Transformational and abusive leadership practices: impacts on novice nurses, quality of care and intention to leave

Academic leadership in nursing: A concept analysis

BACKGROUND

Research on improving academic leadership in nursing is paramount to increase new faculty support, improve retention, and ensure a high academic standard for the next generation of nurses. However, an operational definition of academic leadership in nursing is missing from the literature and a common language is needed to cohere research.

AIM

This study aimed to analyze the concept of academic leadership in nursing to inform future research on the factors that affect nursing faculty career development, job satisfaction, and retention.

METHODS

A concept analysis using Walker and Avant's eight-step method.

DATA SOURCES

Five databases were searched (CINAHL, PubMed, OVID Emcare, ERIC, and Google Scholar), with 16 articles identified for analysis. The term "academic leadership" was used in a title search with "nursing" as a keyword.

RESULTS

Three main attributes were found: administrator, mentor, and nurse. The consequences of academic leadership in nursing are improved work environments, increased job satisfaction, and decreased faculty turnover. Capabilities essential for academic leaders in nursing include vision, risk-taking, excellent communication, mentoring, succession planning, advocacy, and education.

CONCLUSION

An academic leader in nursing is a transformational leader who encourages, empowers, and motivates team members to grow, develop and thrive.

Transformational Leadership and Nursing Retention: An Integrative Review

Aim

To establish current evidence on the relationship between transformational nursing leadership and turnover intention.

Background

The persistent nursing shortage in healthcare has led to heightened demands for addressing both current needs and the healthcare requirements of a growing population. Recognizing the pivotal role of nursing leadership in fostering retention, this review highlights the influence of positive leadership on nursing staff. Evaluation. An integrative review, guided by Whittemore and Knafl's (2005) framework, was conducted using articles sourced from four online databases deducing to an inclusion of sixteen quantitative articles, one systematic review, and one integrative review published between 1992 and 2022. Key Issues. The study reveals conflicting evidence regarding the sole impact of transformational leadership on the nursing staff's intention to remain. However, it highlights transformational leadership's ability to enhance job satisfaction and organizational commitment contributes significantly to retention.

Conclusion

Using transformational leadership can effectively bolster nursing staff retention along with promoting other favorable workplace outcomes. Implications for Nursing Management. This review underscores the importance of enhancing leadership skills within nursing management. This involves not only fostering transformational leadership but also cultivating positive work-related outcomes to optimize nursing staff retention.

Exploring the impact of compassion and leadership on patient safety and quality in healthcare systems: a narrative review

BACKGROUND

Patient safety and healthcare quality are considered integral parts of the healthcare system that are driven by a dynamic combination of human and non-human factors. This review article provides an insight into the two major human factors that impact patient safety and quality including compassion and leadership. It also discusses how compassion is different from empathy and explores the impact of both compassion and leadership on patient safety and healthcare quality. In addition, this review also provides strategies for the improvement of patient safety and healthcare quality through compassion and effective leadership.

METHODS

This narrative review explores the existing literature on compassion and leadership and their combined impact on patient safety and healthcare quality. The literature for this purpose was gathered from published research articles, reports, recommendations and guidelines.

RESULTS

The findings from the literature suggest that both compassion and transformational leadership can create a positive culture where healthcare professionals (HCPs) prioritise patient safety and quality. Leaders who exhibit compassion are more likely to inspire their teams to deliver patient-centred care and focus on error prevention.

CONCLUSION

Compassion can become an antidote for the burnout of HCPs. Compassion is a behaviour that is not only inherited but can also be learnt. Both compassionate care and transformational leadership improve organisational culture, patient experience, patient engagement, outcomes and overall healthcare excellence. We propose that transformational leadership that reinforces compassion remarkably improves patient safety, patient engagement and quality.

Validity and reliability of the toxic leadership behaviors of nurse managers scale among Chinese nurses

Objectives

Toxic leadership is increasingly becoming common in the nursing field, but the measurement tools are lacking. Therefore, this study aimed to translate the toxic leadership behaviors of nurse managers (ToxBH-NM) scale into Chinese and test its psychometric properties among Chinese nurses.

Methods

The data for this study were obtained from a cross-sectional survey of 1,195 nurses. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine the structural validity of the ToxBH-NM. The following psychometric properties of the scale were assessed: content validity, criterion validity, internal consistency reliability, and test-retest reliability.

Results

The Chinese version of the ToxBH-NM (C-ToxBH-NM) scale had two dimensions and 30 items. The correlation coefficients between the scores of each item and the total scores were 0762-0.922 (p < 0.001), and the range of the CR determination values of all the items were 8.610-18.998, with statistical significance (p < 0.001). The total content validity index (CVI) was 0.996, the average CVI was 0.996, and the item-level CVI was 0.875-1.000. Two common factors were identified in the EFA, and 81.074% of the variation was explained cumulatively. The CFA showed that all the fitting indexes reached the standard, and the model fit degree was good. When the Chinese version of the Destructive Leadership Scale was used as calibration, the correlation coefficient was 0.378 (p < 0.001). The Cronbach's alpha coefficients of the overall scale were 0.989 and of the two dimensions were 0.969 and 0.987, respectively, with a split-half reliability of 0.966 and test-retest reliability of 0.978.

Conclusion

The research results show that the C-ToxBH-NM scale has good reliability and validity and can be used to evaluate the severity of toxic leadership behavior among nursing managers.

Stress as a mediator between abusive supervision and clinical nurses' work outcomes

AIMS

This study aimed to test whether stress could mediate the association between abusive supervision and nurses' work engagement, absenteeism, and turnover intention.

BACKGROUND

Abusive supervision has been attributed to suboptimal work performance and reduced productivity among employees in different sectors. While existing nursing literature links abusive supervision to a wide range of work-related outcomes in the nursing workforce, little is known regarding the mechanism underlying this relationship.

DESIGN

Data for this descriptive study were collected from 770 direct-care nurses from seven acute care hospitals in the Philippines, utilizing five standardized scales.

RESULTS

Abusive supervision had direct positive effects on absenteeism (β = .189, p < .001) and intent to leave (β = .138, p < .001) and a direct negative effect on job engagement (β = -.131, p < .001). The relationships between abusive supervision and absenteeism (β = .175, p < .001), intent to leave (β = .131, p < .001), and work engagement (β = -.122, p < .001) were partially mediated by stress.

CONCLUSIONS

Stress mediated the relationship between abusive supervision and nurses' work outcomes, including turnover intention, absenteeism, and work disengagement.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The evident connection between abusive supervision, stress, and work-related outcomes underscores the importance of focusing on enhancing managerial supervisory styles as a potential organizational strategy to enhance staff retention and well-being.

Relationship between transformational leadership, adverse patient events, and nurse-assessed quality of care in emergency units: The mediating role of work satisfaction

BACKGROUND

Effective leadership plays a pivotal role in healthcare settings, particularly in the fast-paced and high-pressure environment of the emergency room, as it is closely linked to patient safety and the overall quality of care. This study assessed the mediating role of work satisfaction in the relationship between nurses' perceptions of their nurse managers' transformational leadership, reported adverse patient events, and the nurse-assessed quality of care in the emergency units.

METHODS

A cross-sectional survey design was carried out involving 283 emergency room nurses from the Philippines, utilizing standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).

RESULTS

Emergency room nurses perceived their nurse managers as highly transformational. Nurses' perceptions of transformational leadership in their nurse managers were associated with a reduction in reported adverse patient events and an increase in nurse-assessed nursing care quality. Work satisfaction partially mediated the relationship between transformational leadership and nurse-assessed nursing care quality, but it did not serve as a mediator between transformational leadership and reported adverse patient events.

CONCLUSION

The results suggested that enhancing transformational leadership behaviors among nurse leaders can foster work satisfaction in ER nurses, which, in effect, contributes to enhanced nursing quality of care provision in emergency settings.

Advancement, barriers and collaboration: the ABC's of addressing challenges and designing solutions between front-line physicians and business-oriented leaders

BACKGROUND

The complexity of US healthcare has been increasing for many years, requiring clinicians and learners to understand care delivery systems in addition to clinical sciences. Thus, there has been a major push to educate faculty and trainees on healthcare functionality. This comes as hospitals expand into health systems requiring the help of more sophisticated expertise of departments such as operations excellence when problem-solving. As a medical student with a background in operations excellence, medical education leader and clinical administration leader all currently facilitating this transition, we wanted to reflect on the barriers we have experienced in clinical implementation of quality improvement projects and educating learners on the impact of operations excellence principles in their clinical education.

