Paths to nursing leadership

The clinical learning environment, supervision and future intention to work as a nurse in nursing students: a cross-sectional and descriptive study

BACKGROUND

Clinical practice is a core component of nurse education. It is believed that nursing students' clinical placement experiences can affect their learning outcomes, satisfaction, as well as influence their choice of future career. To examine nursing students' perception of clinical learning environment and mentoring in hospital where they perform their clinical placement and the connection of these factor with intention to work as a nurse once graduated.

METHODS

Nursing students enrolled in clinical practice at least 6 months in hospitals in China were surveyed between January-March 2021. Percentages, frequencies, mean, standard deviation, t-test, ANOVA, and regression analysis were used to analyse the data.

RESULTS

Of the five scales in the CLES+T, 'Leadership style of the ward manager' scored the highest mean while 'Pedagogical atmosphere at the ward' scored the lowest. Nursing students with lower educational level, those supervised by fixed preceptor, and those intent to be a nurse in the future were significantly more satisfied with the CLES+T. Most of the nursing students are intent to work as a nurse in the future. CLES+T total scores and sub-dimensions (Premises of nursing on the ward) have significantly effectiveness on the intention to be a nurse in the future.

CONCLUSIONS

Given the significant correlation of between learning environments and nursing students intention to be a nurse in the future, ward managers need to build a good clinical teaching atmosphere and promote opportunities for theoretical and practical connections among students through effective feedback mechanisms, which can enable students to experience a better clinical learning environment and meaningful experiences to build their professional roles and competencies, thus helping to enhance students' willingness to pursue nursing careers in the future.

Redefining nursing solidarity

The idea of solidarity is in vogue, especially since the eruption of the COVID-19 pandemic. However, the term "solidarity," as used in nursing, is imprecise and vague, lacking clear definition and connoting a variety of general meanings. Based on the original meaning of "solidarity" in ancient Roman law, this article captures the archetypical idea of solidarity from a historical and interdisciplinary perspective. This archetypical or primary meaning comes before the development of any other meanings of the word, and it is therefore authentic and genuine because it does not derive from something else. After establishing the archetypical meaning of solidarity, the article translates this meaning into the area of nursing and demonstrates a deep connectivity between healthcare and solidarity. The second part of the article offers and develops a new definition of nursing solidarity as the responsibility for the healthcare of a person (unit) shared as a whole (entirety) by that person and a nurse or a nursing team (plurality). This new definition has some implications for nursing practice and education, since the definition emphasizes the idea that solidarity helps to (a) foster respect and avoid discrimination, (b) promote cohesion in health communities, (c) increase individual responsibility and a spirit of service, (d) stimulate motivation, (e) improve communication, (f) create an engaging workplace, and (g) develop leadership.

The factors influencing the innovative performance of leaders in nurses' professional: a developing country perspective

PURPOSE

The health-care services in Iraq currently face many challenges. The most noted is the lack of effective nursing leaders to meet the growing needs of the health-care services. Effective nursing leadership is critical to the health-care system, affecting work performance, quality of care and staff satisfaction. The literature suggests that nursing leaders in Iraq are not adequately trained to provide leadership to improve the nursing profession and have limited involvement in decision-making. The purpose of this study is to explore the views of nurses on what they believe constitutes effective leadership in Iraq.

DESIGN/METHODOLOGY/APPROACH

A qualitative methods approach is used involving 20 semi-structured interviews of senior nurses. The sample of nurses came from two large general hospitals in Iraq. The qualitative data was thematically analyzed and interpreted.

FINDINGS

The study results indicated that there were factors that influence the performance of nurse leader, namely, excessive workload, personal relationship with nursing staff, professional recognition of nursing and selection criteria of leaders. Test results show that there were significant differences in views of the nurses toward nurse leaders' performance. This research concludes that the nurse leader performance in developing countries is affected by excessive workload, personal relationship with nursing staff, professional recognition of nursing and selection criteria of leaders.

ORIGINALITY/VALUE

The relevance of the study stems from the scarcity of research on the leader performance in developing countries, while studies on the factors influencing the innovative performance of leaders in nurses' professional are significantly limited. This study is one of the earliest studies that investigate these factors influencing the nurse leader's performance.

Just a leader? Leadership work challenges and identity contradiction experienced by Finnish physician leaders

Purpose

This study seeks to improve the understanding of physician leaders' leadership work challenges.

Design/methodology/approach

The subjects of the empirical study were physician leaders ( n  = 23) in the largest central hospital in Finland.

