Correlation between nursing managers' leadership styles and nurses' job stress and anticipated turnover

Transformational Leadership and Nursing Retention: An Integrative Review

Aim

To establish current evidence on the relationship between transformational nursing leadership and turnover intention.

Background

The persistent nursing shortage in healthcare has led to heightened demands for addressing both current needs and the healthcare requirements of a growing population. Recognizing the pivotal role of nursing leadership in fostering retention, this review highlights the influence of positive leadership on nursing staff. Evaluation. An integrative review, guided by Whittemore and Knafl's (2005) framework, was conducted using articles sourced from four online databases deducing to an inclusion of sixteen quantitative articles, one systematic review, and one integrative review published between 1992 and 2022. Key Issues. The study reveals conflicting evidence regarding the sole impact of transformational leadership on the nursing staff's intention to remain. However, it highlights transformational leadership's ability to enhance job satisfaction and organizational commitment contributes significantly to retention.

Conclusion

Using transformational leadership can effectively bolster nursing staff retention along with promoting other favorable workplace outcomes. Implications for Nursing Management. This review underscores the importance of enhancing leadership skills within nursing management. This involves not only fostering transformational leadership but also cultivating positive work-related outcomes to optimize nursing staff retention.

A systematic review of leadership styles in healthcare sector: Insights and future directions

In light of the ongoing global health crisis, the significance of leadership within the healthcare sector has intensified. Given this consideration, the significance of appropriate leadership styles cannot be overstated. The objective of this paper is to critically review published studies on leadership elements in the healthcare sector. Using Bibliometrix R package and VOS viewer, we conducted bibliometric and network analyses on publications retrieved from the Web of Science (WOS) database, with content analysis integrated throughout the paper to deepen understanding. Ultimately, 243 articles were identified as relevant. The findings revealed transformational leadership emerges as the most extensively discussed leadership style. 91% of the articles' theme focus on quantitative research methods. This study synthesizes the influencing factors of the three most frequently discussed leadership styles-transformational, authentic, and ethical leadership-emphasizing the importance of job satisfaction and organizational citizenship behavior. And provides direction for future research through thematic analysis.

[Sistematic review on the influence of leadership style on job satisfaction of health professionals]

INTRODUCTION AND OBJECTIVES

Healthcare organisations are highly complex entities that live with a high risk of instability. In order to minimise this instability, interactions and personal relationships play a major role and accordingly the figure of the leader gains full significance. The leadership style used can produce different reactions and lead to multiple outcomes, including job satisfaction. The aim of the present review is to correlate leadership style with job satisfaction in healthcare professionals.

MATERIAL AND METHODS

A systematic review was carried out in BVS, Cochrane plus, CINAHL, ApaPsycinfo and Pubmed, selecting publications that mentioned leadership styles and job satisfaction in healthcare professionals. Publications search strategy were limited for the 5-10last years, full text availability and language of writing: English, French and Spanish. Review-type publications were excluded. Of the 1566 initial titles, 15 were selected for analysis.

RESULTS AND CONCLUSIONS

The transformational style showed the highest number of positive correlations, followed by the authentic and transactional styles. On the other hand, the passive and laissez-faire styles showed a negative correlation regardless of the professional category to which they belonged. The results of this study provide a starting point for adopting effective leadership styles to optimise the recruitment and training processes of staff in management and coordination roles.

Relationship between leadership and work readiness in a cohort of new head nurses in China: A cross-sectional study

To identify the relationship between leadership and work readiness in a cohort of new head nurses in China. This cross-sectional study enrolled 225 newly appointed head nurses in public tertiary hospitals in China, which were selected using convenience sampling. Data were collected using online questionnaires that included a sociodemographic characteristics form, the Nursing Managers Leadership Scale (NMLS), and the New Nurse Leaders' Job Readiness Scale (NNLJRS). IBM SPSS v.25 was used for statistical analysis. The overall mean scores of NMLS (100.50 ± 17.64) and NNLJRS (111.90 ± 15.84) of the 225 new nurse leaders were at moderate levels. The results of the Pearson correlation analysis and the hierarchical regression analysis further indicated that there was a significant positive correlation between leadership and work readiness of new head nurses (r = 0.85, P < .001), as well as charisma (β = 0.19, P < .01), affinity (β = 0.18, P < .01), coordination ability (β = 0.32, P < .01), and motivational ability (β = 0.21, P < .01) in leadership were found to be positively associated with work readiness. This study found that the leadership and work readiness of the new head nurses still needed improvement. A significant relationship was found between these 2 variables, and charisma, affinity, coordination ability, and motivational ability in the leadership ability of the new head nurses facilitated the level of work readiness. Nursing administration should create a leadership development series program focusing on the development of charisma, affinity, coordination ability, and motivational ability to support the work readiness of new nurse managers and help them with role transition.

Income gap between male and female psychiatric nurses in China: A national survey

AIM

To investigate gender differences in the actual and expected income among psychiatric nurses in China.

BACKGROUND

Although studies have shown that male nurses earn more than female nurses in other countries, there are no published data regarding gender income differences among psychiatric nurses in China.

METHODS

We conducted a cross-sectional study involving 41 representative psychiatric hospitals in China. Demographic, income, and job-related data were analyzed using the inverse probability of treatment weighting (IPTW) based on the propensity score.

FINDINGS

The sample included 9256 psychiatric nurses, and nearly four-fifths (79.3%) were female. Males earned slightly higher average monthly incomes than female nurses, while initial analysis showed no significant overall gender income difference (p > 0.05). Notably, most participants (92.5%) desired an income increase of at least 10%, with over half (56.2%) expressing significant dissatisfaction with their current income. After adjustment using propensity score combined with IPTW, females in the junior and mid-level groups had significantly lower income than their male counterparts (all p < 0.01), despite having different night shift patterns. However, there were no significant gender differences in actual or expected income among senior-level psychiatric nurses (p > 0.05).

CONCLUSION

A majority of psychiatric nurses in China express dissatisfaction with their current incomes and expect higher incomes. Male nurses earned significantly more than female nurses in the junior and mid-level professional groups, potentially due to their differences in night shifts.

IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY

Policymakers and hospital administrators should optimize the income structures of nurses and develop targeted policies to address the gender income gap. Improving nurse income has the potential to enhance motivation and satisfaction within the profession.

