Factors that facilitate Registered Nurses in their first-line nurse manager role

Factors influencing nurse manager retention, intent to stay or leave and turnover: A systematic review update

AIMS

To understand factors influencing nurse manager retention or intention to leave, develop a preliminary theoretical model and identify strategies and interventions for workforce planning.

DESIGN

Systematic review update of literature with integrated design of mixed research synthesis.

METHODS

We included peer-reviewed articles examining factors influencing retention or intention to leave for front-line, middle or patient care nurse managers. Authors independently screened articles for inclusion and assessed included articles for quality. We adhered to a convergent synthesis approach.

DATA SOURCES

Nine databases included MEDLINE, EMBASE, PsychINFO, CINAHL Plus with Full Text, ERIC, Health Source Nursing/Academic Edition, Scopus, ProQuest Dissertations and Theses and LILACS in January 2023.

RESULTS

Thirty-five studies published between 1990 and 2022, 22 quantitative and 13 qualitative or mixed methods, were included. 155 factors influencing nurse manager retention, intention to stay, or turnover were reported. Job satisfaction was most frequently examined (n = 7), followed by factors such as empowerment (n = 3), decision-making (n = 3) and resilience (n = 2). We developed a preliminary theoretical model demonstrating staff relations and leadership, organizational and job characteristics, socio-demographics, personal characteristics, well-being and nurse manager relationship with work influence managers' intention to stay or to leave.

CONCLUSIONS

Nurse managers who were empowered, satisfied with their work, received constructive feedback and found meaning in their roles showed greater intent to stay.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurse administrators can ensure managers are provided with authority to make decisions that promote autonomy. Work cultures that allow for regular meaningful constructive feedback from staff and leaders may contribute to nurse managers feeling valued.

IMPACT

Understanding factors that influence job retention or intention to leave may help nurse managers and their supervisors identify areas for strategy and intervention design to ensure sustainability of this workforce.

REPORTING METHOD

PRISMA 2020 Guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring the role of the nurse unit manager in forensic mental health inpatient units: A qualitative study

Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting.

Factors Facilitating or Inhibiting the Capacity for Effective Leadership Among Front-Line Nurse Managers: A Scoping Review

AIMS

The purpose of this scoping review is to map and synthesize research studies addressing the factors that impact leadership behaviors of Front-Line Nurse Managers.

BACKGROUND

Leadership is a fundamental component of the role of Front-Line Nurse Managers. Ineffective leadership is associated with costly outcomes; thus, organizations seek effective strategies to facilitate consistent demonstration of leadership behaviors.

EVALUATION

Using a scoping review methodology, findings from 26 empirical studies were mapped to identify barriers and facilitators of leadership among Front-Line Nurse Managers. Major categories included personal and environmental factors with subthemes of personal characteristics, competencies, and social support.

KEY ISSUES

Available evidence captures the influence of personal characteristics, education, competency, and formal social support on leadership capacity. The role of informal social support was not captured.

CONCLUSIONS

Multiple personal and environmental factors influence the capacity for leadership behaviors among Front-Line Nurse Managers. Strategies such as leadership development programs, mentorship and peer support programs, and work environments that support relational and structural support may increase leadership capacity for Front-Line Nurse Managers IMPLICATIONS FOR NURSING MANAGEMENT: Senior nurse leaders can use the results of this review to guide implementation of evidence-based strategies to recruit and retain Front-Line Nurse Managers.

Leading Change and Transforming Practice: Implementation Guide for Developing a Successful Nurse Manager Residency Program

Many nurse managers transition from proficient bedside nurses to leadership roles without formal leadership training. Their new role moves beyond the bedside of affecting an individual patient outcome to a position where their leadership behaviors, decisions, and actions impact the staff, patients, and families on a unit and organizational level. While new nurse managers are coached and mentored by their director, there is still an opportunity to provide a more standardized and structured approach to ensure optimal development and outcomes. A Nurse Manager Residency program supports the new leader by providing a forum for education, leadership development, and mentorship to demonstrate the critical components of a successful leader that promote staff engagement, patient experience, and excellence in nursing.