Findings

A total of five largely identity-related, partially paradoxical dilemmas appeared regarding why working as “just a leader” is challenging for physician leaders. First, the dilemma of identity ambiguity between being a physician and a leader. Second, the dilemma of balancing the expected commitment to clinical patient work by various stakeholders and that of physician leadership work. Third, the dilemma of being able to compensate for leadership skill shortcomings by excelling in clinical skills, encouraging physician leaders to commit to patient work. Fourth, the dilemma of “medic discourse”, that is, downplaying leadership work as “non-patient work”, making it inferior to patient work. Fifth, the dilemma of a perceived ethical obligation to commit to patient work even if the physician leadership work would be a full-time job. The first two issues support the findings of earlier research, while the remaining three emerging from the authors’ analysis are novel.

Practical implications

The authors list some of the practical implications that follow from this study and which could help solve some of the challenges.

Originality/value

This study explores physician leaders' leadership work challenges using authentic physician leader data in a context where no prior empirical research has been carried out.

Nursing and Midwifery Students' Satisfaction with Their Clinical Rotation Experience: The Role of the Clinical Learning Environment

BACKGROUND

The clinical learning environment and clinical rotation experience of students are integral to nursing curriculum and are a crucial component of nursing education which helps transform theoretical knowledge to clinical practical skills.

OBJECTIVE

This study was aimed at assessing the role of the clinical learning environment on undergraduate nursing and midwifery students' satisfaction with their clinical rotation experience.

METHOD

The study employed a quantitative cross-sectional survey design. Data was collected from a sample of 240 undergraduate nursing and midwifery students of the University for Development Studies, Tamale, Ghana, using a structured questionnaire. Ethical approval was obtained from the University of Cape Coast Ethics Review Board. Descriptive analysis was displayed as frequencies and percentages. Inferentially, Fisher's exact test, linear regression, and Spearman's correlation tests were used to test for and quantify associations between independent and dependent variables at p ≤ 0.05.

RESULTS

The level of students' satisfaction with both clinical rotation experience and the clinical learning environment was high (65.6% and 63.5%, respectively). A statistically significant association of the students' satisfaction with their clinical rotation experience was found. There was a statistically significant relationship between the clinical learning environment (χ 2 (9, N = 224) = 80.665, p < 0.001), pedagogical atmosphere in the clinical area (r s  = 0.379, p < 0.001), the leadership style of the ward manager (r s  = 0.340, p < 0.001), the premises of nursing in the ward environment (r s  = 0.501, p < 0.001), and the students' satisfaction with their clinical rotation experience.

CONCLUSION

These findings provide nurse educators and clinicians with meaningful understanding about areas to prioritise when planning clinical learning opportunities in such a way that skills learning and practice of nursing skills are successful and satisfactory for undergraduate student nurses and midwives.

First-Line Nurse Managers' Challenges at the Crossroads of Norwegian Health Care Reforms

Norwegian municipal health care has large public service offerings, funded by tax revenues; however, the current Norwegian welfare model is not perceived as sustainable and future-oriented. First-line nurse managers in Norwegian municipal health care are challenged by changes due to major political and government-initiated reforms requiring expanded utilization of home nursing. The aim of this theoretical study was to describe challenges the first-line nurse managers in a Nordic welfare country have encountered on the basis of government-initiated reforms and to describe strategies to maintain their responsibilities in nursing care. First-line nurse managers' competence, clinical presence, and support from superiors were identified as prerequisites to maintain sight of the patients in leadership when reforms are implemented. The strategies first-line nurse managers in Norwegian municipal health care use to implement multiple reforms, regulations, and new acts require solid competencies in nursing, leadership, and administration. Competence in nursing enables focus on the patient while leading the staff. Supports from superiors and formal leadership networks are described as prerequisites for managing the challenges posed by change and to persist in leadership positions.

Emotional intelligence, gender and transformational leadership among nurses in emerging economies

PURPOSE

In spite of the observation that nurse managers' style of authority in sub-Saharan Africa is one of antagonistic vibe and lordship, there is not much information on the kind of leadership provided in the hospitals by nurse managers. Following the notion that transformational leadership is a solution to many leadership problems and often creates valuable positive change in followers, this study aims to examine the level of transformational leadership behavior of nurse leaders; determining the effects of the sub-constructs of emotional intelligence (EI) on the transformational leadership behavior of leaders; and determining whether there is a difference in the exhibition of transformational leadership behavior due to the gender of leaders.

DESIGN/METHODOLOGY/APPROACH

The study uses five of the major public hospitals in the Greater Accra Region (the capital) of Ghana. Evidence of such links would be considerable for Ghanaian healthcare providers in their quest to find potential nurse leaders to train, so as not to dwell highly on the seniority criterion in the selection of leaders. Using a quantitative approach, the Wong Law EI Scale (2002) and leadership items adapted from Rafferty and Griffin (2004) were used to collect the data. A descriptive statistics (mean) revealed that nurse leaders from the selected hospitals exhibited a high level (M= 3.90, SD = 0.14) of transformational leadership behavior.

