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

Translation and psychometric evaluation of the Chinese version of the Nursing Time Management Scale

Background

Reasonable and effective time allocation can promote the improvement of medical care service quality. This study aimed to translate, cross-culturally adapt and validate the Chinese Nursing Time Management Scale (NTMS).

Methods

Using a cross-sectional survey, 345 clinical nurses were selected from June to September 2023 for a general information questionnaire and Nursing Time Management Scale (NTMS) study. Item analysis, exploratory factor analysis and validation factor analysis were used to verify the reliability and validity of the Chinese version of Nursing Time Management Scale.

Results

The Chinese version of the Nurses' Time Management Competency Scale includes 17 entries in 3 dimensions: planning activities and setting goals, coordinating activities and procedures, and organizing nursing activities. The Cronbach's alpha coefficient for the total scale was 0.966. Exploratory factor analysis showed that the cumulative variance contribution of the three male factors was 97.44%.

Conclusion

The NTMS has acceptable validity and reliability and can be used to evaluate the nursing time management skills of Chinese clinical nurses.

Relationships between nursing leadership and organizational, staff and patient outcomes: A systematic review of reviews

AIM

To assess and describe reviews of nursing leadership styles associated with organizational, staff and patient outcomes.

DESIGN

A systematic review of reviews.

METHODS

Reviews describing a search strategy and quality assessment. The review followed the PRISMA statement. Nine databases were searched in February 2022.

RESULTS

After screening 6992 records, 12 reviews were included reporting 85 outcomes for 17 relational, nine task-oriented, five passive and five destructive leadership styles. Transformational leadership, which is one of the relational styles, was the most studied among all the styles. Of the outcomes, staff outcomes were the most reported, notably job satisfaction, and patient outcomes were less reported. Also, mediating factors between relational leadership styles and staff and patient outcomes were identified.

CONCLUSION

Extensive research shows the beneficial impacts of relational leadership; however, destructive leadership research is lacking. Relational leadership styles should be conceptually assessed. More research is needed on how nurse leadership affects patients and organizations.

Under pressure - The working situation of Swedish healthcare managers during the first wave of COVID-19

Introduction

The aim of this study is to provide insight into the psychosocial work situation of hospital managers during the first wave of the COVID-19 pandemic.

Methods

Mixed-effect modelling was used on survey data on job demands, job resources, job motivation, and work-life balance among over 500 managers working in 55 departments of a large Swedish university hospital in 2019 and 2020. Responses from 6011 employees were then used to stratify the analysis for COVID-19 exposure. Inductive content analysis was applied to open-ended questions on the managers' views on organisational prerequisites during the onset of the pandemic.

Results

The proportion of managers reporting difficulties with role clarity, quantitative demands, decision-making authority, and emotional support, time for recovery at work, motivation deficits, or problems with work-life balance clearly increased during the first wave of the pandemic. The proportion of managers reporting negative responses was higher in departments with high COVID-19 exposure. The qualitative analysis shows that overall governance in terms of clear, fair, and well-communicated routines, resource allocation, and division of responsibilities constituted an important framework for managerial during the crisis. First-line managers also require a mandate to re-organize their roles and their teams to successfully adapt to the situation. Organisational and social support was also important resources.

Discussion

This is the first study investigating healthcare managers' work situation during the first wave of the COVID-19 pandemic in a Swedish context. As expected, it indicates an increasingly strained work situation during the crisis, but it also provides findings on organisational prerequisites that allow healthcare managers to cope with stressful situations. In line with previous research on organisational resilience, the study provides suggestions for how higher-level managers can act in order to provide front-line managers with the organisational prerequisites they need to adapt, learn and develop successfully during times of unpredictability, insecurity, and rapid change in order to offer the best possible support to health care workers.

Validation of the Nurse Managers' Work Content Questionnaire and Factors-A Structural Equation Modeling Study

BACKGROUND

The responsibilities of nurse managers are diverse and occasionally inadequately organized. Moreover, the role of nurse manager often lacks a clear job description. Few methodologies for evaluating the content of nurse managers' work exist.

PURPOSE

This study was designed to validate the Nurse Managers' Work Content Questionnaire (NMWCQ) instrument and to analyze the relationships between NMWCQ factors and background variables using structural equation modeling.