'I need support in becoming the leader I would like to be' - A qualitative descriptive study of nurses newly appointed to positions of leadership

AIM

The aim of the study was to understand the experiences of nurses who were newly appointed to a position of leadership including facilitators and barriers to success and what they considered important for the development of their role.

METHODS

We used a qualitative descriptive research design. The study was conducted in Norway with 10 nurses who had been appointed to a leadership position within the last 2 years. Participants were interviewed with individual qualitative interviews which were transcribed and subsequently analysed using thematic analysis.

RESULTS

The following four main themes were identified from the data: I feel lonely in the leadership position, I am not confident as a leader, I am unsure of the requirements and expectations of me, and I need support and supervision.

CONCLUSION

The results underscore the challenges reported by new leaders in nursing and their advocacy for mentorship as a facilitator for success. The qualifications of mentors were emphasised with a need for a comprehensive leadership skill set to address the multifaceted aspects of leadership development.

Effects of Length of Employment and Head Nurse Leadership Style on the Clinical Competency of Staff Nurses in Taiwan

BACKGROUND

High-quality patient care requires nurses with strong clinical competency. Thus, it is essential to examine the factors associated with clinical competency.

PURPOSE

This study was designed to (a) investigate head nurse leadership, staff nurse demographics, and clinical competency; (b) examine the impact of demographics on the clinical competency of staff nurses; (c) analyze the correlation between head nurse leadership and staff nurse clinical competency; and (d) examine the effects of demographics on clinical competency after controlling for the head nurse leadership.

METHODS

A cluster sampling method was used to collect data from 200 staff nurses at a national medical center in Taiwan. Questionnaires were used to gather information on head nurse leadership style and staff nurse clinical competency. Descriptive and inferential statistical analyses were conducted, including Mann-Whitney U test, Kruskal-Wallis test, Spearman's rank correlation coefficient, and multivariate analysis of covariance.

RESULTS

The average score for transformational leadership style among the head nurses was 2.89, whereas transactional leadership style scored an average of 2.49. The average scores for the components of clinical competency, listed from highest to lowest, were as follows: patient care (3.35), professionalism (3.28), communication skills (3.18), management (2.84), and knowledge (2.73). In addition, statistically significant differences were found in clinical competency based on demographic factors, including age, marital status, educational level, job title, and length of employment. Also, a statistically significant, positive correlation between the head nurse transformational leadership style and nurse clinical competency was found. The main effect of length of employment on the five competency components was statistically significant after controlling for transformational leadership. Furthermore, post hoc analysis of covariance revealed a significant effect of length of employment on patient care, knowledge, communication skills, and management.

CONCLUSIONS

The findings of this study indicate transformational leadership and employment length impact the clinical competency of staff nurses, particularly in terms of patient care, communication skills, management, and knowledge. Providing education and training in leadership and management to current and prospective head nurses may be expected to enhance clinical competency in staff nurses and create a more nurturing work environment. Moreover, targeted training may help current head nurses gain insight into their leadership styles and acquire skills to promote transformational leadership. In addition, leadership development may help equip prospective head nurses with critical competencies before assuming leadership responsibilities.

"I feel broken": Chronicling burnout, mental health, and the limits of individual resilience in nursing

Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of "Breaking Point," in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future.

New insights on a recurring theme: A secondary analysis of nurse turnover using the National Sample Survey of Registered Nurses

BACKGROUND

Registered nurse (RN) turnover is a recurring phenomenon that accelerated during COVID-19 and heightened concerns about contributing factors.

PURPOSE

Provide baseline RN turnover data to which pandemic and future RN workforce turnover behaviors can be compared.

METHODS

A cross-sectional, secondary analysis of RN turnover using U.S. National Sample Survey of Registered Nurses 2018 data. Responses from 41,428 RNs (weighted N = 3,092,991) across the United States were analyzed. Sociodemographic, professional, employment, and economic data and weighting techniques were used to model prepandemic RN turnover behaviors.

DISCUSSION

About 17% of the sample reported a job turnover, with 6.2% reporting internal and 10.8% reporting external turnover. The factors common across both internal and external turnover experiences included education, employment settings, and years of nursing experience.

CONCLUSIONS

Baseline RN turnover data can help employers and policymakers understand new and recurring nursing workforce trends and develop targeted actions to reduce nurse turnover.

Identifying the predictors of turnover intention based on nurse managers' toxic leadership behaviors among nurses in Iran: a cross-sectional correlational study

BACKGROUND

Unfavorable leadership practices are a growing concern in the field of healthcare and nursing that have adverse consequences on nurses' career outcomes. One of the undesirable leadership styles is the toxic leadership style. Considering the importance of nursing managers' leadership style and its impact on nurses' performance and the scarcity of studies in this field, the present study was conducted to determine toxic leadership behaviors in nursing managers and their relationship with the turnover intention among nurses.

METHODS

A multicenter cross-sectional correlational study. This study involved 551 nurses from 5 educational-medical centers in Ardabil province, north-western Iran. Three self-report scales, including The demographic and occupational information form, the Toxic Leadership Behaviors of Nurse Managers Scale (ToxBH-NM), and the turnover intention questionnaire were adopted for assessment purposes in this study. Data were analyzed using SPSS (Version 22) software using descriptive statistics, Pearson correlation coefficient test, t-test, ANOVA test, and multiple linear regression analysis.

RESULTS

Overall, 551 nurses participated in this research. There was a significantly positive relationship between Turnover intention and Toxic leadership behavior Subscales (r = 0.475, p < 0.001). Furthermore, multiple linear regression analysis showed Toxic leadership behavior Subscales (Intemperate behavior, Narcissistic behavior, Self-promoting behavior, and Humiliating behavior), Hospital, unit, Age, and Marital status predict Turnover intention when other variables are controlled.

CONCLUSION

A leader who directly and indirectly adopts toxic behavior toward their employees destructively affects both individuals and organizations. Nurses who work for a manager exhibiting toxic leadership behaviors demonstrated higher turnover intention.

