The role of the charge nurse manager: a descriptive exploratory study

Socializing into a Profession with High Early Turnover: Nursing Students' Expectations for Leader-Member Relationships

The nursing profession is wrought with high levels of turnover, particularly among new nurses. One reason for this turnover may be explained by a disparity between what new nurses expect in terms of communication from leaders and coworkers and what they realistically receive. This study uses a mixed-methods experimental design to explore young adult nursing students' preferences for manager communication behaviors, how different managerial archetypes influence nursing students' perceptions of their leader, and how personal factors may influence nursing students' preferences for various managerial styles. Findings suggest that new nurses prefer more mentor- and teacher-type managers and that managerial archetypes influence young adult nursing students' perceptions of leader credibility, effectiveness, leader-member exchange, and employee commitment. Furthermore, personal factors such as self-worth and desire for relational communication behaviors influence preferred manager type. Participants' qualitative responses reveal several task and behavioral wants and needs of new nurses. Findings from this study can informatively help to bridge the gap between expectations and reality in the nursing profession, thus addressing a potential reason for consistent turnover.

Early Career Nurses' Experiences of Engaging in a Leadership Role in Hospital Settings

BACKGROUND

Early career nurses (ECNs) can be expected to assume shift charge nurse leadership roles quickly upon entering practice. Since the emergence of the COVID-19 pandemic, junior nurses may find their leadership capabilities tested further as the challenges of leadership are made increasingly complex in the context of an infectious disease outbreak.

PURPOSE

The purpose of this qualitative study was to explore early career registered nurses' (RNs) experiences of engaging in shift charge nurse roles in hospital settings.

METHODS

This study used an interpretive descriptive (ID) approach. Semi-structured, in-depth interviews were conducted with 14 RNs across Ontario, who had up to three years of experience and who had engaged in a shift charge nurse role in a hospital setting. Recruitment and data collection took place from January to May 2021 during the COVID-19 pandemic. Interviews were recorded, transcribed, and analyzed following the principles of content analysis.

RESULTS

Content analysis of the 14 participant interviews revealed four main themes: nominated and necessitated into leadership, diverse and demanding responsibilities, factors that help and hinder, and leadership as an impactful experience.

CONCLUSIONS

Study findings provide insights into potential strategies to support ECNs in shift charge nurse roles, during the remaining course of the COVID-19 pandemic and beyond. Greater support for nurses who engage in these roles may be achieved by promoting collaborative unit and organizational cultures, prioritizing leadership training programs, and strengthening policies to provide greater clarity regarding charge nurse role responsibilities.

Succession Planning and Leadership Development in Nursing: A Bibliometric Analysis (2000-2023)

Succession planning is a commonly employed term in business strategy, referring to the systematic process of transferring leadership responsibilities to another employee to ensure the seamless continuity of an organization's operations. Today, this concept has acquired importance in various industries, including healthcare, with a specific focus on nursing. Several factors led nurse managers to consider preparing potential leaders for primary leadership roles due to the shortage of nurses, significantly impacting healthcare services and patient safety. Because of the importance of this topic, this present bibliometric analysis aims to analyze research studies conducted on succession planning and leadership development in nursing from 2000 to 2023 to identify research trends, key themes, and the evolution of research during this period. The Elsevier Scopus database was utilized for this analysis. This methodology identified (n = 326) journal studies based on the predefined keywords and timeframe. The data derived from this bibliometric analysis offers a robust foundation for conducting a systematic review, enabling a comprehensive synthesis and evaluation of the evidence in this significant field of study.

Lived experiences of Iranian nursing managers in organizing and confronting the COVID-19 pandemic

BACKGROUND

The prevalence of the new infectious disease is a global health issue and a threat to nurses and other health care workers. In addition to nurses who have been directly involved in the care of patients with coronavirus disease 2019 (COVID-19), nursing managers have also played a key role in the management and control of this disease. The present study aimed to investigate the lived experiences of nursing managers in organizing and confronting COVID-19 in Iran.

MATERIALS AND METHODS

This study was a qualitative research design conducted by descriptive phenomenology based on Husserl philosophy. Participants consisted of 32 nursing managers working in general public hospitals in East Guilan, north of Iran, selected using purposive sampling. In-depth and semi-structured interviews were used to collect data. Colaizzi's strategy was used to analyze the data. Coding was done with MAXQDA 2007 software. Lincoln and Guba trustworthiness criteria were used to achieve accuracy and reliability of the data.

RESULTS

Data analysis led to the emergence of a main theme called "Management in the COVID-19 Crisis" and three sub-themes: "Dealing with the unknown", "Managing deficiencies and assets" and "Structural challenges".

CONCLUSION

In this study the nursing managers experienced how to deal with the COVID-19 crisis. By examining the experiences of managers involved in the COVID-19 pandemic, a rich set of managerial experiences can be gathered that prepare them for other infectious diseases in the future.

Managing in Critical Care Settings: A Qualitative Study of South African Nurse Unit Managers and the Psychological Contract

Introduction

Little is written about the management of psychological contracts by nurse unit managers (NUMs) in critical care settings and how this perspective contributes to the performance, experiences, and views of nurses and nursing teams. Psychological contracts are important regulators of the employer-employee relationship, with managers (NUMs) being the embodiment of the employer in managing the contract.

