Being a team leader: newly registered nurses relate their experiences

The opportunity to lead facilitates PA professional well-being

OBJECTIVE

Physician associates/assistants (PAs) with mature careers represent an important leadership resource for healthcare employers. This study sought to determine whether PA leadership task responsibility interacted with experience level to predict professional well-being.

METHODS

This quantitative study used an archival dataset from a national sample of PAs. The Professional Fulfillment Index was used to measure well-being and career length was used to represent experience level. PA leadership task responsibility was calculated as an aggregate score. Bivariate linear regression with mediation analysis was conducted to determine the relationship between variables.

RESULTS

An increase in PA experience level predicted higher professional fulfillment and lower burnout, and aggregate leadership task score partially mediated this relationship.

CONCLUSIONS

Granting leadership task responsibility compatible with experience level may enhance PA professional fulfillment, mitigate burnout, and increase PA usefulness for healthcare employers.

Factors influencing early career nurses to adopt leadership roles: a literature review

Effective nursing leadership has been shown to improve patient outcomes, but there has been little exploration of the factors that influence early career nurses to develop their leadership skills and adopt leadership roles. This article presents a rapid review of the literature on these factors, integrating data from 25 articles. Findings suggest that improving leadership confidence and self-efficacy, particularly in relation to system leadership, can increase nurses' motivation for adopting leadership roles. Supportive organisations that value leadership and give nurses opportunities to exercise it are equally important. Training and education, preceptorship, peer-to-peer shadowing, modelling and mentoring can all be useful in improving leadership skills and inspiring the next generation of nurse leaders.

Early Career Nurses' Experiences of Engaging in a Leadership Role in Hospital Settings

BACKGROUND

Early career nurses (ECNs) can be expected to assume shift charge nurse leadership roles quickly upon entering practice. Since the emergence of the COVID-19 pandemic, junior nurses may find their leadership capabilities tested further as the challenges of leadership are made increasingly complex in the context of an infectious disease outbreak.

PURPOSE

The purpose of this qualitative study was to explore early career registered nurses' (RNs) experiences of engaging in shift charge nurse roles in hospital settings.

METHODS

This study used an interpretive descriptive (ID) approach. Semi-structured, in-depth interviews were conducted with 14 RNs across Ontario, who had up to three years of experience and who had engaged in a shift charge nurse role in a hospital setting. Recruitment and data collection took place from January to May 2021 during the COVID-19 pandemic. Interviews were recorded, transcribed, and analyzed following the principles of content analysis.

RESULTS

Content analysis of the 14 participant interviews revealed four main themes: nominated and necessitated into leadership, diverse and demanding responsibilities, factors that help and hinder, and leadership as an impactful experience.

CONCLUSIONS

Study findings provide insights into potential strategies to support ECNs in shift charge nurse roles, during the remaining course of the COVID-19 pandemic and beyond. Greater support for nurses who engage in these roles may be achieved by promoting collaborative unit and organizational cultures, prioritizing leadership training programs, and strengthening policies to provide greater clarity regarding charge nurse role responsibilities.

Valuing the emotions of leadership learning experience in nursing education

AIM

This paper argues that a greater understanding of the role of emotions in experiencing leadership, the impact of role models and cultures of the workplace and profession, may enable further development for effective leadership development at undergraduate level and beyond.

BACKGROUND

Leadership has gained prominence as a necessary skill in nursing literature and policy, linking its importance to patient safety, working cultures, resilience and emotional labour globally. Viewed as essential in many undergraduate nursing programmes and a requirement by professional regulators, there is a globally agreed acceptance of its importance. Despite this, the focus on evaluating and researching the effectiveness of leadership learning and through experiences of students in contexts of learning remain limited. This paper presents a discussion on the importance of experiences of leadership, exploring the emotional impact and how enabling reflexivity and critical analysis can be integrated in education. An approach is proposed for nursing education where the emotional impact of experiencing leadership is given significance. Experiences of leadership in practice and educational learning in higher education should allow students to reflect and conceptualise experience, aligning educational contexts of learning. Acknowledgement of emotional experience and pragmatism provides opportunity to strengthen evidence and knowledge and establish leadership as a concept of value in the profession from an early stage.

