Authentic leadership and nurse-assessed adverse patient outcomes

Nursing leadership style and error management culture: a scoping review

PURPOSE

This paper aims to assess the influence of nursing leadership style on error management culture (EMC).

DESIGN/METHODOLOGY/APPROACH

This scoping review was conducted following the integrative review methodology of the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, CINAHL, Scopus, Web of Science, Embase and EBSCO databases were systematically searched to identify studies on nursing leadership, error management and measurement, and error management culture. The studies' methodological quality was then assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies.

FINDINGS

Thirteen manuscripts were included for review. The analysis confirmed that nursing leadership plays an important role in EMC and nurses' intention to report errors. Three emerging themes were identified: 1) leadership and EMC; 2) leadership and the intention to report errors; and 3) leadership and error rate.

RESEARCH LIMITATIONS/IMPLICATIONS

A major limitation of the studies is that errors are often analyzed in a transversal way and associated with patient safety, and not as a single concept.

PRACTICAL IMPLICATIONS

Healthcare managers should promote training dedicated to head nurses and their leadership style, for creating a good work environment in which nurses feel free and empowered to report errors, learn from them and prevent their reoccurrence in the future.

ORIGINALITY/VALUE

There is a positive relationship between nursing leadership and error management in terms of reduced errors and increased benefits. Positive nursing leadership leads to improvements in the caring quality.

Healthy work environment: A systematic review informing a nursing professional practice model in the US Military Health System

AIM

The aim of the study was to develop recommendations for creating a healthy work environment based on current literature for nurses working within the US Military Health System (MHS). However, our findings would likely benefit other nursing populations and environments as well.

DESIGN

Systematic literature review.

DATA SOURCES

We conducted a systematic literature search for articles published between January 2010 until January 2024 from five databases: PubMed, Joanna Briggs, Embase, CINAHL and Scopus.

METHODS

Articles were screened, selected and extracted using Covidence software. Article findings were synthesized to create recommendations for the development, implementation and measurement of healthy work environments.

RESULTS

Ultimately, a total of 110 articles met the criteria for inclusion in this review. The articles informed 13 recommendations for creating a healthy work environment. The recommendations included ensuring teamwork, mentorship, job satisfaction, supportive leadership, nurse recognition and adequate staffing and resources. Additionally, we identified strategies for implementing and measuring these recommendations.

CONCLUSIONS

This thorough systematic review created actionable recommendations for the creation of a healthy work environment. Based on available evidence, implementation of these recommendations could improve nursing work environments.

IMPACT

This study identifies methods for implementing and measuring aspects of a healthy work environment. Nurse leaders or others can implement the recommendations provided here to develop healthy work environments in their hospitals, clinics or other facilities where nurses practice.

REPORTING METHOD

PRISMA 2020 guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Head Nurse Leadership: Facilitators and Barriers to Adherence to Infection Prevention and Control Programs-A Qualitative Study Protocol

BACKGROUND

The effective management of Healthcare-Associated Infections (HAIs) relies on the implementation of good practice across the entire multidisciplinary team. The organizational context and the role of head nurses influence the team's performance and behavior. Understanding how decision-making processes influence healthcare professionals' behavior in the management of HAIs could help identify alternative interventions for reducing the risk of infection in healthcare organizations. This study aims to explore how the behaviors promoted and actions implemented by the head nurse can influence healthcare professionals' adherence to Infection Prevention and Control (IPC) programs.

METHODS

A multi-center qualitative study will be conducted using a Grounded Theory approach. Observations will be conducted, followed by individual interviews and/or focus groups. A constructive and representative sample of healthcare professionals who care directly for patients will be enrolled in the study. The COnsolidated criteria for REporting Qualitative research (COREQ) checklist will be followed to ensure the quality of this study protocol. A multistep inductive process will be used to analyze the data.

CONCLUSIONS

The study results will provide an understanding of how nurses perceive the influence of leadership and how they modify their behaviors and activities toward patients according to IPC programs. The study will identify barriers and facilitators to IPC compliance and suggest strategies to minimize negative patient outcomes, such as the development of an HAI.

Assessment of management styles among top nursing leaders in Slovenian primary health centers: a cross-sectional analysis

PURPOSE

This study aims to endeavor to discern the predominant leadership styles used by nursing managers within the framework of Slovenian primary health centers. Using a quantitative research approach, the study was conducted through the administration of a structured questionnaire.

DESIGN/METHODOLOGY/APPROACH

The investigation encompassed 67 nursing managers, representing the entire spectrum of primary health centers in Slovenia. A stratified representative subset comprising 53 top nursing managers actively participated in this study.

FINDINGS

The prevailing leadership style among nursing managers predominantly manifests as the "integrated" style, characterized by a balanced emphasis on both interpersonal relationships and task-oriented elements. These nursing leaders exhibited a proclivity for fostering collaborative teamwork, with their leadership approach notably shaped by traits such as positive thinking, self-assuredness, comprehensive leadership knowledge and an intrinsic motivation to guide and inspire individuals. Notably, leadership knowledge emerged as the most influential factor in determining the selected leadership style. The study's findings recognize specific areas in which leadership competencies among nurse managers may require further enhancement and development.

