Health-promoting leadership: An integrative review and future research agenda

Nurses' and nurse leaders' perspectives on a health-promoting work environment: a meta-ethnographic study

PURPOSE

The purpose of this meta-ethnography is to integrate and synthesize nurses' and nurse leaders' perspectives on a health-promoting work environment to enhance understanding of its essential aspects.

METHODS

A meta-ethnographic approach developed by Noblit and Hare was conducted.

FINDINGS

Line of argument synthesis led to the development of an overarching tree metaphor: "cultivating a flourishing environmental tree rooted in values, held stable by leadership, and nurtured by safe working conditions." This metaphor illustrates that a health-promoting work environment is imbued with three interdependent aspects: 1) core values as the roots of the tree, including respect, recognition, community, and engagement 2) value-conscious leadership as the trunk of the tree, meaning a leader who is conscious of their power position and responsibilities and 3) safe working conditions as fertile soil for the tree, comprising the physical and administrative dimensions of the work environment.

CONCLUSIONS

Collaboration between nurses and leaders is crucial for cultivating a health-promoting work environment. However, nurse leaders, due to their influential positions, have the responsibility to facilitate this environment. Consequently, leaders need to receive adequate resources and support from their superiors to foster an environment that enhances nurses' health and job satisfaction.

Concept, Influencing Factors, and Interventions of Nursing Health Leadership: A Scoping Review

Background: With increasing burnout and turnover rates among nurses, health leadership can effectively improve the health and well-being of both leaders and staff. However, in the nursing field, the definition and mechanisms of health leadership remain unclear and require further research. Aim: The main objective of this study was to define the concept of health leadership in nursing, construct a nursing model program, and promote the formation of normative nursing health leadership theories and strategies. Evaluation: We searched the PubMed, CINAHL, Embase, Web of Science, PsycINFO, and Scopus databases. The following themes were extracted from the included articles: the concept, assessment tools for health leadership, influencing factors, intervention measures, and health effects. Key Issues: A systematic search of the relevant databases yielded 3161 initial search results. Thirty-two studies were eligible for inclusion. Research shows that the concepts and measurement tools of health leadership are rarely applied in the field of nursing. Health leadership is influenced by personal factors (e.g., leadership qualities such as care, support, courage, patience, tolerance for uncertainty, persuasion skills, work ethic, pressure, experience, effort-reward imbalance, etc.; specific knowledge; self-awareness; psychological capital; leadership style; motivation; consideration; and a commitment to health issues) and organizational factors (e.g., work environment, attention to subordinates, job expectations, and relationship transparency). Several studies have demonstrated that interventions, such as personal development planning, leadership training, face-to-face communication, self-directed learning, and reflection, are effective in promoting healthy leadership styles and improving the well-being of leaders and employees. Conclusions: We constructed a health leadership model as a reference for the development of relevant measurement tools and intervention strategies for the nursing field. Implications for Nursing Management: Nursing leaders should focus on their health and that of their subordinates, develop and implement health leadership, and aim for improvement in employees' well-being and nursing quality.

Nurse Leaders' Motivational Forces in Developing a Health-Promoting Work Environment: A Hermeneutic Study

Background: The literature review highlights that a motivated leader plays a key role in motivating employees and fostering a health-promoting work environment. Despite its importance, there is limited knowledge about the motivational forces, from a caring science perspective, that drive nurse leaders to develop a health-promoting work environment. Aim: This study aims to gain a deeper understanding of the motivational forces driving nurse leaders toward developing a health-promoting work environment. Method: A qualitative design with a hermeneutic approach inspired by Gadamer was chosen. Data were collected through semistructured interviews with 13 nurse leaders in northern Norway between December 2023 and February 2024. The Standards for Reporting Qualitative Research (SRQR) were followed in reporting the results. Findings: The nurse leader's motivational forces in developing a health-promoting work environment imbued with an ethos of (1) sense of inner responsibility for promoting the wellbeing of others, (2) sense of trusting relationships in the workplace, (3) sense of mastery through learning and development, and (4) sense of recognition from superiors through being seen, supported, and involved. Conclusion: This study highlights the importance of raising awareness and articulating nurse leaders' underlying motives and values. Doing so transforms abstract concepts into tangible factors that stakeholders can grasp. In particular, this insight provides valuable guidance to politicians and decision-makers on how to facilitate improved working conditions for nurse leaders, thereby maintaining and enhancing their motivation. Implications for Nursing Leadership: The findings of this study recommend that superior leaders and policymakers should prioritize involving nurse leaders in decision-making and promoting their autonomy and room for action. In addition, it suggests facilitating further education and training programs for leaders, as well as maintaining leadership networks where nurse leaders can reflect, exchange experiences, and address challenges.

