‘I'm actually being the grown-up now’: leadership, maturity and professional identity development

A rapid realist review on leadership and career advancement interventions for women in healthcare

Women represent 70% of the global health workforce but only occupy 25% of health and social care leadership positions. Gender-based stereotypes, discrimination, family responsibilities, and self-perceived deficiencies in efficacy and confidence inhibit the seniority and leadership of women. The leadership inequality is often compounded by the intersection of race and socio-economic identities. Resolving gender inequalities in healthcare leadership brings women's expertise to healthcare decision making, which can lead to equity of healthcare access and improve healthcare services. With the aim of enhancing women's advancement to leadership positions, a rapid realist review (RRR) was conducted to identify the leadership and career advancement interventions that work for women in healthcare, why these interventions are effective, for whom they are effective, and within which contexts these interventions work. A RRR ultimately articulates this knowledge through a theory describing an intervention's generative causation. The Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) for conducting a realist synthesis guided the methodology. Preliminary theories on leadership and career advancement interventions for women in healthcare were constructed based on an appraisal of key reviews and consultation with an expert panel, which guided the systematic searching and initial theory refinement. Following the literature search, 22 studies met inclusion criteria and underwent data extraction. The review process and consultation with the expert panel yielded nine final programme theories. Theories on programmes which enhanced leadership outcomes among women in health services or professional associations centred on organisational and management involvement; mentorship of women; delivering leadership education; and development of key leadership skills. The success of these strategies was facilitated by accommodating programme environments, adequacy and relevance of support provided and programme accessibility. The relationship between underlying intervention entities, stakeholder responses, contexts and leadership outcomes, provides a basis for underpinning the design for leadership and career advancement interventions for women in healthcare.

Characteristics of strong midwifery leaders and enablers of strong midwifery leadership: An international appreciative inquiry

OBJECTIVES

This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally.

DESIGN

In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022.

SETTING

Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya.

PARTICIPANTS

An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218).

MEASUREMENTS

Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics.

FINDINGS

Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives' clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools.

Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review

AIM

To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies.

DESIGN

Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES).

DATA SOURCES

PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022.

REVIEW METHODS

Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group.

RESULTS

Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only.

CONCLUSIONS

A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies.

IMPACT

Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated.

NO PATIENT OR PUBLIC CONTRIBUTION

Prospero ID CRD42021292290.

Nurse Managers' Perceived Self-leadership Levels: A Cross-sectional Study

OBJECTIVE

The aim of this study was to determine the perceived levels of self-leadership among nurse managers in the United States.

BACKGROUND

Self-leadership is the ability to influence and engage oneself to be self-aware and responsible, and leverage strengths to perform. Despite benefits identified from extant literature, there are no studies on self-leadership among nurse managers in the United States.

METHODS

A cross-sectional descriptive design was used. Eighty-eight nurse managers completed a survey using the Revised Self-Leadership Questionnaire.

RESULTS

Nurse managers identified moderate levels of self-leadership; the strategies with the lowest scores were constructive thought strategies, self-reward behaviors, and visualizing performance. There was a relationship between age and the identified self-leadership levels.

CONCLUSIONS

Further studies are needed to understand self-leadership among nurse leaders in the United States and beyond. There is an opportunity to increase nurse managers' self-leadership level by focusing on interventions to increase constructive thought pattern strategies, self-reward behaviors, and visualizing successful performance.

Smartphone addiction and its associated factors among freshmen medical students in China: a cross-sectional study

BACKGROUND

With smartphone use widespread worldwide, smartphone addiction is an emerging epidemic. This study aims to investigate the prevalence of smartphone addiction among freshmen medical students and to explore its association with personal factors, mental health, and professional identity.

METHODS

This cross-sectional study was conducted from October 10th to November 10th, 2020 and included 2,182 first-year college students at Wannan Medical College, China. The smartphone addiction test, professional identity, and a 12-item general health questionnaire were used for this cross-sectional survey. Pearson's correlation coefficient (r) was employed to examine the correlations between smartphone addiction and mental health and professional identity. Binary logistic regression analysis was carried out to assess the factors influencing smartphone addiction. Of the 2,182 students, 866 (39.7%) were identified as having smartphone addiction. The logistic regression analysis shows that four factors (professional identity scale, poor mental health, smartphone use before sleep, and perceived study pressure) were significantly associated with smartphone addiction.