DESIGN

A critical theoretical discussion paper METHODS: Based on a narrative inquiry study, drawing on theory and philosophies of emotions in education and leadership from 1907 to 2023 RESULTS: Acknowledgement of emotional experience and pragmatism provides opportunity to strengthen evidence and establish leadership as a concept of value in the profession from an early stage.

CONCLUSIONS

Placing value on the experience of leadership by reflexivity and pragmatic, experiential approaches to learning can align educational contexts of learning and focus on effective leadership learning for the nursing profession.

TWEETABLE ABSTRACT

Pragmatic approaches and reflexivity rationalise emotional experiences of leadership and encourage critical thinking and learning.

Newly qualified intensive care nurses' lived experiences of being a shift leader in a private healthcare institution in Gauteng, South Africa

Objective

Newly qualified intensive care nurses (NQICNs) are expected to execute the shift-leading role immediately after graduation. Critical reasoning, problem-solving, decision-making, and evidence-based clinical judgment are thus essential skills for intensive care nursing graduates. This study aimed to explore and describe NQICNs' lived experiences of being shift leaders.

Methods

This descriptive qualitative study was based on the data collected through semi-structured individual interviews. Five NQICNs in five hospitals from one region in Gauteng, South Africa, were interviewed between September and December 2019. NQICNs working as shift leaders for 10 to 12 months after intensive care training were eligible for inclusion in the study. Data were analyzed using the four steps suggested by Giorgi.

Results

The results revealed three themes and seven sub-themes. NQICNs suffered greatly intrapersonally (NQICNs reported intrapersonal suffering, manifesting as pre-shift anxiety, severe work stress, and post-shift exhaustion; NQICNs employed coping mechanisms and either fought, fled, or froze during conflict or crises; NQICNs lack of shift-leading experience did not match their heavy load of responsibilities and accountability); the NQICNs interpersonally matured and empowered themselves (NQICNs experienced support and challenges on an interpersonal level; NQICNs improved their interpersonal relationships and felt proud of and empowered by their professional growth); NQICNs highlighted various requirements to help them manage the high demands of leading shifts (others should fulfill certain needs to enable NQICNs to handle the shift-leading role; self-awareness as a need to enable NQICNs to embrace the shift-leading role).

Conclusion

A greater understanding of NQICNs and their unmet needs will enable nurse managers, educators, and nurses to better support NQICNs' evolution from novice to competent shift leaders.

Registered nurses' challenges and suggestions for improvement of their leadership close to older adults in municipal home healthcare

BACKGROUND

Worldwide people are living longer. The need for healthcare for older adults is increasing. The trend is towards advanced home healthcare, where registered nurses are key figures. This implies challenges for municipal home healthcare, as well as for registered nurses' leadership. The aim is to explore registered nurses' perceptions of challenges and suggestions for improvements in their leadership close to older adults in municipal home healthcare.

METHODS

The present study is part of a larger web-based questionnaire survey with a cross-sectional design. The design is inductive, analysing data using qualitative content analysis and descriptive statistics. A questionnaire with open-ended and closed-ended questions was used. A total of n = 70 registered nurses leading close to older adults participated in seven municipalities in two geographic areas in Sweden.

RESULTS

The results show registered nurses' perceptions of challenges as leaders close to older adults in terms of 11 categories. The categories are motivating for care, adjusting and coordinating nursing care to the older adult, relating to next of kin, managing communication difficulties, relating to social situations in the home, managing demands, working alone, having lack of time, collaborating with physicians, and care staff having low competence. The registered nurses suggested improvements for their leadership close to older adults in terms of nine categories. The categories are adjusting the work to the older adult, clarifying registered nurses' responsibility, balancing demands and resources, setting time aside, improving staffs' competence, ensuring staff's competence development, improving the work environment, and cooperation between professions in the municipality, as well as between healthcare organizations.

CONCLUSION

The results show that registered nurses' leadership in municipal home healthcare implies a wide range of challenges. There is a need for strategies to improve the organizational preconditions to reduce challenges in registered nurses' leadership in order to promote positive patient outcomes for safe and quality care.