Objectives

This qualitative study answers a call for research on the NUM perspective of the psychological contract given the role they play in the wellbeing of critical care nurses and quality of care provided. The study aims to understand the expectations and obligations that constitute the psychological contract NUMs have with their nursing teams, the nature of the contract, and how NUMs practically manage these aspects on their teams.

Methods

Using an interpretive qualitative research design and a purposive sampling technique, semi-structured interviews were conducted with 10 of the 14 NUMs from a public health facility about critical incidents relating to their obligations and expectations of managing critical care nurses.

Results

A thematic analysis of their responses revealed five main themes that represent the contents of their psychological contracts with critical care nurses: professional commitment and obligation; leading by example; trust and support; teamwork; and on-the-job training and further development. In their discussion of these components, the NUMs also revealed how they manage the psychological contract with nurses.

Conclusion

Based on the expectations and obligations NUMs hold with their staff, their psychological contracts were found to be largely relational, with elements of the balanced type, suggesting that they rely on interpersonal connection and coordination, as well as knowledge dissemination, to uphold the contract. This contract appears to be effective in inculcating the commitment of nurses to their profession and professional standards through the building of trust and offering of support. However, recommendations are offered to ensure NUMs are best prepared to sustain these psychological contracts and continue to support nurse wellbeing and related patient care.

Sleep disturbances in nurse managers during the early and late stages of the COVID-19 pandemic

Introduction

Working conditions during the COVID-19 pandemic have affected health professionals' quality of sleep. To date, most of the studies that assess the impact of the COVID-19 pandemic on sleep have been carried out with front-line health personnel, and almost none of them have been carried out with managers.

Objective

To evaluate the quality of sleep and the level of stress in nurse managers during the early and late stages of the COVID-19 pandemic.

Methods

Cross-sectional studies were carried out at two time points: after the lockdown period (July 2020) and a year and a half after the start of the pandemic (October 2021). A total of 102 nurse managers of a tertiary hospital were invited to participate. The Perceived Stress Scale (PSS-14) and Pittsburgh Sleep Quality Index (PSQI) were administered to assess stress levels and sleep quality.

Results

The response rate was 85.2% in 2020 and 81.3% in 2021. Nursing managers showed alterations in sleep quality throughout the pandemic: 70.1% after confinement and 61.4% at the beginning of the second wave. In addition to stress, the fear of contagion by COVID-19 influenced sleep problems. More than a year after the start of the pandemic, the professionals' fear of contagion decreased. Perceived stress also decreased, but sleep disturbances remained.

Conclusion

High stress and poor sleep quality among nurse managers require special attention, and specific interventions need to be implemented. Hospitals should develop programs that help nurse managers develop skills to mitigate stress levels and thus improve sleep quality and professional quality of life.

Multi-Generational Perspectives on the Competencies Required of First-Line Nurse Managers: A Phenomenological Study

First-line nurse managers play an integral role in ensuring team and organizational effectiveness and quality of care. They are facing increasing challenges arising from the need to lead a generation-diverse workforce. Further research that examines multi-generational perspectives on the competencies of first-line nurse managers is warranted. This paper aimed to elucidate multi-generational perspectives on the competencies required of first-line nurse managers based on their lived experiences and perceptions, as well as those of frontline nurses. A descriptive phenomenological approach was adopted. A total of 48 informants were invited to individual semi-structured interviews to share their perspectives on the competencies required of first-line nurse managers. Findings were analyzed using Van Kaam's controlled explication method. Four themes that described four areas of competency were generated: (1) advocating for the interests of the staff, (2) allocating resources effectively, (3) building cohesive teams, and (4) embracing change and quality. The findings indicated that there were significant discrepancies among the different generations of informants in terms of their degree of commitment to work, preferred modes of team communication and collaboration, and perspectives on the role and function and preferred leadership styles of first-line nurse managers. This study fell short in examining the experiences of Generation Z nurses, and the findings are subject to further validation by larger samples. However, this study has implications for hospital administrators, nurse educators, and managers, encouraging them to rethink the notion of management competencies to develop effective strategies for leading a multi-generational workforce.

Business Acumen for Nursing Leaders: An Exploratory Qualitative Study

AIM

The aim of this study is to explore the status of and need for business acumen of nurse leaders.

BACKGROUND

Health systems globally continue to reform to deliver better care, while working within sustainable budgets. However, beyond leadership and management expertise, nurse leaders need strong business acumen to appreciate the complexity of the system.

METHOD

Two groups, emerging nurse leaders and established health system leaders, were interviewed for their perspective on four elements related to business acumen.

RESULTS

Business in healthcare was defined and therefore valued with variation across both groups. Adequate business education for nurse leaders was considered lacking by both groups. Inconsistent business acumen was seen as a barrier for nursing inclusion at the system level.

CONCLUSIONS

Business acumen is a skillset more valuable for the nursing profession, than the current educational preparation allows, creating a reputational barrier for nursing's full participation in health system level leadership, but is considered an opportunity for the future.

IMPLICATIONS FOR NURSING MANAGEMENT

Improving the foundation business acumen across the nursing profession will not only raise the profile of nurse leader capability to input and influence across the health system, but also improve the wider nursing team's understanding around nurse leader advocacy and decision making.