CONCLUSIONS

This cross-sectional study suggests that smartphone addiction is common among Chinese freshmen medical students. Smartphone addiction was common among the freshmen medical students surveyed. The findings imply that promotional programs, aimed at enhancing mental health and professional identity among freshmen medical students, help to reduce smartphone addiction in this population.

The impact of nurse leadership education on clinical practice: An integrative review

AIM

The aim of this paper is to critically evaluate the literature investigating the impact of nurse leadership education on clinical practice.

BACKGROUND

Effective leadership is vital for high-quality patient care. Leadership education is designed to support nurses to develop the appropriate skills and behaviors to become clinical leaders. However, to date, the impact of such education on subsequent clinical practice is unclear.

EVALUATION

An integrative review was conducted. Ten papers were included related to the experiences of nurses undertaking leadership education.

KEY ISSUE

Analysis of the included papers indicated that leadership education contributed to improving clinical practice in two ways. These two key themes were; impact on the individual and impact on others.

CONCLUSION

While there is a plethora of literature reviewing nurse leadership and clinical practice, there is a gap in understanding how nurse leadership education can contribute to changed practice.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can use this information to guide future leadership education programs to ensure that they promote positive work environments and high-quality care that improves clinical outcomes.

Influence of psychological stress and coping styles in the professional identity of undergraduate nursing students after the outbreak of COVID-19: A cross-sectional study in China

Aim

To investigate the influencing factors in professional identity of undergraduate nursing students after the outbreak of COVID‐19.

Design

Cross‐sectional study.

Methods

The study covered 2,999 nursing students in six undergraduate nursing schools. Several self‐report questionnaires were used to collect the general information, psychological stress, coping styles and professional identity of the undergraduate nursing students.

Results

The overall average score of the professional identity of nursing students (3.67 ± 0.51) has increased significantly after the outbreak of COVID‐19. The professional identity of the undergraduate nursing students was negatively correlated with psychological stress (r = −0.23, p < .001), expectation (r = −0.12, p < .001) and avoidance (r = −0.16, p < .001), but was positively correlated with solving problems (r = 0.18, p < .001) and seeking support (r = 0.12, p < .001). Academic performance, positions, grades, reasons for choosing a nursing profession, parents or relatives engaged in nursing work and the risk degree of residence were the factors influencing the professional identity score of undergraduate nursing students' (p < .001).

What do midwifery leaders need in order to be effective in contributing to the reform of maternity services?

PROBLEM

Little is known about what midwifery leaders need to effectively contribute to maternity services reform.

BACKGROUND

Despite evidence establishing midwifery continuity of care as the gold standard of maternity care, implementation of these models has been slow. Midwives in health service leadership roles are in an ideal position to re-orientate maternity services to midwifery continuity of care.

QUESTION

What do midwives in leadership positions need in order to be effective in contributing to the reform of maternity services in Australia?

METHODS

This qualitative descriptive study used purposive sampling to recruit 13 midwifery leaders from across Australia. Individual telephone interviews were conducted and analysed through line-by-line coding and identification of themes.

FINDINGS

Five main themes emerged from the data: 'core leadership skills and education are essential'; 'motivation and commitment to implementing evidence-based maternity care'; 'ability to create and sustain strategic relationships'; 'bringing the vision to life' which contained two sub-themes of 'changing the culture' and 'reaching midwifery's full potential'; and, 'organisational support and commitment are key to maternity reform'.

DISCUSSION

This study echoes findings from previous research emphasising the importance of leadership attributes and development opportunities for midwifery leaders. Additional needs of midwifery leaders were also revealed, which have not yet been extensively explored in the literature, including a strong commitment to continuity of care, effective relationships with key stakeholders and support from healthcare executives.

CONCLUSION

Midwifery leaders need to be equipped to contribute to maternity care reform through leadership development opportunities, effective relationships and support from healthcare executives.

Professional identity in nursing: A mixed method research study

Professional identity is developed through a self-understanding as a nurse along with experience in clinical practice and understanding of their role. Personal and professional factors can influence its development. A recent integrative literature review synthesised factors that influenced registered nurse's perceptions of their professional identity into three categories of the self, the role and the context of nursing practice. This review recommended that further research was needed into professional identity and how factors and perceptions changed over time. The aims of this study were to explore registered nurses' understanding of professional identity and establish if it changed over time. A mixed-methods study using a two-stage design with an on-line survey and focus groups was implemented with registered nurses who were studying nursing at a postgraduate level in Australia or Scotland. The reported influences on professional identity related to the nurse, the nursing role, patient care, the environment, the health care team and the perceptions of nursing. Professional development and time working in the profession were drivers of changes in thinking about nursing, their role and working context and their professional identity. Additionally, participants sought validation of their professional identity from others external to the profession.