Hospital managers' perspectives on pregnancy policy and work adjustments: A cross-sectional study

BACKGROUND

Risk assessment and work adjustment according to EU legislation may safeguard pregnant employees and their offspring. Knowledge on management perspectives in relation to implementation of protective measures is limited.

OBJECTIVES

The primary aim was to describe Danish hospital managers' engagement in pregnancy policy and work adjustment for pregnant employees. The secondary aim was to investigate how managers' characteristics and the setting affect engagement and behaviour.

METHODS

This was a cross-sectional study of survey data from 212 managers. Outcomes were within dimensions of health promotion, pregnancy policy, work adjustment, collaboration, manager support, and sick leave. Logistic and ordinal logistic regression models were applied to identify associations between background information and outcomes.

RESULTS

Of the managers included, 84% arranged meetings and 76% conducted occupational risk assessment. Most managers (96%) engaged in dialogue with the employees before sick leave. Most managers felt competent in providing guidance for pregnant employees and 99% considered work adjustment important, mainly to safeguard mothers and children. The self-reported data showed positive associations between female managers and feeling competent to guide the employee. Further, management training was associated with meetings with pregnant employees. Seniority was associated with feeling competent to guide and dialogue. Midwifery support was associated with competence in guiding employees about risk factors.

CONCLUSION

Work adjustment and risk assessment for pregnant employees are considered a priority by Danish hospital managers. Overall, managers feel competent guiding pregnant employees. However, managers experience midwifery support beneficial for the guidance of pregnant employees.

A qualitative study of leaders' experiences of handling challenges and changes induced by the COVID-19 pandemic in rural nursing homes and homecare services

BACKGROUND

The COVID-19 pandemic had a major impact on healthcare services globally. In care settings such as small rural nursing homes and homes care services leaders were forced to confront, and adapt to, both new and ongoing challenges to protect their employees and patients and maintain their organization's operation. The aim of this study was to assess how healthcare leaders, working in rural primary healthcare services, led nursing homes and homecare services during the COVID-19 pandemic. Moreover, the study sought to explore how adaptations to changes and challenges induced by the pandemic were handled by leaders in rural nursing homes and homecare services.

METHODS

The study employed a qualitative explorative design with individual interviews. Nine leaders at different levels, working in small, rural nursing homes and homecare services in western Norway were included.

RESULTS

Three main themes emerged from the thematic analysis: "Navigating the role of a leader during the pandemic," "The aftermath - management of COVID-19 in rural primary healthcare services", and "The benefits and drawbacks of being small and rural during the pandemic."

CONCLUSIONS

Leaders in rural nursing homes and homecare services handled a multitude of immediate challenges and used a variety of adaptive strategies during the COVID-19 pandemic. While handling their own uncertainty and rapidly changing roles, they also coped with organizational challenges and adopted strategies to maintain good working conditions for their employees, as well as maintain sound healthcare management. The study results establish the intricate nature of resilient leadership, encompassing individual resilience, personality, governance, resource availability, and the capability to adjust to organizational and employee requirements, and how the rural context may affect these aspects.

Exploring leadership in health professionals following an industry-based leadership program: A cross-sectional survey

AIM

To evaluate the self-reported leadership practices and behaviours of health professionals following a leadership program and explore factors that impacted leadership style.

DESIGN

An online cross-sectional survey was conducted from August to October 2022.

METHODS

The survey was disseminated via email to leadership program graduates. The Multifactor Leadership Questionnaire Form-6S was used to measure leadership style.

RESULTS

Eighty completed surveys were included in the analysis. Participants scored highest on transformational leadership and lowest on passive/avoidant leadership style. Participants with higher qualifications scored significantly higher in the inspirational motivation scores (p = 0.03). As years in their profession increased, there was a significant decrease in contingent reward scores (p = 0.04). The younger participants scored significantly higher on the management-by-exception than older participants (p = 0.05). There were no significant associations with the year the leadership program was completed, gender or profession and Multifactor Leadership Questionnaire Form - 6S scores. Most participants (72.5%) strongly agreed that the program enhanced their leadership development and 91.3% strongly agreed or agreed that they routinely apply the skills and knowledge learnt in the program in their workplace.

