequences of nurse leader fatigue. As health care organisations continue to raise awareness and establish systems to reduce nurse fatigue, policies and programmes must be adapted to address nurse leader fatigue.

Crisis Leadership in an Acute Clinical Setting: Christchurch Hospital, New Zealand ICU Experience Following the February 2011 Earthquake

Introduction

On Tuesday, February 22, 2011, a 6.3 magnitude earthquake struck Christchurch, New Zealand. This qualitative study explored the intensive care units (ICUs) staff experiences and adopted leadership approaches to manage a large-scale crisis resulting from the city-wide disaster.

Problem

To date, there have been a very small number of research publications to provide a comprehensive overview of crisis leadership from the perspective of multi-level interactions among staff members in the acute clinical environment during the process of the crisis management.

Methods

The research was qualitative in nature. Participants were recruited into the study through purposive sampling. A semi-structured, audio-taped, personal interview method was chosen as a single data collection method for this study. This study employed thematic analysis.

Results

Formal team leadership refers to the actions undertaken by a team leader to ensure the needs and goals of the team are met. Three core, formal, crisis-leadership themes were identified: decision making, ability to remain calm, and effective communication. Informal leaders are those individuals who exert significant influence over other members in the group to which they belong, although no formal authority has been assigned to them. Four core, informal, crisis-leadership themes were identified: motivation to lead, autonomy, emotional leadership, and crisis as opportunity.

Shared leadership is a dynamic process among individuals in groups for which the objective is to lead one another to the achievement of group or organizational goals. Two core, shared-leadership themes were identified: shared leadership within formal medical and nursing leadership groups, and shared leadership between formal and informal leaders in the ICU.

Conclusion

The capabilities of formal leaders all contributed to the overall management of a crisis. Informal leaders are a very cohesive group of motivated people who can make a substantial contribution and improve overall team performance in a crisis. While in many ways the research on shared leadership in a crisis is still in its early stages of development, there are some clear benefits from adopting this leadership approach in the management of complex crises. This study may be useful to the development of competency-based training programs for formal leaders, process improvements in fostering and supporting informal leaders, and it makes important contributions to a growing body of research of shared and collective leadership in crisis.

ZhuravskyL. Crisis leadership in an acute clinical setting: Christchurch Hospital, New Zealand ICU experience following the February 2011 earthquake. Prehosp Disaster Med. 2015;30(2):1-6.

Human Factors in Critical Care Medical Environments

The purpose of this chapter on human factors in critical care medical environments is to provide a systematic review of the human factors and ergonomics contributions that led to significant improvements in patient safety over the last five decades. The review will focus on issues that contributed to patient injury and fatalities and how human factors and ergonomics can improve performance of providers in critical care. Given the complexity of critical care delivery, a review needs to cover a wide range of subjects. In this review, I take a sociotechnical systems perspective on critical care and discuss the people, their technical and nontechnical skills, the importance of teamwork, technology, and ergonomics in this complex environment. After a description of the importance of a safety climate, the chapter will conclude with a summary on how human factors and ergonomics can improve quality in critical care delivery.