"This Isn't Just Busy, This is Scary": Stress, Social Support, and Coping Experiences of Frontline Nurses During the COVID-19 Pandemic

Despite having previous experience and extensive trauma training, the COVID-19 pandemic presented unprecedented challenges for nurses working in hospital settings. During the pandemic, nurses struggle to care for patients and protect themselves from infection, while navigating ongoing organizational changes. Guided by prior literature on social support and coping, this study explores nurses' experiences of coping with stress while treating COVID-19 patients during the pandemic. In-depth semi-structured interviews were conducted with 14 active staff nurses working in hospitals and one licensed practical nurse (LPN) at a rehabilitation center who treated COVID-19 patients during the pandemic. An inductive thematic analysis was employed to analyze those data, and three overarching themes emerged: (1) nurses' unique experiences in the [COVID-19] trenches, (2) nobody else understands, and (3) coping with stress together. Practically, this study is heuristic and generates an increased understanding of professional communication during times of healthcare crises, illuminating the need to enhance communication skills for both staff nurses and management. This study also extends our understanding of communal coping in the context of healthcare organizations.

Business acumen for nursing leaders: A scoping review

AIM

The aim of this study is to explore the current evidence on business acumen of nurse leaders.

BACKGROUND

Health systems across the world are under immense pressure to stay solvent, maintaining services within a defined budget as we recover from the COVID-19 pandemic. Effective nurse leaders not only need to have strong leadership and management skills but also strong business acumen to navigate the complexity of the system.

EVALUATION

A scoping review of research was undertaken, using preferred reporting items for systematic reviews and meta-analyses (PRISMA) scoping extension checklist, with 571 studies found across multiple databases, 17 meeting final review eligibility.

KEY ISSUES

Findings were noted surrounding three themes: the value of business acumen in nursing, the gaining of business acumen in health care as a nursing leader and the utilizing business acumen as a nurse leader in the health care industry.

CONCLUSION

While nursing leadership and management were well researched, limited studies covered the specific focus of business acumen in health care for nurses or broader clinicians.

IMPLICATIONS FOR NURSING MANAGEMENT

While evidence points towards business acumen being important for health care leaders in balancing care and cost, inadequate research limits the recognition of these professional capabilities of nurse leaders. Further understanding could inform future policy and curriculum, as well as empower our next generation of clinicians.

Operating theatre nurses' with managerial responsibility: Self-reported clinical competence and need of competence development in perioperative nursing

AIM

The aim of this study was to investigate operating theatre nurses (OTNs) with managerial responsibility, and their self-rated clinical competence and need for competence development in perioperative nursing.

DESIGN

A cross-sectional study was applied using a modified version of Professional Nurse Self-Assessment Scale of Clinical Core Competence I.

METHOD

Data were collected from 303 OTNs in Sweden, 80 of whom indicated that they had managerial responsibility. Statistics analysis was used to identify the relationships between background variables to compare OTNs with and without managerial responsibility and their need for competence development.

RESULTS

OTNs with an academic degree and managerial responsibility self-rated their clinical competence higher compared with OTNs without an academic degree. It also turned out that OTNs with RN education and 1-year advanced nursing in theatre care, and master's 60 credits had a lower need for competence development in cooperation and consultation, professional development and critical thinking.

The need for management education of healthcare management employees

Given the wide professional discussion on the dominating professional focus of healthcare managers at the expense of management knowledge, the main goal of this paper is to verify the extent, to which management education of healthcare workers affects the level of their management skills.

METHODOLOGY

The Descriptive statistics methods have been used to answer research questions regarding the differences in the perception of the managerial skills and their disposition importance between managers with a completed management education and without it. Emphasis was placed on people management skills and communication skills. The research sample consisted of 253 healthcare managers.

RESULTS

Managers with a completed specialized management study are characterized by higher values of entrepreneurial competences and communication skills. They also have exceptional skills in the area of initiator of change. Another significant difference is the higher adaptation of roles and low critique of their subordinates. They are oriented at workers and relationships with them.

CONCLUSION

Our results show that management education of healthcare managers significantly contributes to the implementation of newer approaches to people management and the use of the necessary management skills, which are a source of higher efficiency in the context of the present world of work and its challenges.

Valuing nurse and midwifery unit managers' voices: a qualitative approach

Background

Nurse and Midwifery Unit Managers (NMUMs) play pivotal roles in quality patient care, nurse and midwife satisfaction and retention. NMUMs are expected to be both leaders and managers simultaneously, which may create role tension. This study aimed to explore the understanding and experience of NMUMs regarding their role; to explore what barriers and facilitators NMUMs identified to achieving the goals of their clinical area; and to explore NMUMs’ career plans.

Methods

Set in Victoria, Australia, this study was guided by naturalistic inquiry using a qualitative descriptive approach. Thematic analysis was used to inductively develop core themes, which facilitated the motivations, experience and meanings underlying the data to be elaborated.

Results

In all, 39 interviews were conducted with NMUMs across four hospitals. Two overarching themes were identified from the data; system challenges and influences on people and each theme had three sub-themes. In relation to system challenges, participants spoke about the structural challenges that they encountered such as financial stressors and physical infrastructure that made their work difficult. Participants felt they were unprepared for the NMUM role and had limited support in the preparation for the role. Participants also related their frustration of not being included in important decision-making processes within the hospital. Regarding their career plans, most did not envisage a career beyond that of a NMUM.

Conclusions

This study of contemporary NMUMs uncovered a continued lack of investment in the orientation, professional development and support of this critical leadership and management role. There is an urgent need for targeted interventions to support and develop capabilities of NMUMs to meet the current and evolving demands of their role.