FINDINGS

A multiple regression analysis revealed that three of the sub-constructs of EI significantly affected transformational leadership with the "self-emotion appraisal" construct having the strongest effect on transformational leadership behavior (β = 0.508, p = 0.000). However, the others' emotion appraisal sub-construct did not significantly affect transformational leadership. Furthermore, the results from the independent sample t-test revealed no significant difference in the exhibition of transformational leadership due to gender.

PRACTICAL IMPLICATIONS

Based on the findings, when leaders are trained to be emotionally intelligent and their skills are fostered, they are more likely to exhibit transformational leadership behaviors, which will further result in organizational effectiveness and follower satisfaction. Hospitals must focus on the control of one's emotions at work, and subsequently, understanding others' emotions. In developing transformational leaders, there is the need to identify some tools that will increase EI level, more specifically, traits related to the understanding of others' emotion. The findings from this study indicate that one of the factors to check when selecting nurse leaders should be their EI and not necessarily a matter of seniority in many cases in emerging economies.

ORIGINALITY/VALUE

The originality of this study is in the fact that it focuses on an emerging economy, which is under researched. In Ghana, the criteria for promotion of nurse leaders' is based strictly on seniority and age and not on factors such as the leaders EI. The profession of nursing is such that leaders need to understand that certain soft skills such as EI are considered necessary to transform the hospitals and staff they lead. This study, therefore, sheds light on these key areas from the perspective of an emerging economy, which are usually not in the domain of literature in the area of healthcare leadership.

Challenges in municipality healthcare services-The nurse leaders' perspective

AIM

To examine perceptions of key challenges that nursing leadership face when organizing healthcare services in the municipality.

DESIGN

A qualitative study involving community nurse leaders (N = 9) in two focus group interviews.

METHODS

The material has been processed and interpreted in accordance with the phenomenological-hermeneutical tradition, and this process was inspired by Graneheim and Lundman.

RESULTS

Three themes were identified in this study: (a) Tension between organizing the daily work and future challenges; (b) Challenges with recruiting enough registered nurse (RNs) in municipal healthcare services; and (c) Competence development plan-a strategic tool for nursing leadership. The municipal healthcare services need a better knowledge base with better knowledge of both the content and quality of services, organization, leadership and management, thus improving new forms of work and professional approaches.

Making a career in hospitals: Determinants of registered nurses' aspirations to become a manager

AIM

To examine seven determinants of Registered Nurses' aspirations to become a manager in four Norwegian public hospitals.

BACKGROUND

Research evidence shows that nurses submit few applications to management positions. Understanding the determinants that influence nurses' aspirations to become managers can provide healthcare organizations with important knowledge on the drivers and barriers in recruitment and on the development of nurse managers.

DESIGN

This study adopted a cross-sectional web-based survey design.

METHOD

Logistic regression analysis based on 2,630 Registered Nurses' responses to a self-completion survey in a Norwegian regional health authority collected during October 2014. The overall response rate was 40%.

RESULTS

Findings indicate that men and younger nurses are most likely to report an aspiration in management. The social support of an immediate supervisor and institutional stress are positively associated with an aspiration to become a manager; however, high experienced workloads have the opposite effect.

CONCLUSION

Healthcare organizations should work strategically to develop a human resource management policy that ensures that the organization develops the nurse managers it needs now and in the future.

IMPACT

This study addresses the challenge of having enough qualified nurse managers. The main findings indicate that job demands can have both a negative and positive impact on nurses' aspirations to become a manager. Healthcare organizations should, however, reduce demands and consider increasing job resources. The results should have an impact on the human resource department, managers, and other key personnel in healthcare organizations.

International Nursing: Caring in Nursing Leadership-A Meta-ethnography From the Nurse Leader's Perspective

To explore and derive new conceptual understanding of nurse leaders' experiences and perceptions of caring in nursing.

RESEARCH QUESTION

What is caring in nursing leadership from the nurse leaders' perspectives? There is a paucity of theoretical studies of caring in nursing leadership. Noblit and Hares interpretative meta-ethnography was chosen because of its interpretative potential for theory development. Caring in nursing leadership is a conscious movement between different "rooms" in the leader's "house" of leadership. This emerged as the metaphor that illustrates the core of caring in nursing leadership, presented in a tentative model. There are 5 relation-based rooms: The "patient room," where nurse leaders try to avoid patient suffering through their clinical presence; the "staff room," where nurse leaders trust and respect each other and facilitate dialogue; the "superior's room," where nurse leaders confirm peer relationships; the "secret room," where the leaders' strength to hang on and persist is nurtured; and the "organizational room," where limited resources are continuously being balanced. Caring in nursing leadership means nurturing and growing relationships to safeguard the best nursing care. This presupposes that leaders possess a consciousness of the different "rooms." If rooms are not given equal attention, movement stops, symbolizing that caring in leadership stops as well. One room cannot be given so much attention that others are neglected. Leaders need solid competence in nursing leadership to balance multiple demands in organizations; otherwise, their perceptiveness and the priority of "ministering to the patients" can be blurred.