METHODS

The ideas presented in this article were the result of a several collaborative discussion between the authors, on the key challenges to adopting operations excellence principles into health system science education. In an effort to add context to this reflection through the current body of research present, they supplemented a literature review on the topic which included 86 studies published between 2013 and 2021 regarding health systems science and healthcare leadership engagement in the USA. The themes that intersected between the literature review and the discussions were then expanded on in this paper.

RESULTS

Through this process, we identified four challenges: (1) the difference in thinking styles, which we term, 'mental model differences'; (2) the strategic nature of process improvement projects and how that collides with physician priorities, or 'the chess game of stakeholder engagement'; (3) the language and precise methodology, or 'consistency of language and need for administrative resilience' and (4) the issue of teaching these concepts or bridging the learning gap.'

CONCLUSION

In an increasingly complex healthcare landscape, physicians and trainee's need to bridge gaps between the mental models of administrative and clinical workflow.

Abusive Supervision and Its Relationship With Nursing Workforce and Patient Safety Outcomes: A Systematic Review

Despite efforts to improve management and leadership behaviors among nurse managers, studies have shown the pervasive nature of abusive supervision in nursing practice, with strong evidence linking this type of behavior to reduced work productivity among nurses. This systematic review aimed to appraise and synthesize peer-reviewed studies that examine nurse-related and patient safety outcomes associated with abusive supervision. The review searched nursing literature from five databases (PubMed, CINAHL, Scopus, Web of Science, and PsycINFO) between August and November 2022. A total of 21 relevant studies were identified, with the Abusive Supervision Scale being the most frequently used measurement tool. Through content analysis, the review identified 29 outcomes which were categorized into six groups: (a) affective-based, (b) behavior/performance-based, (c) relationship-based, (d) cognitive-based, (e) health and well-being, and (f) nursing care. In addition, 10 mediators were identified and grouped into three categories: (a) affective-based, (b) motivation-based, and (c) health and well-being. The review findings provide compelling evidence regarding the detrimental effects of abusive supervision in the nursing workforce. Moreover, the review emphasizes the need for further research to explore how such behavior can impact patient safety outcomes. To address abusive supervision, it is crucial to promote positive behaviors among nurse managers through human resource mechanisms, relevant rules and policies, and theory-driven leadership development programs.

Toxic leadership, mental well-being and work engagement among nurses: a scale adaptation study and structural equation model approach

PURPOSE

Although the background on positive and supportive leadership styles and their positive effects is constantly increasing, it is known that negative and destructive leadership styles are less researched. Thus, examining the toxic leadership behaviors of nurse managers and the effects of these on nurses has a critical significance. When the measurement tools evaluating toxic leadership are examined, it is seen that there is a need for measurement tools that evaluate the toxic leadership behaviors of nurse managers. This study's purpose is to psychometrically examine the Turkish version of the Toxic Leadership Behaviors of Nurse Managers (ToxBH-NM-TR) Scale and test the hypothesized conceptual model that includes the relationships between toxic leadership, mental well-being and work engagement.

DESIGN/METHODOLOGY/APPROACH

This quantitative research was carried out in psychometric, correlational and cross-sectional design. A total of 559 nurses were included in the study by using the convenience sample method. The ToxBH-NM-TR Scale, Warwick-Edinburg Mental Well-Being Scale and Utrecht Work Engagement Scale (UWES) were used to measure the latent variables of the study. The data were collected between June and October 2020 with the online survey method. IBM SPSS Statistics 24 and Amos 21 statistical programs were used to analyze the data.

FINDINGS

The scale-content validity index of the ToxBH-NM-TR was 0.88. Confirmatory factor analysis results showed that the fit indices were acceptable. The ToxBH-NM-TR had high internal consistency and temporal stability. In addition, the relationships between the latent variables of the study were in the expected direction and statistically significant (p < 0.001). The hypothesized conceptual model showed an acceptable or good fit to the data. Mental well-being partially mediated the relationship between toxic leadership and work engagement. The study showed that the ToxBH-NM-TR is a valid and reliable instrument and provided evidence that confirmed the hypothesized conceptual model.

RESEARCH LIMITATIONS/IMPLICATIONS

The first of these is the fact that managers' toxic leadership behaviors were determined based on nurses' self-report. For this reason, participants' potential prejudices may have affected the results of the study. The second limitation concerns the data collection technique. Using face-to-face data collection techniques during the COVID-19 pandemic could create a danger/risk for the health of nurses, researchers and patients. Therefore, the nurses in this research were reached through an online survey on social media platforms. The participants of the study were limited to those who had access to social media. Finally, some socio-demographic and professional characteristics of the participants may be a confounding variable for the model. For this reason, this conceptual model needs to be validated on other samples in different countries to increase the generalizability of the research results.

PRACTICAL IMPLICATIONS

The characteristics of this leadership style should be understood, and its effects on employees and organizations should be evaluated by screening regularly to prevent the development of toxic leaders and to eliminate the harmful effects of their behavior. The nurses should respond decisively to the forces that cause them to submit in order not to encourage a toxic leadership style. Healthcare institutions should develop procedures and take a proactive approach to destructive and negative leadership behaviors and practices. In addition, nurse managers should get feedback by using informal networks and 360-degree assessment tools and evaluate whether their leadership has a toxic function by regularly screening the effects of their leadership.

ORIGINALITY/VALUE

The results of this study offer important implications for nurses, managers and healthcare institutions and can be useful in gaining awareness about the negative effects of a toxic leadership style. In addition, the study provides a valid and reliable scale that will enable the identification of managers with this leadership style to prevent the development of toxic leaders and eliminate the harmful effects of their behavior.

Investigating the influence of selected leadership styles on patient safety and quality of care: a systematic review and meta-analysis

BACKGROUND

There is a popular belief that transformational leadership (TL) and servant leadership (SL) styles are influential in establishing a patient safety (PS) culture and improving the quality of care (QC). However, there are very few review articles investigating this phenomenon.

PURPOSE

This study performs a systematic review and meta-analysis to ascertain the influences of TL and SL on PS and QC.

METHODS

Published research work indexed in the two popular databases, that is, Scopus and PubMed, was selected based on the inclusion criteria. The systematic review was performed as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data such as country of publication, year, data type, research design, target population, sample size and conclusion were selected from the studies.

RESULTS

There are pieces of evidence suggesting a medium to strong effect of TL on PS. At the same time, the effect of TL on QC is not direct but indirect and is mediated through variables such as fostering positive organisational culture and enhancing organisational outcomes such as job satisfaction, leader effectiveness and willingness of nurses to spend some extra effort. A total of 27 studies were selected for final evaluation and 11 reported a relationship between TL and PS. The 'Fisher r-to-z transformed correlation coefficients' ranged from 0.3769 to 0.8673. Similarly, a total of four studies reported the relationship between TL and QC, 'Fisher r-to-z transformed correlation coefficients' ranged from 0.0802 to 0.5101, with most estimates being positive (80%).

CONCLUSION

TL has a strong and positive effect on PS but a positive and weak effect on the QC. There is not much evidence to establish SL's influence on PS and QC.

Toxic leadership behaviour of nurse managers and turnover intentions: the mediating role of job satisfaction

INTRODUCTION

Globally, hospitals are confronted with major challenges of turnover of nurses. Knowledge of the factors that account for the turnover of nurses will aid in creating strategies that will enhance nurse managers' leadership behaviour and job satisfaction to reduce turnover. The study, therefore, investigated the mediating role of job satisfaction on toxic leadership and turnover intentions of nurses.

METHODS

A multi-centre cross-sectional study was undertaken to assess 943 nurses using the Toxic-leadership Behaviour of Nurse Managers scale, Minnesota Satisfaction Questionnaire and Turnover Intention scale. Descriptive statistics was used to assess the prevalence of toxic leadership, job satisfaction and turnover and Pearson's correlation examined the relationships between the variables. Hayes' PROCESS macro approach of mediation was used to determine the effect of toxic leadership behaviour on the turnover intention on the possible influence of job satisfaction.