'The office of disaster management' nurse managers' experiences during COVID-19: A qualitative interview study using thematic analysis

AIM

The purpose of this study was to understand the experiences of nurse managers during the COVID-19 pandemic.

BACKGROUND

There is a growing body of knowledge about the experiences of clinical nurses during COVID-19. However, there is less evidence about the experiences of nurse managers during the pandemic.

METHODS

Eight nurse managers, from acute care and outpatient settings, completed semistructured interviews about how their roles had changed during the pandemic, how they felt about these changes, and what had gone well or been difficult. Each participant was interviewed once, for 20-60 min. We used thematic analysis methods to analyse the interview transcripts.

FINDINGS

Nurse managers had to coordinate care in a context of uncertainty and guidance that changed frequently. Participants found that their roles and responsibilities either expanded to include more duties, or they were asked to take on a completely new role, with no orientation or training. Nurse managers were expected to provide support to their staff and patients, but did not necessarily receive support themselves. Participants were expected to plan simultaneously for care during the pandemic and for a return to normal working conditions. These factors contributed to challenging and difficult participant experiences of managing during COVID-19.

CONCLUSION

Nurse managers' experiences during COVID-19 are influenced by changes to their roles and the support they received. Nurse managers continue to support high-quality care despite working a difficult context.

IMPLICATIONS FOR NURSING MANAGEMENT

Where possible, nurse managers can be supported to extend their roles or receive additional education and support if they are required to take on new responsibilities. Nurse managers require support in order to be a resource for their staff.

Nurse managers' learning facilitation practices: A philosophical hermeneutic study

AIM(S)

To understand how nurse managers facilitate learning in clinical workplaces.

BACKGROUND

Meeting staff learning needs in the complex workplaces of contemporary health care is paramount to the delivery of safe patient care. Hospitals employ a range of strategies to address these needs. However, nurse managers' contribution to staff learning at the unit level is underexplored in contemporary literature.

METHOD(S)

A Gadamerian philosophical hermeneutic framework guided data collection and analysis. Thirteen nurse managers from two Australian hospitals each participated in two interviews and a period of observation.

FINDINGS

Nurse managers' learning facilitation practices were enacted with staff individually, within teams, and through artefacts, and were shaped by their identities, perspectives on staff learning, knowledge of staff performance, and motivations. Power was revealed as a uniquely enacted driver of their learning facilitation practices.

CONCLUSION(S)

This paper illuminates an aspect of nurse managers' practice that has been poorly acknowledged in contemporary nursing literature. Nurse managers' learning facilitation practices were found to be complex, fluid, and embedded in their everyday work routines.

IMPLICATIONS FOR NURSING MANAGEMENT

Given current concerns about safety and quality in health care, this research opens up possibilities for definition and enrichment of nurse managers' practice as facilitators of learning.

The effectiveness of the Ethics Quarter intervention on the ethical activity profile of nurse managers: A randomized controlled trial

AIM

To test the effectiveness of a new ethics educational e-learning intervention, Ethics Quarter, in supporting nurse managers' ethical activity profile.

BACKGROUND

Health care organisations need evidence-based ethics interventions to support nurse managers' ethical activity profile.

METHODS

A parallel-group, individually randomized controlled trial was conducted in 2020. Finnish nurse managers nationwide [members of the Union of Health and Social Care Professionals in Finland (Tehy) trade union] were randomly allocated to intervention (n = 169) or control group (n = 172). The intervention group participated in the Ethics Quarter comprising twelve 15-min evidence-based educational 'quarters' spread over 6 weeks. The control group had standard organisational ethics structures. The primary and secondary outcomes were ethical activity profile and ethics knowledge, respectively. The Consolidated Standards of Reporting Trials (CONSORT) statement for study design and reporting was adopted.

RESULTS

Ethical activity profile showed statistically significant differences in mean changes between the groups from baseline to 10 weeks: all five dimensions were statistically significantly higher in the intervention group compared with the control group (p = <.0001).

CONCLUSION

The Ethics Quarter was effective in increasing nurse managers' ethical activity profile.

IMPLICATIONS FOR NURSING MANAGEMENT

Applying this ethics educational e-learning intervention would benefit nursing management education and health care organisations.

TRIAL REGISTRATION

clinicaltrials.gov: NCT04234503.

Mental Health Status and Its Influencing Factors: The Case of Nurses Working in COVID-19 Hospitals in South Korea

The mental health of nurses participating in patient care is under threat amid the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to identify the mental health status (depression, anxiety, and stress) and its influencing factors on nurses who provided patient care at a specialized hospital for COVID-19 in South Korea. Of the 180 nurses who participated in this study, 30.6% had moderate or higher levels of depression, 41% had moderate or higher anxiety levels, and 19.4% had moderate or higher stress levels. In this study, stigma influenced nurses’ mental health, such that the higher the stigma, the higher the nurses’ depression, anxiety, and stress. Depression was higher in female nurses than in male nurses, and stress was higher in charge nurses than nurses in other job positions. Therefore, a management program should be designed to improve the mental health of nurses during the current pandemic. In particular, a solution to reduce stigma is required, and the mental health of female nurses and nurses in leadership roles requires special attention.

Psychometric properties and development of the competency inventory for Taiwanese nurse managers across all levels

AIMS

To describe the development and psychometric testing of the competency inventory for nurse managers across all levels in Taiwan.

BACKGROUND

The competency-based approach to develop nursing leadership and management competencies for the health care context is still insufficiently explored in terms of professional development in nursing administration.