METHODS

A multicenter descriptive and cross-sectional study design was used. The NMWCQ, which includes 87 items across 13 components, was developed based on a comprehensive literature review and pilot study. The questionnaire was sent to all of the nurse managers ( N = 756) employed at eight Finnish hospitals in 2019. Exploratory and confirmatory factor analyses were used to psychometrically test and validate the NMWCQ, whereas Cronbach's alpha values were calculated to explore the internal consistency of the instrument. Structural equation modeling was applied to detect the relationships between the constructed factor structure and the background variables.

RESULTS

Two hundred seven nurse managers participated in this study. The final solution for the NMWCQ included 75 items across 12 factors. The NMWCQ factors were as follows: responsibility for new employees, daily management, human resource management, decision making, clinical nursing, development, planning of processes, collaboration, ensuring knowledge, evidence-based management, ensuring care quality, and financial management. The items showed factor loadings that were either positive or negative, with values ranging from .314 to .846. The Cronbach's alpha values for the factors ranged between .605 and .851. All of the covariances and relationships between background variables and factors were found to be significant ( p ≤ .05). The structural equation modeling showed acceptable index results (incremental fit index = .954, comparative fit index = .951, and root mean square error of approximation = .048).

CONCLUSIONS

The NMWCQ version assessed in this study shows a more robust structure than the previously published pilot version. Psychometric testing showed the NMWCQ as suitable for describing the diverse work requirements of nurse managers and may offer a framework for concretizing the job description of nurse managers.

Time management disposition and relevant factors among new nurses in Chinese tertiary hospitals: A cross-sectional study

Introduction

New nurses struggled with time management, which was a prominent theme in safety care for patients. However, the transition training of time management for new nurses was complicated and ignored by clinical managers. The purpose of this study was to understand the level of new nurses’ TMD from a nationwide perspective and detect the influencing factors of the TMD.

Materials and methods

A cross-sectional study design with a stratified sampling method was sampled in China. Six hundred and seventy new nurses within the first year of employment were recruited. New nurses’ time management disposition, job stressors, self-efficacy, clinical communication competence, and safety behavior were measured by corresponding scales.

Results

New nurses showed the best sense of time’s value, followed by the sense of time efficacy and time monitoring view for time management disposition. The related factors of time management disposition were communication skills, safety behavior, job stressors, and being without a preceptor. New nurses’ time management disposition was at a moderate level and they performed worse in time allocation. The highest education, with or without a preceptor, the experience of part-time jobs, and class cadre were significantly influencing the time management disposition of new nurses.

Conclusion

Nursing managers should pay attention to new nurses’ time management disposition. Reducing the job stressors, improving communication ability, and safe behavior were important measures to improve the time management disposition.

Relationships between self-efficacy, coping-style and quality of work-life among nursing managers in China: A cross-sectional study

AIM

To investigate the quality of work-life among nursing managers in China and analyze the relationships between self-efficacy, coping-style, and quality of work-life.

BACKGROUND

Self-efficacy, coping-style, and quality of work-life play significant roles in the stability of nursing teams, the quality of clinical care, and patient safety. Although some factors influencing quality of work-life have been identified, there is no large-scale study of the relationships among self-efficacy, coping-style, and quality of work-life of nursing managers. Strategies to strengthen the quality of work-life of nursing managers should be developed by exploring the relationships between the three variables.

METHODS

A nationwide cross-sectional study was conducted. A total of 1498 nursing managers from 51 tertiary general hospitals in 20 provinces in China were selected for the study using multistage stratified proportional sampling. Registered full-time nursing managers with more than one year of management experience were eligible for the study. The participants completed online questionnaires to assess their self-efficacy, coping-style, and work-related quality of life. The data were analyzed using descriptive analysis, Pearson's correlation, hierarchical multiple linear regression, and structural equation modelling to verify the relationships between variables.

RESULTS

The quality of work-life score for the nursing managers surveyed was 3.74 ± 0.56 out of a possible five. Self-efficacy was positively correlated with quality of work-life (β = 0.484, P < 0.01) over all demographic variables. Positive coping was also positively associated with quality of work-life (β = 0.404, P < 0.01). Self-efficacy and positive coping explained 22.7% and 14.2% of the variance in the quality of work-life, respectively. Structural equation modelling indicated that self-efficacy positively and directly predicted the quality of work-life (β = 0.395, P < 0.001), and indirectly affected quality of work-life via positive coping (β = 0.186, P < 0.001), but not via negative coping (β = 0.005, P > 0.05). The final model could explain 44% of the variance in the quality of work-life.