Impact of pre-registration extended immersive ward-based simulation on student learning in preparation for clinical placement

BACKGROUND

Graduate nurses commonly experience significant challenges in transitioning to professional practice. The practice readiness of graduate nurses continues to be a concern for nurse educators and industry partners. Introduction of pre-registration extended immersive ward-based simulation can provide opportunities for students to practice the role of registered nurse before graduation. It is not clear if participation in simulation-based learning transfers to increased preparedness for dealing with real-life situations following entry into the workforce.

OBJECTIVE

To report on student views on how ward-based immersive simulation assisted in preparing for clinical placement and graduate practice.

DESIGN

A qualitative, descriptive design was used to conduct a series of face-to-face focus groups.

SETTING

School of Nursing and Midwifery metropolitan Western Australian university.

PARTICIPANTS

Final year baccalaureate nursing students who had participated in six four-hour simulation workshops between February and April 2021 were selected through purposive sampling.

METHODS

Focus group and interview data was transcribed from audio recordings. A six-phase approach was used to analyse data into themes and sub-themes. The study adhered to the consolidated criteria for reporting of qualitative research.

RESULTS

Three focus groups and one interview were conducted. Eight themes emerged. Student learning was identified as occurring in a variety of ways, such as how to work as a team and was influenced by a number of factors, such as the capacity for students to self-reflect.

CONCLUSIONS

Learning opportunities for students to practice how to think and work independently as a registered nurse is something that can be supported by pre-registration extended immersive ward-based simulation. Understanding of what will be expected of them once qualified can make students more prepared for professional practice enabling them to apply knowledge gained from simulated experiences to a similar situation as a graduate nurse.

Nurses' leadership in psychiatric care-A qualitative interview study of nurses' experience of leadership in an adult psychiatric inpatient care setting

WHAT IS KNOWN ON THE SUBJECT?: Previous studies on leadership in psychiatric care have focussed on a diversity of staff and on different healthcare settings. Nurses in both Sweden and internationally, working with patients newly diagnosed with psychosis and addiction, describe an overwhelming workload. Existing research points out that experience and leadership training are the most important factors to exert a good nursing leadership. In Sweden, requirements for leadership exists already from the first day of a nurse's career. The relationship and communication between nurses in psychiatric care and members of the staff is decisive for whether the leadership will work. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: The study adds knowledge regarding the challenges leading the nursing care for patients diagnosed with psychosis and addiction. Ambivalence in the leadership role is prominent among nurses in psychiatric care and feelings of responsibility and meaningfulness are mixed with feelings of powerlessness and uncertainty. Swedish psychiatric nurses lack mandate to lead psychiatric nursing care. This may increase the feelings of uncertainty in their leadership role. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A mandate to lead as well as a leadership guidance in communication and teambuilding will enhance the leadership, especially among newly graduated nurses. Heightened awareness within the healthcare organization about nurse's experience of difficulties in leading the psychiatric nursing care of the most severe psychiatric illnesses could increase the right prerequisites for leadership. ABSTRACT: Introduction Research shows that psychiatric nursing care puts additional demands on the nurse as a leader due to the psychological complexity of care. Experience and leadership training are most important to exert leadership. In Sweden, demands for leadership exist already at the beginning of a nursing career, and in psychiatry, it may lead to an overwhelming workload. Aim/Question The aim of the present study is to highlight nurses' experiences of leading the psychiatric nursing care in an adult psychiatric context. Method A qualitative interview study of eleven registered nurses within psychiatric inpatient care. Content analysis was used for analysis. Results Leading with combined feelings of both meaningfulness and uncertainty were the theme arising from the result. Discussion Findings from Swedish and international studies stress special demands on leadership in psychiatric care. The result shows that nurses perceived an ambivalence of their leadership in terms of both meaningfulness and uncertainty. Implications for Practice An official mandate to lead as well as leadership guidance in communication and teambuilding will enhance leadership, especially among newly graduated nurses. Heightened awareness within healthcare organizations about difficulties in leading psychiatric nursing care could increase the possibility to create right prerequisites for leadership.

Perceptions and experiences of leadership in undergraduate nurse education: A narrative inquiry

BACKGROUND

This research explored the experiences and perceptions of leadership preparation in pre-registration nursing education. The development of leadership skills in the pre-registration period is often considered a continuous process, and evidence suggests there has been an inconsistent approach to leadership within undergraduate nurse education. Exploring perceptions of experiences in this area was deemed important to guide future leadership development for undergraduate nursing students and formed the rationale for this Doctoral study.