ORIGINALITY/VALUE

The study's findings are based on a specific subset of nursing leaders in a particular region, which can add to the originality, especially as there is limited prior research in this specific context. The study's exploration of leadership styles is original in the sense that it provides insights into the leadership behaviors and traits of nursing managers in the given context. The emphasis on factors such as positive thinking and leadership knowledge as influential elements adds originality to the study.

PROTOCOL: Do hospital leadership styles predict patient safety indicators? A systematic review

This is the protocol for a Campbell systematic review. The objectives are as follows: The main aim of this systematic review is to identify whether hospital leadership styles predict patient safety as measured through several indicators over time. The second aim is to assess the extent to which the prediction of hospital leadership styles on patient safety indicators varies as a function of the leader's hierarchy level in the organization.

Povezava lastnosti vodje in vodenja s kakovostjo storitev v zdravstveni negi

Uvod: Vodenje je proces, ki se nanaša na zmožnost vplivati na zaposlene, jih usmerjati in motivirati. Namen članka je bil raziskati povezavo med kakovostjo zdravstvene nege z vodenjem in lastnostmi vodje tima zdravstvene nege.Metode: Uporabljena je bila opisna metoda dela, s katero je bil med 2018 in 2020 izveden sistematični pregled literature po bazah podatkov Medline, CINAHL, Cochrane Library in PubMed. Iskalna strategija je sledila protokolu PICO. Iskalni pojmi so bili: leader, leadership, leaders competencies, quality indicators, health care, nursing leadership, patient outcomes, personnel management, outcome assesment, patient satisfaction.Rezultati: Identificiranih je bilo 462 zadetkov, med katerimi je bilo za analizo izbranih 20 prispevkov, objavljenih med letoma 2010 in 2020. Deset raziskav je bilo sistematičnih pregledov literature, devet kvantitativno presečnih ter ena eksperimentalna raziskava. Prispevki so bili kritično ovrednoteni z orodji JBI. V analizi je bilo identificiranih 163 kod, ki so bile združene v šest kategorij: slogi vodenja v zdravstvu; lastnosti dobrega vodje v zdravstvu; učinkovitost zdravstvenega tima, dejavniki, ki vplivajo na kakovost zdravstvene nege; izidi zdravstvene nege; izidi negativnega delovnega okolja.Diskusija in zaključek: V kliničnem okolju je najpogosteje omenjen in priporočen transformacijski slog vodenja, v katerem ima vodja posluh za zaposlene, vodenje je usmerjeno v odnose. Med zaposlenimi se ustvarja klima zaupanja, ki vpliva na zadovoljstvo zaposlenih in posledično pozitivno tudi na kakovost zdravstvene nege.

Nurse Managers' Leadership, Patient Safety, and Quality of Care: A Systematic Review

This review examined relationships between nurse unit managers' leadership and patient safety and quality of care outcomes in hospital settings. Employing four databases (CINAHL, Embase, PubMed, and Web of Science) and ancestry searches, we identified 14 English-language, peer-reviewed, primary studies that examined such relationships using quantitative analyses. The studies were published between 2012 and 2021, and most used a cross-sectional design. Each study's quality was assessed using the Mixed-Method Appraisal Tool. In synthesizing results by categorizing outcomes, we found a positive trend in associations between effective nurse unit manager leadership and better outcomes, including fewer patient adverse events, increased nurse error reporting, and higher patient satisfaction and care quality. However, the heterogeneity of leadership measurement approaches and outcomes limited integration of study findings. Future researchers should clearly define study concepts to support interpretation of their findings and should use a suitable theoretical framework to help determine appropriate units of analysis.

New Graduate Nurses’ Incivility Experiences: The Roles of Workplace Empowerment, Nursing Leadership and Areas of Worklife

Aims

To determine what extent are workplace empowerment, New Graduate Nurses’ (NGN) perceptions of nurse leaders, trust in management, and areas of worklife predict coworker incivility experiences?

Background

NGNs’ perceptions of nursing leaderships’ control over workload contribute to coworker incivility experiences were tested. The relationship between workplace empowerment, authentic leadership, and areas of work life (workload control and fair resource allocation) to coworker incivility experiences were examined.

Design

Secondary analysis of Starting Out, national survey, Time 1 dataset. Select factors of workplace empowerment, authentic leadership, areas of worklife, trust in management and NGNs’ co- worker incivility experiences were situated within an ecological approach. Multiple linear regression was used to test whether a negative relationship of workplace empowerment, areas of worklife and authentic leadership to NGNs co-worker incivility experiences and important new findings were discovered.

Results

First, NGNs’ perceptions of workplace empowerment predict coworker incivility experiences when controlling for authentic leadership and trust in management. Second, NGNs’ perceptions of areas of worklife predict coworker incivility experiences when controlling for authentic leadership, trust in management, and workplace empowerment. Third, NGNs’ perceptions of authentic leadership do not predict coworker incivility experiences when controlling for workplace empowerment and trust in management. Finally, NGNs’ perceptions of authentic leadership do predict coworker incivility experiences when trust in management and workplace empowerment are not controlled.

Conclusions

NGNs’ perceptions of authentic leadership would benefit from workplace empowerment of the nurse leader in workplace environments to mitigate coworker incivility experiences.