CONCLUSION

Formal leadership education is important in developing a transformational nursing workforce. This study found that program graduates had adopted a transformational leadership style. Education, years of experience and age impacted the specific leadership elements. Future work needs to incorporate longitudinal follow-up to relate changes in leadership with impact on clinical practice.

IMPLICATIONS FOR THE PROFESSION

Transformational leadership as a dominant style can contribute to nurses and other disciplines positively contributing to innovative and person-centred approaches to health service delivery.

SUMMARY STATEMENT

What already is known-Leadership amongst nurses and other health professionals impacts patients, staff, organizations and ultimately healthcare culture. What this paper adds-Formal leadership education is important in developing a transformational healthcare workforce. Implications for practice/policy-Transformational leadership can enhance nurses and other disciplines commitment to innovative and person-centred approaches.

IMPACT STATEMENT

This research identifies that lessons learnt from formal leadership education are retained over time by healthcare providers. This is important for nursing staff, and other healthcare providers, who are leading teams and overseeing care delivery, can ensure leadership behaviours and practices are enacted to influence a transformational workforce and culture.

REPORTING METHOD

This study adhered to STROBE guidelines. No Patient or Public Contribution.

Exploring the impact of nursing home managers' leadership on staff job satisfaction, health and intention to leave in nursing homes

AIMS AND OBJECTIVES

To explore the impact of nursing home leadership and staffing characteristics on staff job satisfaction, health and intention to leave.

BACKGROUND

The number of older people has outpaced growth in the nursing home workforce worldwide. Identifying predictors with the potential to positively impact staff job satisfaction, health and intentions to leave are important. Leadership of the nursing home manager can be one such predictor.

DESIGN

Cross-sectional design.

METHODS

A sample of 2985 direct care staff in 190 nursing homes in 43 randomly selected municipalities in Sweden completed surveys on leadership, job satisfaction, self-rated health and intention to leave (response rate 52%). Descriptive statistics and Generalised Estimating Equations were conducted. The STROBE reporting checklist was applied.

RESULTS

Nursing home managers' leadership was positively related to job satisfaction, self-rated health and low intention to leave. Lower staff educational levels were related to poorer health and lower job satisfaction.

CONCLUSIONS

Nursing home leadership plays a significant role in the job satisfaction, self-reported health and intention to leave of direct care staff. Low education levels among staff seem to negatively influence staff health and job satisfaction, suggesting that educational initiatives for less-educated staff could be beneficial for improving staff health and job satisfaction.

RELEVANCE TO CLINICAL PRACTICE

Managers seeking to improve staff job satisfaction can consider how they support, coach and provide feedback. Recognising staff achievement at work can contribute to high job satisfaction. One important implication for managers is to offer continuing education to staff with lower or no education, given the large amount of uneducated direct care workers in aged care and the impact this may have on staff job satisfaction and health.

NO PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was required to outcome measures in this study. Direct care staff and managers contributed with data.

Building a Transition Program for Senior Nurse Leaders

Professional development educators undertake a primary role in building organizational transition programs for nurses. Transitions of senior nurse leaders are complex and poorly understood. A Hermeneutic phenomenological study was conducted to investigate the lived experiences of nine novice senior nurse leaders. Four principle themes and five subthemes are identified so that professional development educators may customize situation-specific learning for senior nurse leader onboarding.

Association between triage nurses' job satisfaction and professional capability: Results of a mixed-method study

AIM

This study aims to examine factors related to the job satisfaction of triaging nurses and their professional capability in the clinical setting.

BACKGROUND

Triage is a complex process that relies on making decisions in favour of the patient and his treatment. The professional capability of a triaging nurse is an important psychological construct of job satisfaction.

METHODS

The study used a mixed-method methodology, with data collection based on an explanatory research design. The research instrument in the quantitative part was a survey questionnaire, and in the qualitative part, a semi-structured interview. The results were integrated using the 'Pillar Integration Process'.

RESULTS

There are significant relationships between professional capability and job satisfaction. Six main topics were exposed: characteristics and traits, work organization, safety is the key, burdening circumstances, capability and self-evaluation.

CONCLUSION

Professional capability is associated with job satisfaction. The necessary managerial changes should be made to achieve job satisfaction and develop professional competence while focusing on already trained and competent triage nurses, as satisfied triage nurses will stay longer in the institution.