DESIGN AND METHODS

The phenomena of interest were the expectations, experiences and perceptions of student nurses, academics, and nurses in preparation for the role of leadership. A narrative methodology to learning and contexts of learning was applied, data collection included semi structured interviews conducted early in 2020. Metaphorical associations through images are thought to support leadership development and philosophies; therefore, photographic elicitation was used to evoke association and emotions, facilitate reflection, and enable expression. The framework for narrative inquiry combined with the theoretical background was used for data analysis.

RESULTS

Leadership is perceived to be an important aspect of the role of a qualified nurse and should be considered as central to learning development for undergraduate students. While all participants valued the importance of leadership in nursing, this research revealed how each narrated experience of leadership holds emotional impact on how leadership is viewed in self and others.

CONCLUSIONS

Participants' experience shaped each story of perceptions of leadership, both within education and in clinical practice. Students' narratives revealed tensions between expectations of leadership, defining leadership and associating their experiences with a personal vision of self as leader in the future role, along with a perceived disconnect between the social and cultural experiences and context of learning. Tensions within the experiences of the academics also revealed a juxtaposition between aligning their experience of leadership with the educational preparation of students and the experiences from clinical leadership, within the social constructs of dual professions and learning contexts.

Nursing students' experiences of applying problem-based learning to train the core competence teamwork and collaboration: An interview study

AIM

To explore nursing students' experiences of applying problem-based learning to train the core competence teamwork and collaboration.

DESIGN

The study used a qualitative descriptive design.

METHOD

The data were collected using individual interviews with a purposive sample of 11 students and analysed using inductive qualitative content analysis.

RESULTS

The students' experiences of applying problem-based learning to train the core competence teamwork and collaboration were described in two generic categories: prerequisites to train teamwork and collaboration and abilities practised in the base group. The generic category "prerequisites to train teamwork and collaboration" includes three subcategories: previous experience and education, composition of the base group, and common goals and values in the base group. The generic category "abilities practised in the base group" includes four subcategories: taking personal responsibility, practising role distribution and leadership, developing communication skills and creating togetherness in the base group.

Clinical leadership in nursing students: A concept analysis

OBJECTIVES

To undertake a concept analysis of clinical leadership in nursing students.

DESIGN

Concept analysis.

DATA SOURCES

A comprehensive search was conducted using the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline and PsychINFO using the following search terms: clinical leadership AND management AND preregistration OR pre-registration OR undergraduate AND nursing student* OR student nurse*.

REVIEW METHODS

Nursing student clinical leadership was explored using the eight-step process of concept analysis proposed by Walker and Avant (2014).

RESULTS

The defining attributes included effective interpersonal communication skills, contemporary clinical knowledge and being a role model to others.

CONCLUSION

This concept analysis provides a definition of clinical leadership in nursing students. It will support understanding of the concept and how it is enacted in clinical placement settings.

Tätigkeiten und Rollen von neu graduierten Bachelorabsolvent_innen der Pflege im akutstationären Setting

Zusammenfassung. Hintergrund: Institutionen im deutschsprachigen Gesundheitswesen sind trotz Bedarf nicht auf Bachelorabsolvent_innen von berufsqualifizierenden Pflegestudiengängen vorbereitet, da keine Tätigkeits- und Rollenprofile zu deren Einsatz in bestimmten Settings vorliegen. Ziel: Ziel ist ein nationaler und internationaler Überblick über Tätigkeiten und Rollen von neu graduierten Bachelorabsolvent_innen im akutstationären Setting. Methoden: Deutsch- und englischsprachig publizierte Studien wurden zwischen 2010 und 2021 in den Datenbanken CINAHL und MEDLINE gesucht und unabhängig ihres Studiendesigns in das Scoping Review aufgenommen. Ergebnisse: Die acht eingeschlossenen Studien folgen qualitativen (n = 5), einem Querschnitt (n = 2) und Mixed-Method Design (n = 1). Sie wurden überwiegend im skandinavischen (n = 3) und nordamerikanischen Raum (n = 3) durchgeführt. Die Ergebnisse zeigen einen Mix an Tätigkeiten und Rollen, in dem Absolvent_innen in der primären pflegerischen Versorgung als Edukator_innen (inkl. Lehrende) und im Medikamentenmanagement bei allen Altersgruppen genauso eingesetzt werden wie für fortgeschrittene pädiatrische Lebensrettung, Überwachung und Wartung von Geräten zur Beurteilung und Diagnostik und als Manager_innen von Bereichspflegeteams. Schlussfolgerungen: Die Entwicklung von Tätigkeits- und Rollenprofilen für spezifische Versorgungssettings, die sich aus Kompetenzzuschreibungen ableiten, sind notwendig. Darauf basierende Traineeprogramme unterstützen die Einarbeitung und fördern die Sicherung einer qualitativen interprofessionellen Versorgung.