RESULTS

The response rate for the study was 76.0%. Mean scores for turnover intentions and toxic leadership behaviour were 3.71 and 2.42 respectively. Nurses who work with toxic managers showed a higher propensity to leave their jobs. Job satisfaction acted as a mediator between the toxic leadership practices of managers and turnover intentions. The total effect of toxic leadership behaviour on turnover intention comprised its direct effect (β = 0.238, SE = 0.017, 95% CI [0.205, 0.271]) and its indirect effect (β = -0.020, SE = 0.017).

CONCLUSIONS

Job satisfaction acted as a mediating factor for toxic leadership behaviour and nurses' turnover intentions. As part of nurse retention initiatives, avoiding toxic leadership behaviours will be the ultimate agenda. Nurse administrators should recognize the value of excellent leadership and develop a structured training programme through the use of evidence-based professional development plans for nurse managers.

Toxic leadership and its relationship with outcomes on the nursing workforce and patient safety: a systematic review

PURPOSE

This study aims to appraise and synthesize evidence examining the effects of toxic leadership on the nursing workforce and patient safety outcomes.

DESIGN/METHODOLOGY/APPROACH

This is a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases (SCOPUS, PubMed, Web of Science, CINAHL and Psych INFO) were searched to identify relevant articles. Two independent researchers conducted the data extraction and appraisal. A content analysis was used to identify toxic leadership outcomes.

FINDINGS

The initial literature search identified 376 articles, 16 of which were deemed relevant to the final review. Results of the content analysis identified 31 outcomes, which were clustered into five themes: satisfaction with work; relationship with organization; psychological state and well-being; productivity and performance; and patient safety outcomes. Seven mediators between toxic leadership and five outcomes were identified in the included studies.

PRACTICAL IMPLICATIONS

Organizational strategies to improve outcomes in the nursing workforce should involve measures to build and develop positive leadership and prevent toxic behaviors among nurse managers through theory-driven strategies, human resource management efforts and relevant policy.

ORIGINALITY/VALUE

The review findings have provided modest evidence suggesting that working under a leader who exhibits toxic behaviors may have adverse consequences in the nursing workforce; however, more research examining if this leadership style influences patient safety and care outcomes is warranted.

Nurse managers' support of fundamental care in the hospital setting. An interpretive description of nurse managers' experiences across Australia, Denmark, and New Zealand

AIMS

To explore the role of ward-based nurse managers in supporting nurses to undertake high-quality fundamental care.

DESIGN

A qualitative study guided by the principles of interpretive description. Reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ).

METHODS

Nurse managers in three urban, publicly funded hospitals in Australia, Denmark and New Zealand, were invited to participate in group interviews to discuss how they support fundamental care in their clinical areas. Six group interviews were conducted between February 2017 and March 2020 involving 31 participants.

RESULTS

Six interrelated themes were identified: Difficulty expressing how to support the nurse-patient relationship; Establishing expectations for care delivery without clear strategies for how this can be achieved; Role modelling desired behaviours; Significance of being present to support care quality; The importance of engaging and supporting staff in their work; and Recognizing the challenges of prioritizing care needs.

CONCLUSION

This study indicates that nurse managers are not universally clear in explaining how they support their staff to provide fundamental care. If fundamental care is not clearly understood and communicated in the nursing team, then there are risks that fundamental care will not be prioritized, with potential negative consequences for patient care. Nurse managers may benefit from additional resources and guidance to help them to support fundamental care delivery in their clinical areas.

IMPACT

Previous research exploring fundamental care and missed care highlights the importance of the role of the nurse manager in influencing nursing care. This study demonstrates that though nurse managers have a passion for supporting their staff to deliver fundamental care, clear strategies to achieve this are not always evident. This study suggests that scholarship around leadership to promote and facilitate fundamental care is crucial to improving nursing practice and patient outcomes.

Abusive supervision and employee well-being of nursing staff: Mediating role of occupational stress

AIM

The study examined whether occupational stress mediated the relationship between abusive supervision and well-being of nursing staff.

DESIGN

A cross-sectional questionnaire survey was administered.

METHODS

Data were collected at three-time points between July 2020 and January 2021. A total of 313 valid responses were obtained from nurses working in a general hospital in Taiwan. The data were analysed using descriptive statistics, Pearson's correlation analysis and the bootstrap method.

RESULTS

Abusive supervision was positively associated with occupational stress (β = 0.288, SE = 0.069, 95% CI [0.152, 0.423]) and negatively associated with employee well-being, including psychological (β = -0.350, SE = 0.084, 95% CI [-0.515, -0.186]), physical (β = -0.301, SE = 0.080, 95% CI [-0.459, -0.143]) and social well-being (β = -0.422, SE = 0.121, 95% CI [-0.661, -0.183]). Occupational stress was negatively related to employee well-being. A mediation analysis with bootstrapping revealed that occupational stress mediated the relationship between abusive supervision and employee well-being, which included psychological (95% bootstrap CI [-0.183, -0.046]), physical (95% bootstrap CI [-0.212, -0.062]) and social well-being (95% bootstrap CI [-0.178, -0.040]).

CONCLUSION

Abusive supervision influences employee well-being. Occupational stress mediates the relationship between abusive supervision and employee well-being. To improve employee well-being, hospital administrators should develop policies for effectively managing nursing supervisors' abusive behaviour and subordinates' stress management.

IMPACT

Abusive supervision increased the occupational stress of employees and influenced their well-being. Thus, educational courses should be implemented to train supervisors to practice positive leadership and treat employees fairly. Promoting stress management among nursing staff may lead to the prompt reporting of abusive events and improved employee well-being.

NO PATIENT OR PUBLIC CONTRIBUTION

This study investigated the relationship between the abusive supervision and employee well-being of nursing employees. No patient or public contribution is involved in this study.

Leadership Practices as Perceived by Emergency Nurses During the COVID-19 Pandemic: The Role of Structural and Psychological Empowerment

INTRODUCTION

To our knowledge, no studies have explored leadership practices in relation to structural and psychological empowerment among nurses during COVID-19. Therefore, the purpose of this study was to examine those relationships in Jordanian nurses working in emergency departments during the COVID-19 pandemic.

METHODS

A descriptive, correlational cross-sectional design was used in this study. The participants were emergency nurses working at 3 large hospitals in Jordan. The participants were surveyed via an online questionnaire between September 2021 and January 2022. A total of 3 valid scales were included in the questionnaire to assess the nurses' clinical leadership practices in relation to perceived structural and psychological empowerment.

RESULTS

A total of 193 emergency nurses were surveyed, of which 116 participants (60.1%) were male, and their average age was 29.64 (SD 4.74) years. Nurses had a moderate level of clinical leadership practices 12.50 (SD 1.65), moderate level of perceived structural empowerment 3.67 (SD 0.44), and a high-moderate level of perceived psychological empowerment 5.96 (SD 0.65). Clinical leadership practices were shown to have a significant positive relationship with structural (r = 0.65; P < .01) and psychological (r = 0.74; P < .01) empowerment. Predictors of clinical leadership practices of the Jordanian emergency nurses during COVID-19 were ranked in order of significance; structural and psychological empowerments were the highest significant predictors. However, patient to nurse ratio (>6 patients/nurse) was the lowest significant predictor.

DISCUSSION

Although structural and psychological empowerments play a pivotal role in predicting the leadership practices of the emergency nurses in Jordan, the nurses should enhance their leadership style for better management and effective communication during critical situations such as pandemics.

The association between nurse managers' transformational leadership and quality of patient care: A systematic review

AIM

To examine and summarize the reported association of nurse managers' transformational leadership and quality of patient care based on the perceptions of registered nurses.

BACKGROUND

Transformational leadership behaviors of nurse managers result in staff nurses' satisfaction and retention and patient satisfaction. Patient safety and quality of care are vital to high-performing healthcare organizations. Perceptions of registered nurses are important because nurses are frontline healthcare providers fundamental to patient safety and quality of care and are considered the final line of defense in preventing adverse events and errors and improving the safety of patients.

MATERIALS AND METHODS

We  searched the CINAHL, ProQuest, PubMed, Science Direct, and Web of Science databases for evidence published between 2018 and 2022 in the English language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in carrying out this meta-analysis.