METHODS

This study used mixed methods, including qualitative study for generating the preliminary inventory and a cross-sectional survey of 573 nurse managers for psychometric properties of the inventory.

RESULTS

Exploratory factor analysis revealed four domains with 23 items that explained 58.21% of the overall variance. The overall Cronbach's alpha coefficient was 0.93. Confirmatory factor analysis showed a well-fitting goodness-of-fit statistics. The construct validity was adequate, with an average variance extracted of 0.68 and composite reliability of 0.90.

CONCLUSIONS

Across different levels, nurse managers have 23 essential competencies. The competency inventory demonstrates adequate psychometric properties with good construct validity and internal consistency, thereby reliable and valid for guiding the competency development of nurse managers.

IMPLICATIONS FOR NURSING MANAGEMENT

The essential competencies of the inventory serve as a criterion-referenced measurement for competence proficiency in professional development of nursing administration and contribute to performance improvement of nurse managers in practice.

Communication Skills and Transformational Leadership Style of First-Line Nurse Managers in Relation to Job Satisfaction of Nurses and Moderators of This Relationship

The job satisfaction of nurses is reflected in almost all organizational outputs of medical facilities. First-line nurse managers (FLNMs), who are directly related to subordinate nurses, have a great influence on this satisfaction. The aim of our paper is to examine the connection between communication skills and the transformation style of FLNMs management with the job satisfaction of nurses and to verify the influence of three moderators on the strength of this relationship. The chosen moderators-the practice of managing FLNMs, the degree of control (span of control) and psychosocial work-follow from theoretical studies. The moderating effect of the variable management practice is also significant from the point of view of Slovak legislation. The sample consisted of 132 FLNMs from five university hospitals in Slovakia. Data collection took place in the form of a questionnaire. All data were processed using the SPSS 24 software package. A series of regression analyzes were used to identify the proposed hypotheses. ANOVA analysis was used to analyze multiple dependencies. We worked at a 5% level of significance. The findings point to the strong direct effects of communication skills and the transformational leadership style of FLNMs on nurses' job satisfaction. Moderation effects are mild, but significant in the case of management and span of control practices. The lower values of both variables reinforce the positive relationships among the two predictors and the job satisfaction of nurses. The third moderator, psychosocial work factors, also have a significant moderating effect, which is negative, and the higher value of this moderator mitigates both positive direct effects.

Determining nursing service management standards in Turkey: A Delphi study

OBJECTIVE

To establish the current management standards needed by nurse managers in Turkey and to share the process of establishing standards.

BACKGROUND

Relevant and utilizable nursing management standards are needed for effective and efficient nursing administration to achieve better outcomes in health care.

METHODS

A three-round e-Delphi method was used in this study. First, the experts were asked an open-ended question. In the second and third rounds, data analysis measurements included item-by-item per cent agreement, standard deviation, average, median and interquartile range.

RESULTS

At the end of the third round, 49 standards were obtained under five main standards for nurse managers: management and organisation; leadership; human resources management; quality management; and professionalism.

CONCLUSION

The results of this study, which represent a consensus on nursing management standards drawn from the views of experts across regions and institutions in Turkey, provide a baseline to design, manage and evaluate nursing services.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing management standards, which are fundamental for designing, leading and evaluating nursing services, give a framework for nurse managers to provide effective and efficient administrative practices.

Nurse managers experiences of their leadership roles in a specific mining primary healthcare service in the West Rand

BACKGROUND

Nurse managers are leaders in mining primary healthcare. Their leadership roles include inspiring and empowering operational managers and nursing personnel, by leading with competence developing them to become followers with insight and direction. However, these leadership roles are not clearly defined, and are negatively influenced by the traditional mining leadership style.

OBJECTIVES

The aim of this study was to explore and describe the nurse managers' experiences of their leadership roles in a specific mining primary healthcare service on the West Rand, to develop recommendations to enhance these roles.

METHOD

A qualitative, exploratory, descriptive and contextual research design was used in this study, following a phenomenological approach as a research method. A non-probability purposive sampling method was used. Nurse managers described experiences of their leadership roles during individual phenomenological interviews. Data saturation was reached on participant number 7. To analyse data, four stages of Giorgi's descriptive phenomenological data analysis was used. An independent coder coded the data and a consensus meeting was held. The study was guided by the theoretical framework of Winkler's role theory.

RESULTS

The following subthemes emanated from data analysis: (1) leadership role ambiguity, (2) leadership roles experienced and (3) challenges experienced in leadership roles.

CONCLUSION

This study revealed that the leadership roles for nurse managers in a specific mining primary healthcare service are not clearly defined. Hence enhancements and expansions of these leadership roles remained stagnant. A clearly defined policy on leadership roles for nurse managers should be developed.

Leadership and Management Competencies for Hospital Managers: A Systematic Review and Best-Fit Framework Synthesis

OBJECTIVE

Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system. To improve their management competence, understanding of management competency requirements is important. The purpose of this study was to synthesize the evidence related to the leadership and management competencies in healthcare organizations through the best-fit method.

METHODS

A systematic review of literature published between 2000 and 2020 was performed to identify studies focusing on confirming and/or identifying the competency requirements of hospital managers. The best-fit framework synthesis method was used to map the identified competencies and associated behavioral items against the validated management competency assessment program (MCAP) management competency framework.