Relationships influencing caring in first-line nursing leadership: A visual hermeneutic study

AIM

To explore and interpret relationships that influence caring in nursing leadership, in the context of Nordic municipal health care, from first-line nurse managers' perspectives.

DESIGN AND METHOD

We chose a visual hermeneutic design. A three-stage interpretation process outlined by Drew and Guillemin, based on Rose, was used to analyse drawings and the following reflective dialogue from three focus groups, with a purposive sample of 11 first-line nurse managers. The study was conducted from February to May 2018.

RESULTS

The findings demonstrated that first-line nurse managers struggled to balance their vision with administrative demands. Caring for patients implied caring for staff; however, they often felt as if they were drowning in contradictory demands. First-line nurse management could be a lonely position, where the first-line nurse managers longed for belonging based on increased self-awareness of their position within an organisation. Superiors' support enabled first-line nurse managers' in their primary aim of caring for patients.

CONCLUSION

First-line nurse managers showed deep roots to their identities as nurses. Caring for patients included caring for staff and was their main concern, despite demanding reforms and demographic changes affecting leadership. Superiors' support was important for FLNMs' self-confidence and independence in leadership, so the first-line nurse managers can enact their vision of the best possible patient care. This study adds knowledge of the significance of caring in nursing leadership and the caritative leadership theory.

IMPACT

In order to recognise FLNMs as vulnerable human beings and provide individual confirmation and support, a caring organisational culture is needed. FLNMs need knowledge based on caring and nursing sciences, administration and participation in formal leadership networks. These findings can serve as a foundation for developing educational programmes for nurse leaders at several organisational levels.

Difficulties of unit managers in selected district hospitals in Cameroon

BACKGROUND

Being appointed to a managerial position because of one's clinical skills seems to be prestigious, even powerful. However, being a unit manager in a resource-constrained district hospital can be a daunting task. Also, managing a ward unit with no previous training in leadership and management can be very challenging.

OBJECTIVES

The purpose of this study was to describe the difficulties, in the day-to-day activities, of unit managers in selected Cameroonian district hospitals.

METHOD

A constructionist, descriptive Husserlian phenomenological inquiry was conducted to describe the difficulties of unit managers in two district hospitals. Ten unit managers were selected through a purposive sampling scheme, and then interviewed using semi-structured interviews. Coliazzi's qualitative data analysis method was used for analysis.

RESULTS

This study revealed that unit managers looked for assistance because it is not easy to be in their position. Their role implied facing difficulties and making sacrifices for something that is not even worth the trouble. Therefore, as a way to overcome their difficulties, they asked for assistance from the organisation, from their families and from God as strategies to face their difficulties.

CONCLUSION

The difficulties faced by unit managers in the selected district hospitals revealed the need to prepare nurses for managerial positions by ensuring they are trained as managers before commencing employment as a manager.

A comparative analysis of work-family conflict among staff, managerial, and executive nurses

BACKGROUND

Nurses frequently are caught between the demands of work and family. While studies have explored this issue among staff nurses, none have compared nurse leaders to staff nurses. This study compares work-family conflict (WFC) and family-work conflict (FWC) among staff, managerial, and executive nurses.

METHODS

In this survey design, 20% of registered nurses were randomly sampled across Florida with a 9% response rate. Survey questions included personal, professional, and work environment characteristics and perceptions of WFC/FWC. Analyses of variance tested the differences between- and within-group scores for WFC/FWC for staff, managerial, and executive nurses. Ordinary Least Squares regressions tested the relationships between personal, professional and work environment measures, focusing on the three different nursing roles, and WFC/FWC scores.

FINDINGS

Nurses experienced more WFC than FWC. Staff nurses experienced significantly less WFC than nurse managers and nurse executives (analysis of variance mean difference -0.881 and -2.693, respectively). Nonwhite nurses experienced more WFC and FWC than white nurses. Longer shift length predicted greater WFC. FWC was lower with paid leave for childbirth.

DISCUSSION

Higher WFC among nurse managers and executives may discourage nurses from taking on or staying in leadership roles. Efforts must be taken to decrease WFC/FWC among nurses in these roles.

Describing Nurse Manager Role Preparation and Competency: Findings From a National Study

OBJECTIVE

The aim of this study was to describe the role preparation and competency development of nurse managers.