RESULTS

Nine quantitative studies were appraised using the Joanna Briggs Institute checklists and were included in the final review that involved a total sample of 3633 registered nurses. The included studies were reported across Asian, Middle East, and European countries within the past five years. The association between the transformational leadership behaviors of nurse managers and the quality of patient care was found in varying degrees (i.e., insignificant, weak, indirect, and strong direct association) based on the perceptions of registered nurses.

CONCLUSIONS

There is a direct and indirect association between the transformational leadership behaviors of nurse managers and the quality of patient care internationally. This association is influenced by confounding and mediating factors, including gender, organizational culture, structural empowerment, and job satisfaction.

IMPLICATIONS FOR NURSING AND HEALTH POLICIES

Healthcare organizations need to support nursing leaders to have a stronger transformational leadership style by considering several factors that influence their leadership to improve the quality of patient care their staff nurses provide at the bedside.

A systematic review of the relationships between nurse leaders' leadership styles and nurses' work-related well-being

AIM

This systematic review aimed to summarize current research knowledge about the relationships between nurse leaders' leadership styles and nurses' work-related well-being.

BACKGROUND

Due to the global shortage of nurses, it is essential for nurse leaders to maximize staff retention and work-related well-being.

METHODS

Following Cochrane Collaboration procedures, the PRISMA statement and PRISMA checklist, relevant quantitative studies published between 1 January 2012 and 31 December 2020 were retrieved from the CINAHL, Scopus, PubMed and Medic databases and then systematically reviewed. Seventeen cross-sectional and follow-up studies with surveys were retained for inclusion and evaluated with the Critical Appraisal of a Survey instrument. The data were summarized narratively.

RESULTS

Three core themes of leadership styles: destructive, supportive and relationally focused, were identified, with statistically significant direct and indirect connections between nurses' work-related well-being. Well-being was mainly assessed in terms of burnout. Effects of leadership styles on work-related well-being were reportedly mediated by trust in leader, trust in organization, empowerment, work-life conflict, relational social capital, emotional exhaustion, affectivity, job satisfaction and motivation.

CONCLUSION

Nurse leaders' leadership styles affect nurses' work-related well-being. In developing intervention studies and providing training on work-related well-being, the impact of the indirect effects and the mediating factors of the leadership styles should be acknowledged.

Toxic Leadership Behaviour of Nurse Managers on Perceived Job Satisfaction and Productivity of Nursing Workforce in Sub-Saharan Ghana: A multi-centre cross-sectional study

This study aimed at assessing the nature and effect of toxic leadership of nurse managers on the perceived job satisfaction and productivity of the nursing workforce.

BACKGROUND

Nursing job outcomes such as job satisfaction and nurses' productivity are influenced by various factors in the nursing practice environment including leadership. Due to rising healthcare expenses and depleting material resources, the productivity of nurses which is expected to improve the efficiency of healthcare organizations is mostly low. Managers' toxic behaviour toward nurses affects their job satisfaction and subsequently low productivity.

METHOD

A multi-centre, cross-sectional descriptive design was used. Validated tools were used to collect data from participants and data was analyzed using descriptive, correlation, and hierarchical linear regressions.

RESULTS

Registered nurses appraised the leadership behaviour of nurse managers to be toxic, with most managers exhibiting narcissistic leadership behaviour. While all components of toxic leadership behaviour of managers were associated with the perceived productivity of the nurses; intemperate leadership behaviour of the managers (β = -.301, p <.005), and job satisfaction (β = .296, p < .001) significantly predicted perceived productivity among nurses (R² = .238, F _{(7, 922)} = 41.088, p< .001).

CONCLUSION

Nurse managers' leadership behaviours were toxic. Nurses' job satisfaction and all components of managers' toxic leadership behaviour influenced productivity.

IMPLICATIONS FOR NURSING MANAGEMENT

There should be a policy developed to guide the creation and maintenance of efficient nursing leadership to enhance job satisfaction and productivity among nurses.

The effects of leaders' abusive supervision on employees' work engagement: a moderated-mediation model of employees' silence and employees' proactive personalities

PURPOSE

This study aims to examine the impact of leaders' abusive supervision on employees' work engagement in the health sector. The study further examined the interactive effect of leaders' abusive supervision and employees' proactive personality on work engagement via employees' silence.

DESIGN/METHODOLOGY/APPROACH

Data were collected from 343 health workers in five hospitals in Ghana. The Hayes Process Macro and AMOS were used to analyse mediation, moderation and moderated-mediation relationships.

FINDINGS

The study findings indicate that leaders' abusive supervision has a detrimental impact on employees' work engagement. The study further found that employees' silence did not mediate the relationship between abusive supervision and work engagement. Employees' proactive personalities positively moderated the relationship between abusive supervision and employees' silence.

ORIGINALITY/VALUE

This study advances understanding of how perceived leaders' abusive supervision affects health workers' work engagement. This study contributes to the literature by confirming employees' silence as a pathway linking abusive supervision to work engagement. The study further identifies employees' proactive personality as a moderating variable in the relationship between abusive supervision and employees' silence.

The pathway from mental health, leaves of absence, and return to work of health professionals: Gender and leadership matter

Health professions are ranked among the most stressful occupations and have a much higher likelihood of absenteeism from work. In this article, we present findings from four health professional case studies in our Healthy Professional Worker partnership, involving surveys with 1,860 respondents and 163 interviews with nurses, physicians, midwives, and dentists conducted between December 2020 and April 2021. We found that the pathway from mental health experiences through to the decision to take a leave of absence and return to work differed between the health professions and that both gender and leadership matter greatly. There is a need to de-stigmatize mental health issues and encourage greater awareness and support from supervisors and colleagues. Leadership can play an important role in mitigating mental health issues, and as such investment in both leadership training and mentorship are important first steps in acting upon our research findings.

The Relationship between Work Environments and Intention to Leave in Nursing: A Cross-sectional and Correlational Study

Objective: Unfavorable work environments are among the factors that affect nurses’ intention to leave. This study was explored to examine the relationship between nurses’ work environments and their intention to leave. Methods: This cross-sectional and correlational design study was carried out with 547 nurses working in a university, a private hospital, and a teaching hospital between November 2016 and February 2017. The Practice Environment Scale of the Nursing Work Index and a question about intention to leave was used. Descriptive statistics, Pearson correlation and multiple linear regression analysis were used in the analysis of the data. Results: The mean total score of scale was found to be M= 2.30±0.56 and nurses' perceptions of work environments to be unfavorable. It was found that; 13.9% of the nurses did not intend to leave, 35.5% had a low, and 50.8% had a high intention to leave. It was determined that unfavorable work environments increases intention to leave (R= .370, R2= .137, p

Leadership Style, Work Engagement and Organizational Commitment Among Nurses in Saudi Arabian Hospitals

Purpose

The purpose of this paper is to examine how nurse managers’ leadership styles, work engagement, and nurses’ organizational commitment are related in Saudi Arabia.

Methods

This study used a cross-sectional design using an online survey instrument targeted at nurse managers and nurses working in Saudi Arabian hospitals. Multi-factor leadership questionnaire (MLQ), organizational commitment questionnaire (OCQ), and Utrecht Work Engagement Scale (UWES) were used in the Questionnaire. The survey link is forwarded to HR administrators of 71 hospitals, which includes public, private, and public–private partnership hospitals. The survey link was active from 27th November 2021 to 18th December 2021, and at the end of the survey, 394 responses were received. After removing the incomplete responses, 390 participant responses are considered for data analysis. t-tests and correlation analysis are used to analyze the data.

Results

Among the participants, 84.4% of the participants were nurses and 15.6% were nurse managers. Significant difference (p < 0.05) of opinions is observed among nurse managers in relation to transformational and transactional leadership styles and engagement. Transformational and transactional leaderships are positively correlated with organizational commitment and nurses’ engagement.

Conclusion

Differences in leadership style perceptions among nurses and nurse managers reflected issues in nursing management, which have to be addressed in light of rapid infrastructural changes owing to Saudi vision 2030.

