Transformational Leadership Principles and Tactics for the Nurse Executive to Shift Nursing Culture

A systematic review of leadership styles in healthcare sector: Insights and future directions

In light of the ongoing global health crisis, the significance of leadership within the healthcare sector has intensified. Given this consideration, the significance of appropriate leadership styles cannot be overstated. The objective of this paper is to critically review published studies on leadership elements in the healthcare sector. Using Bibliometrix R package and VOS viewer, we conducted bibliometric and network analyses on publications retrieved from the Web of Science (WOS) database, with content analysis integrated throughout the paper to deepen understanding. Ultimately, 243 articles were identified as relevant. The findings revealed transformational leadership emerges as the most extensively discussed leadership style. 91% of the articles' theme focus on quantitative research methods. This study synthesizes the influencing factors of the three most frequently discussed leadership styles-transformational, authentic, and ethical leadership-emphasizing the importance of job satisfaction and organizational citizenship behavior. And provides direction for future research through thematic analysis.

The Association of Transformational Leadership on Safety Practices Among Nurses: The Mediating Role of Patient Safety Culture

Background

To ensure best possible patient outcomes, patient safety is a major component of healthcare delivery system that needs to be prioritized. Safety practices among nurses are essential to maintain patient safety, especially the practices of medication administration, handover, patient falls and unplanned extubations prevention.

Purpose

To investigate the mediating effect of patient safety culture between the relationship of transformational leadership and safety practices among nurses.

Methods

The data in this cross-sectional study were gathered from a survey targeted clinical nurses using a random sampling technique. The study was conducted in a medical city in Saudi Arabia, and two hundred nurses were surveyed. The Multifactor Leadership, Hospital Survey on Patient Safety Culture, and Nursing Safety Practice questionnaires were used in the study.

Results

The results revealed significant positive associations between transformational leadership, patient safety culture, and nursing safety practices. Moreover, patient safety culture mediates the association between transformational leadership and safety practices among nurses.

Conclusion

Enhancing transformational leadership capabilities among nurse managers should be considered in order to improve nursing safety practices. Additionally, patient safety culture should be measured and improved periodically to ensure better nursing safety practices.

Application of Within-Methods Triangulation to Analyze Hospital System Health

Qualitative descriptive research can be used when researchers are seeking to find the "how," "what," or "when" of phenomena. The most common qualitative descriptive analysis methods are content and thematic analyses. Data triangulation through content analysis and natural language processing was first described in 2018 for the analysis of nurse-to-nurse communication in an acute care setting. The purpose of this article is to discuss a within-methods data triangulation of interviews done with nurses and nursing leaders in Magnet- and non-Magnet-designated hospitals through integration and application of content analysis, code quantification via the Goodwin statistic, and natural language processing.

Nurse Leadership Development: A Qualitative Study of the Dutch Excellent Care Program

Aims. To understand how nurses perceived the contributions of the Dutch Excellent Care Program, the development of nurses’ leadership, and their ability to positively influence their work environment. Background. Research shows that the nursing work environment influences job satisfaction, retention, and quality of care. Many countries have created programs such as the Excellent Care Program to improve nurses’ leadership and facilitate a positive work environment. Methods. A descriptive qualitative study based on 17 semistructured group interviews (participants N = 52) and directed content analysis using thematic coding. Results. Four program processes contribute to leadership development: (1) nurses taking responsibility for their knowledge and skills development; (2) strengthening organizational structures to improve nursing governance; (3) challenging the status quo with quality-enhancing projects; and (4) enhancing awareness of the supportive role of the nurse manager. Conclusions. The program supported nurses’ leadership development for a positive work environment. The interrelatedness of the four processes enhanced the nurses’ ability to solve day-to-day problems and challenge the status quo that influenced working practices. Implications for Nursing Management. The findings support making improvements to healthcare organizational strategies to encourage nurses to show leadership in their work environment.