Individual perspectives and mental maps of working conditions and intention to stay of physicians in academic medicine

Introduction

Job satisfaction has a strong impact on the intention to stay which is an important aspect to counter skills shortage in academic medicine. The purpose of the three studies reported here is to find out what specific factors are relevant for the intention to stay and turnover intention of physicians in academic medicine -and what measures might have a positive impact on employee retention.

Methods

In an interview study combining qualitative and quantitative methods, we investigated how the individual mental representation of working conditions influences job satisfaction and its impact on the intention to stay. In total, 178 physicians from German university hospitals, residents, and physicians, in 15 departments of anesthesiology were interviewed and surveyed. In a first study, chief physicians participated in interviews about job satisfaction in academic hospitals. Answers were segmented into statements, ordered by topics, and rated according to their valence. In a second study, assistant physicians during and after their training period talked about strengths, weaknesses, and potential improvements of working conditions. Answers were segmented, ordered, rated, and used to develop a "satisfaction scale." In a third study, physicians participated in a computer-led repertory grid procedure composing 'mental maps' of job satisfaction factors, filled in the job satisfaction scale and rated if they would recommend work and training in their clinic as well as their intention to stay.

Results

Comparing the interview results with recommendation rates and intention to stay show that high workload and poor career perspectives are linked to a negative attitude. A positive attitude towards work environment and high intention to stay is based on sufficient personnel and technical capacities, reliable duty scheduling and fair salaries. The third study using repertory grids showed that the perception of current teamwork and future developments concerning work environment were the main aspects to improve job satisfaction and the intention to stay.

Discussion

The results of the interview studies were used to develop an array of adaptive improvement measure. The results support prior findings that job dissatisfaction is mostly based on generally known "hygiene factors" and whereas job satisfaction is due to individual aspects.

Factors related to a successful professional development for specialist nurses in surgical care: a cross-sectional study

BACKGROUND

A high level of competence among staff is necessary for providing patient-safe surgical care. Knowledge regarding what factors contribute to the professional development of specialist nurses in surgical care and why they choose to remain in the workplace despite high work requirements is needed. To investigate and describe the organizational and social work environment of specialist nurses in surgical care as part of studying factors that impact on professional development.

METHOD

This was a cross-sectional study with a strategic convenience sampling procedure that recruited 73 specialist nurses in surgical care in Sweden between October to December 2021. The study was guided by STROBE Statement and checklist of cross-sectional studies. The validated Copenhagen Psychosocial Questionnaire was used, and additional demographic data. Descriptive statistics were performed and the comparison to the population benchmarks was presented as the mean with a 95% confidence interval. To study potential differences among the demographic and professional characteristics, pairwise t tests were used with Bonferroni adjustment for multiple comparisons with a significance level of 5%.

RESULTS

Five domains were identified as factors related to success, as they received higher scores in relation to population benchmarks: quality of leadership, variation of work, meaning of work and work engagement as well as job insecurity. There was also a significant association between a having a manager with low nursing education and job insecurity (p = 0.021).

CONCLUSIONS

Quality of leadership is important for the professional development of specialist nurses in surgical care. Strategic work seems to include managers with a higher nursing education level to prevent insecure professional working conditions.

The lens of Yin-Yang philosophy: the influence of paradoxical leadership and emotional intelligence on nurses' organizational identification and turnover intention

PURPOSE

This study aims to use "both-and" thinking of Yin-Yang philosophy to extend the field of leadership literatures and explore the influences of paradoxical leadership and emotional intelligence on organizational identification and turnover intentions of nurses.

DESIGN/METHODOLOGY/APPROACH

The authors adopted a cross-sectional survey completed by 285 nurses in Taiwan. SPSS 22, PROCESS and AMOS 21 were used for data analysis.

FINDINGS

The results reveal that paradoxical leadership has a significant positive relationship with nurses' organizational identification and a significant negatively relationship with their turnover intentions, and organizational identification partially mediated the relationship between paradoxical leadership and turnover intentions. The results further show that emotional intelligence strengthens the effect of paradoxical leadership on organizational identification, and paradoxical leadership had a stronger indirect effect on turnover intentions through organizational identification under strong emotional intelligence.

ORIGINALITY/VALUE

Paradoxical leadership can strengthen managers' abilities in dealing with interrelated and substantial issues and correspond to organizing and belonging paradoxes in holistic thinking processes. Health-care organizations must shape a coordinated institution and offer training initiatives to increase managers' ability and attitude to control organizational rules and procedures while allowing employees' flexibility and autonomy according to the requirements of the situation, which will maintain both organizational short-term benefits and long-term growth.

Leadership styles' influence on ICU nurses' quality of professional life: A cross-sectional study

BACKGROUND

Intensive Care Units are emotionally intense environments where professional autonomy and interprofessional collaboration are essential. Nurses are at high risk of burnout, and the level of compassion satisfaction has a deep impact on the quality of their professional life. Although leadership styles and burnout have been the subject of an extensive body of research, there is an existing gap regarding the relationship between leadership strategies and intensive care nurses' quality of working life and the impact on their compassion satisfaction. Specifically, there is a lack of literature in southern European countries concerning the influence of organizational and cultural contexts.

AIM

To evaluate the impact of nurse managers' leadership styles on Intensive Care Unit nurses' job satisfaction and compassion satisfaction.

DESIGN

A cross-sectional study.

METHODS

An online set of validated tests was sent to a non-probabilistic sample of nurses, recruited via the Italian association of intensive care and emergency nursing website. The set of tests consisted of the Empowering Leadership Questionnaire, Compassion Satisfaction Scale, and McCloskey Mueller Satisfaction Scale. Nurses actively working in intensive care and critical care settings were included in this study. ICU managers and leaders were excluded.

RESULTS

308 nurses (response rate 63,2%) completed the questionnaires. Statistical analysis showed that the Leadership dimension of "Showing concern towards the team" had a significant effect on Compassion Satisfaction. In addition, this dimension had an effect on nurses' overall job satisfaction on five out of eight subscales.

CONCLUSIONS

Leaders' authentic listening, communication, and participation capabilities have a positive impact on nurses' job and compassion satisfaction. The interest for team well-being, taking time to discuss team concerns, and working closely with the team affects unpredicted factors like working hours, flexibility in shift scheduling, satisfaction about recognition, and career advancement.