IMPLICATIONS FOR NURSING MANAGEMENT

The manager's job is to be aware of the level of job satisfaction, take care to develop their employee's professional capability and take action in case of disrupted balance.

The Impacts of Applications of Criminal Law on Medical Practice

Background

Human health is the single most asset that any one person can and need to have it as qualitative as.. Despite this, however, there are occasions when things go wrong in practice and the patients wind up getting hurt while they are receiving treatment at the healthcare facility Obtaining and maintaining a good health are the goals of individuals and communities, which require having good medical systems. In rare cases, malpractice of medical systems may occur, a matter that affects patients and health providers.

Objective

The main objectives of the present study were to review the literature for medical malpractice and how the application of criminal law impacts the medical practice.

Methods

This is descriptive review based on the related studies published in scientific literature and deposited in on-line indexed databases.

Results and Discussion

Main findings of the study showed that medical errors are likely to increase overtime. Malpractice is likely to take place as if good intention to do the best. Activation of criminal law against medical malpractice may put stress on medical staff, and may be a triggering factor for improving services submitted to the patients.

Conclusion

Activation of criminal law against medical errors places stress on medical community from one side, and may be a triggering factor for improving services from another side.

Supportive Communities: Conceptualizing Supportive Structures for Coaches’ Learning and Well-Being in Community Youth Soccer

Sweden has an extensive culture of community club sports for children and youths, based on voluntary leadership. Being a voluntary coach can be stressful and can affect coaches’ well-being. Since voluntary coaching is closely connected to and conditioned by family life and civil occupation, coaches need support for practical issues as well as for developing their coaching assignment in relation to the constantly changing conditions within sports for children and youths. The aim of this paper was to conceptualize and problematize the supportive structures in everyday activities, in order to promote learning and well-being and to prevent mental health issues. This paper is conceptual and based on a paradigm case. The starting point is communities of practice (CoP) and how CoPs can contribute to the development of supportive structures for coaches in youth sports. In conclusion, a CoP is dependent on negotiation within the coaching team as well as on facilitating factors that can add knowledge, perspectives, and experiences to the CoP. The facilitating factors mean that a CoP has the potential to be health-promoting for both coaches and players. Hence, it is important to create conditions, structures, and support—such as policies, practice-based education, mentorship, and facilitators.

How and When Health-Promoting Leadership Facilitates Employee Health Status: The Critical Role of Healthy Climate and Work Unit Structure

Health-promoting leadership has attracted a lot of attention from scholars in recent years. However, majority studies focused on theoretical arguments rather than empirical examination. Not only that, extant research often theorizes health-promoting leadership as a combination of a series of direct and explicit health-related behaviors, neglecting the potential social information it may convey to employees. Based on social information processing theory, this study empirically examines how and when health-promoting leadership can facilitate employees’ health status. Using a time-lagged data of 370 employees (i.e., matched to 51 leaders), we found that health-promoting leadership has a significant and positive influence on employees’ health status, and healthy climate acts as a linking pin. In addition, work unit structure moderates the relationship between health-promoting leadership and healthy climate. Specifically, compared with mechanic work unite structure, employees rely more on social information conveyed by health-promoting leadership when working at an organic work unite structure. This study not only extends current knowledge about the effect of health-promoting leadership, but also provides useful guidance for practitioners.

Associations between nurse managers' leadership styles, team culture and competence planning in Norwegian municipal in-patient acute care services: A cross-sectional study

BACKGROUND

Increased complexity in the primary healthcare services has followed in the wake of health reforms and reveals the need for competence enhancement in the nursing services. Effective and visionary leadership, sufficiently qualified staff and cooperation among professionals are considered as key measures to safeguard quality in the services.

AIMS

To identify which leadership styles characterise first-line nurse managers in Norwegian municipal in-patient acute care (MipAC) units and to investigate how first-line nurse managers' leadership styles are associated with team culture and documented nursing competence planning.

METHODS

A cross-sectional survey was distributed to all the first-line nurse managers in Norwegian MipAC units (n = 229). Data were collected between March and June 2019. The response rate was 80.5% (n = 182). First-line managers' background information and data about their focus on team culture and competence planning were recorded. Furthermore, we noted organisational structural characteristics, and managers' transformational (relational) leadership and transactional (task-oriented) leadership styles.

