Ethical leadership and decision authority effects on nurses' engagement, exhaustion, and turnover intention

Authentic Leadership-A Concept Analysis

AIM

To report an analysis of the concept of authentic leadership.

DESIGN

Concept analysis.

DATA SOURCES

Data sources included core databases: CINAHL, PubMed, Embase, ProQuest, APA PsycINFO, ERIC, ABI/Inform and Tomlinson's Nursing Core Collection (2010).

METHODS

Walker and Avant's method was used to identify descriptions, antecedents, consequences and empirical referents of the concept. Model, related and contrary cases were developed.

RESULTS

Defining attributes were identified as self-awareness, transparency, balanced processing, internalised moral perspective, caring, shared decision making and moral/ethical courage. Antecedents were authenticity, positive psychological capacities, life experiences, leadership development programme, supportive organisational climate and an ethical climate. Consequences are employee well-being and satisfaction, positive work environment and enhanced performance and safety.

CONCLUSION

While authentic leadership is an emerging and popular leadership approach, there are gaps in relation to agreed definitions. Moreover, core textbooks within the subject area also fail to provide these definitions. This concept analysis represents the first comprehensive and robust analysis of the concept of authentic leadership that will serve to reliably inform research, education and practice.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This analysis reveals that authentic leadership can have a positive effect on staff well-being and satisfaction, their work environment, performance and ultimately safety. This has potential for a positive impact on patient care and patient outcomes by fostering an ethical and supportive work environment.

IMPACT

This study revealed a new comprehensive understanding of authentic leadership that provides conceptual clarity that will guide research and practice in the field, which refines the existing understanding, highlighting essential attributes and their relevance in nursing practice.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Relationship between nurses' mood at work and work engagement: Work morale as a mediator

AIM

To determine the effect of nurses' mood at work (positive and negative) on work engagement and whether work morale mediates this relationship.

BACKGROUND

Nurses' work engagement is a key research area, yet limited data regarding the relationship between nurses' mood at work and work engagement are available. Therefore, how nurses' positive or negative mood at work affects their work engagement remains unclear.

METHODS

This study analyzed nurses from a medical center in Taipei City. A total of 279 completed questionnaires were returned. The data were analyzed using two-stage structural equation modeling to test the hypothesized relationships.

FINDINGS

Nurses' positive mood had a significantly positive effect on work morale, whereas their negative mood had a significantly negative effect on work morale. Additionally, work morale played a mediating role in the relationship between mood at work and work engagement.

CONCLUSION

The results revealed that nurses' moods affected their work engagement and that this relationship was affected by work morale.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Healthcare institutions and hospitals could develop a positive work environment to help nurses maintain their good mood and reduce negative affectivity. They should also provide nurses with counseling services, offer morale-boosting activities, and adopt an inspirational leadership style to maintain their work morale.

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

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

Investigating the relationship between nurses' workplace behaviour and perceived levels of ethical leadership in managers

BACKGROUND

There is increasing research interest in the relationship between ethical leadership and deviant workplace behaviour. Ethical leadership encompasses altruism, courage, ethical orientation, integrity and fairness. Examples of deviant workplace behaviours include theft, fraud, sabotage, assault, abuse, manipulation and bullying. It appears that when leaders are fair and emphasise ethical conduct, followers are less inclined to engage in deviant workplace behaviour.

AIM

To investigate the relationship between nurses' self-rated levels of deviant workplace behaviour and perceived levels of ethical leadership in managers.

METHOD

For this descriptive correlational study, 355 nurses from one university hospital in Egypt responded to an online questionnaire comprising the Ethical Leadership Scale and the Workplace Deviance Behavior Scale. Descriptive and inferential statistics were used to explore results and examine the relationships between study variables.

RESULTS

There was a statistically significant negative relationship between respondents' self-rated levels of deviant workplace behaviour and their perceptions of levels of ethical leadership in managers. The results appeared to confirm previous research. Nurses who feel that they are treated fairly by their managers tend to have positive attitudes towards work, colleagues and management.

CONCLUSION

Ethical leadership on the part of managers is a significant determinant of nurses' behaviour in the workplace and should therefore be fostered by healthcare organisations.

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.

The impact of evidence-based nursing leadership in healthcare settings: a mixed methods systematic review

BACKGROUND

The central component in impactful healthcare decisions is evidence. Understanding how nurse leaders use evidence in their own managerial decision making is still limited. This mixed methods systematic review aimed to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurse leaders and their performance, organizational, and clinical outcomes.