Nursing leadership in Ireland: experiences and obstacles

PURPOSE

This paper aims to investigate nurses' experiences of leadership within health care in the Republic of Ireland.

DESIGN/METHODOLOGY/APPROACH

This mainly qualitative study made use of a mail survey sent to a random national selection of registered nurses. Participants were asked to provide narrative descriptors of good nursing leadership and identify obstacles to such leadership.

FINDINGS

Participants mainly provided examples of nursing leadership within a hierarchical context (concentrated leadership), such as meeting organisational goals and decision-making. While elements of distributed leadership were mentioned (good communication, providing help and support), they were mainly described as part of formal management roles, rather than leadership. Observed obstacles to developing nursing leadership included high workload, lack of support from management and peers, limited opportunities to gain experience, lack of education/training and poor work environments.

RESEARCH LIMITATIONS/IMPLICATIONS

The small sample (n = 72) limits generalisation. A wider interdisciplinary effort to address experiences with nursing leadership in Ireland may be needed to inform health services of the issues from a broader perspective.

PRACTICAL IMPLICATIONS

The findings suggest that development of nursing leadership in Ireland may still be in its infancy, and that several obstacles need to be overcome.

ORIGINALITY/VALUE

Very few studies have addressed narratives from nurses regarding personal experiences with nursing leadership. The examples provided by participants have yielded significant insight into the issues they encounter, which are reflective of health care elsewhere.

Self-organizing Development Teams for Innovative Nursing Care

The purpose of this study was to describe the participation of nurses and nurse leaders in self-organizing teams formed to develop innovative nursing care. The theoretical perspective combines Bondas' caritative theory on nursing leadership with Waterman's and Dolan's work on ad hoc organizations. Seven self-organizing teams participated in a 2-year action research project. Data were collected through fieldwork, formal and informal individual and group interviews, and diaries. Analytical abstraction methodology described by Miles et al was used. The metaphor "overcoming the jet lag of bureaucracy" is based on 5 themes: struggling to design the new team; investing time and self; needing research and leadership support; evolving collegial collaboration, professional growth, and pride; and growing professional security and the will to continue education as a result of learning.

Role of nursing leadership in providing compassionate care

This article encourages nurses to explore the concept of leadership in the constantly changing field of health and social care. All nurses have an important role in leadership, and they should consider what type of leader they want to be and what leadership skills they might wish to develop. This article examines what leadership might involve, exploring various leadership styles and characteristics and how these could be applied in nurses' practice. A core component of nursing and nursing leadership is the ability to provide compassionate care. This could correspond with the idea of servant leadership, an approach that moves the leader from a position of power to serving the team and supporting individuals to develop their potential.

Nurses' leadership self-efficacy, motivation, and career aspirations

Purpose This paper aims to test a model examining precursors and outcomes of nurses' leadership self-efficacy, and their aspirations to management positions. Design/methodology/approach A cross-sectional survey of 727 registered nurses across Canada was conducted. Structural equation modelling using Mplus was used to analyse the data. Findings Results supported the hypothesized model: χ²(312) = 949.393; CFI = 0.927; TLI = 0.919; RMSEA = 0.053 (0.049-0.057); SRMR 0.044. Skill development opportunities ( ß = 0.20), temporary management roles ( ß = 0.12) and informal mentoring ( ß = 0.11) were significantly related to nurses' leadership self-efficacy, which significantly influenced motivation to lead ( ß = 0.77) and leadership career aspirations ( ß = 0.23). Motivation to lead was significantly related to leadership career aspirations ( ß = 0.50). Practical implications Nurses' leadership self-efficacy is an important determinant of their motivation and intention to pursue a leadership career. Results suggest that nurses' leadership self-efficacy can be influenced by providing opportunities for leadership mastery experiences and mentorship support. Leadership succession planning should include strategies to enhance nurses' leadership self-efficacy and increase front-line nurses' interest in leadership roles. Originality value With an aging nurse leader workforce, it is important to understand factors influencing nurses' leadership aspirations to develop and sustain nursing leadership capacity. This research study makes an important contribution to the nursing literature by showing that nurses' leadership self-efficacy appears to be an important determinant of their motivation to lead and desire to pursue a career as a nurse leader.

