The impact of a leadership development programme on nurses' self-perceived leadership capability

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

AIM

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

DESIGN

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

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPACT

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

NO PATIENT OR PUBLIC CONTRIBUTION

Prospero ID CRD42021292290.

An authentic leadership training programme to increase nurse empowerment and patient safety: A quasi-experimental study

BACKGROUND

Authentic leadership and empowered nurses are necessary if a healthy work environment is to be created and patient safety maintained; however, few studies have examined the impact of authentic leadership, on nurse empowerment and the patient safety climate.

PURPOSE

The aim of the study was to investigate the impact of an educational intervention delivered through a multi-faceted training programme on nurses' perceptions of authentic leadership, nurse empowerment (both structural and psychological) and the patient safety climate.

DESIGN

A quasi-experimental study using a one-group pretest-posttest design consistent with TREND guidelines.

METHODS

The study was conducted in a university hospital between December 2018 and January 2020. Participants were followed for 6 months. The programme involved 36 head nurses (leaders) and 153 nurses (followers). The effectiveness of the programme was evaluated using repeated measures of analysis of variance, dependent sample t-tests and hierarchical regression analysis.

RESULTS

Following the intervention, safety climate and authentic leadership scores increased among both leaders and followers. Structural and psychological empowerment scores also increased among followers. We found that authentic leadership and structural empowerment were predictors of safety climate.

CONCLUSION

The implementation of the education programme resulted in positive changes in participants' perceptions of authentic leadership and empowerment, which can enhance patient safety.

IMPLICATIONS

Healthcare organizations can implement similar multi-faceted training programmes focused on authentic leadership, and nurse empowerment to increase patient safety. Achieving effective results in such programmes can be facilitated by motivating participants with the support of the top management.

PATIENT OR PUBLIC CONTRIBUTION

The study included nurses in the intervention and the data collection processes.

IMPACT

Patient safety is a global concern, and improving patient safety culture/climate is a key strategy in preventing harm. Authentic leadership and nurse empowerment are essential in creating healthy work environments and delivering safe, high-quality care. Training programmes addressing these issues can help bring about improvements in healthcare organizations.

Leadership Development Strategies in Interprofessional Healthcare Collaboration: A Rapid Review

Background

Contemporary healthcare practitioners require leadership skills for a variety of professional roles related to improved patient/client outcomes, heightened personal and professional development, as well as strengthened interprofessional collaboration and teamwork.

Objective/Aim

The aim of this study is to systematically catalogue literature on leadership in healthcare practice and education to highlight the leadership characteristics and skills required by healthcare practitioners for collaborative interprofessional service delivery and the leadership development strategies found to be effective.

Methods/Design

A rapid review was conducted. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) diagram shows that the 11 databases, yielded 465 records. A total of 147 records were removed during the initial screening phase. The remaining 318 records were uploaded onto Rayyan, an online collaborative review platform. Following abstract level screening, a further 236 records were removed with 82 records meeting the eligibility criteria at full text level, of which 42 were included in the data extraction. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal.

Results

Results showed variability in methodologies used, representing various healthcare disciplines with a range in population size (n = 6 to n = 537). Almost half of the results reported on new programs, with interprofessional collaboration and teamwork being the most frequently mentioned strategies. The training content, strategies used as well as the length of training varied. There were five outcomes which showed positive change, namely skills, knowledge, confidence, attitudes, and satisfaction.

Conclusion

This rapid review provided an evidence-base, highlighted by qualitative, quantitative, and mixed methods research, which presents distinct opportunities for curriculum development by focusing on both content and the methods needed for leadership programs. Anchoring this evidence-base within a systematic search of the extant literature provides increased precision for curriculum development.

The association between nurse managers' transformational leadership and quality of patient care: A systematic review

AIM

To examine and summarize the reported association of nurse managers' transformational leadership and quality of patient care based on the perceptions of registered nurses.