METHODS

We included articles using any type of research design. We referred nurses, nurse managers or other nursing staff working in a healthcare context when they attempt to influence the behavior of individuals or a group in an organization using an evidence-based approach. Seven databases were searched until 11 November 2021. JBI Critical Appraisal Checklist for Quasi-experimental studies, JBI Critical Appraisal Checklist for Case Series, Mixed Methods Appraisal Tool were used to evaluate the Risk of bias in quasi-experimental studies, case series, mixed methods studies, respectively. The JBI approach to mixed methods systematic reviews was followed, and a parallel-results convergent approach to synthesis and integration was adopted.

RESULTS

Thirty-one publications were eligible for the analysis: case series (n = 27), mixed methods studies (n = 3) and quasi-experimental studies (n = 1). All studies were included regardless of methodological quality. Leadership problems were related to the implementation of knowledge into practice, the quality of nursing care and the resource availability. Organizational data was used in 27 studies to understand leadership problems, scientific evidence from literature was sought in 26 studies, and stakeholders' views were explored in 24 studies. Perceived and measured effects of evidence-based leadership focused on nurses' performance, organizational outcomes, and clinical outcomes. Economic data were not available.

CONCLUSIONS

This is the first systematic review to examine how evidence is used to solve leadership problems and to describe its measured and perceived effects from different sites. Although a variety of perceptions and effects were identified on nurses' performance as well as on organizational and clinical outcomes, available knowledge concerning evidence-based leadership is currently insufficient. Therefore, more high-quality research and clinical trial designs are still needed.

TRAIL REGISTRATION

The study was registered (PROSPERO CRD42021259624).

Female managers' organizational leadership during telework: experiences of job demands, control and support

The frequent use of telework during the COVID -19 pandemic has created a more challenging work situation for managers who need to lead effectively in the virtual space, this especially concerns female managers. Therefor it is of importance to investigate female managers' experiences of job related demands, control and support within this work context. Accordingly, we investigated female managers' experiences of demands, control and support in their organizational leadership during telework. The present study used a deductive, theory-driven, qualitative approach with predetermined themes defined within the demand-control-support model. Data were collected by semi-structured interviews. The female managers had at least 50% of their working hours as telework. The results showed that the female managers experienced demands in terms of hard, fast or even excessive work in order to be available and solve complex problems, and control as varied work content, new learning, planning and decision freedom. Support was experienced in terms of attentive superior manager, good cooperation and helpfulness among colleagues. Theoretical and practical implications of the results are discussed in terms of telework situation for female managers.

Individual perspectives and mental maps of working conditions and intention to stay of physicians in academic medicine

Introduction

Job satisfaction has a strong impact on the intention to stay which is an important aspect to counter skills shortage in academic medicine. The purpose of the three studies reported here is to find out what specific factors are relevant for the intention to stay and turnover intention of physicians in academic medicine -and what measures might have a positive impact on employee retention.

Methods

In an interview study combining qualitative and quantitative methods, we investigated how the individual mental representation of working conditions influences job satisfaction and its impact on the intention to stay. In total, 178 physicians from German university hospitals, residents, and physicians, in 15 departments of anesthesiology were interviewed and surveyed. In a first study, chief physicians participated in interviews about job satisfaction in academic hospitals. Answers were segmented into statements, ordered by topics, and rated according to their valence. In a second study, assistant physicians during and after their training period talked about strengths, weaknesses, and potential improvements of working conditions. Answers were segmented, ordered, rated, and used to develop a "satisfaction scale." In a third study, physicians participated in a computer-led repertory grid procedure composing 'mental maps' of job satisfaction factors, filled in the job satisfaction scale and rated if they would recommend work and training in their clinic as well as their intention to stay.

Results

Comparing the interview results with recommendation rates and intention to stay show that high workload and poor career perspectives are linked to a negative attitude. A positive attitude towards work environment and high intention to stay is based on sufficient personnel and technical capacities, reliable duty scheduling and fair salaries. The third study using repertory grids showed that the perception of current teamwork and future developments concerning work environment were the main aspects to improve job satisfaction and the intention to stay.