Strategies and interventions that foster clinical leadership among registered nurses: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify and describe strategies and interventions aimed at fostering registered nurses' clinical leadership in any clinical setting, identify the theories and/or frameworks that guide registered nurses' clinical leadership development, and describe the types of research conducted on this topic.

INTRODUCTION

Registered nurse clinical leaders may be defined as staff nurses in clinical settings who influence and coordinate patients, families, and health care team members for the purpose of integrating care for positive patient outcomes. They have been described as expert clinicians, effective decision-makers, and relationship-focused professionals who build trust among patients, families, and health care colleagues to ensure the best possible patient care. Clinical nursing is the cornerstone of the nursing profession. Registered nurses' clinical leadership is considered critical to the health of patients and to the advancement of nursing practice. Hence, it is important to understand strategies and interventions for fostering this leadership.

INCLUSION CRITERIA

This scoping review will include any quantitative, qualitative, or mixed methods studies that have registered nurse participants practicing in any clinical setting globally and that examined strategies and interventions to foster registered nurses' clinical leadership. Besides primary research studies, we will also include reviews.

METHODS

This scoping review will be conducted using JBI methodology. Academic databases and sources of gray literature will be searched for published and unpublished studies. Screening and full-text review of accessed records will be conducted to determine alignment with the inclusion criteria. For records that meet the inclusion criteria, data will be extracted, mapped, and presented in a table. A narrative summary will describe how the tabulated results addressed the review questions.

SCOPING REVIEW REGISTRATION

Open Science Framework Registration: https://osf.io/hjfkd.

Nurses' role in accomplishing interprofessional coordination: Lessons in 'almost managing' an emergency department team

AIM

To describe how nurse coordinators accomplished day-to-day interprofessional coordination in an Australian emergency department team, drawing some lessons for the design of nurse coordinator roles in other settings.

BACKGROUND

Previous studies have examined leadership within nursing teams, and there are a growing number of registered nurses employed as care coordinators. There is limited literature on how the day-to-day coordination of interprofessional teams is accomplished, and by whom.

METHOD

Nineteen semi-structured interviews with emergency department registered nurses, doctors and nurse practitioners analysed thematically.

RESULTS

Three themes describe how coordinators accomplished interprofessional coordination: task coordination and oversight, taking action to maintain patient flow and negotiating an ambiguous role.

CONCLUSION

Better-defined nurse coordinator roles with clearer authority and associated training are essential for consistent practice. However, accomplishing interprofessional coordination will always require the situated knowledge of the complex nursing-medical division of labour in the workplace and the interpersonal relationships that are only gained through experience.

IMPLICATIONS FOR NURSING MANAGEMENT

The design of nurse coordinator roles must include the thorny question of 'who leads' interprofessional teams in the day-to-day coordination of tasks. New and inexperienced nurses may not have the necessary situated knowledge or interpersonal relationships to succeed. However, such roles offer an important development opportunity for future nurse managers.

Nurse managers' learning facilitation practices: A philosophical hermeneutic study

AIM(S)

To understand how nurse managers facilitate learning in clinical workplaces.

BACKGROUND

Meeting staff learning needs in the complex workplaces of contemporary health care is paramount to the delivery of safe patient care. Hospitals employ a range of strategies to address these needs. However, nurse managers' contribution to staff learning at the unit level is underexplored in contemporary literature.

METHOD(S)

A Gadamerian philosophical hermeneutic framework guided data collection and analysis. Thirteen nurse managers from two Australian hospitals each participated in two interviews and a period of observation.