RELEVANCE TO CLINICAL PRACTICE

Results suggest that nurse managers can draw on/adopt leadership strategies oriented to authentic listening and interaction with the team in order to manage organizational issues, increase nurses' professional quality of life and prevent burnout.

Nurse Managers' Involvement in Decision-Making and Associated Factors in Selected Government Hospitals, Addis Ababa, Ethiopia: A Cross-Sectional Study

Introduction

In the healthcare system, nurse managers' participation in decision-making was invaluable in preserving cost-effective service and safe patient care. Despite the fact that nurse managers have the power to ensure optimal health care service, their involvement in decision-making has not been well studied.

Objectives

To assess nurse managers' decision-making involvement and associated factors working in selected governmental hospitals in Addis Ababa, Ethiopia 2021.

Methods

A cross-sectional study was conducted among 176 nurse managers from government hospitals in Addis Ababa, with a response rate of 168 (95.5%). The total sample size is assigned in proportion. The technique of systematic random sampling was used. A structured, self-administered questionnaire was used to collect data, which was then checked, cleaned, entered into EPI Info version 7.2, and exported to SPSS software version 25 for analysis. In a binary logistic regression model analysis, a p-value < .25 was used as the cut-off point to consider variables as candidates for multivariable analysis. A p-value of .05 was used to determine the predictor variables with a 95% confidence interval.

Result

The mean age and standard deviation of the 168 respondents were 34.9 ± 4.1 years. More than half, 97 (57.7%), were excluded from general decision-making. Nurse managers in matron positions were 10 times more likely to participate in decision-making than head nurses (AOR = 10.00, 95% CI: 1.14-87.72, p = .038). Nurse managers who received managerial support were five times more likely to participate in good decision-making than nurse managers who did not receive managerial support (AOR = 5.29, 95% CI: 1.208-23.158, p = .027). Nurse managers who received feedback on their decision-making involvement had 7.7 times more good decision-making involvement than those who did not (AOR = 7.70, 95% CI: 2.482-23.911, p = .000).

Conclusion

According to the findings of the study, the majority of nurse managers were not involved in decision-making.

Turnover Intention and Organizational Commitment of Primary Healthcare Nurses

Turnover intention is a predictor of the decision to leave an organization, which, if carried out, affects the quality of care provided. There is an association between turnover intention and organizational commitment. The more committed nurses are to the unit in which they work, the more committed they become to the unit's organizational goals; thus, they tend to continue working for the organization. Aiming to assess the turnover intention and the organizational commitment of nurses in primary healthcare, we conducted a quantitative, observational, descriptive, and cross-sectional study. The Intention of Turnover Scale and the Organizational Commitment Scale were applied in a sample of 297 nurses. Data were analyzed based on descriptive statistics. About 92.8% of the nurses intend to stay at their current workplace and only 7.3% plan to leave soon, suggesting low turnover intention; 84.5% of the nurses are willing to make an effort beyond what is normal to help their organization succeed, and 88.7% feel really interested in the destiny of the organization, which shows high organizational commitment. Pearson's Coefficient revealed the existence of a significant negative correlation between the factors "Intention to leave" and "Committed to the organization" (r = -0.51, p < 0.01). These findings suggest that, when nurses are more committed to their work and to the organization, they display less intention to leave, keeping the teams committed and motivated towards the organizational goals Our findings may guide nurse managers and policy-makers to develop strategies that retain nurses in organizations, keeping them motivated and engaged, and focusing on higher organizational commitment due to the influence it may have on the turnover intention.

Predictors of job burnout among Chinese nurses: a systematic review based on big data analysis

Job burnout is an occupational hazard induced by prolonged exposure to excessive work-related stress -a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity. Knowledge jobs involve many health-promoting features, but stress and burnout may be caused by the rapid increase in the knowledge intensity of work, new job demands, and emerging new professional subcultures emphasizing the excessive commitment to work. Although there are studies on job burnout and predictors among nurses worldwide, evidence specific to Chinese nurses is lacking. The purpose of this review is to synthesize current research on predictors related to burnout affecting Chinese nurses. We searched the Chinese databases including National Knowledge Infrastructure (CNKI), WanFang, China Science and Technology Journal Database, and Chinese Biological Medical Database (CBM); and international databases including Cochrane Library, PubMed, EMBASE, and Web of Science published up to 30th August 2022. The 125 studies identified assessed a range of predictors of job burnout. The results showed good working relationships and internally controlled individuals were found to be predictive of job burnout. Moreover, numerous predictors produced contradictory data. There are still challenges with how to systematically operationalize such a complicated phenomenon to effectively prevent or reduce job burnout.

The Impact of Transformational Leadership Style on Nurses' Job Satisfaction: An Integrative Review

Introduction

The argument about whether leadership style affects nurses' job satisfaction is centered around the impact of different leadership styles on the work environment and the quality of care provided by nurses. Therefore, this review was primarily aimed at assessing the impact of transformational leadership style on the job satisfaction of hospital nurses.

Methods

This is an integrative review conducted according to the Whittemore and Knafl's framework. Comprehensive literature searches were conducted in PubMed, MEDLINE, CINAHL, Web of Science, Research4Life, and APA PsychInfo. In addition, studies were included through hand-searching from different sources of grey literature and a reference list of identified articles. All English articles published between 2012 and 2023 reporting the impact of transformational leadership style on nurses' job satisfaction were eligible for inclusion.

Results

Seventeen articles were included in the review, of which 16 were cross-sectional studies, while one was mixed. The majority (n = 12) of the studies were conducted in at least two or more healthcare settings, with a total of 5841 nurses. Almost all (n = 16) articles reported the positive influence of transformational leadership on nurses' job satisfaction. In addition, the transformational leadership style was reported to have a positive impact on nurses' intentions to stay at work, quality care, and patient outcomes.

Conclusion

By adopting a transformational leadership approach within clinical environments, there is a potential to boost nurses' job satisfaction.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A psychometric assessment of nurses: Development of the innovative leadership scale

PURPOSE

The study aims to develop a measurement tool that will determine the innovative leadership levels of nurses.

METHODS

This methodological paper was conducted with 615 nurses. The content validity, factor analyses, and Cronbach's alpha test were used for psychometric assessment.