Going the Extra Mile (or Not): A Moderated Mediation Analysis of Job Resources, Abusive Leadership, Autonomous Motivation, and Extra-Role Performance

Abusive leadership is particularly prevalent in nursing and it can have multiple adverse effects on performance at work. However, little research has examined whether and under what conditions abusive leadership may be detrimental to nurses’ extra-role performance. This cross-sectional study explores whether abusive leadership intensifies the effects of emotional job resources on autonomous motivation, a psychological mechanism that could be responsible for extra-role performance. Data were collected from dyads of registered French-Canadian nurses and their immediate supervisors (n = 99 dyads). The models were tested with path analysis using Mplus. Our results show that extra-role performance is positively associated with nurses’ job emotional resources and autonomous motivation, but negatively associated with abusive leadership. Nurses’ cynicism is also negatively associated with autonomous motivation. Importantly, the indirect relation between emotional resources and extra-role performance through autonomous motivation is moderated by abusive leadership, providing support for a moderated mediation effect. These results add to those supporting a similar moderated mediation mechanism to explain employee attitudes and demonstrate the relevance of self-determination theory in a work context. These findings reinforce the need to focus on the quality of leadership practices as well as interventions aimed at promoting the performance of nurses at work.

Associations among professional quality of life dimensions, burnout, nursing practice environment, and turnover intention in newly graduated nurses

BACKGROUND

Professional quality of life affects nurses' well-being and the quality of care. However, little attention is paid to the relationships among professional quality of life dimensions, burnout, nursing practice environment, and intention to leave this job in newly graduated nurses.

AIMS

To assess the levels of professional quality of life dimensions and turnover intention, to examine the predictors for turnover intention, and to explore the mediating roles of professional quality of life dimensions on the associations between these predictors and turnover intention in Chinese newly graduated nurses.

METHODS

This was a cross-sectional study with 315 newly graduated nurses selected from five tertiary hospitals and five secondary hospitals in Sichuan province, China. Multiple regression analysis was used to examine the effects of demographic characteristics and work-related factors on intention to leave this job. Structural equation modeling technique was performed to explore the mediating effect of each domain of professional quality of life on the relationships between the predictors and turnover intention.

RESULTS

The prevalence of average levels of burnout, secondary traumatic stress, and compassion satisfaction was 43.2%, 57.1%, and 81.3%, respectively. Moreover, 43.8% and 0.6% of the participants reported high and exceptionally high intention to leave this job. Nursing practice environment, social support, and empathy indirectly and significantly affected turnover intention via the mediating roles of burnout and compassion satisfaction, respectively. However, no significant mediating effect of secondary traumatic stress was found between these predictors and turnover intention.

LINKING EVIDENCE TO ACTION

Perceptions of greater nursing practice environment, social support, and empathy result in lower turnover intention via reducing burnout and facilitating compassion satisfaction. Strategies such as developing a supportive work and family environment, and cultivating empathic capacity can be effective methods to mitigate against intention to leave this job in newly graduated nurses.

An analysis of the effect of nurse managers' toxic leadership behaviours on nurses' perceptions of professional values: A cross-sectional survey

AIM

This study aimed to investigate whether or not the toxic leadership behaviours of nurse managers influence nurses' perceptions of professional values.

BACKGROUND

Professional values are among the factors that influence the development and the enhancement of the quality of health services. The professional development of nurses at work is particularly shaped by the guidance and counselling of nurse managers. Therefore, it is vitally important to determine the effects of nurse managers' toxic leadership behaviours on nurses' perception of professional values in terms of the development of professional values and the nursing image.

METHOD AND MATERIAL

This study was designed as a descriptive and correlational study and was conducted with 244 nurses working in a university hospital between 09.01.2020 and 12.03.2020. The study data were collected using a Personal Information Form (11 questions) designed by the researchers in line with the recent literature, the Nurses Professional Values Scale-Revised (NPVS-R) and the Toxic Leadership Scale. The study data were analysed with SPSS 25.0, and they were evaluated using frequency, percentage, the Mann-Whitney U test and the Kruskal-Wallis H test, one-way ANOVA, the t-test for independent groups, the Cronbach alpha coefficient and Spearman correlation coefficient methods. The significance level was taken as p < 0.001, and p < 0.05 was used to interpret the study results.

RESULTS

The mean age of the nurses in the study was 31.79 ± 6.68 years. A statistically significant difference was found between the scores for the NPVS-R and their previous education about leadership (U:5.273, p < 0.05). A significant difference was also noted between the Toxic Leadership Scale scores and the educational status of the nurses (𝜒²  = 9.971, p < 0.001), whether or not they deliberately chose nursing as a profession (U:7.777, p < 0.05), whether or not they willingly served as a nurse (U:8.458, p < 0.001) and whether or not they willingly served in their current unit (U:8.475, p < 0.05). The total score and the subdimension scores of the Toxic Leadership Scale and NPVS-R Scale were not significantly correlated (p > 0.05).

CONCLUSION

The results demonstrated that nurses who deliberately chose nursing as a career option, who willingly served as a nurse and who willingly served in their current units were comparatively less influenced by the managers with toxic leadership attitudes. It was similarly determined that nurses with higher levels of education and those who received in-service training were less influenced by toxic managers. It was finally noted that working with toxic managers had no significant effect on the nurses' perception of professional values.

IMPLICATIONS FOR NURSING MANAGEMENT

The results indicated that although toxic leadership and nurses' perception of professional values were not significantly correlated, toxic behaviours may cause a depreciation in nurses' perception of professional values and beliefs, as noted in other relevant studies. It is thus necessary to be aware of the effects of toxic leadership behaviours on nurses and the institution and that precautions be taken by management against any negative effects. Supporting nurses with in-service training and building up resistance against toxic leadership behaviours will be beneficial for the proper and effective functioning of the institution.

The influence of nursing leadership styles on the outcomes of patients, professionals and institutions: An integrative review

AIM

This review was conducted to map leadership styles that positively impact patients, professionals and institutions.

BACKGROUND

Leadership is a topic widely studied because it is a fundamental skill in establishing favourable work environments, in addition to enabling nurses to influence their team in the search for better results. Therefore, a synthesis of the various studies produced to date is essential for nurses, managers and researchers to understand the different styles of leadership that positively influence organizational results, so they can choose the style they deem most appropriate.

EVALUATION

An integrative literature review retrieved articles from five databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level of evidence and its quality were assessed using the criteria of the Joanna Briggs Institute.

KEY ISSUES

Thirty-five studies were included, 18 of which reported the influence of leadership styles on patients (safety), nine on professionals (burnout) and eight on institutions (turnover and absenteeism).

CONCLUSION

Transformational leadership had positive results for patients, professionals, and institutions alike.

IMPLICATIONS FOR NURSING MANAGEMENT

The results showed the need for nurses to improve their leadership skills, especially in the transformational style, to achieve positive results.

Is leadership of nurses associated with nurse-reported quality of care? A cross-sectional survey

Background

Nurses need to exhibit stronger leadership by taking more responsibility and accountability to improve healthcare quality and patient safety.

Aims

The aim of this study was to determine the association between quality of care and leadership styles and practices, and whether the characteristics of nurses influence this interaction.

Methods

We conducted a multicentre cross-sectional survey of 655 nurses working on clinical wards in Dutch university medical centres in 2018.

Results

Transformational leadership was significantly associated with quality of care which explained 5.9% of the total variance (R²= 0.059 F = (11,643) = 3.726, p = 0.011), and the nurse characteristics gender, profession and type of practice area were significant influencing factors. Nurses rated the quality of care (mean (M) = 7.7, standard deviation (SD) = 1.3) as moderate and they showed moderate levels of transformational leadership style (M = 3.7, SD = 0.5) and transformational leadership practices (M ≥ 6.2 and ≤ 7.6).

Conclusions

When considering quality improvement on clinical wards strategic managers need to be aware of the fact that leadership is associated with quality of care and that nurse characteristics influence this association. The findings indicate a pressing need for education and training for nurses in how to develop leadership and raising the awareness among strategic managers about the importance of leadership in health care is recommended.

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Introduction&#160;: The continuing professional development of nurses remains a key issue within the health context.Context&#160;: The Questionnaire - Professional Development Nurses (Q-PDN) was developed to understand the opinions and beliefs of nurses regarding continuing professional development is essential to improving the quality of care and optimizing job satisfaction. With this in mind, researchers from the Netherlands developed the Questionnaire &#8211; Professional Development Nurses (Q-PDN).Objectives&#160;: Adapt the Q-PDN to a French-Canadian context according to recognized guidelines.Method&#160;: The six stages of the Beaton et al. (2000) cross-cultural adaptation process were followed to produce a tool adapted to the French-Canadian context.Results and discussion&#160;: This study describes the different steps necessary for the cross-cultural adaptation of the Q-PDN tool to the French-Canadian context. Following the adaptation, minor content adjustments were made to the original version. General comments have highlighted the clarity and simplicity of the questionnaire.Conclusion&#160;: This first step in the cross-cultural French-Canadian adaptation of Q-PDN has enabled the development of a tool to identify gaps and priorities for action to promote the continuing professional development (CPD) of nurses.