CONCLUSION

Self-efficacy was positively correlated with quality of work-life among Chinese nursing managers, and positive coping partially mediated this relationship. The results suggest that self-efficacy and positive coping are pivotal facilitators for improving the quality of work-life and need to be taken into account in measures to improve the quality of work-life of nursing managers.

IMPLICATIONS FOR NURSING MANAGEMENT

Hospital administrators should recognize the importance of nursing managers' work-life quality to promote both the stability of nursing teams and the quality of clinical care and safety provided. They should help nursing managers foster self-efficacy and active coping abilities through incentive measures and provide positive coping training courses to enhance their quality of work-life.

Explanatory Models of Burnout Diagnosis Based on Personality Factors and Depression in Managing Nurses

Nurse managers are affected by burnout due to the high degree of interaction between managers with their registered nurses. Explanatory models based on psychological, and personality related variables purvey an estimation to level changes in the three dimensions of the burnout syndrome. A categorical-response logistic ordinal regression model, supported on a quantitative, crosscutting, multicentre, descriptive study with 86 nursing managers in the Andalusian Health Service in Granada, Spain is performed for each dimension. The three models included different variables related to personality, as well as depression as the only explanatory variable included in all the models. The risk factor neuroticism was significant at population level and related to emotional exhaustion, whilst responsibility was significant in the model estimated to personal accomplishment dimension. Finally, depression was significant for the three dimensions of Burnout. This analysis provides useful information to help the diagnosis and evolution of this syndrome in this collective.

Prevalence, Levels and Related Factors of Burnout in Nurse Managers: A Multi-Centre Study

Aims

The aims of this study are to analyse the prevalence and levels of burnout syndrome in nurse managers and to evaluate the relationship between burnout and related sociodemographic, occupational and psychological factors.

Background

Burnout syndrome, defined as an emotional response to chronic stress, is a major problem among nurse managers.

Methods

The study was conducted using a cross‐sectional survey design and data collected by the Maslach Burnout Inventory, the revised NEO Five Factor Inventory and the Educational‐Clinical Questionnaire for Anxiety and Depression. The sample population consisted of 86 nurse managers from different hospitals from the Public Health Service of Andalusia, Spain.

Results

A total of 22.4% of the participants presented high levels of emotional exhaustion, 21% experienced depersonalisation and 57.6% had little sense of personal accomplishment. Working long shifts was related to burnout. Emotional exhaustion and depersonalization were predicted by depression, while personal accomplishment was predicted by conscientiousness, agreeableness and openness.

Conclusions

A total of 34.1% of the participants presented high levels of burnout, manifested by feelings of low personal accomplishment. Psychological and occupational factors play an important role in the development of this syndrome.

Implications for Nursing Management

Nurse managers should seek to detect burnout among staff and colleagues matching the risk profile for this condition and promote interventions to prevent it.

Associations between nurse managers' leadership styles, team culture and competence planning in Norwegian municipal in-patient acute care services: A cross-sectional study

BACKGROUND

Increased complexity in the primary healthcare services has followed in the wake of health reforms and reveals the need for competence enhancement in the nursing services. Effective and visionary leadership, sufficiently qualified staff and cooperation among professionals are considered as key measures to safeguard quality in the services.

AIMS

To identify which leadership styles characterise first-line nurse managers in Norwegian municipal in-patient acute care (MipAC) units and to investigate how first-line nurse managers' leadership styles are associated with team culture and documented nursing competence planning.

METHODS

A cross-sectional survey was distributed to all the first-line nurse managers in Norwegian MipAC units (n = 229). Data were collected between March and June 2019. The response rate was 80.5% (n = 182). First-line managers' background information and data about their focus on team culture and competence planning were recorded. Furthermore, we noted organisational structural characteristics, and managers' transformational (relational) leadership and transactional (task-oriented) leadership styles.

RESULTS

The managers exhibited a high degree of transformational leadership behaviour, which was significantly associated with team culture. No significant associations between leadership behaviours and documented competence planning were found. Notably, we found a significant correlation between transformational and transactional leadership styles, indicating that the managers adapt their leadership behaviours to actual requirements and situations. Organisational structural factors: the share of registered nurses (RNs) on the staff and having a position for a professional development nurse were positively associated with competence planning.