The Effect of Authentic Leadership on Nurses' Trust in Managers and Job Performance: A Cross-Sectional Study

BACKGROUND

Nurse leaders have the responsibility to build healthy work environments for staff nurses and enhance nurses' outcomes. Authentic leadership is one of the leadership theories that have been shown to have positive impacts on nurses' outcomes. The goal of this study was to test the effect of authentic leadership on trust in managers and job performance among nurses in Saudi Arabia.

METHODS

A non-experimental, cross-sectional design was applied. A total of 116 nurses who met the inclusion criteria completed the survey. To test the study variables, three different scales were used. The data in this study were analyzed using SPSS version 28.0.1.1.

RESULTS

The findings of this study showed that there were significant and positive effects of authentic leadership and its four components on trust in managers. However, no relationships were found between authentic leadership and its four elements, and job performance.

CONCLUSIONS

Authentic leaders have the ability to improve work environments by building a trustful relationship with nurses. This study focuses on the role of authentic leadership in nursing practice and its essential effects to enhance the work environments. It also provides future researchers in Saudi Arabia with comprehensive knowledge about conducting studies of authentic leadership in nursing and examine its effects on outcomes related to nurses.

Comparing the Nurse Work Environment, Job Satisfaction, and Intent to Leave Among Military, Magnet®, Magnet-Aspiring, and Non-Magnet Civilian Hospitals

OBJECTIVE

This study aimed to compare the nurse work environment, job satisfaction, and intent to leave (ITL) among military, Magnet®, Magnet-aspiring, and non-Magnet civilian hospitals.

BACKGROUND

The professional nurse work environment is an important, modifiable, organizational trait associated with positive nurse and patient outcomes; creating and maintaining a favorable work environment should be imperative for nursing leaders.

METHODS

Secondary data from the Army Nurse Corps and the National Database of Nursing Quality Indicators included the Practice Environment Scale of the Nursing Work Index (PES-NWI) and single-item measures of job satisfaction and ITL.

RESULTS

Magnet and military hospitals had identical PES-NWI composite scores; however, statistically significant differences existed among the subscales. Military nurses were the most satisfied among all groups, although this difference was not statistically significant, yet their ITL was highest.

CONCLUSIONS

Favorable work environments may exist in other organizational forms besides Magnet; however, the specific components must be considered.

Exploring the role of authentic leadership in nursing

Authentic leadership is a relatively new concept in nursing, with limited studies undertaken into its application in healthcare. Authentic leadership emphasises the importance of the leader being true to their personal core values and developing honest relationships with team members, valuing their contributions, and behaving ethically and transparently. Trust is a central tenet of authentic leadership that aims to lead to increased staff engagement, and enhanced individual and team performance. This article explores the principles, benefits and challenges of authentic leadership, as well as examining its potential role in nursing.

The influence of nurse manager competency on practice environment, missed nursing care, and patient care quality: A cross-sectional study of nurse managers in U.S. hospitals

AIMS

Identify and examine drivers of nurse manager competency and high-quality practice environments.

BACKGROUND

Nurse managers are a key predictor of positive professional practice environments which are, in turn, associated with nurse, patient, and organizational outcomes. However, little work has examined the factors that contribute to nurse manager competency.

METHODS

Nurse managers completed online surveys which were matched to unit-level aggregate data of their subordinate direct care nurses' responses on the National Database of Nursing Quality Indicators. This resulted in a final sample of 541 nurse managers across 47 U.S. hospitals. Multilevel path analysis was utilized to assess a model of the antecedents and consequences of nurse manager competency.

RESULTS

Nurse manager competency and practice environments were predictive of missed nursing care and nurse-reported quality of care. Nurse manager experience was found to have twice the effect on competency as advanced education.

CONCLUSIONS

Nurse manager competency and its downstream effects are achieved through nurse manager experience and advanced education.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse manager competency yields better practice environments and nursing care. Considering the influence of experience, careful attention should be paid to the competency development process of more novice nurse managers.

Workplace Predictors of Quality and Safe Patient Care Delivery Among Nurses Using Machine Learning Techniques

BACKGROUND

Working in unhealthy environments is associated with negative nurse and patient outcomes. Previous body of evidence in this area is limited as it investigated only a few factors within nurses' workplaces.

PURPOSE

The purpose of this study was to identify the most important workplace factors predicting nurses' provision of quality and safe patient care using a 13-factor measure of workplace conditions.

METHODS

A cross-sectional correlational survey study involving 4029 direct care nurses in British Columbia was conducted using random forest data analytics methods.

RESULTS

Nurses' reports of healthier workplaces, particularly workload management, psychological protection, physical safety and engagement, were associated with higher ratings of quality and safe patient care.

CONCLUSION

These workplace conditions are perceived to impact patient care through influencing nurses' mental health. To ensure a high standard of patient care, data-driven policies and interventions promoting overall nurse mental health and well-being are urgently required.

A review: Developing an ecological model approach to co-worker incivility experiences of new graduate nurses

AIM

To explore how an ecological approach be used to explore relationships among workplace empowerment, authentic leadership, trust in management, areas of work life and co-worker incivility experiences of new graduate nurses.

DESIGN

Key concepts related to new graduate nurses' incivility experience informed the research question building on the findings of our first author's integrative review. Second, relevant theories and concepts were identified by conducting a literature review. Third, the themes build on prior theories and factors to propose a hypothetical model.