Discussion

The results of the interview studies were used to develop an array of adaptive improvement measure. The results support prior findings that job dissatisfaction is mostly based on generally known "hygiene factors" and whereas job satisfaction is due to individual aspects.

The Effect of Work Engagement and Perceived Organizational Support on Turnover Intention among Nurses: A Meta-Analysis Based on the Price–Mueller Model

Aim. To elaborate on the relationship between work engagement, perceived organizational support, and the turnover intention of nurses by analysing some potential moderators. Background. Nurses’ turnover intention is negatively impacted by their level of work engagement and perceptions of organizational support. However, it is challenging to reach a consistent conclusion. Methods. Data were acquired from six electronic databases. Each study was evaluated using the quality assessment tool for cross-sectional studies of the Agency for Healthcare Research and Quality (AHRQ). STATA 15.0 was used to analyse the data, and a random effects model was used. The groups that included two or more studies were added to the moderator analysis. Results. A total of 40 study articles involving 23,451 participants were included. The turnover intention of nurses was inversely associated with work engagement (coefficient: −0.42) and perceived organizational support (coefficient: −0.32). A substantial moderating role was played by cultural background, economic status, working years, and investigation time ( $P<0.05$ ). Conclusion. Work engagement and organizational support significantly reduced turnover intention among nurses. Considering the acute shortage of nurses worldwide, nurses with lower wages, fewer working years, and lower levels of work engagement should be given more attention and support from their organizations. Implications for Nursing Management. The meta-analysis suggested that managers should give their employees a more organizational support and promote their work engagement to motivate nurses’ retention intention and maintain a stable workforce with little employee turnover.

Impact of ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses: a cross-sectional study

BACKGROUND

While several studies have been performed on turnover intention among nurses, limited studies have considered the ethical perspectives on turnover intention among haemodialysis nurses. The purpose of this study was to clarify the impact of ethical factors, namely ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses.

METHODS

This cross-sectional research was conducted between July and August 2017. A total of 148 haemodialysis nurses were invited to participate in the study by convenience sampling from 11 general and university hospitals in South Korea. Data were analysed using SPSS for t-test, one-way analysis of variance, Pearson's correlation coefficients, and multiple regression analysis.

RESULTS

In the final regression model, the adjusted R-squared significantly explained 34.6% of the variance in turnover intention (F = 22.534, p < .001) when moral distress related to physician practice (β = 0.310, p = .001) and ethical climate related to the hospital climate (β = - 0.253, p = .003) and manager (β = - 0.191, p = .024) were included. Following the stepwise multiple regression process, all subdomains related to moral sensitivity were excluded due to no statistical significance in the final regression model.

CONCLUSION

To reduce turnover intention among haemodialysis nurses, hospitals and managers should pay attention to haemodialysis nurses' moral distress originating from physicians' practice and improve their ethical climate. Additionally, it is required that the impact of moral sensitivity on turnover among nurses working in diverse care settings be examined further.

Leaders' Role in Shaping Followers' Well-Being: Crossover in a Sample of Nurses

The link between well-being at work and leadership has received considerable attention. Leaders have the power to influence followers not only due to formal position, but also their positive behaviors could reinforce the followers' positive working experience. Following the crossover model (Westman, 2001), this study investigates whether leaders' work-related positive psychological states (i.e., work engagement) cross over to those of the followers (i.e., work engagement and job satisfaction) through the mediation of the latter's perception of transformational leadership. We used MPlus 8 to test two multilevel mediations in a sample of 1505 nurses nested in 143 groups led by as many leaders (87.19% of nurses and 56.50% of head nurses of the entire population). Results show that while there is not a crossover of leader work engagement to nurse work engagement, manager work engagement can cross over to nurse job satisfaction, enhancing their well-being through transformational leadership behaviors. This study adds further insights both on crossover theory and on the importance of leaders in expanding and transferring resources to followers at work. Fostering work engagement at a managerial level in the healthcare sector could be the driver to facilitate the well-being of nurses at work, address negative outcomes, and promote positive ones.