CONCLUSION

A relational leadership style promotes team culture and both factors may empower the professional nursing environment. However, first-line nurse managers need to acknowledge nursing competence planning as a central part of effective leadership. Having a professional development nurse position seems to complement leadership and ease the manager's responsibilities regarding team culture and competence planning.

Automating Time-Consuming and Error-Prone Manual Nursing Management Documentation Processes

A German regulation requires nursing managers to document patient-nurse ratios. They have to combine heterogeneous hospital data from different sources. Missing documentation or ratios that are too high lead to sanctions. Automated approaches are needed to accelerate the time-consuming and error-prone documentation process. A documentation and visualization system was implemented. The system allows nursing managers to quickly and automatically create the documentation required by the regulation. Interactive visualization dashboards assist with the analysis of patient and staff numbers. The developed method was effectively used in nursing management tasks. No changes to the information technology infrastructure were needed. The new process is around 35 hours per month faster and less error-prone. The documentation functionality automatically reads the required information and correctly calculates the documentation. The visualization functionality allows nursing managers to assess the current patient-nurse ratios before the documentation is submitted. The method scales to multiple wards and locations. It calculates the sanctions to expect and is easily updatable. The proposed method is expected to decrease nursing administration workloads and facilitate the analysis of nursing management data in a cost-effective way.

The burden of implementation: A mixed methods study on barriers to an ICU follow-up program

PURPOSE

It has been suggested that ICU follow-up clinics can offer support for ICU survivors and their relatives. However, implementation of such clinics can be challenging. We explored the barriers to implementation of an ICU follow-up program from the healthcare providers' perspective.

METHODS

This was a mixed methods study with a triangulation design conducted over the 7-month pilot period of an ICU follow-up program.

RESULTS

The quantitative analysis showed that two main tasks within the program took the most time to be completed: training and tracking. Training new healthcare professionals to acquire the necessary competences for the follow-up clinic was the most time-consuming task [30 min (IQR 13-56)]. Tracking patients, which consists of keeping records of a patient during the hospital stay and when discharged, was the second most time-consuming task [15 min (IQR 10-20)]. We recorded 291 items of qualitative data from the 12 team members who participated. The qualitative analysis identified three domains that were crucial barriers for program implementation: Luhr et al. (2019) [1] organization (37.1%), Máca et al. (2017) [2] engagement (38.5%), and (Gayat et al., 2018 [3]) resources (24%). In agreement with the quantitative data, training and tracking were perceived by participants as laborious tasks and key barriers to implementation of the ICU follow-up program. Despite the expectation that resources would be the most important barrier, they were not considered as such by our participants being only mentioned in 13.4% of our qualitative reports; when mentioned, this barrier was related mostly to insufficient numbers of staff members.

CONCLUSIONS

Awareness of those barriers can help healthcare providers and ICU managers in developing strategies adapted to overcome constraints, thus facilitating the implementation process.

Components of the Magnet® model provide structure for the future vision of nurse managers' work: A qualitative perspective of nurse managers

AIM

To describe nurse managers' views of their work in the future.

BACKGROUND

Ongoing reformation of health care organisations includes profound changes to nurse managers' work practices.

METHOD

A qualitative approach was applied to elicit views of nurse managers (n = 133) from eight Finnish specialized medical care hospitals through one open-ended question about their future work in November 2019. The acquired data were subjected to inductive thematic content analysis.

RESULTS

Four themes were identified in the nurse managers' responses, indicating that they anticipated: 1) a shift from hierarchical leadership to shared governance, 2) an increasing focus on proactive and systematic work, 3) development of evidence-based practices and 4) improvement in the attractiveness and effectiveness of the organisation.

CONCLUSIONS

Nurse managers envisage their future work will follow the transformational leadership model. Shared governance and multidisciplinary team leading, with a stronger focus on proactive strategic planning will extend their power to influence decision-making. Administrative supporting systems will free more time from their daily routine work for interactions with staff.

IMPLICATIONS FOR NURSING MANAGEMENT

Clarification of the managers' job description along with administrative support systems is anticipated to strengthen leadership, facilitate management, enhance decision-making and increase the attractiveness and effectiveness of both health care organisations and nurse managers' work.