BACKGROUND

Transformational leadership behaviors of nurse managers result in staff nurses' satisfaction and retention and patient satisfaction. Patient safety and quality of care are vital to high-performing healthcare organizations. Perceptions of registered nurses are important because nurses are frontline healthcare providers fundamental to patient safety and quality of care and are considered the final line of defense in preventing adverse events and errors and improving the safety of patients.

MATERIALS AND METHODS

We  searched the CINAHL, ProQuest, PubMed, Science Direct, and Web of Science databases for evidence published between 2018 and 2022 in the English language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in carrying out this meta-analysis.

RESULTS

Nine quantitative studies were appraised using the Joanna Briggs Institute checklists and were included in the final review that involved a total sample of 3633 registered nurses. The included studies were reported across Asian, Middle East, and European countries within the past five years. The association between the transformational leadership behaviors of nurse managers and the quality of patient care was found in varying degrees (i.e., insignificant, weak, indirect, and strong direct association) based on the perceptions of registered nurses.

CONCLUSIONS

There is a direct and indirect association between the transformational leadership behaviors of nurse managers and the quality of patient care internationally. This association is influenced by confounding and mediating factors, including gender, organizational culture, structural empowerment, and job satisfaction.

IMPLICATIONS FOR NURSING AND HEALTH POLICIES

Healthcare organizations need to support nursing leaders to have a stronger transformational leadership style by considering several factors that influence their leadership to improve the quality of patient care their staff nurses provide at the bedside.

Correlates and predictors of clinical leadership need analysis (CLeeNA) for nurses: A cross-sectional web-based study

BACKGROUND

Clinical leadership is the process of improving different organizational and patient care processes that achieve high-quality and safety of care outcomes. Clinical leadership is about having the appropriate skills and attributes to manage clinical settings. Nurses need to develop managerial and leadership skills; thus, nurses clinical leadership skills should be developed in all clinical settings. The clinical leadership needs of nurses received limited focus; the concept is still not fully understood.

AIM

This study aimed to assess the correlates and predictors of nurses' clinical leadership needs in Jordan.

MATERIALS AND METHODS

Using a cross-sectional research design utilizing a purposive sample of 349 nurses were recruited from different hospitals. Pearson correlation coefficients standard multiple linear regressions were mainly used to analyze the data.

RESULTS

The "leadership and clinical practice" was the highest mean score of the subscales, while the "financial and service management" was the lowest. At an alpha of 0.05, significant positive moderate correlations were found between nurses' clinical leadership needs and: level of education, age, years of experience in nursing, years of experience in leadership, number of employees under the direct supervision of the leader, and type of the hospitals. At an alpha of 0.01, significant positive weak correlations were found between nurses' clinical leadership needs and: marital status, title, and unit/ward organizational structure. Marital status-separated/divorced/widowed, and years of nursing-4 years or less predicted negatively affect nurses' clinical leadership needs.

DISCUSSION AND CONCLUSION

Meeting the clinical leadership needs of nurses will positively contribute to various clinical settings outcomes. Leadership training is needed to enhance nurses' clinical leadership skills and competencies.

Collective leadership to improve professional practice, healthcare outcomes and staff well-being

BACKGROUND

Collective leadership is strongly advocated by international stakeholders as a key approach for health service delivery, as a response to increasingly complex forms of organisation defined by rapid changes in health technology, professionalisation and growing specialisation. Inadequate leadership weakens health systems and can contribute to adverse events, including refusal to prioritise and implement safety recommendations consistently, and resistance to addressing staff burnout. Globally, increases in life expectancy and the number of people living with multiple long-term conditions contribute to greater complexity of healthcare systems. Such a complex environment requires the contribution and leadership of multiple professionals sharing viewpoints and knowledge.  OBJECTIVES: To assess the effects of collective leadership for healthcare providers on professional practice, healthcare outcomes and staff well-being, when compared with usual centralised leadership approaches.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 5 January 2021. We also searched grey literature, checked references for additional citations and contacted study authors to identify additional studies. We did not apply any limits on language.