FINDINGS

Nurse managers' learning facilitation practices were enacted with staff individually, within teams, and through artefacts, and were shaped by their identities, perspectives on staff learning, knowledge of staff performance, and motivations. Power was revealed as a uniquely enacted driver of their learning facilitation practices.

CONCLUSION(S)

This paper illuminates an aspect of nurse managers' practice that has been poorly acknowledged in contemporary nursing literature. Nurse managers' learning facilitation practices were found to be complex, fluid, and embedded in their everyday work routines.

IMPLICATIONS FOR NURSING MANAGEMENT

Given current concerns about safety and quality in health care, this research opens up possibilities for definition and enrichment of nurse managers' practice as facilitators of learning.

Exploring the role of effective nurse leadership during COVID-19

The role of leadership in nursing and healthcare is continuously being examined, and has undergone increasing public and media scrutiny due to the coronavirus disease 2019 (COVID-19) pandemic. This article details a project that brought together five final-year nursing students and two experienced nurses who had all worked as part of the early response to the pandemic. Meeting regularly online, the participants sought to explore the literature on nursing leadership as well as their own clinical experience and personal reflections of leadership during the pandemic. This process, which took place over a period of four months, also enabled the participants to examine their own leadership style. Four themes emerged from the group discussions: learning about and building on the history of nursing, the participants' role in nursing leadership, effective leadership during times of uncertainty and the role of communication in effective leadership.

Development and Evaluation of the Validity and Reliability of the Leading and Managing Care Pre-Registration Nursing Student Assessment Tool

Background

Clinical nursing leadership influences patient safety and the quality of care provided. Nurses at all levels require leadership and management skills. Despite recognition of the importance of leadership, student nurses often feel ill prepared to make the transition to Registered Nurse and struggle with prioritisation and delegation. In order to standardise student experience and promote the development of skills and attributes, a leadership and management competency assessment was developed and implemented.

Aims

This study aimed to identify the constructs that should be part of an assessment of student nurse competence in relation to clinical nursing leadership, and to evaluate the tool’s reliability.

Method

The first phase was to construct the competency assessment tool, using a mixture of deductive methods, including literature and expert review. Second, psychometric evaluation of the tool, including tests to examine its internal consistency and reliability, comparing test and retest reliability, exploratory factor analysis and generalisability theory analysis to identify reliability and sources of error.

Results

Five attributes were identified for inclusion in the tool alongside a scale of competence. 150 assessments were conducted with an average time between each assessment of three days. The results show that the tool was consistent over time with no significant difference in the mean scores. The Cronbach alpha was 0.84 and the tool had good internal consistency. The results of the factor analysis revealed loading onto a single construct. Generalisability theory analysis revealed 0.90 global reliability, with students accounting for the majority of the variation in scores.

Conclusions

The Leading and Managing Care assessment tool represents a valid and reliable assessment of student nurse competence to lead care delivery. Use of the tool during practice placement allows for a structured approach to the development of skills around prioritisation, management of resources, communication and the management of risk.

Nursing student's expectations for their future profession and motivating factors - A longitudinal descriptive study from Sweden

BACKGROUND

The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored.

OBJECTIVE

To describe students' motives to become registered nurses and their expectations regarding their future profession.

DESIGN

A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.

PARTICIPANTS AND SETTING

A purposive sampling of a group with initially 75 students starting a three-year nursing program at a university in Sweden.

METHODS

A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students' education. At data collection two and three, a copy of the earlier answers was attached. Data were analysed using manifest and latent content analysis.

RESULTS

An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education.

CONCLUSION

The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.

The Leadership Gap: Supporting New Front line Leaders in Cancer Care

INTRODUCTION

Although an individual may have gained considerable competence and skill in their specific discipline, it is unclear what resources are required for an experienced clinician to develop to a clinical leader. As a first step for many, front line leadership positions are often the only practical way to develop behaviors suited to more advanced leadership roles in health care. A new role requires impactful change in perspective that creates intensive learning opportunities for staff and an organization. Conversely, this transition may also represent risk to those failing to adjust to new behaviors and environment. A paucity of scholarly literature on this subject makes recommendations for best practice challenging, particularly in cancer care. The goals of this project were to understand the current state of leadership orientation in a single cancer center, while encouraging collaborative dialog to connect and engage stakeholders.