Relationships between nurse managers' work activities, nurses' job satisfaction, patient satisfaction, and medication errors at the unit level: a correlational study

BACKGROUND

Nurse managers play a critical role in enhancing nursing and patient outcomes. The work of nurse managers, who can be described as middle-managers at health care organizations, is complex and changes on a daily basis. Only a few studies have clarified how nurse managers divide their time across various work activities. This study aimed to describe the relationships between nurse managers' work activities, nurses' job satisfaction, patient satisfaction, and medication errors at the hospital unit level.

METHODS

A cross-sectional and correlational study design was used. The data were collected from nurse managers (n = 29), nursing staff (n = 306), and patients (n = 651) from 28 units across three Finnish acute care hospitals between April and November 2017. In addition, data concerning medication errors (n = 468) over one calendar year (2017) were acquired from the hospitals' incident reporting register. Analysis of covariance (ANCOVA) was used to estimate relationships between data from subareas of Nurse Managers' Work Content Questionnaire, Kuopio University Hospital Job Satisfaction Scale, and Revised Humane Caring Scale, along with medication error reports. A significance level of 95% was applied when estimating the covariances between variables. Unstandardized regression coefficients (B) were used to explain the relationships between variables.

RESULTS

Multiple relationships between nurse managers' work activities, nurses' job satisfaction, patient satisfaction, and medication errors were identified. Nurse managers' work activities had both positive and negative relationships on the other studied variables. The Requiring factors of work (p < .001) subarea of nurses' job satisfaction, total patient satisfaction (p < .001), and medication errors (p < .001) were identified as the variables most significantly affected by other factors.

CONCLUSIONS

The findings suggest that nurse managers should focus on improving nursing practices by managing and organizing nurses' work in a way that makes their employees feel supported, motivated and secure. Furthermore, nurse managers should adopt a leadership style that emphasizes safe and patient-centered care. The results also suggest that the administration of today's health care organizations should actively evaluate nurse managers' share of work activities to ensure that their daily work is in line with the organizational goals.

Validation study of the Italian version of Temporal Focus Scale: psychometric properties and convergent validity

Background

Over the last decade, international research has produced a large number of studies that have stressed the importance of temporal focus in various aspects of the lives of individuals, groups and organizations. This first Italian validation study of the Temporal Focus Scale (TFS) has shown a reliable measurement to assess the tendency of individuals to characteristically think about different periods of their lives.

Methods

TFS/I was administered to a sample of 1458 participants, while three other convenience samples (N₁ = 453; N₂ = 544; N₃ = 168) were used for convergent validity testing.

Results

Confirmatory factor analysis confirmed a three-factor solution (including 10 items) with good indices of fit to data, e.g., χ² = 49.533, CFI = 0.992, TLI = 0.986, RMSEA = 0.034, RMSEA 90% CI .018–.048. Convergent validity assessment confirmed predictive indications with variables such as life satisfaction, optimistic/pessimistic orientation, perceived general self-efficacy, self-regulatory modes, anxiety, depression.

Conclusion

The temporal focus has proven to be a significant feature associated with various aspects of both well-being and personal discomfort. By virtue of its good psychometric properties, the TFS can be an integrative tool along with others for a better evaluation of the person’s profile in different contexts such as education, coaching, psychotherapy, counseling and career guidance.

Burnout in Nursing Managers: A Systematic Review and Meta-Analysis of Related Factors, Levels and Prevalence

Burnout syndrome is a major problem in occupational health, which also affects nursing managers. The main aim was to analyze the level, prevalence and risk factors of burnout among nursing managers. A systematic review with meta-analysis was conducted. The databases used were Medline (Pubmed), PsycINFO, CINAHL, LILACS, Scielo and Scopus. The search equation was “burnout AND nurs* AND (health manager OR case managers)”. Nursing managers present high levels of emotional exhaustion and a high degree of depersonalization. Some studies show that variables like age, gender, marital status, having children or mobbing and other occupational factors are related with burnout. The prevalence estimation of emotional exhaustion with the meta-analysis was high; 29% (95% CI = 9–56) with a sample of n = 780 nursing managers. The meta-analytical estimation of the correlation between burnout and age was r = −0.07 (95% CI = −0.23–0.08). Work overload, the need to mediate personnel conflicts, lack of time and support from superior staff, contribute to the development of burnout among nursing managers.