SELECTION CRITERIA

Two groups of two authors independently reviewed, screened and selected studies for inclusion; the principal author was part of both groups to ensure consistency. We included randomised controlled trials (RCTs) that compared collective leadership interventions with usual centralised leadership or no intervention.

DATA COLLECTION AND ANALYSIS

Three groups of two authors independently extracted data from the included studies and evaluated study quality; the principal author took part in all groups. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We used the GRADE approach to assess the certainty of the evidence.

MAIN RESULTS

We identified three randomised trials for inclusion in our synthesis. All studies were conducted in acute care inpatient settings; the country settings were Canada, Iran and the USA. A total of 955 participants were included across all the studies. There was considerable variation in participants, interventions and measures for quantifying outcomes. We were only able to complete a meta-analysis for one outcome (leadership) and completed a narrative synthesis for other outcomes. We judged all studies as having an unclear risk of bias overall. Collective leadership interventions probably improve leadership (3 RCTs, 955 participants). Collective leadership may improve team performance (1 RCT, 164 participants). We are uncertain about the effect of collective leadership on clinical performance (1 RCT, 60 participants). We are uncertain about the intervention effect on healthcare outcomes, including health status (inpatient mortality) (1 RCT, 60 participants). Collective leadership may slightly improve staff well-being by reducing work-related stress (1 RCT, 164 participants). We identified no direct evidence concerning burnout and psychological symptoms. We are uncertain of the intervention effects on unintended consequences, specifically on staff absence (1 RCT, 60 participants).  AUTHORS' CONCLUSIONS: Collective leadership involves multiple professionals sharing viewpoints and knowledge with the potential to influence positively the quality of care and staff well-being. Our confidence in the effects of collective leadership interventions on professional practice, healthcare outcomes and staff well-being is moderate in leadership outcomes, low in team performance and work-related stress, and very low for clinical performance, inpatient mortality and staff absence outcomes. The evidence was of moderate, low and very low certainty due to risk of bias and imprecision, meaning future evidence may change our interpretation of the results. There is a need for more high-quality studies in this area, with consistent reporting of leadership, team performance, clinical performance, health status and staff well-being outcomes.

Leadership to improve nurse engagement and empowerment: evidences to improve the training of nurses

Aim

The objective of this study was to identify the key dimensions of transformational leadership that influence the promotion of engagement and structural empowerment in a population of nurses from different care settings.

Method

A cross-sectional survey study asking about engagement, leadership style and structural empowerment was used. Descriptive and correlational statistics were applied followed by hierarchical regression. 131 nurses were recruited from a Spanish health organisation using random sampling.

Results

Individualised consideration and intellectual stimulation were predictors of structural empowerment in a hierarchical regression of transformational leadership dimensions controlled by demographic variables (R2=0.467). In addition, intellectual stimulation was a predictor of engagement (R2=0.176).

Conclusion

The results are the starting point for the design of an organisationwide educational intervention to increase the engagement of nurses and staff development.

Exploring crucial programme characteristics and group mechanisms of an empowerment programme for certified nursing assistants-A qualitative study

Aims

To identify crucial programme characteristics and group mechanisms of, and lessons learned from hindrances in an empowerment programme for certified nursing assistants and contribute to the development of similar programmes in other care settings.

Design

Exploratory qualitative study.

Methods

Between May 2017 and September 2020, we used in‐depth interviews and participant observations to study four groups participating in an empowerment programme for certified nursing assistants (N = 44).

Results

We identified three crucial empowerment‐enhancing programme characteristics: (1) inviting participants to move outside their comfort zone of caregiving; (2) stimulating the use of untapped talents, competencies and interests; (3) supporting the rediscovery of participants' occupational role and worth. Crucial group mechanisms encompassed learning from and with each other, as well as mechanisms of self‐correction and self‐motivation. Hindrances included a perceived lack of direction, and a lack of organizational support and facilitation.