The development of a talent management framework for the private sector

Orientation: Talent management is a strategic priority especially for profit-generating organisations in the private sector. Limited research has been conducted on the theoretical development of talent management. The need for talent management is also triggered by a need to align and integrate people management practices with those of the organisation in order to achieve strategic execution and operational excellence.Research purpose: The primary aim of the study was to develop a talent management framework for the private sector. The research proposed to conduct an in-depth exploration of talent management practices in key and leading organisations already in the mature stages of talent management implementation in South Africa.Motivation of the study: There is a need for the development of best practices in talent management – where talent management strategy is designed to deliver corporate and human resource management strategies. The formal talent management initiative would be linked to the human resources management function and will flow vertically from the corporate strategy-making process.Research approach, design and method: The modernist qualitative research approach was applied to the study. Data were collected through semi-structured interviews (18 persons were interviewed in total). Analytical induction method was instrumental in facilitating the overall data analysis, while constructivist grounded theory assisted with the operationalisation of the data analysis.Main findings: The study has mapped out key dimensions which are essential for the implementation of talent management. The dimensions of talent management are attraction, sourcing and recruitment, deployment and transitioning, growth and development, performance management, talent reviews, rewarding and recognising, engagement and retention. With each of the above-mentioned dimensions, the activities that are to be carried out to achieve the outcome of each dimension are specified.Practical and managerial implications: Role clarifications pertaining to talent management responsibilities and accountabilities are still unclear in most instances. Early identification of key role players and articulation of duties will lead to ownership and clear accountabilities for the successful implementation of talent management.Contribution/value add: The study brought to light critical factors for organisations in the private sector to consider for the successful implementation of an integrated, holistic and comprehensive talent management framework. The proposed framework guides talent management practices within companies in the private sector by highlighting activities to be carried out to achieve outcomes per talent management dimension.

Turbulent Atmosphere-Based Dominant Management Behavior of the Head Nurses in Clinical Wards: A Qualitative Study

Background:

Nursing management is the most important aspect for providing high-quality nursing care. Therefore, skillful nursing managers, such as head nurses, are required to accomplish this goal. High-quality nursing care is one of the most important principles of health organizations to ensure society’s health.

Objectives:

The goal of the conventional content analysis is to explain the dominant experienced-based behavior of the head nurses in clinical wards.

Materials and Methods:

This study was conducted by applying a quality study approach with a common content analysis model (Granheim and Lundmen). The participants were 25 head nurses who were working in the wards of various hospitals in Zahedan City. They were selected via the purposeful sampling method. The data were collected thoroughly and continued until a saturation stage was reached.

Results:

The result of data analysis was the theme “turbulent atmosphere-based management,” which consists of five categories as follows: the work culture of the ward, job burnout, negligent evaluation, job conflict, and decision making with limited effects.

Conclusions:

The analysis of the findings of the present study through considering the defined categories demonstrated that, to modify and correct the turbulent atmosphere-based management, several important measures are required and need to be continually monitored.

Governance of professional nursing practice in a hospital setting: a mixed methods study

Objective:

to elaborate an interpretative model for the governance of professional nursing practice in a hospital setting.

Method:

a mixed methods study with concurrent triangulation strategy, using data from a cross-sectional study with 106 nurses and a Grounded Theory study with 63 participants. The quantitative data were collected through the Brazilian Nursing Work Index - Revised and underwent descriptive statistical analysis. Qualitative data were obtained from interviews and analyzed through initial, selective and focused coding.

Results:

based on the results obtained with the Brazilian Nursing Work Index - Revised, it is possible to state that nurses perceived that they had autonomy, control over the environment, good relationships with physicians and organizational support for nursing governance. The governance of the professional nursing practice is based on the management of nursing care and services carried out by the nurses. To perform these tasks, nurses aim to get around the constraints of the organizational support and develop management knowledge and skills.

Conclusion:

it is important to reorganize the structures and processes of nursing governance, especially the support provided by the organization for the management practices of nurses.

Professional identity and role transitions in clinical managers

Purpose

– The purpose of this paper is to investigate how clinicians’ professional background influences their transition into the managerial role and identity as clinical managers.

Design/methodology/approach

– The authors interviewed and observed 30 clinicians in managerial positions in Norwegian hospitals.

Findings

– A central finding was that doctors experienced difficulties in reconciling the role as health professional with the role as manager. They maintained a health professional identity and reported to find meaning and satisfaction from clinical work. Doctors also emphasized clinical work as a way of gaining legitimacy and respect from medical colleagues. Nurses recounted a faster and more positive transition into the manager role, and were more fully engaged in the managerial aspects of the role.

Practical implications

– The authors advance that health care organizations need to focus on role, identity and need satisfaction when recruiting and developing clinicians to become clinical managers.

Originality/value

– The study suggests that the inclusion of aspects from identity and need satisfaction literature expands on and enriches the study of clinical managers.

The medical leadership challenge in healthcare is an identity challenge

Purpose

– The purpose of this article is to describe and analyse the identity challenges that physicians with medical leadership positions face.

Design/methodology/approach

– Four qualitative case studies were performed to address the fact that identity is processual, relational and situational. Physicians with managerial roles were interviewed, as well as their peers, supervisors and subordinates. Furthermore, observations were made to understand how different identities are displayed in action.