Gut Microbiota Metabolism and Interaction with Food Components

The human gut contains trillions of microbes that play a central role in host biology, including the provision of key nutrients from the diet. Food is a major source of precursors for metabolite production; in fact, diet modulates the gut microbiota (GM) as the nutrients, derived from dietary intake, reach the GM, affecting both the ecosystem and microbial metabolic profile. GM metabolic ability has an impact on human nutritional status from childhood. However, there is a wide variability of dietary patterns that exist among individuals. The study of interactions with the host via GM metabolic pathways is an interesting field of research in medicine, as microbiota members produce myriads of molecules with many bioactive properties. Indeed, much evidence has demonstrated the importance of metabolites produced by the bacterial metabolism from foods at the gut level that dynamically participate in various biochemical mechanisms of a cell as a reaction to environmental stimuli. Hence, the GM modulate homeostasis at the gut level, and the alteration in their composition can concur in disease onset or progression, including immunological, inflammatory, and metabolic disorders, as well as cancer. Understanding the gut microbe–nutrient interactions will increase our knowledge of how diet affects host health and disease, thus enabling personalized therapeutics and nutrition.

Effect of Anxiety on Empathy: An Observational Study Among Nurses

Empathy, defined as an emotional ability to put oneself in the place of others, read their state of mind, and think how they are feeling, is an essential pillar of nursing care. On the other hand, anxiety is a frequent emotion that can be generated in stressful work environments, like nurses developing their activity. The aim of the present study is to explore the value of empathy and anxiety personal traits in staff nurses. The sample was comprised of 197 staff nurses from tertiary level hospitals from Madrid, Spain, where 79.2% were women and 20.8% were men in the present study. The instrument used for analysis was the Spanish adaptation of the 16PF5 questionnaire. The results showed the following measurements to warmth (5.58), lively (5.25), socially bold (5.6), privacy (5.82), open to change (5.62), self-reliance (6.12), and anxiety (6.38). Furthermore, anxiety affects positively to warmth (t: 2.66; p > 0.0001) and lively (t = 2.36; p < 0.05), but in a negative way to social bold (t = −3.17; p < 0.001) or open to change (t = −5.81; p < 0.0001). However, it was not seen to have any effect over privacy (t = 1.96; p = 0.052) and self-reliance (t = 1.19; p = 0.234). Finally, it is recommended that healthcare professionals reinforce their personal competencies to strengthen their skills to manage anxiety and improve their empathy competencies.

Nurse managers' work content: development of the questionnaire and results of the pilot study

AIM

To develop the Nurse Managers' Work Content Questionnaire (NMWCQ) and to describe nurse managers' work content.

BACKGROUND

Restructuring within health care has expanded the nurse manager's role to include organisational, patient and staff demands.

METHODS

The pilot study employed a cross-sectional study design. Based on a literature review, the NMWCQ with 102 items was developed and pretested for this study. Data were collected in 2017 from three Finnish acute care central hospitals that provide specialised health care. A total of 61 nurse managers participated, which represents a response rate of 59%. Principal component analysis was used to test the construct validity of the instrument. Cronbach's alpha values were used to analyse the internal consistency of the instrument. In addition, descriptive and nonparametric analysis was used.

RESULTS

Ultimately, 13 components with 87 items were identified in the questionnaire. The construct validity and internal consistency of the questionnaire were at acceptable levels. Cronbach's alpha rates of the components were 0.554 - 0.890. The most frequently performed daily work of nurse managers was in the component of organising, and the most infrequently performed daily work was in the component of clinical nursing.

CONCLUSIONS

The study shows that the Nurse Managers' Work Content Questionnaire (NMWCQ) is suitable for measuring the current content of nurse managers' work. However, the questionnaire is new and needs additional testing such as confirmatory factor analysis with larger amounts of data.

Comparing the Two Techniques for Nursing Staff Rescheduling to Streamline Nurse Managers' Daily Work in Finland

The aim of this study was to identify nurse managers' daily tasks during the rescheduling of sudden nursing staff absences by comparing two techniques: a paper-based system as phone calls and emails or information technology-based staffing systems. In addition, it is intended to evaluate the usability of information technology-based staffing solutions and evaluate estimated cost savings by using hospital permanent staff to cover sudden absences. A quasi-experimental pretest and posttest one-group study design was used to evaluate nurse managers' (n = 61) daily tasks (n = 5800) during rescheduling nursing staff sudden absences (n = 2628); furthermore, we engaged in observations and provided estimates of cost savings generated by our proposed intervention. The number of nurse manager tasks during rescheduling decreased significantly (P < .001) as well as unstaffed shifts (P < .001) and unplanned shift changes (P < .001) after the information technology-based scheduling system was implemented. The usability score ranged from 76 to 100, showing that the information technology-based scheduling solution has good usability. The use of information technology-based staffing solution can streamline the rescheduling process, save nurse managers time for other activities, and offer organizations opportunities for cost savings.