Transformational leadership as a mediator between work-family conflict, nurse-reported patient safety outcomes, and job engagement

PURPOSE

Work-family conflict (WFC) is an important issue in nursing administration and management that is associated with reduced work effectiveness and patient safety issues. To date, very few studies have attempted to explain the mechanisms underlying these relationships. The aim of this study was to determine the influence of work-family conflict (WFC) on patient safety outcomes and job engagement via the intermediary role of transformational leadership (TL).

DESIGN

Cross-sectional study.

METHODS

Seven hundred fifty-four nurses from 10 acute care hospitals in the Philippines were included in this cross-sectional study.

FINDINGS

A higher perception of WFC was associated with increased adverse events, reduced quality of care and decreased job engagement. WFC was indirectly associated with quality of care, adverse events and job engagement through the intermediary of TL.

CONCLUSIONS

The results of this study underscore the important role of nurse managers' TL in sustaining work-family balance and, in turn, improving patient safety outcomes and enhancing job engagement among nurses.

CLINICAL RELEVANCE

Institutional measures to foster patient safety outcomes and sustain the nursing workforce should involve enhancing nurse managers' leadership behaviors through theory-driven interventions, periodic leadership assessment, and implementation of leadership development activities. WFC may be addressed by creating empowering work conditions, providing adequate coaching and mentorship to nurses, and implementing work-family friendly policies in the workplace.

An integrative review of nursing leadership in Saudi Arabia

Aims

The aims of this integrative review were to describe leadership styles from the nursing literature in Saudi Arabia and to identify the current state of evidence about relationships between leadership styles and nurse, patient and organization outcomes in Saudi Arabia.

Design

Integrative review was used as a design for this study.

Methods

The following search terms were used with databases: ‘Saudi Arabia’, ‘leadership theory*’, ‘leadership style*’, ‘leadership model*’, ‘management style’ and ‘nurse*’. Methodological quality was assessed using two different quality rating tools for quantitative and qualitative studies. Databases used for this review included Nursing & Allied Health Database, Cochrane Database of Systematic Reviews, PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science and ProQuest Dissertations & Theses.

Results

Nine manuscripts representing eight studies were included in this review. The papers reviewed included quantitative (n = 6), qualitative (n = 2) and mixed methods studies (n = 1). Results were grouped into different themes, identified as nursing leadership styles in Saudi Arabia, leadership styles and nurses' outcomes, and demographics and leadership styles.

Organizational Culture, Quality of Care and Leadership Style in Government General Hospitals in Kuwait: A Multimethod Study

Purpose

To investigate the organizational culture, assess the quality of care, and measure their association with a transformational/transactional leadership style in six hospitals.

Materials and Methods

We used cross-sectional and retrospective quantitative approaches in government-sponsored secondary-care hospitals. A sample of 1626 was drawn from a frame of 9863 healthcare workers in six hospitals. Followers were surveyed using the Multifactor Leadership Questionnaire and the Organizational Description Questionnaire. We reviewed and analyzed one year (2012) of quarterly and annual quality indicators from the hospitals. Data were analyzed using suitable statistical analyses.

Results

We collected 1626 responses from six hospitals. 66.4% to 87.1% of participants in each hospital identified their hospital's organizational culture as transformational, whereas 41 out of 48 departments were identified as having a transformational culture. The percentage of participants at each hospital rating their leader and organizational culture as transformational ranged from 60.5% to 80.4%. The differences between leadership style and organizational culture were statistically significant for four of the hospitals. For most of the quality indicators, there was a positive, but nonsignificant, correlation with leadership style.

Conclusion

Leaders define and influence organizational culture. The prevailing transformational leadership style creates and maintains a transformational organizational culture. The effect of transformational leadership on the quality of care delivered by the organization was measured in this study, and showed a positive and nonsignificant relationship between generic quality indicators and the transformational style.

Effects of work conditions and organisational strategies on nurses' mental health during the COVID-19 pandemic

AIMS

This study aims to examine coronavirus disease 2019 (COVID-19) pandemic-related work factors for adverse effects on the mental health and whether organisational strategies attenuate these effects.

BACKGROUND

COVID-19 pandemic has led to increased work burden and mental health risks for nurses.

METHODS

A total of 1499 Taiwanese full-time nurses completed a web-based questionnaire between July and December 2020. Pandemic-related work conditions, namely, increased working hours, caring for COVID-19 patients, occupational stigma and redeployment, were assessed. Organisational strategies to combat pandemic-related work stressors including compensation to workers and adequate protection equipment were surveyed. Outcome measures were intention to leave, burnout and depression assessed using validated questionnaires.

RESULTS

Redeployment, increased working hours and occupational stigma were associated with adverse mental health and intention to leave in logistic regression analysis. Caring for COVID-19 patients was negatively associated with depression. Adequate compensation for workers modified the association between redeployment and burnout.

CONCLUSIONS

Pandemic-related work conditions were associated with adverse mental health and intention to leave. Organisational strategies attenuated the adverse impact of the pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT

Efforts to decrease stigma and organisational strategies including compensation for workers and adequate protection equipment provision should be adopted to improve nurses' health during a pandemic.

Optimizing nurses' enacted scope of practice to its full potential as an integrated strategy for the continuous improvement of clinical performance: A multicentre descriptive analysis

AIM

This study aims at better understanding the relationships between nurses' enacted scope of practice, work environment and work satisfaction, missed care, and organizational indicators of performance.

BACKGROUND

The enacted scope of practice model describes the determinants and consequences of the actual enactment of the nursing scope of practice.

METHOD

A correlational design was used to investigate nurses' enacted scope of practice in five Canadian healthcare centres.

RESULTS

Suboptimal enacted scope of practice were found in the current sample. Significant positive correlations were found between the total enacted scope of practice score, use of qualification, control over tasks, decisional latitude and psychological demand as well as role ambiguity. Moreover, a higher enacted scope of practice was correlated with lower organizational indicators of short-term absenteeism.

CONCLUSION

Results suggest an insufficient deployment of nurses' enacted scope of practice, likely caused by some job characteristics, leading to lower work satisfaction and negative patients and organizational outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Optimizing nurses' enacted scope of practice would be a significant integrated strategy for improving organizational performance, patient care and nurses' satisfaction and well-being. Nurses and frontline managers must be involved in the decision-making process necessary to improve nurses' enacted scope of practice.

Influence of caring for COVID-19 patients on nurse's turnover, work satisfaction and quality of care

Aim

This study aims to examine, through the lens of the Job Demands‐Resources model, the influence of caring for COVID‐19 patients on nurse's perception of chronic fatigue, quality of care, satisfaction at work and intention to leave their organisation and the profession.

Background

Studies have examined how fear of COVID‐19 contributes to the mental, physical and work adjustment among nurses. To date, few studies have been conducted examining how caring for patients with COVID‐19 contributes to work outcomes among nurses.

Methods

This is a cross‐sectional survey involving 1705 frontline nurses and licensed practical nurses in Quebec, Canada. From these, 782 reported caring for COVID‐19 patients.

Results

High chronic fatigue, poor quality of care, lower work satisfaction and higher intention to leave their organisation were found for nurses caring for COVID‐19 patients. Poorly prepared and overwhelmed nurses showed higher turnover intention than those well prepared and in control.

Conclusions

There is an urgent need to provide support to nurses during the pandemic, with a long‐term strategy to increase their retention.

Implications for Nursing Management

Nurse administrators play an important role in supporting their nurses during a pandemic in the form of education, training and policy development to positively impact quality of care and retention.

Missed nursing care and its relationship with perceived ethical leadership

BACKGROUND

Determination of the factors affecting missed nursing care and the impact of ethical leadership is important in improving the quality of care.

AIM

This study aims to determine the missed nursing care and its relationship with perceived ethical leadership.