Conclusion

We showed the significance of creating an inviting and stimulating environment in which participants can explore and function in ways they otherwise would not. Likewise, we identified how this can help participants learn from, critically correct and motivate one another.

Impact

The programme under study was uniquely aimed to empower certified nursing assistants. Our insights on crucial programme characteristics and group mechanisms may benefit those who develop empowerment programmes, but also policymakers and managers in supporting certified nursing assistants and other nursing professions in empowerment endeavours. Such empowerment may enhance employee retention and make occupational members more likely to address challenges affecting their occupational group and the long‐term care sector.

Evaluation of the Impact of an Education Program on Self-Reported Leadership and Management Competence Among Nurse Managers

Background

Developing leadership and management competencies for nursing managers is critical to the effective leadership of others and driving team and organizational performance. This paper aimed to evaluate the impact of a system-wide nursing leadership quality improvement initiative in a network of four public hospitals and one specialized outpatient center in the United Arab Emirates (UAE). The initiative was designed to enhance nursing middle managers’ leadership and managerial competencies.

Methods

This is a quantitative evaluation following the Standards for Quality Improvement Reporting Excellence (SQUIRES) guidelines. Secondary Data analysis of a pre- and post-course self-assessment for 105 middle nursing managers who attended a nursing leadership quality improvement training program between December 2017 and April 2019.

Results

Following participation in this quality improvement initiative, the paired sample t-test analysis demonstrated a statistically significant difference between the pre- and post-assessments total and individual leadership domains mean scores.

Conclusion

Attending well-structured nursing leadership quality improvement programs positively enhances nurse managers’ professional abilities and perception of their management and leadership competencies. Leadership development programs should equip managers with the skills and tools to achieve their professional goals effectively and support their transition to becoming expert nurse leaders. Healthcare institutions’ ethical obligation is to provide them with the necessary resources and training to achieve this goal.

Fragilities and potentialities in the training of nurse leaders

OBJECTIVE

To know the perception of nursing professors about the fragilities and potentialities in the training of nurse leaders.

METHOD

Multiple case study, with a qualitative approach, performed with 36 nursing professors from a public university in the State of Bahia, Brazil. Data were collected through semi-structured interviews, interpreted in the light of Paulo Freire's theoretical framework and analyzed according to Thematic Analysis and the Nvivo®11 software.

RESULTS

Were highlighted as fragilities the need to improve the transversality of leadership throughout graduation and teaching focused on the banking model. The potentialities refer to the insertion of the students in the practice scenarios, enabling the approximation with the nursing and multidisciplinary teams, the use of active methodologies and participation in research groups.

FINAL CONSIDERATIONS

Professors consider the importance of problematizing pedagogical practices and invest in methodological strategies capable of promoting the training of nurse leaders.

Using adaptive leadership principles to support Public Health 3.0 in multidisciplinary undergraduate education

Purpose

The COVID-19 pandemic has uncovered public health vulnerabilities worldwide, particularly in the hard-hit USA. US public health professionals, regardless of role, may need to exercise leadership in both planned and unexpected situations. This model of practice outside of traditional roles, known as Public Health 3.0, requires adaptive leadership – a systems approach to making progress on complex challenges. Educational programs should improve students’ adaptive leadership competency to prepare them for the public health workforce. This paper aims to provide an educational framework for implementing adaptive leadership instruction for undergraduate students.

Design/methodology/approach

This paper used experiential and traditional instructional strategies and adaptive leadership competencies to develop a semester-length leadership course for undergraduate students in health, nursing, social science, business and education. Adaptive leadership principles were learned and practiced, preparing students for systemic challenges through the lens of Public Health 3.0. Competencies were assessed pre- and post-semester.

Findings

Of 248 students, 72% were health professions majors. Students reported pre-post scores on 29 measures of competency, interest, learning and behavioral change. Quantitative evaluations identified statistically significant improvement in all domains. Additional quantitative feedback indicated improvement on the three Kirkpatrick levels of evaluation assessed (reaction, learning and behavior).