Analysis on professional identity and related factors among Chinese general practitioners: a National Cross-sectional Study

BACKGROUND

Studies on professional identity and related factors among Chinese general practitioners (GPs) are unavailable. The objective of this study was to investigate the professional identity level of GPs in China and explore factors associated with GPs' perceptions of their professional identity.

METHODS

A multistage stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs working in community health service institutions (CHIs) in China between October, 2017 and February, 2018. Professional identity was measured by the 13 items scale. Descriptive statistics were calculated and groups' differences were estimated using nonparametric tests. Multiple linear stepwise regression analysis was used to analyze factors associated with professional identity among GPs.

RESULTS

Based on a total score of 65 on the professional identity scale, the average score for GPs' professional identity was 51.23 (SD = 6.56). Multiple linear stepwise regression analysis showed that GPs who practiced in Central China, with an administrative responsibility, at a moderate or higher income level, who frequently worked overtime, had more occupational development opportunities, with a higher level of job satisfaction and older GPs had higher levels of professional identity.

CONCLUSIONS

Professional identity level among GPs in China is high. Region, administrative responsibility, income level, working overtime, occupational development opportunities, age, and job satisfaction were significant predictors of professional identity.

A hermeneutic-phenomenological study of paediatric intensive care unit nurses' professional identity following hospital redesign: Lessons learned for managers

AIM

To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change.

BACKGROUND

While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity.

METHOD

The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n = 15) in a large Canadian paediatric hospital.

RESULTS

Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions.

CONCLUSION

Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes.

IMPLICATIONS FOR NURSING MANAGEMENT

The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated; 2) the physical environment needs to be considered when determining staffing requirements; and 3) identity transitions need to be managed.

Young Midwifery Leaders Programs: Capacity Building for the Future

This article describes the program components, program outcomes and challenges of two iterations of a leadership development program that was intended to contribute not only to individual capacity building but also to succession planning within midwifery professional associations. The young midwifery leaders programs were similarly designed, using self-study modules that focused on essential leadership knowledge and skills, and a mentor–mentee relationship to provide guidance and support to selected midwives early in their professional careers. The International Confederation of Midwives (ICM) implemented a 3-year leadership program conducted from 2004 to 2007 for five mentee participants. A collaborative United Nations Population Fund (UNFPA)/ICM team in Latin America designed and implemented an 18-month program with 12 mentees that began in 2013. Examples of leadership outcomes in policy and education include assumption of elected offices in midwifery associations, integration of evidence-based topical content into an established midwifery education program, and development of a new preservice education program in a rural zone of a large country. The vision for the future is to expand this program globally while simultaneously adapting the program content and strategies to reflect the leadership needs of the regional context in which it is implemented.

Nursing identity and patient-centredness in scholarly health services research: a computational text analysis of PubMed abstracts 1986-2013

BACKGROUND

The most important and contested element of nursing identity may be the patient-centredness of nursing, though this concept is not well-treated in the nursing identity literature. More conceptually-based mapping of nursing identity constructs are needed to help nurses shape their identity. The field of computational text analytics offers new opportunities to scrutinise how growing disciplines such as health services research construct nursing identity. This paper maps the conceptual content of scholarly health services research in PubMed as it relates to the patient-centeredness of nursing.

METHODS

Computational text analytics software was used to analyse all health services abstracts in the database PubMed since 1986. Abstracts were treated as indicative of the content of health services research. The database PubMed was searched for all research papers using the term "service" or "services" in the abstract or keywords for the period 01/01/1986 to 30/06/2013. A total of 234,926 abstracts were obtained. Leximancer software was used in 1) mapping of 4,144,458 instances of 107 concepts; 2) analysis of 106 paired concept co-occurrences for the nursing concept; and 3) sentiment analysis of the nursing concept versus patient, family and community concepts, and clinical concepts.

RESULTS

Nursing is constructed within quality assurance or service implementation or workforce development concepts. It is relatively disconnected from patient, family or community care concepts.

CONCLUSIONS

For those who agree that patient-centredness should be a part of nursing identity in practice, this study suggests that there is a need for development of health services research into both the nature of the caring construct in nursing identity and its expression in practice. More fundamentally, the study raises questions about whether health services research cultures even value the politically popular idea of nurses as patient-centred caregivers and whether they should.