RESULTS

Twelve studies were identified for inclusion in the review. The mapping of the identified competencies and behavioral items generated a competency model for hospital managers that can apply for different healthcare context. The new competency model includes the following seven core leadership and management competencies: evidence-informed decision-making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism.

CONCLUSION

This review and the mapping of the competencies identified in previous studies against the validated MCAP framework has resulted in the recommendation for an extended leadership and management competency framework for health service managers. It provides guidance for the formulation of training and development directions for the health service management workforce in a different healthcare context.

Nurse managers in perioperative settings and their reasons for remaining in their jobs: A qualitative study

AIM

The study describes what helps nurse managers maintain the strength to keep going as leaders.

BACKGROUND

Good leadership is important for the quality of patient care, patient satisfaction in care and efficiency. Many nurse managers stay on despite challenges at work.

METHODS

Twelve nurse managers were interviewed. Data were analysed by systematic text condensation according to Malterud.

RESULTS

The results were as follows: A-Walking side by side with my employees; B-Knowing that I mean something to my employees; C-Talking to myself-asking myself tough questions; D-Having someone to talk to, to decrease the feeling of being alone; E-Leading and managing in my own way-the fear of not succeeding is my motivation.

CONCLUSION

The nurse managers built their own strategies to get through and get on when difficult situations arose. In order to succeed in leading their employees, the nurse managers gathered their inner strength through moving caritatively back and forth between the 'secret room' and the 'staff room' in the house of leadership.

IMPLICATIONS IN NURSING MANAGEMENT

The manuscript gives insights into where nurse managers found sources of strengths in their everyday work. To realize their employees' strengths and motivation made a difference for nurse managers as a driving force. By having someone to talk to and by asking themselves tough questions, they were prepared for the challenges that came.

Diversity Management as a Tool for Sustainable Development of Health Care Facilities

Organizations providing health services are often criticized because of inadequate and unsuitable management processes or procedures. Today’s challenge is focused on effective management and leadership skills in the area of health care. The aim of the research is to describe, analyze, and evaluate the current state of diversity management in details in the context of human resources management in the selected healthcare facilities. The source of the information was a questionnaire survey. The sample consists of 181 managers from various health care and health service organizations. The method of analysis of variance (ANOVA) was used for data processing. The results were processed in SPSS and Excel programs. Pearson’s coefficient was used to evaluate the cross-correlation of the variables. The level of significance was 5% on both sides. Basic awareness of diversity management in the healthcare facilities is low. Some tools of diversity management are used, but only in isolation, non-conceptually, and unsystematically. The acknowledgment of diversity concept is poor and chaotic. The basic models of this concept defining its goals, activities, programs, responsibilities, and measurements are not known. One of the strong areas of the diversity management in the healthcare facilities is the diversity of working teams. On other hand, the weak side is the diversity as part of the organization culture and diversity as a part of human resource management. The summarizing index Attitudes towards Diversity received a higher average value than the Diversity Management Implementation index. Significant variables influencing the level of aggregate indices were identified: Ownership, size of the organization in terms of number of employees, patients’ satisfaction, and employees’ satisfaction.

Efforts to reduce the length of stay in a low-intensity ICU: Changes in the ICU brought about by collaboration between Certified Nurse Specialists as head nurses and intensivists

Certified Nurse Specialists (CNS) are advanced practice nurses that often play a role in management. This study aims to investigate whether cooperation between CNSs in the position of Intensive Care Unit (ICU) head nurse and intensivists change the length of stay for ICU patients. A single centered retrospective cohort study design was followed. A multivariable regression analysis was performed to determine whether there is a difference in patients’ length of ICU stay for two years before and after CNS as ICU head nurse and an intensivist started collaborating. The patients’ diagnosis, age, gender, scheduled/emergency admission, surgical history, length of ICU stay, usage of ventilator, and details of ICU treatment were collected from the institution’s electronic medical records. During the study period (April 2015 to March 2019), 3,135 patients were admitted to ICU, with 1,471 in the before collaboration group and 1,664 in the after-collaboration group. Collaboration between the CNS as head nurse and intensivists was significantly associated with shorter length of ICU stay (coefficient -0.03 [95% CI, -0.05–0.01], p < 0.001, t-statistic -3.29). Our main finding illustrates that in low-intensity ICUs, collaboration between CNSs as head nurses and intensivists may reduce patients’ length of ICU stay.

Impact of having a certified nurse specialist in critical care nursing as head nurse on ICU patient outcomes

Objectives

This study evaluated the impact of the presence of a certified nurse specialist in critical care (CNS) as ICU head nurse in an open ICU on clinical outcomes.

Methods

The presence of a CNS as ICU head nurse was implemented in practice in April 2017. To evaluate the impact on patient outcomes before and after the implementation, patients were divided into two groups: before (April 2014 to March 2017; 1988 patients) and after (April 2017 to March 2019; 1664 patients). Patients’ demographic data were collected from the ICU database.

Results

Multivariable logistic regression analysis revealed that the presence of a CNS as ICU head nurse was associated with lower ICU mortality (odds ratio (OR): 0.52, 95% CI: 0.36–0.73, p < .001) and fewer patients receiving mechanical ventilation in the ICU (OR: 0.20, 95% CI: 0.15–0.26, p < .001).

Conclusion

CNSs are defined as one type of advanced practice nurses. Having a CNS as a head nurse in the ICU may have helped improve patient outcomes by leveraging these practical skills in nursing management.