BACKGROUND

Approximately 70 000 nurses are retiring annually. This represents a significant loss of nursing leadership wisdom. Few systematic studies of nurse manager role preparation and competency development have been conducted.

METHODS

An electronic survey was completed by a national sample of 647 nurse managers managing 964 patient care units in 54 hospitals.

RESULTS

Findings suggest that nurse managers rate themselves as competent for the 1st 6 years as a nurse manager. They begin to reach proficiency by year 7. Experience had the strongest association with nurse manager competence, followed by graduate leadership education.

CONCLUSIONS

Nurse executives need to evaluate the bench strength of their nursing leadership talent pool. They need to develop policies and strategies that promote nurse manager competence.

Preparing Nurse Managers for Authentic Leadership: A Pilot Leadership Development Program

OBJECTIVE

This study examined the impact of a pilot leadership development program on nurse managers' (NMs') use of authentic leadership behaviors.

BACKGROUND

Nurse managers often receive little or no formal training. Literature suggests formal leadership development programs can enhance their leadership competency. A leadership development program was designed and pilot tested to determine effectiveness in enhancing authentic leadership competency.

METHODS

A cross-sectional study used a convenience sample of 16 NMs who participated in the pilot program.

RESULTS

Measurable increases in authentic leadership behaviors were demonstrated in both the self-assessments (mean scores increased in 3 of 4 subscales) and RN direct report assessments (mean scores increased in all 4 subscales), with statistical significance achieved in 1 self-awareness behavior.

CONCLUSIONS

The pilot program demonstrated merit as a tool to enhance NMs' authentic leadership behaviors. Managers perceived greater self-awareness, and direct reports perceived positive change in managers' use of authentic leadership behaviors.

Growing Clinical and Academic Nursing Leaders: Building the Pipeline

Nursing faces a crisis because there exists a dearth of qualified nurse academicians and administrators willing to step up to high-level leadership positions such as deanships and chief nursing operators. This article critically appraises the available literature regarding succession planning in the nursing profession and offers pragmatic suggestions to the profession to engage in succession planning in a deliberate and thoughtful manner.

Time allocation and temporal focus in nursing management: an integrative review

AIM

To describe the time allocation and temporal focus in nursing management.

BACKGROUND

There is limited information about the time allocation and temporal focus of nursing management activities. The role of nurse administrators is changing, resulting in challenges related to time management.

METHODS

Published literature in 2005-2014 related to the time allocation or temporal focus of nurse administrators' management activities was retrieved from five databases, and an integrative review was conducted. Data extraction, quality assessment and quantitative content analysis were performed for eight reviewed articles.

RESULTS

Daily reactive management activities and administrative routines were dominant in the nurse administrators' work, and strategic, proactive activities were scarce. Their daily work was fragmented by a variety of activities and numerous interruptions.

CONCLUSION

Little information exists about time allocation or temporal focus in nurse administrators' management activities. Further research on this topic is needed. The evidence was fairly modest, although the studies' results were generally similar.

IMPLICATIONS FOR NURSING MANAGEMENT

These results can be used to clarify the job descriptions of nurse administrators and to plan and focus their education and training. Organisations need to use evidence to standardise the job descriptions of different levels of nurse managers and directors.

Nurse managers' insights regarding their role highlight the need for practice changes

AIM

The purpose of this study was to understand the insights of nurse managers regarding the nurse manager role.

BACKGROUND

Nurse managers are vital to the success of healthcare organizations. Vacancy rates of nurse manager positions are on the rise. Recruiting and retaining qualified individuals for these positions requires an understanding of the perceptions of nurse managers regarding the role and the issues embedded in the role.

METHODS

A descriptive, qualitative investigation was conducted. Data were analyzed using content analysis.

FINDINGS

Although desired, role orientation, mentorship, and a strong foundational knowledge, were often lacking. Personal attributes viewed as important for success in the role included seeking opportunities and intentional self-growth. Lessons learned while in the role included the art of managing role demands and that comfort comes with time.

CONCLUSION

Concerns regarding the preparation for, introduction to, and support in the nurse manager role highlight the need for practice changes.