FINDINGS

As a result of the exploratory factor analysis, the scale consists of 43 items and five subscales. Confirmatory factor analysis showed that the innovative leadership scale (ILS) is a valid model.

PRACTICAL IMPLICATIONS

There is a need for innovative leading nurses in the healthcare field. The psychometric assessment showed the ILS is a valid and reliable scale.

Toxic Leadership Behaviour of Nurse Managers on Perceived Job Satisfaction and Productivity of Nursing Workforce in Sub-Saharan Ghana: A multi-centre cross-sectional study

This study aimed at assessing the nature and effect of toxic leadership of nurse managers on the perceived job satisfaction and productivity of the nursing workforce.

BACKGROUND

Nursing job outcomes such as job satisfaction and nurses' productivity are influenced by various factors in the nursing practice environment including leadership. Due to rising healthcare expenses and depleting material resources, the productivity of nurses which is expected to improve the efficiency of healthcare organizations is mostly low. Managers' toxic behaviour toward nurses affects their job satisfaction and subsequently low productivity.

METHOD

A multi-centre, cross-sectional descriptive design was used. Validated tools were used to collect data from participants and data was analyzed using descriptive, correlation, and hierarchical linear regressions.

RESULTS

Registered nurses appraised the leadership behaviour of nurse managers to be toxic, with most managers exhibiting narcissistic leadership behaviour. While all components of toxic leadership behaviour of managers were associated with the perceived productivity of the nurses; intemperate leadership behaviour of the managers (β = -.301, p <.005), and job satisfaction (β = .296, p < .001) significantly predicted perceived productivity among nurses (R² = .238, F _{(7, 922)} = 41.088, p< .001).

CONCLUSION

Nurse managers' leadership behaviours were toxic. Nurses' job satisfaction and all components of managers' toxic leadership behaviour influenced productivity.

IMPLICATIONS FOR NURSING MANAGEMENT

There should be a policy developed to guide the creation and maintenance of efficient nursing leadership to enhance job satisfaction and productivity among nurses.

Relationship between interprofessional teamwork and nurses' intent to leave work: The mediating role of job satisfaction and burnout

BACKGROUND

Reducing nurse turnover is a top priority for nursing management globally. While evidence has demonstrated that working in a favorable environment with greater interprofessional teamwork is essential in increasing nurse retention, few studies have explored the mechanism underlying this relationship.

AIM

To examine the direct and indirect effects of interprofessional teamwork on nurses' intentions to leave their jobs via the intermediary roles of job satisfaction and burnout.

METHODS

A cross-sectional study was conducted to collect data from 2113 nurses working in 21 hospitals in Oman. Data were collected using a survey questionnaire measuring teamwork, job satisfaction, burnout, and intention to leave. Logistic regression was used to investigate the direct effect of teamwork on intent to leave. A sequential mediation model was conducted to examine the mediating role of job satisfaction and burnout.

RESULTS

Interprofessional teamwork was directly associated with nurses' intentions to leave. The influence of teamwork on intention to leave was indirectly mediated by both job satisfaction and job burnout.

CONCLUSION

Findings illustrate the potential benefits of enhancing interprofessional teamwork in reducing nurses' intentions to leave. Interventions intended to foster teamwork could create satisfying workplaces, reduce perceived burnout, and ultimately contribute to organizational strategy for reducing nursing shortages.

Occupational stress and its relationship with spiritual coping among emergency department nurses and emergency medical services staff

Introduction

Emergency Department (ED) nurses and Emergency Medical Services (EMS) Staff are faced with several stressors daily, such as the COVID 19 pandemic situation, which affects the health and the quality of services to patients. Spiritual coping with stress is an attempt to overcome the stress on the basis of what is transcendent. The use of spiritual coping strategies helps a person to overcome tensions caused by the work environment.

Objective

The current study aimed to investigate occupational stress and its relationship with spiritual coping among ED nurses and EMS staff.

Materials and methods

This study was descriptive-correlational research. Using convenience sampling methods, 516 ED nurses and EMS staff were enrolled in the study. The study instruments included demographic information, HSE Occupational Stress, and spiritual coping questionnaires. Data were analyzed using SPSSv.22 software and the descriptive statistics, Pearson correlation test, t-test, ANOVA, and multiple linear regression.

Results

The highest and lowest levels of occupational stress were the dimensions of “demand” (2.96 ± 0.65) and “role” (3.89 ± 0.81) respectively. Multiple linear regression analysis showed that positive spiritual coping, negative spiritual coping, workplace, service location, type of employment, and work position were important factors affecting the occupational stress of ED nurses and EMS staff, which accounted for 0.34% of the variance.

Conclusion

The findings showed the need to improve the work environment for ED nurses and EMS staff, including changes in physical working conditions, salaries, and better employment conditions. Training programs are recommended to reduce stress through the use of positive spiritual coping strategies.

Empowerment and turnover of nurse managers before and after a major healthcare reform in Cyprus: A cross sectional study

AIM

To investigate the perceived empowerment and turnover intention of middle nurse managers before and after the implementation of a major reform of the healthcare system in Cyprus, which also includes the transition of public hospitals towards administrative and financial autonomy.

BACKGROUND

The empowerment of Nurse Managers is important since previous studies have shown that it is associated with performance at work and may have an impact on their turnover intention.

METHODS

This is a repeated cross-sectional study, which was conducted in March 2019 (first phase) and was repeated in March 2020 (second phase), after the introduction of major changes. The target population was all nurse managers of the public hospitals. The final sample consisted of 175 (RR 94%) participants in the first phase and 178 (RR 95.6%) in the second.

RESULTS

Measurements at both time points revealed moderate levels of perceived empowerment among Cyprus Nurse Managers. Empowerment appeared slightly lower at the repeat measurement compared to the first, but the observed difference was not statistically significant. Among the categories of empowerment «opportunities» was presenting statistically significant differences between the two phases. At the second phase, mean scores of empowerment were consistently lower among those who stated YES compared to those who stated NO in relation to: a) the intention to change department, b) the intention to change profession and c) the intention to change organization/hospital.

CONCLUSIONS

This study demonstrated lower levels of empowerment among Nurse Managers with turnover intentions. It is therefore needed to be investigated further whether lower empowerment levels are the main reason for turnover intentions. It also suggests the need for senior management to create opportunities and to develop and implement interventions which aim to maintain and further improve the empowerment of the Nurse Managers and assess their effectiveness in terms of turnover intention in the organization.