METHODS

Qualitative data were collected using a focus group with novice leaders and individual interviews with experienced leaders at a single cancer center. Novice leadership was defined as less than 2 years in a management role and experienced leadership as greater than 2 years of experience. The collective narrative was coded to identify repeating indigenous ideas and phrases. Broader review explored the relationships between concepts and categories to reveal important themes.

RESULTS

The narrative indicated that contributors understand the importance of support and guidance early in leadership development pathways. Additional findings revealed unmet expectations of novice leadership upon moving from individual clinical expert to front line leader and possible gaps in development support. Further examination of the data shows novice leaders are vulnerable and suggests that alongside didactic programming, peer support, mentorship, coaching with feedback, and project work underpin leadership development.

CONCLUSIONS

This project revealed positive behaviors enhancing new leader assimilation and performance while presenting possible solutions for apparent gaps in organizational support. Recommendations include creation of harmonized programming to address competency development and self-directed learning, enhanced peer support networks with job shadowing opportunities, and heightened organizational awareness of leadership transition supports.

Newly qualified nurses' perceptions of working at mental health facilities: A qualitative study

WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Newly qualified nurses often feel overwhelmed by the challenges of the work environment and struggle to transition into healthcare work environments. Nurses require opportunities during the transition period to develop both competence and confidence in their ability to practise independently. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Newly qualified mental health nurses experience fear during their adaptation period, especially when they perceive mental healthcare users as dangerous and the working environment as risky, with little concern for their safety. Nurses new to the mental health environment learn from accepting responsibility, taking on challenges and making adjustments, in order to develop confidence as mental healthcare professionals. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nursing management should ensure a safe and supportive mental healthcare environment. The potential for and consequences of negative stereotyping of patients among mental health nurses should be acknowledged and addressed as it may hinder the smooth adaptation of newly qualified nurses. Although stressful experiences can help mental health nurses to develop confidence and skills to manage future demanding situations, newly qualified nurses need to be given appropriate support and debriefing to ensure challenging situations do not "go the wrong way" and decrease confidence levels. Abstract Introduction Much has been written about the experiences of newly qualified nurses in their first year of employment, yet not much has been heard from the perspectives of newly qualified nurses working in mental health facilities. Aim To explore and describe the adaptation process of newly qualified nurses working in public mental health facilities in South Africa. Method Following a qualitative descriptive design, 11 newly qualified nurses in their first 6-18 months of employment were purposively selected from three public mental health facilities in South Africa. Data collected through unstructured individual interviews were thematically analysed. Results Four themes emerged from the analysis: fear related to the mental healthcare environment; self-doubt upon meeting the expectations of the inter-professional team; ways to adjust to the challenges; and confidence as mental healthcare professionals. Discussion During the adaptation process newly qualified nurses working in mental health facilities need support to overcome their initial fears and develop self-confidence in both managerial and therapeutic realms. Implications for practice Management of mental healthcare facilities needs to be cognisant of the importance of creating a supportive and safe environment that discourages negative stereotyping of patients and fosters newly qualified nurses' adaptation.

The Intergenerational Impact of Management Relations on Nurse Career Satisfaction and Patient Care

OBJECTIVE

This article provides insights into the role of management relations on nurses' career satisfaction across different career stages.

BACKGROUND

Managers and positive relations with staff are critical to improving job satisfaction, career development, and retention for new graduates to mid- to late-career nurses.

METHODS

Using a descriptive qualitative approach, we conducted a thematic analysis of 18 focus groups held in 8 Canadian provinces with 185 student, early-career, and mid- to late-career nurse participants.

RESULTS

Student participants expressed the need for a supportive environment to enable successful transition to practice. Early-career nurses expected effective leadership at the unit level, effective communication, and positive working relationships to enable best care outcomes. Mid- to late-career nurses were most dissatisfied with management interactions and relationships.

CONCLUSIONS

Management relations are important across all career stages, affecting patient care and job satisfaction. Findings provide insight into how nurse-manager relations can be enhanced from new graduate support to guidance in career development and ongoing recognition and respect for nurses throughout their careers.

Role transition: A descriptive exploratory study of assistant nurse clinicians in Singapore

AIM

To explore the role-transition experiences of assistant nurse clinicians after their first year of appointment.