The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals

The shortage of healthcare workers is a growing problem across the globe. Nurses and physicians, in particular, are vulnerable as a result of the COVID-19 pandemic. Understanding why they might leave is imperative for improving retention. This systematic review explores both the prevalence of nurses and physicians who are intent on leaving their position at hospitals in European countries and the main determinants influencing job retention among nurses and physicians of their respective position in a hospital setting in both European and non-European countries. A comprehensive search was fulfilled within 3 electronic databases on June 3rd 2021. In total 345 articles met the inclusion criteria. The determinants were categorized into 6 themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants for job retention were job satisfaction, career development and work-life balance. European and non-European countries showed similarities and differences in determinants influencing retention. Identifying these factors supports the development of multifactorial interventions, which can aid the formulation of medical strategies and help to maximize retention.

Support from Work and Intent to Stay Among Nurses During COVID-19: An Academic-Practice Collaboration

The COVID-19 pandemic created stressful working conditions for nurses and challenges for leaders. A survey was conducted among 399 acute and ambulatory care nurses measuring availability of calming and safety resources, perceptions of support from work, and intent to stay. Most nurses reported intent to stay with their employer, despite inadequate safety and calming resources. High levels of support from work were significantly influenced nurses' intent to stay. Leadership actions at the study site to provide support are described, providing context for results. Nurse leaders can positively influence intent to stay through consistent implementation of supportive measures.

Preparing for the “black swan”: Reducing employee burnout in the hospitality sector through ethical leadership

Hospitality is at a crossroads. While the growth and developmental indicators in this sector show economic potential, the rising employee burnout rate is a serious challenge to hospitality management. Literature suggests that an ethical leader can reduce employee burnout significantly. Although hospitality employees face a higher risk of burnout than other service segments, shockingly, past leadership studies did not focus on how ethical leaders in a hospitality organization may reduce the risk of burnout. Therefore, we conducted this research to explore ethical leadership-burnout relationships in the hospitality sector with the mediating effects of subjective wellbeing and employee resilience. A questionnaire was provided to employees in different hotel organizations (n = 346). Structural equation modeling was employed for hypothesis testing. The statistical evidence supported the theoretical assumptions that ethical leadership negatively predicts employee burnout, and subjective wellbeing and resilience mediate this relationship. The outcomes of this study suggest different theoretical and social implications. For example, the findings indicate the effectiveness of ethical leadership in reducing employee burnout in the hospitality sector. Several other implications have been discussed in detail.

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.

Supporting nurse leaders to recognise and mitigate the effects of moral injury

The concept of moral injury has been around for several decades, yet its effect on nurses remains under-recognised. Moral injury is defined as the biopsychosocial harm that arises from a violation of one's moral code, meaning that a person is powerless to uphold and enact what they believe is morally right. The coronavirus disease 2019 (COVID-19) pandemic has brought the issue of moral injury into focus because many nurses and other healthcare professionals have encountered potentially morally injurious events, resulting in increased pressure and emotional demands. It is essential that nurse leaders recognise moral injury if its effects are to be addressed. This article describes moral injury and its effects on nurses, and offers nurse leaders a practical framework for mitigating this issue. The framework aims to support nurse leaders to increase their understanding of moral injury, address any ethical challenges, ensure they are adequately prepared to provide support to nurses, and enhance their awareness of various interventions that can mitigate moral injury.

Protective Factors against Morally Injurious Memories from the COVID-19 Pandemic on Nurses' Occupational Wellbeing: A Cross-Sectional Experimental Study

The COVID-19 pandemic was a fertile ground for nurses' exposure to self- and other-Potentially Morally Injurious Events (PMIEs). Our study explored the effects of nurses' memories of self- and other-PMIEs on occupational wellbeing and turnover intentions. Using an experimental design on a convenience sample of 634 Romanian nurses, we tested a conceptual model with PLS-SEM, finding adequate explanatory and predictive power. Memories of self- and other-PMIEs were uniquely associated with work engagement, burnout, and turnover intentions, compared to a control group. These relationships were mediated by the three basic psychological needs. Relatedness was more thwarted for memories of other-PMIEs, while competence and autonomy were more thwarted for memories of self-PMIEs. Perceived supervisor support weakened the indirect effect between type of PMIE and turnover intentions, through autonomy satisfaction, but not through burnout. Self-disclosure weakened the indirect effect between type of PMIE and turnover intentions, through autonomy satisfaction, and both burnout and work engagement. Our findings emphasize the need for different strategies in addressing the negative long-term effects of nurses' exposure to self- and other-PMIEs, according to the basic psychological need satisfaction and type of wellbeing indicator.