DATA SOURCES

(2016-2019) CINAHL, OVID, PSYCINFO, PUBMED, EBSCO, ERIC, SCOPUS, Cochrane Library; PROQUEST and Google Scholar.

REVIEW METHODS

(a) Constructs identified in an IR (Blackstock et al., 2018) guided a literature review on predictive variables linked to new graduate nurse's co-worker incivility experiences; (b) an ecological approach was explored; and (c) we demonstrate how multidimensional organizational factors related to incivility experiences of new graduate nurses can be situated in an ecological model.

RESULTS

Structural and organizational factors, and nurse leaders influencing new graduate nurses' experiences are situated in an ecological model. Placing new graduate nurses' co-worker incivility experiences in the microsystem and close to the mesosystem (nurse supervisor) and exosystem (workplace empowerment) of our ecological model provides new insights into their incivility experiences and informs future research.

CONCLUSION

The ecological approach and operational definition of incivility help to clarify incivility behaviours as not merely individual behaviours observed by others needing corrective cognitive behaviours, nor support in a graduate transition program, but rather a symptom of work environment factors contributing to multidimensional work environments of new graduate nurses' and influence incivility behaviours.

IMPACT

New graduate nurse co-worker incivility research could measure change across time and across system domains informed by this ecological approach and can shape new ways of thinking about how to prevent and mitigate incivility.

The relationship between the nurses' work environment and the quality and safe nursing care: Slovenian study using the RN4CAST questionnaire

Introduction

The safety and quality of patient care are basic guidelines in finding new and improved solutions in nursing. Important and influential factors shape the nurses’ work environment in hospitals.

Purpose

With the study, we intended to investigate whether the perception of nurses’ work environment is related to the safety culture and the quality of patient care and whether it differs according to nurses’ level of education.

Methods of work

The study with a quantitative research method was conducted at the six clinical departments of the University Medical Centre, Ljubljana in 2019. We used a survey questionnaire from the European survey Nurse forecasting in Europe (RN4CAST).

Results

270 nurses were included in the study. The response rate was 54%. The study confirmed that there is a correlation between the assessment of the nurses’ work environment and the general assessment of patient safety (r = 0.36; p <0.001), the general assessment of the quality of nursing care (r = 0.32; p <0.001), the confidence in patient self-care at discharge (r = 0.29; p <0.001) and the quality of patient care in the previous year (r = 0.27; p = 0.001). The results showed frequent verbal abuse of nurses, in 44.9% by patients and their relatives and in 35.4% by staff. Graduate nurses rated the work environment more negatively than healthcare technicians (p = 0.003).

Discussion and conclusion

We confirmed the correlation between the assessment of nurses’ work environment and patient safety and the quality of health care, and that employees’ education influences the assessment and perception of the work environment.

An integrative review of nursing leadership in Saudi Arabia

Aims

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

Design

Integrative review was used as a design for this study.

Methods

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

Results

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

Conceptualisations of Leadership and Relevance to Health and Human Service Workforce Development: A Scoping Review

PURPOSE

This scoping review was undertaken to determine leadership definitions and approaches relevant to health and human service (H&HS) workforce development. This review provides a preliminary analysis of the potential size and scope of available research literature to inform ongoing research with the ultimate aim to inform a future systematic review in relation to leadership development interventions.

METHODS

Following the methodology proposed by Arksey and O'Malley and using PRISMA-ScR, a systematic search was conducted using seven databases (PubMed, Health Business Elite, Medline, CINAHL, Ovid, Scopus, and Web of Science). Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize, collate, and make a narrative account of the findings.

RESULTS

Employing pre-selected criteria, a total of 424 records were identified and 171 full-text articles were assessed. The majority of the papers were studies undertaken by researchers based in North America. Leadership in the H&HS sector was addressed in 35% of the articles. The narrow disciplinary or workforce fields of the nursing and medical professions in hospitals and acute care settings dominated the literature.

CONCLUSION

The findings suggest that while leadership has been studied extensively in the health system, there is a paucity of leadership development research specific to the broader H&HS sector. This review emphasises the need for further research, including a more critical examination of leadership development interventions and their application to the H&HS sector.

On the Relationship Between Authentic Leadership, Flourishing, and Performance in Healthcare Teams: A Job Demands-Resources Perspective

This study integrates the job demands-resources model and authentic leadership theory to test the general hypothesis that authentic leadership is a job resource that enables flourishing and performance in healthcare teams. Furthermore, this article tests the hypothesis that the daily bed occupancy is a job demand that weakens this relationship. Participants were 106 nurses that were distributed across 33 teams from two hospitals. The results suggest that the authentic leadership of team leaders is positively related with subjective and objective team performance, but only when daily bed occupancy is low. Authentic leadership had no relationship with team flourishing, regardless of the daily bed occupancy. Our findings suggest that the extent to which authentic leadership is adequate to promote the performance of teams working in a hospital setting is sensitive to contextual boundary conditions. Leading authentically might only be effective under specific circumstances.

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

BACKGROUND

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

AIM

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

METHODS

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

FINDINGS

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

CONCLUSION

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

IMPLICATIONS FOR NURSING MANAGEMENT

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

Nurse perspectives in the emergency department: The synergy tool in workload management and work engagement

AIM

To explore emergency nurses' perceptions of how a nurse-driven patient needs assessment tool, the synergy tool, influenced their workload management.