Originality/value

Tiered evaluation methods indicated that this leadership course enhanced participants’ self-reported adaptive leadership learning and competency, as well as intention and ability to translate learning into practice. A broad spectrum of competency development is needed for students entering practice in the Public Health 3.0 era, particularly related to pandemic response.

The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership

BACKGROUND

Nursing leadership plays a vital role in shaping outcomes for healthcare organizations, personnel and patients. With much of the leadership workforce set to retire in the near future, identifying factors that positively contribute to the development of leadership in nurses is of utmost importance.

OBJECTIVES

To identify determining factors of nursing leadership, and the effectiveness of interventions to enhance leadership in nurses.

DESIGN

We conducted a systematic review, including a total of nine electronic databases.

DATA SOURCES

Databases included: Medline, Academic Search Premier, Embase, PsychInfo, Sociological Abstracts, ABI, CINAHL, ERIC, and Cochrane.

REVIEW METHODS

Studies were included if they quantitatively examined factors contributing to nursing leadership or educational interventions implemented with the intention of developing leadership practices in nurses. Two research team members independently reviewed each article to determine inclusion. All included studies underwent quality assessment, data extraction and content analysis.

RESULTS

49,502 titles/abstracts were screened resulting in 100 included manuscripts reporting on 93 studies (n=44 correlational studies and n=49 intervention studies). One hundred and five factors examined in correlational studies were categorized into 5 groups experience and education, individuals' traits and characteristics, relationship with work, role in the practice setting, and organizational context. Correlational studies revealed mixed results with some studies finding positive correlations and other non-significant relationships with leadership. Participation in leadership interventions had a positive impact on the development of a variety of leadership styles in 44 of 49 intervention studies, with relational leadership styles being the most common target of interventions.

CONCLUSIONS

The findings of this review make it clear that targeted educational interventions are an effective method of leadership development in nurses. However, due to equivocal results reported in many included studies and heterogeneity of leadership measurement tools, few conclusions can be drawn regarding which specific nurse characteristics and organizational factors most effectively contribute to the development of nursing leadership. Contextual and confounding factors that may mediate the relationships between nursing characteristics, development of leadership and enhancement of leadership development programs also require further examination. Targeted development of nursing leadership will help ensure that nurses of the future are well equipped to tackle the challenges of a burdened health-care system.

Transformational leadership in nursing practice: challenges and strategies

OBJECTIVE

to understand the challenges and strategies adopted by nurses for the exercise of Transformational Leadership in a university hospital.

METHODS

qualitative and exploratory study, in which 25 nurses working in a university hospital in the state of Bahia, Brazil participated. Data collection took place through semi-structured interviews and categorized according to Thematic Analysis, using Nvivo software.

RESULTS

The prevalent challenges involved: lack of encouragement from the institution for the training of leaders; professional inexperience and young age; resistance to leadership and insubordination. The strategies adopted by nurses consist of acting as team examples and establishing dialogic relationships. Final considerations: The practice of Transformational Leadership has been relevant in the daily lives of nurses and contributes to the quality of care.

Developing effective nurse leadership skills

Leadership is a role that nurses are expected to fulfil, regardless of their job title and experience. Nurses are required to lead and manage care as soon as they have completed their training. However, the development of leadership skills and the associated learning can be challenging, especially for less experienced nurses and those at the beginning of their careers. This article examines the importance of effective leadership for nurses, patients and healthcare organisations, and outlines some of the theories of leadership such as transformational leadership. It also details how nurses can develop their leadership skills, for example through self-awareness, critical reflection and role modelling.

Developing clinical leadership in New Zealand hospice staff nurses

BACKGROUND

Staff nurse clinical leadership is a relatively new concept that includes the elements of collaboration, coordination, patient advocacy, and often quite autonomous decision-making required of palliative care nurses. Staff nurses need structural and psychological empowerment to develop as clinical leaders.