Digitization in Everyday Nursing Care: A Vignette Study in German Hospitals

(1) Background: Digitization in hospital nursing promises to transform the organization of care processes and, therefore, provide relief to nurse staffing shortages. While technological solutions are advanced and application fields numerous, comprehensive implementation remains challenging. Nursing leadership is crucial to digital change processes. This vignette study examined the effects of the motives and values on nurses' motivation to use innovative technologies. (2) Methods: We asked hospital nurses in an online vignette study to assess a fictitious situation about the introduction of digital technology. We varied the devices on the degree of novelty (tablet/smart glasses), addressed motives (intrinsic/extrinsic), and values (efficiency/patient orientation). (3) Results: The analysis included 299 responses. The tablet vignettes caused more motivation than those of the smart glasses (Z = -6.653, p < 0.001). The dataset did not show significant differences between intrinsic and extrinsic motives. The nursing leader was more motivating when emphasizing efficiency rather than patient orientation (Z = -2.995, p = 0.003). (4) Conclusions: The results suggest efficiency as a motive for using known digital technologies. The nursing staff's willingness to use digital technology is generally high. Management actions can provide a structural framework and training so that nursing leaders can ensure their staff's engagement in using also unknown devices.

Teleworking, Work Engagement, and Intention to Quit during the COVID-19 Pandemic: Same Storm, Different Boats?

The ability to retain and engage employees is now, more than ever, a major strategic issue for organizations in the context of a pandemic paired with a persistent labor shortage. To this end, teleworking is among the work organization conditions that merit consideration. The purpose of this cross-sectional study is to examine the direct and indirect effects of teleworking on work engagement and intention to quit, as well as the potential moderating effect of organizational and individual characteristics on the relationship between teleworking, work engagement, and intention to quit during the COVID-19 pandemic, based on a sample of 254 Canadian employees from 18 small and medium organizations. To address these objectives, path analyses were conducted. Overall, we found that teleworking, use of emotion, skill utilization, and recognition appear to be key considerations for organizations that wish to increase work engagement and decrease intention to quit, in the context of a pandemic paired with a labor shortage. Our results extend the literature by revealing the pathways through which teleworking, use of emotion, skill utilization, and recognition are linked to work engagement and intention to quit, and by suggesting specific interventions and formation plans that are needed.

Multi-level analysis of individual and work environment factors associated with nurses' perceived emotional exhaustion

BACKGROUND

Several factors at the individual- and work environment-level were suggested to correlate with emotional exhaustion development in nurses.

AIM

To explore nurses' perceived emotional exhaustion and associated factors by employing hierarchical modelling techniques.

METHODS

1539 nurses completed the cross-sectional survey. Generalized Linear Mixed Model was performed to identify predictors of emotional exhaustion.

RESULTS

At the individual level, female gender, high workload and emotional job demands increased the risk of emotional exhaustion; instead, higher education, satisfaction with the role of follower, perceiving nursing profession as meaningful, feeling independent at work, and group closeness were protective factors. At the work environment level, hospital ward type did not affect emotional exhaustion.

CONCLUSIONS

Emotional exhaustion is largely influenced by ward culture and organizational policies, and to a lower extent by socio-demographic variables. Moreover, it emerges as an intrinsic risk of the nursing profession rather than being associated with the clinical area profile.

Cognitive Appraisal of Job Autonomy by Nurses: A Cross-Sectional Study

Introduction

Job autonomy (JA), a task-level job resource has the potential to motivate individual behavior; it is indecisive, however, whether JA promotes or hinders extra-role behavior.

Objective

The study aims to examine the effect of JA on innovative work behavior (IWB) directly and indirectly through cognitive appraisal and work engagement (WE) while considering the organization type and age as control variables.

Methods

Self-administered questionnaires were used to collect the data from 326 nurses. SPSS and Amos 21 software was used to analyze the data. Data was collected between September, 2021 to January, 2022.

Results

According to the findings, JA can both stimulate and impede IWB indirectly through cognitive appraisal and WE depending on how it is appraised as a challenge and a threat (ρ = .089, p <.001); (ρ = -.038, p <.001), respectively.

Conclusion

The current study revealed that JA significantly influences the IWB of nurses directly and indirectly through cognitive appraisal and WE. Therefore, nursing management should find ways to influence nurse's appraisal of JA as a challenge rather than a threat to improve their extra-role behavior.

