Leadership self-perception of clinical nurses at the bedside: A qualitative descriptive study

Evidence behind the exhortation? A rapid review of servant leadership's influence and claims in healthcare over the last decade

Servant leadership is an other-oriented approach to leadership with multiple positive outcomes. However, its influence in the context of medicine, particularly on healthcare leaders, is less clear. We conducted a rapid review to examine the impact of servant leadership in healthcare over the last decade. We included a total of 28 articles, 26 of which described beneficial organisational, relational and personal outcomes of servant leadership. However, most of these were either conceptual or opinion-based articles. Moreover, most quantitative studies were cross-sectional, precluding causal inferences. Our review demonstrates that the purported positive association between servant leadership and healthcare outcomes lacks a strong evidence base. We conclude by calling for more rigorous empirical research to examine the effects and potential challenges of implementing servant leadership in healthcare contexts.

A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses' activities in daily practice regarding antibiotic use

Background

Antimicrobial stewardship (AMS), the set of actions to ensure antibiotics are used appropriately, is increasingly targeted at all those involved in the antimicrobial pathway, including nurses. Several healthcare organizations have issued position statements on how bedside nurses can be involved in AMS. However, it remains unclear how nurses, in reality, contribute to appropriate antibiotic use.

Objectives

To systematically search the literature to describe the activities bedside nurses perform regarding antibiotic use in daily clinical practice, in relation to the activities proposed by the aforementioned position statements.

Methods

We searched MEDLINE, Embase, CINAHL and grey literature until March 2021. Studies were included if they described activities regarding antibiotic use performed by bedside nurses. Methodological rigour was assessed by applying the Mixed Method Appraisal Tool.

Results

A total of 118 studies were included. The majority of the proposed nurses' activities were found in daily practice, categorized into assessment of clinical status, collection of specimens, management of antimicrobial medication, prompting review and educating patient and relatives. Nurses may take the lead in these clinical processes and are communicators in all aspects of the antimicrobial pathway. Patient advocacy appears to be a strong driver of bedside nurses' activities.

Conclusions

Nurses' activities are already integrated in the day-to-day nursing practice and are grounded in the essence of nursing, being a patient advocate and showing nursing leadership in safeguarding the antimicrobial treatment process. An essential element of the nursing role is communication with other stakeholders in the patient-centred antimicrobial pathway. Educating, engaging and empowering nurses in this already integrated role, could lead to a solid, impactful nursing contribution to AMS.

The challenges of change processes for nurse leaders-a qualitative study of long-term leaders' experiences over 25 years

AIM

This study aimed to map what experiences nurse leaders have encountered concerning the change work that political decisions and reforms have created within the healthcare sector in the last 25 years.

DESIGN

A qualitative design with a narrative approach was used.

METHODS

A qualitative study involved individual interviews of eight nurse managers from Norway and Finland with more than 25 years of experience working in specialist and primary healthcare fields.

RESULTS

Two main categories were observed: experiences of organizational challenges and experiences of personnel-administrative challenges. The first main category included two subcategories: A: historical experience with culture and challenges in health services and B: historical experience with mergers and using welfare technology in health services. The second category included the following subcategories: A: historical experience of job satisfaction for leaders and employees and B experiences with interprofessional collaboration in health services.

Nurse performance: A path model of clinical leadership, creative team climate and structural empowerment

AIMS AND OBJECTIVES

This study aimed to: (a) identify and examine the influence of clinical leadership, creative team climate (CTC) and structural empowerment (SE) on the nurse performance (NP) of clinical nurses in hospitals in Turkey, and (b) establish a model designed to verify the fit and effect of these factors.

BACKGROUND

Nurse performance is a significant indicator of work efficiency, patient care quality and patient safety. Existing studies explaining the mechanisms that lead to higher nurse performance have been limited.

DESIGN

This descriptive, cross-sectional study used relation prediction modelling and adhered to STROBE guidelines.

METHODS

This study used an online survey to collect data from volunteered 664 clinical nurses working in hospitals in Turkey. The data were analysed using SPSS version 26.0 and the AMOS 24.0 program. Path analysis was used to verify/test the hypothetical model, and the fit was evaluated by χ² /df, GFI, AGFI, NFI, CFI, IFI, RFI, TLI, RMR and RMSEA.