Manager, clinician or both? Nurse managers' engagement in clinical care activities

AIM

To explore the extent of Australian nurse managers' engagement in clinical care activities.

BACKGROUND

Hybrid nurse manager roles lack clarity in the optimal balance between the clinical and other activities, resulting in stress and challenges in recruiting and retaining nurse managers.

METHODS

In a national survey using the Advanced Practice Role Delineation tool, Australian nurses self-assessed their level of engagement in activities across five domains of nursing practice. The subset sample analysed comprised 2,758 registered nurses, 390 clinical (front-line) nurse managers and 43 organisational (middle) nurse managers. Median domain scores were compared with non-parametric tests of difference.

RESULTS

Clinical nurse managers were in a hybrid role, reporting high levels of engagement across the domains. Lower scores observed for organisational nurse managers highlight the shift to strategy-focussed activities that occurs as nurses up the management hierarchy.

CONCLUSIONS

By indicating their engagement in the clinical care domain, respondents demonstrated that clinically focused activities were not entirely lost from either front-line or middle-management roles.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers equipped with clinical and management skills, and allowed time to remain engage in clinical care activities are critical for patient-centred and cost-effective care in today's complex health care environments.

Perceptions of future hospital management in Finland

PURPOSE

The purpose of this paper is to describe how Finnish experts perceive future (year 2030) hospital management and leadership.

DESIGN/METHODOLOGY/APPROACH

A total of 33 experts participated in a three-round Argument Delphi process. Opposing views of management and leadership in 2030 were analyzed using inductive content analysis.

FINDINGS

The experts' perceptions were divided into two main categories: management and leadership orientation and future organization. Perceptions relating to management and leadership orientation were classified as relating to patient-centred, clinical dominance, professionally divided and management career options. Perceptions relating to future management and leadership organization were classified as representing shared, pair, team and the individual-centered leadership. The results highlighted the most distinctive issues raised by the participants.

RESEARCH LIMITATIONS/IMPLICATIONS

This qualitative study was conducted in the context of Finnish healthcare according to the principles of the Argument Delphi Method. The panel consisted of high-level experts representing a diverse set of roles. However, as suggested in previous literature, these experts may not be the most astute in predicting the future development of hospital organizations.

PRACTICAL IMPLICATIONS

The findings can be used to develop and renew management and leadership training and management practices in hospitals.

SOCIAL IMPLICATIONS

The findings can be exploited in discussions, planning and decision making regarding future management and leadership in hospitals.

ORIGINALITY/VALUE

Only a few studies have investigated perceptions of future management in hospitals. This study adopted the Argument Delphi Method to identify distinct perceptions on the future orientation and organization of management and leadership in hospitals.

Exploring nurse leader fatigue: a mixed methods study

AIM

To describe hospital nurse leaders' experiences of fatigue.

BACKGROUND

Fatigue is a critical challenge in nursing. Existing literature focuses on staff nurse fatigue, yet nurse leaders are exposed to high demands that may contribute to fatigue and associated risks to patient, nurse and organisational outcomes.

METHODS

A mixed method approach comprising semi-structured interviews and the Occupational Fatigue Exhaustion Recovery scale with 21 nurse administrators (10 nurse managers and 11 nurse executives) from hospitals in a Midwestern state.

RESULTS

Most nurse leaders experience fatigue; nurse managers reported higher levels of chronic fatigue. Participants identified multiple sources of fatigue including 24 h accountability and intensity of role expectations, and used a combination of wellness, restorative, social support and boundary setting strategies to cope with fatigue. The consequences of nurse leader fatigue include an impact on decision-making, work-life balance and turnover intent.

CONCLUSIONS

The high prevalence of nurse leader fatigue could impact the turnover intent of nurse administrators and quality of care.

IMPLICATIONS FOR NURSING MANAGEMENT

This study highlights the significance and consequences of nurse leader fatigue. As health care organisations continue to raise awareness and establish systems to reduce nurse fatigue, policies and programmes must be adapted to address nurse leader fatigue.