BACKGROUND

Quadruple Aim, particularly the fourth aim of improved staff work experiences, served as the conceptual framework to engage nurses in a participatory action research project. This project took place between 2017 and 2020 in two tertiary care emergency departments in one large Canadian city.

METHOD

This study employed a qualitative descriptive component, focus group interviews and nurse comments on two open-ended survey questions.

RESULTS

Use of the synergy tool heightened nurses' awareness of patients' holistic care needs. Nurses also stated how patient needs assessment data helped them identify unsafe workloads.

CONCLUSIONS

The synergy tool, adapted for emergency department use by nurses, was a means to engage and empower nurses. Patient needs assessment data from the tool identified staffing gaps, resulting in additional nursing staff for both emergency departments.

IMPLICATIONS FOR NURSING MANAGEMENT

A focus on patient needs assessment can be an effective way to address nurses' workload concerns.

Nursing and values-based leadership: A literature review

AIM

To explore literature that supports an understanding of values-based leadership in nursing.

BACKGROUND

Understanding values-based leadership in nursing means understanding several leadership theories such as authentic, servant and congruent leadership.

EVALUATION

Electronic databases were systematically searched to locate studies with the terms values-based, authentic, servant and congruent leadership. The literature was assessed with the Joanna Briggs Institute Critical Appraisal Tools and the Preferred Reporting Items for Systematic Reviews and meta-analysis approach and a thematic analysis.

KEY ISSUES

Existing evidence focuses on specific perspectives within three dominant leadership approaches under the umbrella of values-based leadership: authentic, servant and congruent leadership. Limited literature suggests that values-based leadership can support professional collaboration, enhanced trust and voice for nurses, support for staff well-being, empowerment, job satisfaction, patient-focused outcomes and quality care.

CONCLUSIONS

A dearth of empirical literature concerning values-based leadership and nursing exists. Evidence suggests that authentic, servant and congruent leadership correlate with values-based leadership theories and core nursing values.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should recognize the potential benefits of a values-based leadership approach for staff well-being, enhanced professional collaboration and the nurses voice, improved insight into clinical leadership attributes and improvements in quality patient care.

Exploring mediating effects between nursing leadership and patient safety from a person-centred perspective: A literature review

AIMS

To evaluate the mechanism through which nursing leadership impacts patient safety.

BACKGROUND

Patient safety has received considerable attention among policymakers, governments and public sectors with the emphasis in health care settings on minimizing the risk to patients. Claims are made leadership plays a crucial role in patient safety. However, the incidents of adverse events are consistently high in hospitals.

EVALUATION

Published English-only research articles that examine the mechanism by which nursing leadership impacts patient safety were selected from seven electronic databases and manual searches. Data extraction, quality assessments and analysis were completed for ten research studies.

KEY ISSUES

There is evidence of significant mediating effects between nursing leadership and decreased adverse patient outcomes specifically with regard to workplace empowerment, leader-nurse relationship and the quality of the care environment.

CONCLUSION

The findings suggest that nursing leadership has a significant indirect impact on patient safety outcomes. From a person-centred perspective, the care environment requires workplace empowerment and effective relationships between leaders and nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

To improve patient safety outcomes, managers must strive to emphasize workplace empowerment, leader-nurse relationship and the quality of the care environment. Managers must consider these domains as part of an effective workplace culture.

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

AIM

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR NURSING MANAGEMENT

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

Leader empowering behaviour: relationships with nurse and patient outcomes

PURPOSE

This study aims to test a model examining the impact of leader empowering behaviour on experienced nurses' self-efficacy, interprofessional collaboration, job turnover intentions and adverse patient outcomes.

DESIGN/METHODOLOGY/APPROACH

Structural equation modelling in Mplus was used to analyse cross-sectional survey data from experienced nurses in Alberta, Ontario, and Nova Scotia, Canada (n = 478).

FINDINGS

The results supported the hypothesized model: (164) = 333.021, p = 0.000; RMSEA = 0.047; CFI = 0.965; TLI = 0.959; SRMR = 0.051. Indirect effects were observed between leader empowering behaviour and nurses' assessment of adverse events and leader empowering behaviour and nurses' job turnover intentions through interprofessional collaboration.

RESEARCH LIMITATIONS/IMPLICATIONS

Leader empowering behaviour plays a role in creating collaborative conditions that support quality patient care and the retention of experienced nurses.

PRACTICAL IMPLICATIONS

The findings will be of interest to academic and hospital leaders as they consider strategies to retain experienced nurses, such as nurse manager selection, development and performance management systems.

ORIGINALITY/VALUE

The influx of new graduate nurses to the nursing profession and changing models of care requires the retention of experienced nurses in the workforce. The findings suggest that leader empowering behaviour and interprofessional collaboration are important factors in supporting quality patient care and stabilizing the nursing workforce.

Dimensions of authentic leadership and patient care quality

PURPOSE

The purpose of this study is to investigate the causal relationships between the dimensions of authentic leadership and patient care quality in the nursing profession of Ghana.

DESIGN/METHODOLOGY/APPROACH

The study used explanatory and cross-sectional survey designs. The data were obtained from 400 respondents, consisting of 200 nurses and 200 patients in selected general hospitals. The analysis was done using descriptive statistics, correlation and multi-linear regression techniques.