Findings

– This study illustrates that medical leadership implies identity struggles when physicians have manager positions, because of the different characteristics of the social identities of managers and physicians. Major differences are related between physicians as autonomous individuals in a system and managers as subordinates to the organizational system. There are psychological mechanisms that evoke the physician identity more often than the managerial identity among physicians who are managers, which explains why physicians who are managers tend to remain foremost physicians.

Research limitations/implications

– The implications of the findings, that there are major identity challenges by being both a physician and manager, suggest that managerial physicians might not be the best prerequisite for medical leadership, but instead, cooperative relationships between physicians and non-physician managers might be a less difficult way to support medical leadership.

Practical implications

– Acknowledging and addressing identity challenges can be important both in creating structures in organizations and designing the training for managers in healthcare (both physicians and non-physicians) to support medical leadership.

Originality/value

– Medical leadership is most often related to organizational structure and/or leadership skills, but this paper discusses identity requirements and challenges related to medical leadership.

Dentists' leadership-related perceptions, values, experiences and behavior: results of a national survey

BACKGROUND

The authors developed a survey and administered it to members of the American Dental Association (ADA) to elicit their views on leadership in dentistry, as well as to explore their leadership-related values and evaluation of their effectiveness as leaders, their experiences with leadership-related activities and perceptions of barriers to being a leader. The authors also examined how male and female dentists differed in their leadership-related responses.

METHODS

The authors collected survey data from 593 ADA members (mean age, 51 years; standard deviation, 10.75 years). Seventy-seven percent of respondents were male and 85 percent were European American.

RESULTS

The most frequently reported aspects of leadership were leadership in one's own practice (31 percent), in the profession (26 percent), in the community (14 percent) and in dental organizations (9 percent). The most valued aspects of leadership were being a good leader in one's own practice (mean rating = 4.64 on a five-point scale, with 5 = very important) and having patients perceive them as leaders (mean rating = 4.38). The most frequent past leadership experiences were related to leadership in dental organizations (47 percent), and the most frequent current activities were related to leadership activities in the community (40 percent). Time constraints (46 percent) and family obligations (20 percent) were the biggest barriers to taking on more of a leadership role. According to the survey results, female respondents valued the importance of leadership more highly than did male respondents.

CONCLUSIONS

The results of this survey show that dentists perceive professional leadership as closely related to leadership in their own dental practices and value this type of leadership most highly. However, about 40 percent of respondents reported that they engaged in current leadership activities in their communities, and 32 percent reported doing so in professional organizations. Practical Implications. ADA members who responded to this survey focused primarily on leadership in their own clinical practices. However, substantial numbers of dentists valued leadership activities in their communities and on a state and national level.

Why is tractable vision loss in older people being missed? Qualitative study

BACKGROUND

There is compelling evidence that there is substantial undetected vision loss amongst older people. Early recognition of undetected vision loss and timely referral for treatment might be possible within general practice, but methods of identifying those with unrecognised vision loss and persuading them to take up services that will potentially improve their eyesight and quality of life are not well understood. Population screening does not lead to improved vision in the older population. The aim of this study is to understand why older people with vision loss respond (or not) to their deteriorating eyesight.

METHODS

Focus groups and interviews were carried out with 76 people aged 65 and over from one general practice in London who had taken part in an earlier study of health risk appraisal. An analytic induction approach was used to analyse the data.

RESULTS

Three polarised themes emerged from the groups and interviews. 1) The capacity of individuals to take decisions and act on them effectively versus a collection of factors which acted as obstacles to older people taking care of their eyesight. 2) The belief that prevention is better than cure versus the view that deteriorating vision is an inevitable part of old age. 3) The incongruence between the professionalism and personalised approach of opticians and the commercialisation of their services.

CONCLUSIONS

The reasons why older people may not seek help for deteriorating vision can be explained in a model in which psychological attributes, costs to the individual and judgments about normal ageing interact. Understanding this model may help clinical decision making and health promotion efforts.

Práticas de enfermeiros na gerência do cuidado em enfermagem e saúde: revisão integrativa

Estudo com objetivo de evidenciar e analisar as práticas dos enfermeiros na gerência do cuidado descritas na produção científica brasileira e internacional, por meio de uma revisão integrativa. Foram pesquisados artigos publicados entre 2005 e 2010, nas bases LILACS, SciELO, BDENF e CINAHL, a partir dos descritores Gerência e Administração, associados a Cuidado e Enfermagem, e os termos Nursing Management e Nursing Care, totalizando 27 publicações. A gerência do cuidado realizada pelo enfermeiro relaciona-se diretamente à busca pela qualidade assistencial e de melhores condições de trabalho, por meio de ações como: realização do cuidado, gerência de recursos humanos e materiais, liderança, planejamento da assistência, capacitação da equipe de enfermagem, coordenação da produção do cuidado e avaliação das ações de enfermagem.