RESULTS

The fit index of the modified path model was χ² /df = 3.730, GFI = 0.904, AGFI = 0.892, NFI = 0.907, CFI = 0.923, IFI = 0.923, RFI = 0.906, TLI = 0.912, RMR = 0.078 and RMSEA = 0.064. Through creative team climate and structural empowerment, clinical leadership had the greatest standardised direct (β = .35) and indirect (β = .17) effects on clinical nurse performance, the final outcome variable. Creative team climate (β = .23) and structural empowerment (β = .19) also had a significant standardised direct effect on nurse performance. Clinical leadership, creative team climate and structural empowerment explained 39% of the total variance of nurse performance.

CONCLUSIONS

This study shows that clinical nurse performance in hospitals was significantly influenced by clinical leadership, creative team climate and structural empowerment. The results suggest that intervention programmes considering these factors could be implemented to enhance nurse performance.

RELEVANCE TO CLINICAL PRACTICE

Improved nurse performance requires strong clinical leadership, creative team climate and structural empowerment. Therefore, healthcare organisations may implement initiatives to enhance nurse performance by taking these factors into account.

Attributes, skills and actions of clinical leadership in nursing as reported by hospital nurses: a cross-sectional study

Background

Research shows a significant growth in clinical leadership from a nursing perspective; however, clinical leadership is still misunderstood in all clinical environments. Until now, clinical leaders were rarely seen in hospitals’ top management and leadership roles.

Purpose

This study surveyed the attributes and skills of clinical nursing leadership and the actions that effective clinical nursing leaders can do.

Methods

In 2020, a cross-sectional design was used in the current study using an online survey, with a non-random purposive sample of 296 registered nurses from teaching, public and private hospitals and areas of work in Jordan, yielding a 66% response rate. Data were analysed using descriptive analysis of frequency and central tendency measures, and comparisons were performed using independent t-tests.

Results

The sample consists mostly of junior nurses. The ‘most common’ attributes associated with clinical nursing leadership were effective communication, clinical competence, approachability, role model and support. The ‘least common’ attribute associated with clinical nursing leadership was ‘controlling’. The top-rated skills of clinical leaders were having a strong moral character, knowing right and wrong and acting appropriately. Leading change and service improvement were clinical leaders’ top-rated actions. An independent t-test on key variables revealed substantial differences between male and female nurses regarding the actions and skills of effective clinical nursing leadership.

Conclusions

The current study looked at clinical leadership in Jordan’s healthcare system, focusing on the role of gender in clinical nursing leadership. The findings advocate for clinical leadership by nurses as an essential element of value-based practice, and they influence innovation and change. As clinical leaders in various hospitals and healthcare settings, more empirical work is needed to build on clinical nursing in general and the attributes, skills and actions of clinical nursing leadership of nursing leaders and nurses.

Developing a Leadership and Management Competency Framework for Nurse Champion: A Qualitative Study from Shanghai, China

AIM

To develop a leadership and management competency framework applicable to Chinese nurse champions guided by the competency matrix for clinical nurse leader (CNL).

BACKGROUND

As the clinical leaders and future nurse manager candidates in the Chinese clinical setting, nurse champions are in great need of leadership and management competency training, but it is unclear what content should be included in the training curriculum, a guiding framework applicable to Chinese nurse champions was needed to be constructed.

METHODS

This study used a qualitative descriptive design to explore nurse champions' competency requirements from clinical nurse managers' perspective. Semi-structure interviews guided by the CNL competency matrix were conducted with twenty-seven clinical nurse managers from six large-scale tertiary grade A hospitals in Shanghai, China. Interview transcripts were analyzed using deductive and inductive content analysis.

RESULTS

The data analysis yielded three main categories: nursing leadership, clinical outcome management and care environment management, containing fourteen subordinate themes, which represent the leadership and management competencies needed for nurse champions.

CONCLUSIONS

A leadership and management competency framework for Chinese nurse champion was built in this study, which covering the competencies needed by Chinese nurse champions to lead care teams, improve quality of care for patient outcomes, and enhance systems and equipment for the better care environment. This framework will be the direct basis for guiding the development of the nurse leadership curriculum for driving nurse champion to achieve role success.

IMPLICATIONS FOR NURSING MANAGEMENT

This framework provides a theoretical foundation for clarifying the role of nurse champion in clinical management. Training curriculum guided by this framework will help nurses in their clinical management role and share the burden of clinical nursing managers, as well as promote the development of a clinical nursing management reserve talents and support the future development of nursing staff in healthcare organizations.