RESULTS

The managers exhibited a high degree of transformational leadership behaviour, which was significantly associated with team culture. No significant associations between leadership behaviours and documented competence planning were found. Notably, we found a significant correlation between transformational and transactional leadership styles, indicating that the managers adapt their leadership behaviours to actual requirements and situations. Organisational structural factors: the share of registered nurses (RNs) on the staff and having a position for a professional development nurse were positively associated with competence planning.

CONCLUSION

A relational leadership style promotes team culture and both factors may empower the professional nursing environment. However, first-line nurse managers need to acknowledge nursing competence planning as a central part of effective leadership. Having a professional development nurse position seems to complement leadership and ease the manager's responsibilities regarding team culture and competence planning.

Nurse’s competences in promoting women’s health in light of the Galway Consensus

ABSTRACT Objectives: to identify nurses’ competences in promoting women’s health. Methods: descriptive study with a qualitative approach that adopted the Galway Consensus as a theoretical-methodological framework. Data collection was performed through semi-structured interviews. Results: most of the Galway Consensus’ competence domains were present in the nurses’ interventions related to health promotion in women’s care. “Assessment of needs” and “Implementation” were the most highlighted domains, followed by “Leadership” and “Impact assessment”. The domain “Defending/Advocating Rights” was not identified. Final Considerations: within the nurses’ work with women, some of the Galway Consensus domains of competencies for health promotion were present. However, there is a need, in the context of continuous health education, to expand strategies and enhance the development and application of these health promotion competences.

Strategic leadership and management factors driving sustainability in health-care organizations in Thailand

Purpose

This empirical study aims to identify the essential strategic leadership and management factors underlying sustainability in healthcare. It also examines which factors drive sustainability performance outcomes (SPO) in health-care organizations, an analysis lacking to date. It provides a strategic leadership and management perspective toward sustainable healthcare, responding to the United Nations Sustainable Development Goals.

Design/methodology/approach

The investigation adopted Sustainable Leadership as its research framework. Using a cross-sectional survey, 543 employees working in health-care and pharmaceutical companies in Thailand voluntarily provided responses. Factor analyses and structural equation modeling were employed.

Findings

The results revealed an emergent research model and identified 20 unidimensional strategic leadership and management factors toward sustainability in healthcare. The findings indicate significant positive effects on SPO in health-care organizations. Significant factors include human resource management/development, ethics, quality, environment and social responsibility, and stakeholder considerations.

Research limitations/implications

The study was conducted in one country. Future studies should examine these relationships in diverse contexts. In practice, health-care firms should foster significant strategic leadership and management practices to improve performance outcomes for sustainability in healthcare.

Originality/value

This paper is the first empirical, multidisciplinary study with a focus on strategic leadership, health-care management and organizational sustainability. It identifies a proxy for measuring the effects of essential strategic leadership and managerial factors for sustainability in pharmaceutical health-care companies. It advances our currently limited knowledge and provides managerial implications for improving performance outcomes toward sustainable healthcare.

The role of managerial leadership in sickness absence in health and social care: antecedent or moderator in the association between psychosocial working conditions and register-based sickness absence? A longitudinal study based on a swedish cohort

BACKGROUND

The prevalence of sickness absence is particularly high among employees in health and social care, where psychosocial work stressors are pertinent. Managerial leadership is known to affect sickness absence rates, but the role leadership plays in relation to sickness absence is not fully understood; that is, whether poor leadership (i) is associated with sickness absence directly, (ii) is associated with sickness absence indirectly through the establishment of poor psychosocial working conditions, or (iii) whether good leadership rather has a buffering role in the association between work stressors and sickness absence.

METHODS

Four biennial waves from the Swedish Longitudinal Occupational Survey of Health (SLOSH, 2010-2016, N=2333) were used. Autoregressive cross-lagged analyses within a multilevel structural equation modelling (MSEM) framework were conducted to test hypotheses i)-iii), targeting managerial leadership, register-based sickness absence and psychosocial work stressors (high psychological demands, poor decision authority and exposure to workplace violence).

RESULTS

A direct association was found between poor leadership and sickness absence two years later, but no associations were found between leadership and the psychosocial work stressors. Finally, only in cases of poor leadership was there a statistically significant association between workplace violence and sickness absence.

CONCLUSIONS

Poor managerial leadership may increase the risk of sickness absence among health and social care workers in two ways: first, directly and, second, by increasing the link between workplace violence and sickness absence.