Facilitating safe care: a qualitative study of Iranian nurse leaders

Aim  The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background  The health-care system's success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method  A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results  The data analysis resulted in three main themes: 'providing environmental prerequisites for safe nursing practice', 'uniting and integrating health-care providers', and 'creating an atmosphere of safe care'. Conclusion  The results indicate that to facilitate providing safe care, nurse leaders should improve nurses' working conditions, develop the nurses' practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers' professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management  Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.

Care of the old-A matter of ethics, organization and relationships

The world stands on the threshold of a demographic revolution called global ageing. According to the World Health Organization (WHO), the population aged 60 and over is expected to increase from today's 650 million to an estimated 2 billion by 2050. Alongside demographic changes, dramatic changes can also be observed in older people's services. The shift has resulted in reduced government spending on caring for ill and frail older people in health care. Today, many governments have developed strategies to keep older people living well in their private home for as long as possible and have replaced long-term care institutions with residential homes. The aim of this study was to illuminate the meaning of caring for older people as experienced by health care students and professionals working in this field. Interviews were carried out with 17 women and one man, aged 21–65 years; six were Registered Nurses (RN), six were Enrolled Nurses (EN) and six were nursing students. The interviews were analyzed with a phenomenological hermeneutical approach and provided three themes and eight sub-themes: Ethical moral self with sub-themes “meeting the needs of the old”, “pliability towards the old”, and “difficulties in meeting aggressiveness”; Organizational and co-workers ethical moral actions with sub-themes, “co-workers who are offensive”, and “supportive and non-supportive leaders”: The relation with the old persons and their relatives with sub-themes “fellowship and closeness in the relation”, “uncertainty and fear in the relation”, and, “demands from the older persons’ close relatives”.

Nursing leadership in a chronic pain management group approach

AIM

To explore and debate nursing leadership and challenges on organizational and group levels when conducting rehabilitation groups for people suffering from chronic pain.

BACKGROUND

Group approaches based on cognitive behavioural therapy are generally described as effective. Leadership in group approaches offered to people suffering from chronic pain is a great challenge for nurses on an organizational as well as a group level.

METHODS

One overall leader and nine group leaders conducting 13 groups constituted the sample. Qualitative content analysis was used by identifying categories, subthemes and themes.

RESULTS

The results from the content analysis revealed one main theme ('Complexity in nursing leadership') and three subthemes ('Challenges in leadership on organizational level', 'Challenges in leadership on teamwork level' and 'Challenges in leadership on group level'.

CONCLUSIONS

The results show how important it is to have firm overall leadership and trained group leaders with a common purpose, interdependent roles and complementary skills, who are thus well prepared to prevent or deal with challenging group processes.

IMPLICATIONS FOR NURSING MANAGEMENT

The leaders of both levels, which are highly interrelated, should have a current theoretical understanding of pain theory, group leadership skills and a cognitive behavioural approach.

Surviving multiple obligations through stimulation, autonomy, and variation

PURPOSE

Professionals in academic health centers (AMCs) face multiple obligations, such as those from research, teaching and clinical care. The purpose of this study is to explore and develop an understanding about how well findings generated from two previous studies about the influence of multiple obligations on health care personnel fit those within health care associated with academic institutions.

DESIGN/METHODOLOGY/APPROACH

A total of 11 professionals engaged in teaching, research, and clinical work were interviewed. Data from the open-ended interactive interviews were transcribed and compared with findings from the two previous studies, using modified analytic induction.

FINDINGS

Work at an AMC can entail balancing three tasks: research, education, and clinical care. These tasks as well as the different employers associated with them can be a source of conflict. For a group of committed professionals, these conflicts were accepted and balanced as long as they experienced stimulus, autonomy, and variation.

RESEARCH LIMITATIONS/IMPLICATIONS

Modified analytic induction, an uncommon analysis method, is useful for comparing findings from previous studies in another context and with different subjects.

PRACTICAL IMPLICATIONS

Stimulation, autonomy, and variation could play a vital role as driving factors in coping and dealing with the unavoidable presence of multiple obligations in today's health care systems.

ORIGINALITY/VALUE

Although AMCs combine clinical care, research, and teaching, the intersection of all three has in contrast not been investigated so thoroughly at the individual level.

Supporting "two-getherness": assumption for nurse managers working in a shared leadership model

New leadership models are developing; one of them is shared leadership, which is often described at the team level. In this study, shared leadership is explored at the managerial level. The aim of this case study was to describe two nurse manager's experiences of working together as equal partners within a shared leadership model at an intensive care unit in Sweden. The study comprised a total of 12 interviews collected over three years with two nurse managers who worked together in shared leadership. 'Developing active influence to improve care' was identified as the core category, which was related to five subcategories 'Safeguarding leadership', 'Enabling leadership', 'Supporting 'two'-getherness', 'Transparent determination' and 'Balancing power'. A new construct 'two'-getherness' was created, this means that two equal nurse managers within a trustful relationship share responsibility and tasks by using the couples' strengths and minimizing their weaknesses. Nurse managers experienced increased opportunities to improve work standards and do the very best for the ward. Moreover, the shared leadership model balanced the burden of day-to-day management. A model of shared leadership was created for further research.