FINDINGS

The study found that all four dimensions of authentic leadership, namely, self-awareness, internalized moral perspective, balanced processing and relational transparency positively correlated with patient care quality, however, only internalized moral perspective and self-awareness have positive significant association with patient care quality and internalized moral perspective being the highest predictor. Thus, the results suggest that authentic leadership can positively predict patient care quality.

PRACTICAL IMPLICATIONS

The study contributes to the understanding of how dimensions of authentic leadership practices affect patient care quality. This understanding is relevant to academics in general and Ghanaian policymakers in particular.

ORIGINALITY/VALUE

The research makes a significant contribution to the existing authentic leadership literature by establishing that the dimensions of authentic leadership predict patient care quality with an internalized moral perspective being the highest predictor followed by self-awareness. Furthermore, the authors anticipate that the outcomes of this research, which so far is the first study in the Ghanaian context, can significantly shape nursing leadership discourse, practices and policies in Ghana and in other developing countries to improve patient care quality.

Authentic leadership and job satisfaction among long-term care nurses

Purpose

The purpose of this study is to examine the effects of managers’ authentic leadership, person–job match in the six areas of worklife (AWLs) and emotional exhaustion on long-term care registered nurses’ job satisfaction.

Design/methodology/approach

A secondary analysis of baseline data from a national survey of 1,410 Canadian registered nurses from various work settings was used in this study, which yielded a subsample of 78 nurses working in direct care roles in long-term care settings. Hayes’ PROCESS macro for mediation analysis in SPSS was used to test the hypothesized model.

Findings

Findings showed that authentic leadership significantly predicted job satisfaction directly and indirectly through AWLs and emotional exhaustion.

Practical implications

Authentic leadership may provide guidance to long-term care managers about promoting nurses’ job satisfaction, which is essential to recruiting and retaining nurses to meet the care needs of an aging population.

Originality/value

As demand for care of the aged is increasing and creating challenges to ensuring a sufficient and sustainable nursing workforce, it is important to understand factors that promote long-term care nurses’ job satisfaction. Findings contribute to knowledge of long-term care nurses by suggesting that managers’ authentic leadership can positively affect nurses’ job satisfaction directly and indirectly through positive perceptions of AWLs and lower emotional exhaustion.

Effect of authentic leadership on newly qualified nurses: a scoping review

Authentic leadership is a relatively new concept in nursing in which authentic leaders are anchored by their deep sense of self, and know where they stand on important issues, values and beliefs. While there is considerable literature available on authentic nurse leadership, little has been written regarding its effect on newly qualified nurses. Therefore, the author undertook a scoping review of the literature on authentic leadership and newly qualified nurses. A total of 12 articles were found through database searches and included in the review. Thematic analysis of the articles identified two primary themes of 'well-being at work' and 'work environment', and two lesser themes of 'transition from student to nurse' and 'retention'. The scoping review found that authentic leadership has a positive effect on newly qualified nurses and that authentic leaders can develop genuine and trusted relationships, thereby promoting a supportive work environment for newly qualified nurses.

The Effect of Nurses' Leadership Behavior on the Quality of Nursing Care and Patient Outcomes

Objective

The effect of nursing management styles on patient outcomes and the quality of nursing care (QNC) has recently become a topic of discussion. This review was conducted to examine the effects of leadership styles or behaviors on QNC and on patient outcomes.

Methods

13 research studies published between 1 January 2010 and 31 May 2016 which conformed to the inclusion criteria were reviewed.

Results

The effects of nursing leaders' leadership styles or behaviors were examined in studies on patient mortality, QNC from the perspective of nurses, patient satisfaction, unwanted/adverse events, health-care-associated infections, pressure ulcers, falls, unwanted weight loss, hospital readmissions, mismanagement of feeding tubes, and inadequacies in daily nursing care.

Conclusions

Relationship-focused leadership behaviors directly or indirectly improved patient outcomes and raised the QNC compared with task-focused leadership behaviors.

Relationships among authentic leadership, manager incivility and trust in the manager

Purpose

This study aims to examine the relationships among authentic leadership of managers and new graduate nurses’ (NGNs) experience of manager incivility and their degree of trust in their managers.

Design/methodology/approach

A secondary analysis of data using a non-experimental, correlational design was undertaken. From 2012 to 2013, 3,743 surveys were mailed to NGNs eligible for the study, and 1,020 returned completed questionnaires for a response rate of 27.3 per cent. The hypotheses were tested using hierarchical multiple linear regression.

Findings

Authentic leadership had a negative relationship with manager incivility, which in turn was negatively related to trust in the manager, and overall the model accounted for 59.9 per cent of the variance in trust. Authentic leadership was positively associated with trust in the manager.

Originality/value

Findings supported that authentic leadership may be an effective approach to enhance manager–nurse interactions because authentic managers are less likely to display uncivil behavior, which diminishes trust. Findings may be useful to inform the development of positive and respectful work environments and the everyday practice of nurse managers.