Stressful Factors in the Working Environment, Lack of Adequate Sleep, and Musculoskeletal Pain among Nursing Unit Managers

Background: Middle managers have not received enough attention within the healthcare field, and little is known how stressful factors in their work environment coupled with a lack of adequate sleep are related to musculoskeletal pain. The aim of this study was to examine the correlation between stressful factors in the work environment, lack of adequate sleep, and pain/discomfort in three body areas. Methods: Questionnaire was sent electronically to all female nursing unit managers (NUM) in Iceland through the outcome-survey system. The response rate was 80.9%. Results: NUM who had high pain/discomfort in the neck area also had very high pain/discomfort in the shoulder area and pain in the lower back. The results also revealed positive a medium-strong correlation between mental and physical exhaustion at the end of the workday and musculoskeletal pain. Stress in daily work, mental strain at work, and being under time-pressures had hardly any correlation with pain/discomfort in the three body parts. Adequate sleep had a significant negative correlation with all stressful factors in the work environment and all three body parts under review. Conclusion: The results will hopefully lead to a better consideration of stressful factors in the work environment, sleep, and musculoskeletal pain in middle managers.

Are hospital managers ready for value-based healthcare?

Purpose

Hospital organisations are currently experiencing significant challenges that have encouraged a move towards a value-based approach to health care. However, such a transition requires understanding the underlying competencies required to enable such a focus. This paper aims to undertake a systematic review of the available literature on managerial competencies in hospitals and considers these in a value-based health-care context.

Design/methodology/approach

A systematic literature review was conducted to identify research studies that describe the characteristics of management competence in hospital environments.

Findings

Categories and sub-categories of management competence in hospitals were identified and considered in a value-based health-care context.

Research limitations/implications

The systematic literature review identifies a need for further research regarding managerial competencies of managers of hospitals. Competencies for managing in a value-based health-care model also require deeper investigation.

Practical implications

The categories of management competence provide guidance to organisations transitioning towards value-based health care in terms of identifying and developing management competencies. Hospitals should consider the development of a competency model that includes broader categories of competencies than purely clinical or professional competencies.

Originality/value

This study builds upon and advances previous reviews of management competence in hospitals, and the competency categories presented can be used as a basis to identify management competency requirements in hospitals.

Understanding how nurse managers see their role in supporting ICU nurse well-being-A case study

AIM

To explore how nurse managers perceive and experience their role in supporting the well-being of intensive care nurses.

BACKGROUND

While it is known that nurse manager behaviours affect nurse well-being, literature indicates that intensive care nurses may not receive the support they require. Understanding how nurse managers see their role in supporting nurse well-being is crucial to offer recommendations for improvement.

METHODS

Qualitative multiple case study design. Twelve semi-structured, in-depth interviews were conducted with nurse managers from Australian intensive care unit settings. Data were analysed using thematic analysis.

RESULTS

Nurse manages felt unsure about what their supportive role involved, lacked training on how to support nurse well-being and called for organisational backup to carry out their role effectively. The study also provided insight into the strategies that enabled nurse managers to support nurse well-being.

CONCLUSION

There is currently no consensus on the role of the nurse manager in supporting nurse well-being resulting in inconsistencies and wide practice variations. Furthermore, nurse managers need support and training if they are required to support nurse well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

A clear definition of the nurse manager supportive role describing the purpose and core functions involved in this role must be developed to support nurse well-being.

The nurse manager's role in perioperative settings: An integrative literature review

AIM

To describe the nurse manager's role in perioperative settings.

BACKGROUND

The nurse manager's role is complex and its content unclear. Research in this area is scarce. We need to better understand what this role is to support the nurse manager's work and decision-making with information systems.

EVALUATION

An integrative literature review was conducted in May 2018. Databases CINAHL, Cochrane, PubMed and Web of Science were used together with a manual search. The review followed a framework especially designed for integrative reviews. Quality of the literature was analysed with an assessment tool. Nine studies published between 2001 and 2016 were included in the final review.

KEY ISSUE

The findings from the review indicate that the nurse manager's role requires education and experience, and manifests in skills and tasks. A bachelor's degree with perioperative specialisation is the minimum educational requirement for a nurse manager.

CONCLUSION

Research lacks a clear description of the nurse manager's role in perioperative settings. However, the role evolves by education. More education provides advanced skills and, thereby, more demanding tasks. Information technology could provide useful support for task management.

IMPLICATIONS FOR NURSING MANAGEMENT

These findings can be used to better answer the current and future demands of the nurse manager's work.

Facilitating a change model in age-friendly hospital certification: Strategies and effects

The ageing population is a powerful and transformative demographic force. The World Health Organization (WHO) has encouraged the development of an age-friendly hospital (AFH) network. However, no specific implementation strategies or best practices of AFH standards have been produced. This study sought to apply Kotter's change model to the elements included in a successful AFH certification process and to evaluate the changes in employees' knowledge of ageing and their attitudes toward the elderly. This was an observational study that utilized a pre- and posttest design, before and after an age-friendly hospital certification process was implemented. Participants were 163 hospital employees in Taiwan, who completed both pre- and postquestionnaires. The self-administered online questionnaire consisted of three sections: The Facts on Ageing Quiz, the Geriatric Attitudes Scale, and a demographic questionnaire. Following introduction of the intervention, the change process began, and later Kotter's model was brought in as a descriptive framework. The results showed that Kotter's eight-step framework is a good choice for thinking about how to change practice and make healthcare more age-friendly. Employee knowledge of ageing and their attitudes toward the elderly improved after this certification process. Appointing a chief executive officer, forming a steering committee, obtaining interdepartmental and interdisciplinary cooperation, and "soliciting support" for new policies from all employees, were identified as key factors influencing the success of age-friendly hospital (AFH) certification. This is the first study to apply Kotter's eight-step framework of organizational change to an AFH certification process.