Nursing coaching leadership and its influence on job satisfaction and patient safety

OBJECTIVE

To compare the nursing technicians' perception with the nurses' self-perception of the exercise of nurses' coaching leadership and to check the influence of this leadership model on the safety climate and on the team's satisfaction.

METHOD

This is a correlational study, carried out with 85 nurses and 85 nursing technicians, using the Questionnaire on the Nurse's Self-Perception of Leadership Exercise, the Questionnaire on Nursing Technicians' and Assistants' Perception of Leadership Exercise, and the subscales Safety climate and Satisfaction at Work. The relations among the professionals' responses were assessed using the Mann Whitney test and Spearman's coefficient.

RESULTS

Nurses achieved higher means in the four dimensions of coaching Leadership, and in three, the differences were significant (p < 0.05). The dimensions of Coaching Leadership obtained positive and significant correlations with the subscales Safety Climate and Satisfaction, the majority being of moderate magnitude.

CONCLUSION

Nurses' self-perception regarding the exercise of leadership was more positive than the technicians' assessment. The more the nurse exercises the dimensions of Coaching Leadership, the better the team's safety climate and satisfaction.

Ergonomic Challenges in the Perioperative Setting

Working in health care can be physically stressful. The perioperative setting, which is largely concealed from other health care workers and the general public, places unique physical demands on its workers. Perioperative personnel are responsible for a variety of physical tasks, including moving and positioning patients, holding extremities, and moving equipment and supplies. As the nursing workforce ages, the physical demands of the perioperative environment may affect the development of musculoskeletal disorders in older nurses. The purpose of this article is to review published research and describe the ergonomic challenges of working in the OR. There currently is a paucity of literature on the effects of ergonomic risk factors on perioperative nurses in the United States. This article also provides some recommendations for perioperative staff members and leaders that may assist them with creating and maintaining a healthy and safe work environment.

Approaches to workload in psychiatric and mental health nursing

OBJECTIVE

to investigate approaches to workload in psychiatric and mental health nursing in Brazilian and international production of knowledge Methods: integrative literature review using six databases, covering January 2005 to March 2019. Articles in full in English, Spanish and Portuguese were included.

RESULTS

the sample consisted of 23 original articles classified as quantitative or emotional. The quantitative dimension was addressed in 12 articles and included: assessing patient care needs, identifying activities performed by the team, measuring time spent and developing and validating a measurement instrument. The emotional dimension included 11 articles the focus of which was on identifying stressors in the workplace, psychosocial risks and coping strategies.

CONCLUSION

strategies were found for measuring workload and assessing the impact of stressors on nursing teams.

Health-Promoting Leadership: Concept, Measurement, and Research Framework

Employee health is not only positively related to the employee well-being and family happiness, but also impacts organizations, and society as a whole. We searched the health-promoting leadership literature in the following databases: Web of Science, ProQuest, EBSCO, and a Chinese local database. Based on this research, we clarify the concept of health-promoting leadership, propose a definition of health-promoting leadership, and examine measurement scales for this type of leadership. We also suggest a research framework for health-promoting leadership, demonstrating its potential outcomes at both the individual level (e.g., health, well-being, job attitudes) and the organizational level (e.g., health management culture and practices); the mechanisms for its development based on conservation of resources theory, the job demands–resources model, social learning theory, and social exchange theory; and antecedents (e.g., health values, health awareness, organizational health culture, organizational health climate, and organizational health promotion behavior control). Finally, we identify six potential research areas: Research level, performance, the impacts of health-promoting leaders on themselves, moderators, research methods, and intervention effects on health-promoting leadership.

Total Worker Health Leadership and Business Strategies Are Related to Safety and Health Climates in Small Business

The purpose of this study was to investigate the relationship between Total Worker Health® (TWH) business strategies and employee perceptions of leadership commitment and safety and health climates. Using data from 53 small enterprises and 1271 of their workers collected as part of the Small + Safe + Well (SSWell) Study, we confirm the primacy of the relationship between leadership commitment to safety and workplace safety climate. After accounting for leadership commitment to safety, business-reported policies and practices that promote the health, safety, and well-being of workers (i.e., TWH strategies) were no longer related to safety climate. In contrast, the relationship between TWH strategies and health climate were significantly associated with the level of small business leadership commitment to worksite wellness. Relatedly, our results demonstrate that leadership is a common correlate to both safety climate and health climate. Future research should investigate integrated TWH leadership development strategies as a means of simultaneously improving safety and health climates.