Can Leadership Enhance Patient Satisfaction? Assessing the Role of Administrative and Medical Quality

This paper aimed to investigate the relationships between participative leadership (PL), administrative quality (AQ), medical quality (MQ), and patient satisfaction (PS) using the Malcolm Baldrige National Quality Award Healthcare Criteria (MBNQA) criteria. The study further examined the intervening influence of administrative quality and medical quality on the relationship between participative leadership and patient satisfaction. The data was obtained from 123 public sector hospitals in Pakistan. We employed confirmatory factor analysis (CFA) and structural equation modeling (SEM) techniques to test the structural model. From the study results, we found significant and positive relationships between participative, administrative quality, medical quality, and patient satisfaction. In addition, our research found administrative quality and medical quality as potential mediators on PL-PS relation. Adopting participative leadership as an exogenous factor, and both administrative and medical quality as potential mediators of patient satisfaction, provided new insights into MBNQA criteria.

Linking Transformational Leadership with Nurse-Assessed Adverse Patient Outcomes and the Quality of Care: Assessing the Role of Job Satisfaction and Structural Empowerment

The purpose of this study was to examine the relationships between transformational leadership (TL), structural empowerment (SE), job satisfaction (JS), nurse-assessed adverse patient outcomes (APO), and the quality of care (QOC). The study further investigates the mediating effects of SE and JS on TL-APO and TL-QOC relationships. A total of 600 nurses working at 17 government hospitals in Pakistan completed the survey. The hypothesized model was tested using a confirmatory factor analysis and structural equation modeling. We found a positive relationship between TL, SE, JS, and QOC but negative relationships between TL and APO, SE and APO, and JS and APO. Our study further suggests that SE and JS strongly mediate both TL-APO and TL-QOC relationships.

The Importance of Role-Based and Collective Authenticity on Well-Being and Withdrawal

Research on the benefits of authenticity tends to focus on expressing one’s authentic individual aspects of self (e.g., personality traits, values, opinions) and less on other identities, such as the roles one inhabits and the collective groups to which one belongs. Across two studies and samples totaling over 4,500 working individuals, we test the relationships between work-related role and collective authenticity and well-being/withdrawal outcomes, as well as their added explanatory value above and beyond the traditional way of conceptualizing authenticity (individual authenticity). In Study 1, we find that both work-related role authenticity and collective authenticity predict well-being above and beyond individual authenticity, whereas only work-related role authenticity adds explanatory value to both withdrawal outcomes. In Study 2, we find a largely similar pattern of results between types of authenticity and well-being/withdrawal outcomes collected approximately 9 months after. Implications are discussed.

Authentic Leadership Theory and Practical Applications in Nuclear Medicine

As the field of nuclear medicine continues to evolve, a need for new leaders will emerge and leadership development will become critical. "Authentic leadership" is an emerging leadership style rooted in humanism that can be used in conjunction with other leadership styles. Authentic leadership has positive implications for health-care settings, including improved patient care, job satisfaction, motivation, collaboration, and knowledge sharing. This article reviews the philosophic foundations of authentic leadership theory and key characteristics of an authentic leader in the context of nuclear medicine.

Psychometric Properties of the Authentic Leadership Inventory in the Nursing Profession

BACKGROUND AND PURPOSE

A valid and reliable Authentic Leadership (AL) measurement instrument is paramount as nursing leadership research grows. The purpose of this study was to analyze the reliability and construct validity of the Authentic Leadership Inventory (ALI) among nurses.

METHODS

This study was a cross-sectional, prospective design that explored the relationship between registered nurses' (RNs) perceptions of AL qualities in nurse managers in a random sample of RNs working in an acute care setting.

RESULTS

A Cronbach α 0.96 confirmed reliability. Exploratory factor analysis determined a one-factor structure. Confirmatory factor analysis utilized the one-factor structure for a final best-fit model (χ² = 107.3, df = 70, p = .003; TLI = 0.95, CFI = 0.96, RMSEA = 0.08).

CONCLUSIONS

This study gives support to using the ALI with the nursing profession.

Developing allied health leaders to enhance person-centred healthcare

PURPOSE

The purpose of this paper is to present findings from a mixed methods study investigating leadership development of allied health practitioners within a large public healthcare organization in Australia.

DESIGN/METHODOLOGY/APPROACH

The South Eastern Sydney Local Health District Allied Health Leadership Development Program was undertaken with an allied health cohort ( n=16) between May 2014 and March 2015 and comprised all-day workshops, action learning sets and individual coaching. Using experiential learning, the program tested whether practice development methods and action learning approaches developed the leadership skills of participants compared with a control group ( n=17). Descriptive statistics were collected to evaluate participant and program outcomes. Leadership, workplace culture and engagement measures were analyzed as part of the study.

FINDINGS

The Allied Health Leadership Development Program received high ratings by participants. They reported enhanced skills in leading self and others through mechanisms such as critical reflection and facilitation, and greater confidence managing change and with engaging staff, colleagues and patients in decision making, affecting the quality and safety of healthcare. Statistically significant differences were found with transformational leadership elements, leadership outcomes, and measures of workplace culture and engagement after program completion for intervention group participants, compared with the control group.

RESEARCH LIMITATIONS/IMPLICATIONS

Results provide new empirical evidence about the effectiveness of using practice development for allied health leadership development.

PRACTICAL IMPLICATIONS

This low-cost leadership program can be replicated by other organizations.

ORIGINALITY/VALUE

Outcomes from an Allied Health Leadership Development Program have not been previously reported in the literature.

Nursing leadership in Ireland: experiences and obstacles

PURPOSE

This paper aims to investigate nurses' experiences of leadership within health care in the Republic of Ireland.