First- and third-year student nurses’ perceptions of caring behaviours

The aim of this study was to investigate significant differences in the mean scores for the Caring Behaviors Inventory between first-year and third-year nursing students. There were two sample groups: group A comprised 117 first-year nursing students and group B included 49 third-year nursing students (n = 166). All participants were from one Slovenian university. Data were collected by questionnaire and ana- lysed using SPSS v. 17.0. Independent sample t-tests were used for the comparison of means for each item in both groups. The results showed that the students in group B (third year) often agreed more significantly with Caring Behaviors Inventory items than the students in group A (first year). Principles of right action indicate how nurses must behave in order to provide good nursing care. Nursing educators can prepare students through demonstrations of their own behaviour in practice

Developing practice in mental health settings

If practice development (PD) is to be implemented in diverse mental health-care settings, it is important that managers, researchers, and policy makers are all clear about the nature of the processes involved. The authors draw on the literature to broadly set out local strategies, practicalities, and issues that should be considered and addressed by those planning to undertake PD projects in mental health. Before implementing PD projects, pre-existing requirements should be recognized and expedited. All aspects of who does what, when, and how should be widely communicated so that continuous evaluation and improvements are generated. Staff need to be adult learners, be aware of their practice values, be able to access supervision, and confront contradictions and tensions between values and practice. PD programmes that are effective are built into mainstream activities, considered core business, utilize existing resources to build sustainable and realistic improvements, take direction from practitioners, and incorporate client needs.

‘We are not blaming anyone, but if we don't know about amenities, we cannot seek them out’: black and minority older people's views on the quality of local health and personal social services in England

Improving access to culturally-appropriate services and enhancing responses to the needs of older people from black and minority ethnic backgrounds were among the aims of theNational Service Framework for Older People(NSFOP) that was introduced in England in 2001. Progress in meeting the aims of the NSFOP was evaluated by a mid-term independent review led by the Healthcare Commission, the body responsible for regulating health-care services in England. This paper reports the consultation with older people that underpinned the evaluation. It focuses on the views and experiences of older people from black and minority ethnic (BME) groups and of the staff that work in BME voluntary organisations. A rapid appraisal approach was used in 10 purposively selected local councils, and plural methods were used, including public listening events, nominal groups and individual interviews. In total 1,839 older people participated in the consultations and 1,280 (70%) completed a monitoring form. Some 30 per cent defined themselves as of a minority ethnic background. The concerns were more about the low recognition of culturally-specific and language needs than for the development of services exclusively for BME older people.

Leadership behaviour of nurse managers in relation to job satisfaction and work climate

AIM

This study examines how nurse managers' leadership behaviour relates to job satisfaction and a creative work climate.

BACKGROUND

The nursing shortage is a challenge for managers all over the world. Leadership is a core element of management and it is important to elucidate leadership behaviour in order to increase knowledge about attracting and retaining talented staff.

METHOD

We studied 770 subordinates at a large university hospital. Three questionnaires for assessing perceived leadership behaviour, creative work climate and job satisfaction were used.

RESULTS

Subordinates with a manager perceived as 'super' have the highest rates on job satisfaction. The correlation between leadership and creative work climate is stronger than between leadership and job satisfaction. Between job satisfaction and work climate the correlation is strong.

CONCLUSIONS

The study shows that the relationship between a creative work climate and job satisfaction is strong. A managers' ability to lead has a major affect on work climate.

IMPLICATION FOR NURSING MANAGEMENT

Nurse managers must work on developing their leadership behaviour towards being an all-round leader that cares about people, is concerned about productivity and can handle changes. Support of ideas and initiatives are important in order to enable subordinates to perceive their work as challenging.

Habits in Perioperative Nursing Culture

This study focuses on investigating habits in perioperative nursing culture, which are often simply accepted and not normally considered or discussed. A hermeneutical approach was chosen as the means of understanding perioperative nurses' experiences of and reflections on operating theatre culture. Focus group discussions were used to collect data, which was analysed using hermeneutical text analysis. The results revealed three main categories of habits present in perioperative nursing culture: habits that promote ethical values (by temporary friendship with patients, showing respect for each other, and spending time on reflection on ethics and caring); habits that hinder progress (by seeing the patient as a surgical case, not acknowledging colleagues, and not talking about ethics); and habits that set the cultural tone (the hidden power structure and achieving more in less time).