The relationship between emotional intelligence, transformational leadership, and performance: a test of the mediating role of job satisfaction

Purpose

This paper examines the effect of job satisfaction on job performance among physicians in Iraq's public hospitals. It also determines the mediating role of job satisfaction on the relationship between emotional intelligence and job performance. It further unveils the mediating role of job satisfaction on the nexus between transformational leadership and job performance. As physicians form the bulk of health-care professionals, their performance at work is crucial in determining patient satisfaction regarding care quality.

Design/methodology/approach

A quantitative approach with structural equation modelling via partial least squares (PLS-SEM) and bootstrapping estimation was used to test the hypotheses developed. A total of 157 responses were utilized in the data analysis.

Findings

Evidence from the study indicates that job satisfaction has a positive relationship with job performance. The study also provides evidence that job satisfaction plays a positive mediating role in the relationship between emotional intelligence and job performance. Similarly, job satisfaction has a positive mediating effect on the nexus between transformational leadership and job performance among physicians in Iraq's public hospitals.

Originality/value

To the best of the authors' knowledge, this is the first study to investigate the relationship between physician job satisfaction and job performance in Iraqi public hospitals. Studies using Eastern samples are scarce, so the findings of this study will add to the body of knowledge from a cross-cultural standpoint.

Reducing Near Miss Medication Events Using an Evidence-Based Approach

BACKGROUND

Near miss medication events are pervasive without patient harm, mostly because of coincidence. Dynamic clinical environments challenge nurse compliance with medication administration rights and proper use of electronic technology.

PROBLEM

All nurses are educated in appropriate medication management, but our unit's barcoded medication administration scanning and electronic patient identification practices fell below the 97% benchmarks, representing hundreds of near miss medication events each month.

APPROACH

Transformative leadership guided frontline staff to identify gaps in care processes and determined root causes for unsanctioned medication administration practices using a FOCUS (Find-Organize-Clarify-Understand-Select)-PDSA (Plan-Do-Study-Act) methodology.

OUTCOMES

An interdisciplinary team committed to zero events of preventable harm overcame challenges to improve care delivery. Medication management scores exceeded organizational benchmarks, with sustainable gains over 2 years.

CONCLUSIONS

A rapid-cycle, evidence-based approach engaged staff to reduce near miss medication events. Workable solutions driven by transparent communication and interpersonal collaboration influenced positive safety behaviors.

A 1-Year Accredited Nurse Residency Program's Effect on Intent to Leave

OBJECTIVE

This article describes the evaluation of a system-wide program to enhance new graduate nurse resident (NGNR) experience, enculturation, and commitment to the organization.

BACKGROUND

Structured nurse residency programs support NGNR transition to the work environment and increase retention and organizational commitment.

METHODS

The study used a descriptive, comparative design measuring NGNR perceptions of affective commitment, job satisfaction, job stress, and other variables over 3 times from baseline to 24 months.

RESULTS

Findings demonstrated a reduction in affective commitment and an increase in nursing stress from baseline to 12 and 24 months of employment. The highest mean in intent to leave occurred at 12 months, highlighting the vulnerability of the NGNR at that time.

CONCLUSIONS

Nurse leaders must consider resources supporting NGNRs beyond the traditional 12 months to ensure retention and organizational commitment, thereby decreasing intent to leave.

Filling the Knowledge Gap for Nurse Leaders: Next Steps Following COVID-19

The purpose of this article is to share gaps in knowledge and research related to pandemic management identified by nurse leaders during the COVID-19 pandemic. As part of a larger Delphi study, nurse leaders responded to an open-ended question about gaps in research they saw as important following the pandemic. Responses were analyzed using directed content analysis. Results are presented as 4 supercategories: Organizational leadership preparedness, adaptive leadership in crisis, innovations in care delivery, and health, well-being, and resilience.