IMPLICATIONS FOR NURSING POLICY

The senior management of the hospitals need to adopt retention strategies by establishing an empowered positive working environment for Nurse Managers. Nurse Managers need to collaborate with the senior management and seek more access to opportunities, information, support and resources which will enable them to perform their duties with efficiency and be more effective.

The influence of nursing leadership styles on the outcomes of patients, professionals and institutions: An integrative review

AIM

This review was conducted to map leadership styles that positively impact patients, professionals and institutions.

BACKGROUND

Leadership is a topic widely studied because it is a fundamental skill in establishing favourable work environments, in addition to enabling nurses to influence their team in the search for better results. Therefore, a synthesis of the various studies produced to date is essential for nurses, managers and researchers to understand the different styles of leadership that positively influence organizational results, so they can choose the style they deem most appropriate.

EVALUATION

An integrative literature review retrieved articles from five databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level of evidence and its quality were assessed using the criteria of the Joanna Briggs Institute.

KEY ISSUES

Thirty-five studies were included, 18 of which reported the influence of leadership styles on patients (safety), nine on professionals (burnout) and eight on institutions (turnover and absenteeism).

CONCLUSION

Transformational leadership had positive results for patients, professionals, and institutions alike.

IMPLICATIONS FOR NURSING MANAGEMENT

The results showed the need for nurses to improve their leadership skills, especially in the transformational style, to achieve positive results.

RESONANT LEADERSHIP PRACTICES OF NURSE MANAGERS IN THE HOSPITAL SETTING: A CROSS-SECTIONAL STUDY

ABSTRACT Objective: analyze Resonant Leadership style among the nurse managers from the perspective of nurse managers and nurses. Methods: cross-sectional study, carried out in a hospital in Guyana. Participants were 171 registered nurses and nurse managers. Data were collected from July to October 2020 using Resonant Leadership scale and a socio demographic questionnaire. Results: in self-version, the total leadership rating was 38.9 for nurses and 41.6 for managers (p=0.003). The age category at most 30 are more likely to give a low rating of themselves than the age category 50 - 69 (p = 0.046). Managers scored on average 3.44 points more than nurses for the self total leadership rating. Conclusion: resonant leadership is practiced at a moderate level and managers have higher scores. Nurse Managers can improve their leadership style.

The nurses' occupational stress components and outcomes, findings from an integrative review

AIM

To identify, evaluate and summarize the components, factors and outcomes of nurses' occupational stress published between 2009-2019.

DESIGN

Integrative literature review.

METHODS

A literature search was conducted on PubMed, CINAHL and PsycINFO databases for articles published in English, between 2009-2019.

RESULTS

The review included 132 studies. Most studies were conducted in the Confucian Asia and Anglo countries, but a growing number of studies were done in other countries. Almost all studies used a quantitative design, and changes in the use of scales indicated an increasing attention to career-related components. Factors were categorized into sociodemographic, work environment and personal resources. Sociodemographic factors were inconsistent across countries. Outcomes were categorized into health status, capability, affective and behavioural responses to work, and organizational performance with generally consistent results. Model validation studies showed the non-linear or non-direct associations between stress and outcomes.

The Impact of an Online Mindfulness-Based Stress Reduction Program on Sleep Quality of Nurses Working in COVID-19 Care Units: A Clinical Trial

The coronavirus disease-2019 (COVID-19) epidemic is associated with impaired sleep quality in nurses for several reasons. The present study aimed to determine the effect of an online mindfulness-based stress reduction (MBSR) program on improving the sleep quality of nurses working in the COVID-19 care units. In this randomized controlled clinical trial study, all nurses in the 2 COVID-19 patient care units were randomly assigned to the control and intervention groups. The MBSR program was implemented online for 7 weeks for the intervention group by a trainer. The Pittsburgh Sleep Quality Index (PSQI) was completed online by the participants in both groups before and after the intervention. The results of the data analysis indicated that the intervention improved the scores of subjective sleep quality, sleep latency, and sleep efficiency in the intervention group. In the control group, there was a significant increase in the scores of subjective sleep quality, daily performance, and the total index score in the posttest. Besides, there was a significant difference between the 2 groups in only 2 components of sleep latency and subjective sleep quality. The MBSR program can be an effective intervention to improve the sleep quality of nurses working in COVID-19 intensive care units who are at risk of sleep quality disorders in stressful situations.

The relationship between leadership behaviours of ward nurse managers and teamwork competency of nursing staff: A cross-sectional study in Japanese hospitals

AIMS

The aim of this study was to clarify what kind of leadership behaviours of ward nursing managers are related to the teamwork competency of nursing staff.

BACKGROUND

There are two types of leadership behaviours: administrative and emotional intelligence leadership. While emotional intelligence leadership is important for teamwork, it is not clear how it relates to individual teamwork competency.

METHODS

This was a cross-sectional study. A questionnaire survey was distributed among 13 hospitals in Japan between May and August 2019.

RESULTS

We analysed 960 questionnaires. Multiple regression analyses revealed that two emotional intelligence leadership behaviours (staff nurturing and support, and care for patients) were positively associated with all three teamwork competencies (skill, knowledge and attitude, β = 0.141-0.318). Regarding administrative leadership behaviours, only human resource management was related to teamwork competency knowledge (β = 0.182).

CONCLUSION

Nurses' teamwork competencies were primarily related to emotional intelligence leadership. Furthermore, their teamwork competency was related more to nurse managers' behaviour towards patients and other staff members rather than towards themselves.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers need to be role models for nursing staff, recognizing that the way they relate to others influences the teamwork competency of their nursing staff.

Correlation between Ethical Intelligence, Quality of Work Life and Caring Behaviour of Paediatric Nurses

AIMS

The aim of this study is to determine correlation between paediatric nurses' "ethical intelligence" with "quality of work life" and "caring behaviour."

DESIGN

Descriptive correlational study.

METHODS

Data were collected with EIQ, QWL and CBI. Two hundred and one nurses and 201 caregivers of children hospitalized in a paediatric hospital in Tehran were randomly selected as participants. Data were analysed by SPSS. The data were collected in 2019.