AIMS

The aim of this study was to establish baseline data regarding the self-perceived structural and psychological empowerment experienced by New Zealand hospice staff nurses and their ability to practise as clinical leaders.

METHODS

An explanatory sequential mixed-methods design was used, which included questionnaires measuring structural and psychological empowerment and clinical leadership behaviours and focus group discussions.

FINDINGS

Survey respondents reported that they were moderately psychologically and sometimes or rarely structurally empowered and felt that they can practise as clinical leaders most of the time. Two themes were identified from the focus groups.

CONCLUSION

New Zealand staff hospice nurses felt that-despite feeling only moderately psychologically empowered, and only sometimes or rarely structurally empowered-they practise as clinical leaders most of the time.

Perceived importance and performance of clinical leadership in practice: A cross-sectional study of nurses and midwives of all grades

AIM

To explore the differences in perceived importance and actual performance of clinical leadership for all grades of nurses and midwives engaged in clinical practice.

BACKGROUND

Clinical leadership is central to the provision of person-centred care. However, little is known about how nurses and midwives perceive this in practice.

METHODS

Data were collected on a sample of nurses and midwives in the Republic of Ireland, using a cross-sectional study design (n = 324). The clinical leadership needs analysis instrument was used to measure perceived importance and performance of clinical leadership in practice. Grades of nurses/midwives included; staff, manager, advanced practitioner and senior manager.

RESULTS

Senior managers were more likely to report significantly higher scores than staff grades for perceived importance of Technology & Care Initiatives (p < .01) and Financial & Service Management (p = .02). Performance of Staff & Care Delivery was significantly higher for senior managers than staff grades [F(5,309) = 6.06 p < .01].

CONCLUSION

There was a mismatch between the perceived importance and actual performance of clinical leadership in practice between different grades of staff.

IMPLICATIONS FOR NURSING MANAGEMENT

Leadership training for all grades and mentoring of staff grades can promote the building of confidence and empower staff in leading clinical practice.

Liderança transformacional na prática dos enfermeiros em um hospital universitário

Resumo Objetivo Analisar o exercício da liderança transformacional na prática dos enfermeiros em um hospital universitário. Métodos Estudo de métodos mistos explanatório sequencial. Na etapa quantitativa, com amostra não probabilística por conveniência, aplicou-se um questionário de atitudes frente a estilos de liderança adaptado para a frequência de adoção dos comportamentos de liderança transformacional a 152 enfermeiros do referido hospital. Estes dados passaram por testes estatísticos descritivos e analíticos. Na etapa qualitativa, 25 participantes da primeira etapa foram sorteados e responderam a uma entrevista semiestruturada, analisadas mediante análise temática de conteúdo. Resultados Identificou-se a prática da liderança transformacional de forma frequente entre os enfermeiros. Entretanto, eles apresentam dificuldades para exercer esse modelo de liderança, devido a carência de apoio da instituição que, majoritariamente adota uma liderança verticalizada, pela falta de capacitação para os enfermeiros assistenciais, e fragilidades na comunicação e discussão dos problemas antes das tomadas de decisões. Conclusão A prática da liderança transformacional encontra resistências pelo maior exercícios da liderança verticalizada pelos gestores, entretanto os enfermeiros acreditam que uma liderança com comportamento horizontalizado pode favorecer mudanças estruturais e comportamentais da instituição.

Development and psychometric testing of the clinical leadership needs analysis (CLeeNA) instrument for nurses and midwives

AIM

The aim of this study is to report the development and psychometric testing of the clinical leadership needs analysis instrument (CLeeNA).

BACKGROUND

Limited emphasis is placed on the clinical leadership needs of nurses and midwives that are fundamental to supporting the delivery of high quality, safe patient care.

METHODS

A development and validation study of CLeeNA was undertaken using cross-sectional data. A sample of 324 registered nurses and midwives completed the questionnaire using a 7-point adjectival scale. Principal component analysis was conducted to explore scale grouping of items (n = 103 items).