Creating Empowering Conditions for Nurses with Workplace Autonomy and Agency: How Healthcare Leaders Could Be Guided by Strengths-Based Nursing and Healthcare Leadership (SBNH-L)

The COVID-19 pandemic had the unintended consequence of placing nurses in the spotlight because their knowledge and skills were in desperate need. While it will be years until we fully understand the impact that this pandemic has exacted on the nursing workforce, early studies have found that nurses have been traumatized by this event and many intend to leave the profession This seismic event only further exacerbated an already vulnerable and strained nursing workforce that pre-existed worldwide prior to COVID-19. The pandemic also highlighted the many challenges facing nursing leadership, in particular, how to create conditions to maintain and sustain a healthy nursing workforce. Nurses’ job satisfaction has emerged as an important predictor of whether nurses remain in an organization and stay in the profession. When examined more closely, job satisfaction has been related to nurses feeling empowered to exercise autonomy over their own practice and having agency. Autonomy and agency, in turn, are affected by their managers' leadership styles. Leaders are instrumental in setting the tone and creating the climate and culture that either values or devalues autonomy and agency. To help leaders create empowering conditions, we have developed a guide for leaders. This guide, based on the value-driven philosophy of leadership called Strengths-Based Nursing and Healthcare Leadership (SBNH-L), is founded on principles of person-centered, empowerment, relationship-focused, and innate capacities (ie, strengths) that are operationalized in eight core values. This guide can be used by leaders as their roadmap to create empowering workplace conditions that value and facilitate nurses’ autonomy and agency.

The Impact of Transformational Leadership on Physicians' Performance in China: A Cross-Level Mediation Model

Transformational leadership has been becoming increasingly vital to the provision of high-quality health care, particularly during major public health emergencies. The present study aims to investigate the impact of transformational leadership on physicians’ performance and explore the cross-level underlying mechanisms with achievement motivations and coping styles among Chinese physicians. During 2017–2019, 1,527 physicians of 101 departments were recruited from six hospitals in China with a cluster random sampling method. Participants completed several questionnaires regarding their job performance, achievement motivations, coping styles, and transformational leadership. Multilevel mediation effects were tested using cross-level path analysis. The result of this study indicated that transformational leadership was applied well in Chinese medical settings with a score of 101.56 ± 6.42. The hierarchical linear model showed that transformational leadership had a cross-level direct positive effect on physicians’ performance (β = 1.524, p < 0.05). Furthermore, results of cross-level path analyses revealed that transformational leadership contributed to physicians’ performance by sequentially influencing achievement motivations first and then coping styles. In addition, the path “transformational leadership → positive coping (PC) style → physicians’ performance” showed the strongest cross-level indirect effect. In summary, public health leaders should enhance physicians’ performance by promoting individual development, especially achievement motivation and PC style.

Chief Nurse Executives involuntary turnover in times of health care reforms: Findings from an interpretative phenomenology study

In recent years, due to several health care system reforms in different countries, an increased involuntary turnover rate of Chief Nurse Executives has been reported around the World. However, no data on their perceived experience of their dismissal have been documented up to now in the European context. Describing the experience of involuntarily dismissed Chief Nurse Executives was the main aim of this interpretative phenomenological study. Data were collected through face-to-face audiotaped interviews performed by involving a purposeful sample of 13 Chief Nurse Executives; data analysis was performed by using the QSR NVIVO 11 software. The Chief Nurse Executives’ experience of Being fired is characterized by three main themes: (1) “Health Care Institutions are places influenced by political turbulences”; (2) “My competence and presence in the arena is despised by a range of strategies”; and (3) “Transiting from darkness to light”. According to their experience, the reason for dismissal was due to changes in the political climate and the introduction of a new chief executive officer; moreover, Being fired caused a deep pain similar to that experienced during bereavement. In some socio-political contexts, the political climate can influence the role of a Chief Nurse Executive: political membership, whether implicit or explicit, is considered of great value. In other contexts, the Chief Nurse Executives’ value is based on professional competences and achieved outcomes. At times of changes in the political climate, the peculiarities of the specific socio-political context should be evaluated as to whether one should anticipate his/her resignation or not.