RESULTS

Comparison of the subscale "ethical intelligence" with the scale "quality of work life" indicated a significant positive correlation between "honesty" with "job and carrier satisfaction" and "forgiveness" with "job and carrier satisfaction". In addition, findings showed a significant positive correlation between "honesty" and "control at work" and between "accountability" with "home-work interface." There was no significant correlation between "ethical intelligence" and "caring behaviours" and between nurses' "quality of work life" and "caring behaviours." Structural equation modelling showed a correlation between nurses' "ethical intelligence" and "quality of work life."

Understanding effective nurse leadership styles during the COVID-19 pandemic

Leadership is central to effective nursing practice and is considered to be particularly important during crises such as the coronavirus disease 2019 (COVID-19) pandemic. This article examines several leadership styles that are commonly used in healthcare - namely the transactional, transformational and laissez-faire leadership styles - and considers their advantages and disadvantages in the context of the COVID-19 pandemic. It also explains the potential benefits of compassionate leadership in supporting the nursing workforce during this highly challenging and stressful period.

Cluster analysis of self-concept and job satisfaction in Chinese nurses with master's degree to identify their turnover intention: A cross-sectional study

AIMS AND OBJECTIVES

This study aimed to implement cluster analysis of self-concept and job satisfaction to identify subgroups in nurses with master's degree and explore the associations of turnover intention with characteristics among these clusters.

DESIGN

A cross-sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

METHODS

A convenience sample of 408 nurses with master's degree in China filled out the survey from 19 November 2019 to 30 December 2019. A sociodemographic questionnaire, the Nurses' Self-Concept Questionnaire (NSCQ), Job Satisfaction Scale (JSS) and Turnover Intention Questionnaire (TIQ) were adopted to collect the data. K-means cluster analysis was implemented on the R software, and data were analysed using SPSS 24.0.

RESULTS

Three subgroups were identified based on cluster analysis of NSCQ and JSS subscales in 405 nurses (99.3%) available for statistical analysis, among whom 30.9%, 17% and 48.1% were allocated to these clusters respectively. Turnover intention significantly differed among the three clusters, with cluster 2 having the highest turnover intention and cluster 1 having the lowest turnover intention. Working department, position, professional title, clinical nurse specialist and annual income were factors differentiating TIQ scores in each cluster.

CONCLUSIONS

This study identified three clusters of nurses with master's degree and showed that each cluster was associated with the level of turnover intention. The unique characteristics of the three clusters may be also helpful in identifying and providing specific managerial or social support to reduce turnover rates in nurses with master's degree.

RELEVANCE TO CLINICAL PRACTICE

Cluster analysis is s an unsupervised machine learning method to identify meaningful subgroups within heterogeneous population based on variables distributions and patterns underlying in the data set. Through clustering, nurses with multi-dimensional characteristics could be allocated into subgroups associated with turnover intention. As a result, nursing managers could provide approaches for each subgroup to reduce turnover intention.

Morality traits for an ideal nurse manager: A multicentre cross-sectional study

AIMS

To investigate which morality traits are more important for nurses to determine positive opinions of their nurse manager.

BACKGROUND

People selected morality more often than sociability and competence when forming a positive opinion towards an ideal or a newcomer manager.

METHODS

A multicentre, cross-sectional study was carried out by administering two questionnaires to 775 nurses on the influence of morality, sociability and competence traits on their impression formation processes.

RESULTS

Regarding nurses' perceptions about the morality, sociability and competence traits of an ideal nurse manager, the total score for morality was 20.0; for sociability, it was 14.2; and for competence, it was 19.6. For nurses' opinions about a new nurse manager, the total score of the morality section was 16.2, which was very similar to the total score of the competence section (mean = 16.1).

CONCLUSION

Morality positively influences nurses' initial impression of an ideal manager, and though it seems to be a necessary condition, it is not sufficient by itself to support the nursing staff's perception towards a new manager.

IMPLICATIONS FOR NURSING MANAGEMENT

Our findings could be useful in better understanding the role of morality in social perceptions and behavioural consequences of staff nurses towards their nurse manager.

Leadership, adequate staffing and material resources, and collegial nurse-physician relationships promote better patients, professionals and institutions outcomes

AIM

To test a theoretical model aiming to understand which characteristics of the professional nursing practice environment most affect patients, professionals and institution outcomes.

DESIGN

A cross-sectional and correlational study, using a structural equation model.

METHODS

One thousand seven hundred and seventy-three staff nurses were recruited using convenience sampling in five Brazilian hospitals from November 2017 to July 2018. Structural equation modelling was used to assess the relationship between the characteristics of the nursing work environment and patients (climate of safety and quality of care), nursing professionals (job satisfaction and emotional exhaustion) and institutions (intention to leave the job) outcomes. The model was tested using the partial least squares method, considering the bootstrapping technique to estimate the results. The path coefficients and their respective 95% confidence intervals were calculated. The quality of fit of the structural model was assessed by calculating the coefficient of determination (R² ), the predictive validity coefficient (Q² ) and the effect size (f² ).

RESULTS

The characteristics that most affected the outcomes for patients were Nurse manager ability, leadership and support of nurses (λ=0.27), and Staffing and resource adequacy (λ=0.26); for nursing professionals, Staffing and resource adequacy (λ=-0.19), and Collegial nurse-physician relations (λ=0.19); and for institutions, Nurse manager ability, leadership and support of nurses (λ=-0.10), and Collegial nurse-physician relations (λ=-0.10).

CONCLUSION

The characteristics of the professional nursing practice environment that most contribute to achieving better outcomes include nurse manager ability, leadership and support of nurses, staffing and resource adequacy, and collegial nurse-physician relations.

IMPACT

This study allowed us to assess which strategies should be prioritized in the professional nursing practice environment to achieve better results. Thus, investment in the training of leadership, in the adequacy of resources, and in physician-nurse relations will bring better results for patients, nursing professionals, and institutions.

Determinants of nurse manager job satisfaction: A systematic review

BACKGROUND

Front-line nurse managers provide direct oversight of healthcare delivery to ensure organizational expectations are implemented to achieve optimal patient and staff outcomes. Ensuring the job satisfaction of front-line nurse managers is key to retaining these individuals in their roles. Understanding factors influencing job satisfaction of nurse managers can support the development and implementation of strategies to enhance job satisfaction and sustain retention.