RESEARCH DESIGN

A cross-sectional study.

PARTICIPANTS AND RESEARCH CONTEXT

The sample consisted of 233 nurses, of whom 92.7% were staff nurses and 7.3% were charge nurses, who work in three different hospitals in Turkey. The study data were collected using a personal and professional characteristics data form, the Missed Nursing Care Survey, and the Ethical Leadership Scale.

ETHICAL CONSIDERATIONS

The study was approved by the non-interventional ethics committee of Dokuz Eylül University Ethics Committee for Noninvasive Clinical Studies. All participants' written and verbal consents were obtained.

FINDINGS

The most missed nursing care practices were ambulation, attending interdisciplinary care conferences, and discharge planning. According to the logistic regression analysis, sex, the number of patients that the nurse is in charge of giving care, the number of patients discharged in the last shift, and satisfaction with the team were determined as factors affecting missed care. No significant relationship was found between ethical leadership and missed nursing care (p > 0.05), and a weak but significant relationship was found between the clarification of duties/roles subscale and missed nursing care (r = -0.136, p < 0.05).

DISCUSSION

Ethical leaders should collaborate with policy-makers at an institutional level to particularly achieve teamwork that is effective in the provision of care, to control missed basic nursing care, and to organize working hours and at the country level to determine roles and to increase the workforce.

CONCLUSION

The results of this study contribute to the international literature on the most common type of missed nursing care, its reasons, and the relationship between the missed care and ethical leadership in a different cultural context.

Factors influencing retention among hospital nurses: systematic review

BACKGROUND

Recruitment and retention of nursing staff is the biggest workforce challenge faced by healthcare institutions. Across the UK, there are currently around 50 000 nursing vacancies, and the number of people leaving the Nursing and Midwifery Council register is increasing.

OBJECTIVE

This review comprehensively compiled an update on factors affecting retention among hospital nursing staff.

METHODS

Five online databases; EMBASE, MEDLINE, SCOPUS, CINAHL and NICE Evidence were searched for relevant primary studies published until 31 December 2018 on retention among nurses in hospitals.

RESULTS

Forty-seven studies met the inclusion criteria. Nine domains influencing staff turnover were found: nursing leadership and management, education and career advancement, organisational (work) environment, staffing levels, professional issues, support at work, personal influences, demographic influences, and financial remuneration.

CONCLUSION

Identified turnover factors are long-standing. To mitigate the impact of these factors, evaluation of current workforce strategies should be high priority.

Manager's influence on the registered nurse and nursing assistant relational quality and patient safety culture

AIMS

The purpose of this study is to describe the perceptions of relational quality of the registered nurse and nursing assistant and examine how their view of the manager's influence impacts overall patient safety culture of a unit.

BACKGROUND

The primary delivery of nursing care within acute care systems uses teams of registered nurses and nursing assistants.

METHODS

A cross-sectional secondary analysis of data collected in the spring of 2018 using the Agency for Healthcare and Quality Hospital Survey of Patient Safety Culture and a seven-item questionnaire measuring relational quality was conducted. The sample included 1,152 responses.

RESULTS

The manager influenced overall perceptions of safety regardless of the relational quality between the registered nurse and nursing assistant.

CONCLUSIONS

This study found manager behaviours that promote patient safety and also influence overall perceptions of patient safety culture regardless of the relational quality between the registered nurse and nursing assistant.

IMPLICATIONS FOR NURSING MANAGEMENT

Positive registered nurse and nursing assistant relational quality amplifies perceptions of patient safety culture, yet it is the manager's behaviours regarding safety that make the stronger contribution in building a culture of safety.

Effects of resilience, social support, and work environment on turnover intention in newly graduated nurses: The mediating role of transition shock

AIM

The aim of this work was to examine the mediating role of transition shock on the relationships between resilience, social support, work environment, and turnover intention in newly graduated nurses.

BACKGROUND

Reports assessing the associations between nurses' resilience, social support, work environment, and turnover intention, both directly and through the mediating effect of transition shock, are scarce.

METHODS

This was a cross-sectional study, which recruited 361 Chinese newly graduated nurses with <1 year of work experience.

RESULTS

Resilience, social support, and work environment directly and significantly predicted transition shock (direct effect -0.158 to -0.350, p < .01). Resilience, work environment, and transition shock directly and significantly affected turnover intention (direct effect -0.118 to -0.257, p < .05). Transition shock mediated the relationships between resilience, social support, work environment, and turnover intention indirectly and significantly (indirect effect -0.019 to -0.041, p < .05).

CONCLUSIONS

The results suggest that nurse managers could enhance resilience and social support and establish a positive work environment to reduce transition shock and turnover intention.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers could continuously provide resilience training and develop a supportive workplace climate for newly graduated nurses to facilitate smooth transition into clinical practice, could alleviate their transition shock and turnover intention.

Authentic leadership, nurse-assessed adverse patient events and quality of care: The mediating role of nurses' safety actions

BACKGROUND

Authentic leadership has been consistently cited as a strong precursor of sustained job performance and work effectiveness in nurses; however, studies linking authentic leadership with nurses' safety actions, nurse-assessed adverse patient events and nursing care quality are scarce.

AIM

To examine whether nurses' safety actions mediate the relationship between authentic leadership, nurse-assessed adverse events and nursing care quality.

METHODS

A multi-centre, cross-sectional study involving 1,608 nurses employed in acute care facilities in Oman. Multi-stage regression analysis was conducted in testing for the mediation model.

FINDINGS

Nurse managers in Oman were perceived to be highly authentic by their staff nurses. Authentic leadership significantly predicted nurses' safety actions (β = 0.168, p < .001), decrease in nurse-assessed adverse events (β = -0.017, p = .024) and increase in care quality (β = 0.121, p < .001). Further, the association between authentic leadership and nurse-assessed adverse events (β = -0.063, p = .057) and care quality (β = 0.038, p = .002) was mediated by nurses' safety actions.

CONCLUSION

Results suggest the importance of developing nurse managers' authentic leadership to foster nurses' safety actions and reduce adverse patient outcomes and promote nursing care quality.

IMPLICATIONS FOR NURSING MANAGEMENT

Organizational efforts to address patient safety issues should be directed towards developing authentic leadership in nurse managers through leadership programmes, periodic evaluation of leadership competencies (e.g., 360-degree or a bottom-up performance evaluation), and a creation of a safe culture in which nurses can openly report safety concerns for corrective action.

Understanding effective nurse leadership styles during the COVID-19 pandemic

Leadership is central to effective nursing practice and is considered to be particularly important during crises such as the coronavirus disease 2019 (COVID-19) pandemic. This article examines several leadership styles that are commonly used in healthcare - namely the transactional, transformational and laissez-faire leadership styles - and considers their advantages and disadvantages in the context of the COVID-19 pandemic. It also explains the potential benefits of compassionate leadership in supporting the nursing workforce during this highly challenging and stressful period.

Fear of COVID-19, psychological distress, work satisfaction and turnover intention among frontline nurses

AIM

To examine the relative influence of fear of COVID-19 on nurses' psychological distress, work satisfaction and intent to leave their organisation and the profession.

BACKGROUND

The emergence of COVID-19 has significantly impacted the psychological and mental well-being of frontline health care workers, including nurses. To date, no studies have been conducted examining how this fear of COVID-19 contributes to health, well-being and work outcomes in frontline nurses.

METHODS

This is a cross-sectional research design involving 261 frontline nurses in the Philippines. Five standardized scales were used for data collection.

RESULTS

Overall, the composite score of the fear of COVID-19 scale was 19.92. Job role and attendance of COVID-19-related training predicted fear of COVID-19. An increased level of fear of COVID-19 was associated with decreased job satisfaction, increased psychological distress and increased organisational and professional turnover intentions.

CONCLUSIONS

Frontline nurses who reported not having attended COVID-19-related training and those who held part-time job roles reported increased fears of COVID-19. Addressing the fear of COVID-19 may result in improved job outcomes in frontline nurses, such as increased job satisfaction, decreased stress levels and lower intent to leave the organisation and the profession.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisational measures are vital to support the mental health of nurses and address their fear of COVID-19 through peer and social support, psychological and mental support services (e.g. counselling or psychotherapy), provision of training related to COVID-19 and accurate and regular information updates.