DESIGN/METHODOLOGY/APPROACH

This mainly qualitative study made use of a mail survey sent to a random national selection of registered nurses. Participants were asked to provide narrative descriptors of good nursing leadership and identify obstacles to such leadership.

FINDINGS

Participants mainly provided examples of nursing leadership within a hierarchical context (concentrated leadership), such as meeting organisational goals and decision-making. While elements of distributed leadership were mentioned (good communication, providing help and support), they were mainly described as part of formal management roles, rather than leadership. Observed obstacles to developing nursing leadership included high workload, lack of support from management and peers, limited opportunities to gain experience, lack of education/training and poor work environments.

RESEARCH LIMITATIONS/IMPLICATIONS

The small sample (n = 72) limits generalisation. A wider interdisciplinary effort to address experiences with nursing leadership in Ireland may be needed to inform health services of the issues from a broader perspective.

PRACTICAL IMPLICATIONS

The findings suggest that development of nursing leadership in Ireland may still be in its infancy, and that several obstacles need to be overcome.

ORIGINALITY/VALUE

Very few studies have addressed narratives from nurses regarding personal experiences with nursing leadership. The examples provided by participants have yielded significant insight into the issues they encounter, which are reflective of health care elsewhere.

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

BACKGROUND

Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.

METHODS

The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers.

RESULTS

A total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.

CONCLUSIONS

The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings.

Use of instruments to evaluate leadership in nursing and health services

OBJECTIVE

To identify the available scientific evidence about the use of instruments for the evaluation of leadership in health and nursing services and verify the use of leadership styles/models/theories in the construction of these tools.

METHOD

Integrative literature review of indexed studies in the LILACS, PUBMED, CINAHL and EMBASE databases from 2006 to 2016.

RESULTS

Thirty-eight articles were analyzed, exhibiting 19 leadership evaluation tools; the most used were the Multifactor Leadership Questionnaire, the Global Transformational Leadership Scale, the Leadership Practices Inventory, the Servant Leadership Questionnaire, the Servant Leadership Survey and the Authentic Leadership Questionnaire.

CONCLUSIONS

The literature search allowed to identify the main theories/styles/models of contemporary leadership and analyze their use in the design of leadership evaluation tools, with the transformational, situational, servant and authentic leadership categories standing out as the most prominent. To a lesser extent, the quantum, charismatic and clinical leadership types were evidenced.

Liderança do enfermeiro e sua relação com o ambiente de trabalho hospitalar

Resumo Objetivo Analisar o ambiente de trabalho do enfermeiro considerando: autonomia, controle, relações entre médicos e enfermeiros e suporte organizacional; verificar o estilo de liderança ideal, na percepção do enfermeiro, e o real de acordo com a avaliação de um dos seus liderados; correlacionar as variáveis ambiente de trabalho e liderança real. Métodos Estudo correlacional realizado nas unidades assistenciais dum hospital geral de São Paulo, SP, Brasil. A amostra de conveniência constituiu-se de 62 duplas (enfermeiros e técnicos/auxiliares de enfermagem). Os enfermeiros responderam três instrumentos: 1-) caracterização; 2-) Brasilian Nursing Work Index Revised (B-NWI-R) que mensura: autonomia, controle, relações entre médicos e enfermeiros e suporte organizacional; e 3-) Grid & Liderança em Enfermagem: comportamento ideal que mensura cinco estilos: 1.1, 1.9, 5.5, 9.1 e 9.9. Os técnicos/auxiliares em enfermagem responderam: 1-) caracterização e 2-) Grid & Liderança em Enfermagem: comportamento real considerando o enfermeiro como líder imediato. Os dados foram analisados com análise de variância (ANOVA- p ≤0,05). Resultados A média do B-NWI-R foi de 2,2. O estilo 1.1 foi o considerado ideal pelos enfermeiros (58,1%), seguido de 35,5% do 9.1. Esses foram os mais apontados pelos técnicos, porém, nesta sequência 9.1 e 1.1. Não houve relação do ambiente de trabalho com liderança real do enfermeiro (p=0,39). Conclusão O ambiente de trabalho mostrou-se favorável à prática de enfermagem. O estilo de liderança ideal dos enfermeiros não apresentou correspondência com o real avaliado pelos técnicos ou auxiliares de enfermagem e o ambiente de trabalho não se relacionou com a liderança dos enfermeiros.

A Thematic Analysis of Self-described Authentic Leadership Behaviors Among Experienced Nurse Executives

OBJECTIVE

The aim of this study is to understand the behaviors experienced nurse executives use to create healthy work environments (HWEs). The constructs of authentic leadership formed the conceptual framework for the study.

BACKGROUND

The American Association of Critical-Care Nurses recommends authentic leadership as the preferred style of leadership for creating and sustaining HWEs. Behaviors associated with authentic leadership in nursing are not well understood.

METHODS

A purposive sample of 17 experienced nurse executives were recruited from across the United States for this qualitative study. Thematic analysis was used to analyze the in-depth, semistructured interviews.

RESULTS

Four constructs of authentic leaders were supported and suggest unique applications of each including self-awareness (a private and professional self), balanced processing (open hearted), transparency (limiting exposure), and moral leadership (nursing compass).

CONCLUSIONS

Authentic leadership may provide a sound foundation to support nursing leadership practices; however, its application to the discipline requires additional investigation.