BACKGROUND

The National Nursing Taskforce was set up in Singapore to examine the professional development and recognition of nurses. It created the assistant nurse clinician role as an avenue for the nurses' career development. The role was intended to assist nurse managers to guide the nursing team in the assessment, planning, and delivery of patient care.

METHODS

A qualitative descriptive study design was adopted. A purposive sample of 22 registered nurses from six acute care institutions and two polyclinics in Singapore participated in the face-to-face interviews. An inductive content analysis approach was used to analyse the data.

RESULTS

Four themes emerged: (a) promotion to assistant nurse clinician is a form of recognition and vindication; (b) there was uncertainty about the expected role of the assistant nurse clinician; (c) experience eases transition; and (d) there was a need for peer support, mentorship, and training.

CONCLUSIONS

The job description of the assistant nurse clinician needs to be better defined to provide greater clarity about their clinical and administrative duties and what is expected of their performance.

IMPLICATIONS FOR NURSING MANAGEMENT

It is essential for nurse managers to provide successful role-transition strategies to help the newly appointed assistant nurse clinicians to become efficient and effective leaders.

Learning to liaise: using medication administration role-play to develop teamwork in undergraduate nurses

Aim: To describe undergraduate nursing students' situational awareness and understanding of effective liaison and collaboration within the nursing team during interrupted medication administration.Background: Medication errors related to interruptions are a major problem in health care, impacting on patient morbidity and mortality and increasing the burden of related costs. Effective liaison, teamwork and situation awareness are requisite skills for nurses to facilitate the safe management of interruptions during medication administration.Method: A role-play simulation was offered to 528 second-year undergraduate Bachelor of Nursing students. Qualitative written reflective responses were subsequently collected and subject to thematic analysis to derive themes.Results: Participants (451:528) reported an improved understanding of an unfamiliar and challenging situation that required cooperation and collaboration amongst the nursing team to improve outcomes.Conclusion(s): This simulation exposed undergraduate nurses with limited clinical experience to a situation otherwise unavailable to them. The skills required to engage in effective liaison and teamwork in dynamic situations are vital elements in achieving quality care and must begin to be taught at an undergraduate level.

MAPPING COMPETENCIES: IDENTIFYING GAPS IN MANAGERIAL NURSING TRAINING

ABSTRACT Objective: mapping necessary competencies in managerial nursing training. Method: a cross-sectional study conducted between March and June 2013 with 258 students from three Higher Education Institutions of a municipality in the South of Brazil. Results: mapping made it possible to identify necessary competencies for managerial nursing training, including those acquired and gaps. The relative majority of the students considered having the right attitude to act as a nurse in the managerial dimension; however, significant gaps during their training were identified in managerial competencies of supervision, auditing and change processes. Conclusion: this mapping provides subsidies for pedagogical planning, seeking to promote the acquisition of managerial competencies during undergraduate course training.

Graduate nurse experiences of support: A review

The first year of practice as a nurse is recognized as stressful. Graduate nurses (GNs) report gaps in their education, reality shock, burnout and other negative experiences that influence their intentions to remain in nursing.

OBJECTIVES

The aim of this literature review was to gain a greater understanding of the experiences of GNs.

REVIEW METHODS

It included thirty-six articles that focused on GNs and their transition to nursing, as part of a graduate nurse program (GNP), from 2005 to present.

RESULT

The review identified three main themes that influence the transition from student to registered nurse. These themes included, 1) feeling stressed and overwhelmed by nursing responsibilities, 2) the amount of support from senior nurses and 3) the importance of feedback on their performance as nurses.

CONCLUSIONS

Further research that is focused on the support and feedback provided to new nurses is needed.

Development of nursing management competencies: guidelines for continuous education services

Abstract OBJECTIVE Developing continuing education guidelines for the development of nursing management competencies along with the members of the Center of Nursing Continuing Education of Parana. METHOD A qualitative research outlined by the action research method, with a sample consisting of 16 nurses. Data collection was carried out in three stages and data were analyzed according to the thematic analysis technique. RESULTS It was possible to discuss the demands and difficulties in developing nursing management competencies in hospital organizations and to collectively design a guideline. CONCLUSION The action research contributed to the production of knowledge, confirming the need and the importance of changing the educational processes and evaluations, based on methodologies and instruments for professional development in accordance with human resource policies and contemporary organizational policies.