RESULTS

Principal component analysis, item reduction and parallel analysis on the items of the instrument resulted in seven factors consisting of 56 items. These factors were identified as: Staff and Care Delivery; Technology and Care Initiatives; Self and Team Development; Standards of Care; Financial and Service Management; Leadership and Clinical Practice; Patient Safety and Risk Management.

CONCLUSION

The identified factors are reflective of an ever-changing health care environment.

IMPLICATIONS FOR NURSING MANAGEMENT

Potentially, after further testing, this instrument could be used by nursing management and educators to measure clinical leadership needs, inform the design of clinical leadership training programmes and provide valuable information about health care leadership development.

Kansas nurse leader residency programme: advancing leader knowledge and skills

AIMS

To evaluate the effectiveness of the Kansas Nurse Leader Residency (KNLR) programme in improving nurses' leadership knowledge and skills and its acceptability, feasibility and fidelity.

BACKGROUND

The Future of Nursing Report (Institute of Medicine, 2011) calls for nurses to lead change and advance health. The 6-month KNLR programme was developed by the Kansas Action Coalition to support nurses' leadership development.

METHODS

Nurses (n = 36) from four nursing specialties (acute care, long-term care, public health and school health) participated in the programme. The adapted Leader Knowledge and Skill Inventory was used to assess leadership knowledge and skills. Programme acceptability, feasibility and implementation fidelity also were evaluated.

RESULTS

The programme completion rate was 67.7% (n = 24). Programme completers had significantly improved self-assessed and mentor-assessed leadership knowledge and skills (p < .05). These post-programme gains were maintained 3 months after programme completion.

CONCLUSIONS

The KNLR programme effectively improved leadership knowledge and skills and was positively evaluated by participants. The implementation of the KNLR programme using a hybrid format of in-person sessions and online modules was feasible across four specialty areas in both rural and urban regions.

IMPLICATIONS FOR NURSING MANAGEMENT

The next steps include the development of an advanced programme. Residency programmes for new nurse leaders are critical for successful transition into management positions.

Leadership in nursing: from teaching to practice in a hospital environment

Abstract Objective: To analyze the knowledge of nurses on teaching of leadership in the undergraduate and its exercise in a hospital environment. Method: Qualitative, descriptive and exploratory study. There were interviewed 37 nurses working in a public hospital in the state of Rio Grande do Sul, Brazil. Data were collected through semi-structured interviews and it was categorized according the Thematic Analysis method, using the NVivo software. Results: The nurses recognize leadership as professional competence and mentioned positive aspects related to the leadership formation in graduation, which was obtained from significant theoretical contribution, provided by nursing professors. The institution lacks investments to offer theoretical and practical leadership support. Final Thoughts: Teaching leadership during graduation requires transversal approach, as well as strategies of permanent education that potentiate the exercise of leadership in a hospital environment.

Contribuições freirianas para entender o exercício da liderança dialógica dos enfermeiros no ambiente hospitalar

RESUMO Objetivo Conhecer o entendimento de enfermeiros sobre o exercício da liderança dialógica no ambiente hospitalar, bem como os desafios enfrentados para exercer a liderança. Métodos Estudo qualitativo do tipo descritivo e exploratório no qual participaram 35 enfermeiros que trabalham em um hospital de médio porte na cidade de Pelotas/RS. Para a coleta dos dados, foram realizadas entrevistas semiestruturadas, sendo que os dados foram analisados por meio da proposta operativa de Minayo. Resultados Formaram-se as seguintes categorias: exercício da liderança dialógica e desafios no exercício da liderança dialógica. Observou-se que a liderança dialógica é entendida como a capacidade do enfermeiro de coordenar e de organizar a equipe de enfermagem a partir de relações horizontalizadas, norteadas pelo diálogo. Quanto aos desafios, destacaram-se a falta de experiência profissional, as relações hierárquicas e de poder. Considerações finais A liderança a partir do diálogo poderá facilitar o gerenciamento do cuidado, da equipe de enfermagem e dos serviços de saúde.