Influence of nurse managers' toxic leadership behaviours on nurse-reported adverse events and quality of care

AIM

To assess the impact of toxic leadership behaviours among nurse managers on nurse-reported adverse events and quality of care.

BACKGROUND

Toxic leadership, a form of ineffective leadership, is increasingly becoming rampant in the field of nursing and has been strongly linked to poor nurse job outcomes including job dissatisfaction, higher stress levels, and increased turnover intention. To date, no studies have been conducted to examine how this type of leadership behaviours affects patient outcomes and care quality.

METHODS

A multicentre, cross-sectional study. This study involved a sample of 1,053 registered nurses working in 20 hospitals in the Philippines. Three standardized scales were deployed, including the Toxic Leadership Behaviors of Nurse Managers Scale, the Adverse Patient Events Scale and the single-item quality-of-care-measure.

RESULTS

Overall, nurses (96.2%) appraised the quality of care of their respective units as 'good to excellent' and cited complaints from patients and their families as the most commonly reported adverse events. Toxic leadership behaviours in nurse managers were strongly associated with increased nurse-reported adverse events including reports of complaints (β = .619; p < .001) and verbal mistreatment from patients and their families (β = .407; p < .001), patient falls (β = .834; p < .001), health care-associated infections (β = .629; p < .001) and errors in administering medication (β = .708; p < .001) and with decreased quality of care (β = -.216; p < .001).

CONCLUSION

Nurses who experience working under a nurse manager exhibiting toxic behaviours reported an increased frequency of nurse-reported adverse events and poorer quality of care in the unit.

IMPLICATIONS FOR NURSING MANAGEMENT

Organizational measure to reduce the occurrence of adverse events and enhance the quality of care provided in medical units may include intervention to develop positive leadership practices among nurse managers.

The Impact of Social Factors on Job Crafting: A Meta-Analysis and Review

Despite the considerable focus on job characteristics and individual differences in job crafting research, the influence of social factors on job crafting has not been well-acknowledged. Based on social interaction and job crafting literature, this meta-analysis estimates the associations between social factors (i.e., organizational insiders and outsiders) and job crafting, and how these social factors contribute to employee outcomes through their job crafting. Based on a sample of 51 empirical studies that included 54 independent samples (N = 17,863), we found that social factors of positive leadership styles (e.g., empowering and transformational) and coworker support were positively related to employee job crafting. Moreover, leadership showed a stronger correlation with employee job crafting than coworker support and Leader-Member-Exchange (LMX). Further, our study showed that employee job crafting positively mediates the relationships between social factors and work outcomes (e.g., job performance and well-being). Our study contributes to job crafting literature by integrating social factors into the job crafting model and demonstrating that the social context of work (in particular organizational insiders) plays a crucial role in shaping employees’ job crafting behavior. We also emphasize the critical role that job crafting plays in transmitting valuable social resources into improved work outcomes. Building on our results, we provide future direction for job crafting research and discuss how our results can imply practice in terms of job crafting training.

Fear of COVID-19, psychological distress, work satisfaction and turnover intention among frontline nurses

AIM

To examine the relative influence of fear of COVID-19 on nurses' psychological distress, work satisfaction and intent to leave their organisation and the profession.

BACKGROUND

The emergence of COVID-19 has significantly impacted the psychological and mental well-being of frontline health care workers, including nurses. To date, no studies have been conducted examining how this fear of COVID-19 contributes to health, well-being and work outcomes in frontline nurses.

METHODS

This is a cross-sectional research design involving 261 frontline nurses in the Philippines. Five standardized scales were used for data collection.

RESULTS

Overall, the composite score of the fear of COVID-19 scale was 19.92. Job role and attendance of COVID-19-related training predicted fear of COVID-19. An increased level of fear of COVID-19 was associated with decreased job satisfaction, increased psychological distress and increased organisational and professional turnover intentions.

CONCLUSIONS

Frontline nurses who reported not having attended COVID-19-related training and those who held part-time job roles reported increased fears of COVID-19. Addressing the fear of COVID-19 may result in improved job outcomes in frontline nurses, such as increased job satisfaction, decreased stress levels and lower intent to leave the organisation and the profession.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisational measures are vital to support the mental health of nurses and address their fear of COVID-19 through peer and social support, psychological and mental support services (e.g. counselling or psychotherapy), provision of training related to COVID-19 and accurate and regular information updates.

Predictors of toxic leadership behaviour among nurse managers: A cross-sectional study

AIM

To identify the predictors of toxic leadership behaviour in nurse managers.

BACKGROUND

Toxic leadership is becoming increasingly prevalent in nursing; however, the literature provides very limited evidence of the different factors that promote toxic leadership behaviour in nurse managers.

METHODS

A descriptive, cross-sectional design was used. Two hundred and forty nurse managers from ten hospitals in the Central Philippines were included in the study. Data were collected using the Nurse Information Form and the Toxic Leadership Behaviours of Nurse Managers Scale (ToxBH-NM). Hierarchical multiple regression was used to analyse the data collected.

RESULTS

The mean of average item score of the ToxBH-NM was 1.250 (SD = 0.470). Multiple regression analyses identified the years of experience in a managerial role (β = -0.165, p = .031), job status (part time) (β = 0.177, p = .002), ward census (30 patients, 40 patients and above 40 patients) ([β = 0.231, p = .005]; [β = 0.345, p < .004]; [β = 0.262, p = .012]), number of units managed (2 units and > 3 units) ([β = 0.292, p < .001]; [β = 0.235, p < .001]), hospital type (private hospital) (β = 0.271, p = .007) and hospital level (secondary hospitals) (β = 0.226, p = .036) predicted toxic leadership behaviour in nurse managers.

CONCLUSIONS

Overall, nurse managers were appraised as non-toxic leaders. Nurse managers who held a part-time job status, those who had lower experience in the managerial role and those who were assigned to wards or units with high patient admission numbers reported increased toxic leadership behaviours. Further, nurse managers who managed more than 2 units, those who were employed in private hospitals and those who worked in secondary hospitals reported increased toxic leadership behaviours.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse administrators can consider the different predictors identified when planning and developing leadership interventions and organisational strategies (e.g. limiting the number of units per nurse manager, provision of full-time job employment, assignment of assistant nurse managers, formulation of policy specific to managing toxic behaviours), which may assist in the determent of toxic behaviours in nurse managers.

Perceived Leadership Styles, Outcomes of Leadership, and Self-Efficacy Among Nurse Leaders:: A Hospital-Based Survey to Inform Leadership Development at a US Regional Medical Center

In response to improving upon a leadership development program at a US regional medical center, coupled with the understanding that transformational leadership is linked with better outcomes, as a first step, we examined the perceived leadership styles, outcomes of leadership, and level of self-efficacy among nurse leaders, namely nurse managers, clinical supervisors, and nurse directors. Twenty-three hospital-based nurse leaders completed the surveys with a response rate of 57.5%. The majority of the leadership styles aligned with that of transformational. However, the items with the 3 lowest average frequency ratings within the transformational leadership style were in the areas of communication and showing confidence. Additionally, the perceived median self-efficacy score was low. Organizational support by way of providing continuous, sustainable professional leadership development, especially in the area of communication, and building self-efficacy is needed to ensure leader effectiveness, and improvement in staff and patient outcomes.

The Effect of Nurse Practice Environment on Retention and Quality of Care via Burnout, Work Characteristics, and Resilience: A Moderated Mediation Model

OBJECTIVE

The aim of this study was to explore the influence of nurse work characteristics, resiliency, and burnout on retention, and patient quality and safety.

BACKGROUND

With an ongoing nursing shortage, maintaining qualified nursing staff is critical. We explored the direct and indirect effects of practice environment, nurse work characteristics, and burnout on retention, and perceived quality and safety.

METHODS

Responses from 507 RNs were collected via an anonymous online survey. Theorized relationships were explored via path analysis and invariance testing.

RESULTS

Positive practice environment and favorable work characteristics lowered burnout and improved outcomes. The indirect effects of work characteristics and burnout were dependent upon individual level of resilience. Social capital minimized the effects of burnout for participants reporting below-average resilience.

CONCLUSIONS

Leader support was critical in shaping positive perception of the practice environment. A nurse leader's visibility and actions impact intent to stay. Results of this study may inform healthcare systems struggling to retain a robust, engaged nursing workforce.