Measured and perceived impacts of evidence-based leadership in nursing: a mixed-methods systematic review protocol

INTRODUCTION

Despite the abundance of existing literature on evidence-based nursing practice, knowledge regarding evidence-based leadership, that is, leadership supported by an evidence-based approach, is lacking. Our aim is to conduct a mixed-methods systematic review with qualitative and quantitative studies to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurses and nurse leaders and their performance as well as on organisational and clinical outcomes.

METHODS AND ANALYSIS

We will search the following databases with no year limit or language restrictions: CINAHL (EBSCO), Cochrane Library, Embase (Elsevier), PsycINFO (EBSCO), PubMed (MEDLINE), Scopus (Elsevier) and Web of Science. In addition, the databases for prospectively registered trials and other systematic reviews will be screened. We will include articles using any type of research design as long as the study includes a component of an evidence-based leadership approach. Three reviewers will independently screen all titles, abstracts and full-text articles and two reviewers will extract the data according to the appropriate checklists. The quality of each study will be appraised using specific appraisal tool fitting in study design used in each study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) grid, PRISMA Protocols, Synthesis Without Meta-analysis and ENTREQ will guide the study process and reporting. Outcomes related to individual or group performance of nurses or nurse managers regarding leadership skills (e.g., communication skills), organisational outcomes (e.g., work environment, costs) and clinical outcomes (e.g., patient quality of life, treatment satisfaction) will be extracted and synthesised.

ETHICS AND DISSEMINATION

This systematic review will not include empirical data, and therefore, ethics approval will not be sought. The results of the review will be disseminated in a peer-reviewed scientific journal and in a conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42021259624.

Workplace violence and turnover intentions among nurses: The moderating roles of invulnerability and organisational Support - A cross-sectional study

AIMS AND OBJECTIVES

To investigate whether internal and external violence are associated with turnover intentions among nurses during demanding periods of work.

BACKGROUND

Workplace violence can negatively impact upon mental and physical health and turnover intentions. Research focusing on how dimensions of workplace violence, internal versus external, influence turnover intentions and the factors that mitigate these effect is lacking.

METHODS

An online cross-sectional survey of multi-item measures was used to collect data from 462 Iranian nurses. We employed path modelling and analysed the data using SPSS and PROCESS macro. A STROBE checklist was used to report findings.

RESULTS

Both dimensions, internal and external, of violence were positively associated with turnover intentions. Moreover, perceived invulnerability and organisational support moderates this association. When individuals perceived invulnerability and perceived organisational support are high, internal violence is no longer indirectly related to turnover intentions via job satisfaction. In a similar vein, when perceived invulnerability and perceived organisational support are low, external violence is not related to intentions to quit. When perceived invulnerability and perceived organisational support are high, however, external violence is indirectly and negatively related to intentions to quit.

CONCLUSIONS

Nurses who regard themselves as invulnerable might be motivated to quit when they experience workplace violence. However, they are motivated to stay on the job when they both perceive themselves as invulnerable and the organisation as supporting.

RELEVANCE TO CLINICAL PRACTICE

Organisations should reconsider their policies and approach towards workplace violence especially during periods of intensive work.

Ethical Leadership, Flourishing, and Extra-Role Behavior Among Nurses

Introduction

The nursing literature is silent about the relationship between ethical leadership, nurses’ flourishing, and extra-role behavior. This study was carried out to contribute to the relevant field research.

Objective

The aim of the present study was to investigate the relationship between nurses’ perceptions of their nursing managers’ ethical leadership behavior, nurses’ flourishing, and their extra-role behavior.

Methods

This was a cross-sectional study involving 302 nurses from six hospitals in Damietta City, Egypt. Data were collected using the following three self-report scales: Ethical Leadership at Work questionnaire, Flourishing Scale, and extra-role behavior scale. The data were analyzed using descriptive statistical, Pearson correlation, regression analysis and the structure equation model.

Results

There was a significant positive relationship between nursing managers’ ethical leadership, nurses’ flourishing, and extra-role behavior. The regression analysis showed that the ethical leadership of nursing managers and nurses’ flourishing predict extra-role behavior.

Conclusion

Nurses with a high level of flourishing and who work with a manager exhibiting ethical leadership behavior are more likely to activate extra-role behavior. Hence, it is recommended that nursing managers embrace an ethical approach in their leadership practices and promote flourishing among nurses to encourage them to go the extra the mile in their jobs.