Physical and Psychosocial Work Environmental Risk Factors for Back Injury among Healthcare Workers: Prospective Cohort Study

The incidence of occupational back injury in the healthcare sector remains high despite decades of efforts to reduce such injuries. This prospective cohort study investigated the risk factors for back injury during patient transfer. Healthcare workers (n = 2080) from 314 departments at 17 hospitals in Denmark replied to repeated questionnaires sent every 14 days for one year. Using repeated-measures binomial logistic regression, controlling for education, work, lifestyle, and health, the odds for back injury (i.e., sudden onset episodes) were modeled. On the basis of 482 back injury events, a higher number of patient transfers was an important risk factor, with odds ratio (OR) 3.58 (95% confidence interval (CI) 2.51–5.10) for 1–4 transfers per day, OR 7.60 (5.14–11.22) for 5–8 transfers per day, and OR 8.03 (5.26–12.27) for 9 or more transfers per day (reference: less than 1 per day). The lack of necessary assistive devices was a common phenomenon during back injury events, with the top four lacking devices being sliding sheets (30%), intelligent beds (19%), walking aids (18%), and ceiling lifts (13%). For the psychosocial factors, poor collaboration between and support from colleagues increased the risk for back injury, with OR 3.16 (1.85–5.39). In conclusion, reducing the physical burden in terms of number of daily patient transfers, providing the necessary assistive devices, and cultivating good collaboration between colleagues are important factors in preventing occupational back injuries among healthcare workers.

Registered nurses' perspectives of work satisfaction, patient safety and intention to stay - A double-edged sword

AIM

To describe job satisfaction in registered nurses (RNs), their intention to stay at their current workplace and in the profession and to explore patient safety in relation to these.

BACKGROUND

Nurse turnover presents a serious challenge to health care that may be predicted by factors related to the work environment.

METHOD

Descriptive design with 25 qualitative interviews.

RESULTS

Five categories were identified: RNs feel satisfied when providing person-centred care; RNs enjoy the variability of the nursing job, but want control; RNs feel frustrated when care is put on hold or left undone; RNs depend on team collaboration and the work environment to assure patient safety; intention to stay depends on the work environment and a chance for renewal.

CONCLUSION

Registered nurses' job satisfaction could be described as a double-edged sword. Although the profession is described as a positive challenge, work overload threatens both job satisfaction and patient safety.

IMPLICATIONS FOR NURSING MANAGEMENT

Our findings suggest that nursing leadership can increase RNs' intention to stay by meeting their needs for appreciation, a better work environment, competence development and professional career development.

Health-promoting leadership: A qualitative study from experienced nurses' perspective

AIMS AND OBJECTIVES

To increase knowledge about experienced nurses' understanding of a health-promoting work environment, health-promoting leadership and its role in retention of staff in the nursing workplace.

BACKGROUND

The quality of leadership is imperative in creating supportive and health-promoting work environments to ensure workforce productivity and ethically sustainable caring cultures. More knowledge on how leaders can promote health and sustainable careers among nurses is needed. At a time of current and projected nursing shortage, it is important to understand the reasons why nurses intend to remain in their jobs.

DESIGN

Qualitative descriptive.

METHOD

Twelve experienced registered nurses participated in an individual, digitally recorded, semi-structured interview. Data were transcribed verbatim and subjected to qualitative content analysis of manifest and latent content.

RESULTS

A health-promoting work environment should provide autonomy, participation in decision-making, skills development and social support. Health-promoting leaders should be attentive and take action.

CONCLUSION

Health-promoting work environments enable nurses to flourish. Having ample autonomy is therefore important to nurses so that when they face new challenges, they see them as a way of using and developing their competencies. Although most nurses claim their own leaders are not health promoting, they have a clear understanding of how a health-promoting leader should act. The health-promoting leader should not only be attentive and promote skills development, but also cater for nurses' meaningfulness.

RELEVANCE TO CLINICAL PRACTICE

Nurses in primary health care understand a health-promoting work environment to be a workplace where they can develop, not only clinical skills, but also flourish as human beings. Further, nurses find it health promoting to have a meaningful job, using their competence to make a difference for patients and their families. Nurse Managers have an important role in facilitating meaningfulness in nurses' jobs to retain nurses as a valuable asset for the organisation.