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.

Examining Variation in Mental Models of Influence and Leadership Among Nursing Leaders and Direct Care Nurses

This study explored similarities and differences in the views on team membership and leadership held by nurses in formal unit leadership positions and direct care nurses. We used a mixed-methods approach and a maximum variance sampling strategy, sampling from units with both high and low safety behaviors and safety culture scores. We identified several key differences in mental models of care team membership and leadership between formal leaders and direct care nurses that warrant further exploration.

The Role of the Registered Nurse Working in Substance Use Disorder Treatment: A Hermeneutic Study

Substance Use Disorders (SUDs) are a national public health crisis. However, there is minimal existing research literature on the role of the nurse working in SUD treatment. The purpose of this study was to describe the meaning of the professional role of the registered nurse working in the SUD setting. The study utilized a Heideggerian Phenomenological approach with a modified Colaizzi method for analysis and interpretation. The nine study participants, two males and seven females, aged 27-60 had worked in SUD treatment for 1-37 years. Three major themes, with sub-themes, emerged: Defining the Role for Self; Learning the Role; and Navigating with Ease in an Unchangeable Culture. Findings demonstrated that nurses in SUD treatment value their role and the care of patients with SUDs. Patient recovery or relapse influenced job satisfaction. Significantly, the findings highlighted an outdated role with rigid boundaries and no real contemporary identity. Findings can be used to address the need for a contemporary SUD nursing identity and to support ongoing involvement of nurses in health policy related to SUDs.

HUMAN RESOURCES AND INNOVATIVE BEHAVIOUR: IMPROVING NURSING PERFORMANCE

This study examines, using the social exchange theory, the mediating effect of employees’ perception of wellbeing on the relationship between two human resource (HR) management factors (satisfaction with teamwork and satisfaction with training opportunities) and innovative behaviour of nurses working in Australian public and private hospitals. Current nurse shortages and limited budgets have increased the need for hospitals to improve their efficiency and cost-effectiveness. It is proposed that fostering innovative behaviour is one way that hospitals can improve the efficiency and effectiveness of nurses. A cross-sectional self-report survey was completed by 220 nurses working within Australian hospitals. The results show that an employee’s perception of their wellbeing completely mediated the relationship between satisfaction with training opportunities and their innovative behaviour and partially mediated the relationship between satisfaction with teamwork and innovative behaviour. The findings shed new light on how HR management factors can foster innovative behaviour. The results raise new implications for managers seeking to stimulate innovative behaviour, highlighting the importance of cultivating an organisational environment conducive to positive perceptions of wellbeing.

International Nursing: Nurse Managers' Leadership and Management Competencies Assessed by Nursing Personnel in a Finnish Hospital

The aim of this research was to describe nurse managers' leadership and management competencies (NMLMC) from the perspective of nursing personnel. Nurse managers are responsible for the management of the largest professional group in social and health care. The assessment of NMLMC is needed because of their powerful influence on organizational effectiveness. An electronic survey was conducted among the nursing personnel (n = 166) of 1 Finnish hospital in spring 2016. Nursing personnel assessed their manager using a NMLMC scale consisting of general and special competences. The data were statistically analyzed. Leadership and management competencies were assessed as being quite good by the nursing personnel. The best-assessed area of general competence was professional competence and credibility and the weakest was service initiation and innovation. The best-assessed area of special competence was substance knowledge and the weakest was research and development. The nursing personnel's assessment of their nurse manger's competencies was associated with the personnel's education level, working experience, and with their knowledge of the manager's education. Conclusion was made that nursing personnel highly value professional competence as part of nursing leadership and management. To achieve more appreciation, nurse managers have to demonstrate their education and competence. They must also work in more open and versatile ways with their nursing personnel.

Factors that influence influenza vaccination rates among the elderly: nurses' perspectives

AIMS

To explore which factors nurses perceive to help and hinder influenza vaccination rates among the elderly.

BACKGROUND

Influenza-related illnesses and deaths have disproportionately high prevalence among the elderly. Vaccination is an effective tool to prevent complications.

METHODS

Semistructured interviews were conducted with nurses focusing on barriers, facilitators and health care providers' roles in influencing patients to be vaccinated. Interviews were recorded, transcribed and thematically analysed.

RESULTS

Nurses identified that the prevalent barriers were fear of the vaccine's side effects, feelings of good health and technical considerations. Facilitators included ease of access and encouragement from health providers, media and social networks. The health care team was influential in raising vaccination rates through direct recommendation, providing concrete information or leading by example.

CONCLUSIONS

The health care team can influence patients to vaccinate. Investments in training nurses in the knowledge and skills needed to educate patients, and providing nurses with the necessary resources to engage patients in these discussions may be beneficial. Nurse managers can be instrumental in enhancing nurses' roles and actions to increase influenza vaccination rates among the elderly.

IMPLICATIONS FOR NURSING MANAGEMENT

It is essential to reinforce the nurses' role in promoting vaccination among seniors. Given that nurses are the largest number of health professionals, their potential outreach to large numbers of people is strong.