OBJECTIVES

We aimed to systematically review the empirical literature measuring determinants of job satisfaction among nurse managers.

DESIGN

We conducted a systematic review using 11 electronic databases.

DATA SOURCES

Electronic databases included ABI Inform, Academic Search Premier, CINAHL, EMBASE, ERIC, Health Source Nursing, Medline, ProQuest Dissertations and Theses, PsychINFO, and LILACS.

REVIEW METHODS

We included research articles that examined the determinants of job satisfaction for front-line nurse managers. Two research team members independently reviewed and determined inclusion of each study. Each study was appraised independently for quality by two team members. Data extraction was completed for included studies. Content analysis was used to categorize factors associated with job satisfaction of nurse managers.

RESULTS

A total of 5608 articles were screened for inclusion or exclusion. Thirty-eight studies were included. One hundred and one factors influencing nurse manager job satisfaction were reported in the included studies. Factors were grouped into three main categories: job characteristics, organizational characteristics, and personal characteristics. Most factors were examined in single studies or their relationship with job satisfaction was equivocal. However, across these categories, findings included significant positive relationships between autonomy, power, social support among team members and job satisfaction of front-line nurse managers. A significant negative relationship between job stress and nurse manager job satisfaction was indicated in the findings.

CONCLUSIONS

Promoting autonomy, power to make decisions for change, social support, team cohesion, and strategies to reduce job stress may improve job satisfaction of front-line nurse managers. Innovative solutions such as co-management and targeted administrative and electronic resources warrant further investigation. Promoting prosocial group behaviours, team building, coaching and the implementation of wellness programs may improve social support, team cohesion, and wellbeing. Examining factors of nurse managers job satisfaction beyond the acute care setting could provide further insights into the role that the practice environment plays in nurse manager job satisfaction.

TWEETABLE ABSTRACT

Promoting autonomy, power to effect decisions for change, social support, team cohesion, and strategies to reduce job stress are important drivers of job satisfaction of front-line managers.

Mediating effect of coping style on the relationship between clinical leadership and quality of work life among nurses in tertiary-level hospitals in China: a cross-sectional study

OBJECTIVE

To explore the association between clinical leadership and quality of work life, as well as the mediating role of coping style in this relationship.

SETTING

Three tertiary-level hospitals in Liaoning Province, China.

PARTICIPANTS

A total of 1209 nurses were recruited for this study. Registered nurses who work full time with at least 1 year of work experience were eligible as subjects. Exclusion criteria were nurses who work indirectly with patients, such as in education, administration or research.

PRIMARY AND SECONDARY OUTCOME MEASURES

Questionnaires consisting of the work-related Quality of Life Scale, the Nurse Leadership Scale and the Simplified Coping Style Questionnaire, as well as a demographic data sheet, were used to collect participant information. Pearson's correlation analysis, hierarchical multiple regression analysis, and asymptotic and resampling strategies were used to analyse the data.

RESULTS

The mean overall quality of work life score among Chinese nurses was 3.50±0.60. After adjusting for demographic characteristics, clinical leadership was positively associated with the score of quality of work life (β=0.55, p<0.01). Clinical leadership explained 27% of the variance in quality of work life. Coping style partially mediated the relationship between clinical leadership and quality of work life. The proportion of mediation of active coping was 21.82% and of passive coping was 5.79%.

CONCLUSIONS

Clinical leadership was positively associated with quality of work life and coping style partially mediated the relationship between clinical leadership and quality of work life among nurses in China. Implementing measures focusing on both clinical leadership and coping style may provide success in improving the quality of work life of nurses.

Nurses' Clinical Work Experience during Pregnancy

The working environment of nurses contains numerous hazards that can be particularly harmful to pregnant women. In addition, pregnancy-induced changes can themselves cause discomfort. Therefore, it is necessary to analyze pregnant nurses' experiences of clinical work. This qualitative study analyzed data collected through in-depth interviews. From January to June in 2020, 12 shift-work nurses who had experienced pregnancy within three years were interviewed. The main question was "Could you describe your clinical work experience during pregnancy?" Qualitative data from field notes and transcriptions of the interviews were analyzed using Colaizzi's method. Six categories were extracted that described the nurses' clinical work experience during pregnancy, as follows: "enduring alone," "organizational characteristics of nursing," "risky work environment," "strengths that sustain work during pregnancy," "growth as a nurse," and "methods to protect pregnant nurses." Pregnant nurses experienced various difficulties due to physical and mental changes during pregnancy, and the clinical working environment did not provide them with adequate support. The findings of this study will be helpful for developing and implementing practical maternity protection policies and work guidelines.

Influence of nurse managers' toxic leadership behaviours on nurse-reported adverse events and quality of care

AIM

To assess the impact of toxic leadership behaviours among nurse managers on nurse-reported adverse events and quality of care.

BACKGROUND

Toxic leadership, a form of ineffective leadership, is increasingly becoming rampant in the field of nursing and has been strongly linked to poor nurse job outcomes including job dissatisfaction, higher stress levels, and increased turnover intention. To date, no studies have been conducted to examine how this type of leadership behaviours affects patient outcomes and care quality.

METHODS

A multicentre, cross-sectional study. This study involved a sample of 1,053 registered nurses working in 20 hospitals in the Philippines. Three standardized scales were deployed, including the Toxic Leadership Behaviors of Nurse Managers Scale, the Adverse Patient Events Scale and the single-item quality-of-care-measure.

RESULTS

Overall, nurses (96.2%) appraised the quality of care of their respective units as 'good to excellent' and cited complaints from patients and their families as the most commonly reported adverse events. Toxic leadership behaviours in nurse managers were strongly associated with increased nurse-reported adverse events including reports of complaints (β = .619; p < .001) and verbal mistreatment from patients and their families (β = .407; p < .001), patient falls (β = .834; p < .001), health care-associated infections (β = .629; p < .001) and errors in administering medication (β = .708; p < .001) and with decreased quality of care (β = -.216; p < .001).

CONCLUSION

Nurses who experience working under a nurse manager exhibiting toxic behaviours reported an increased frequency of nurse-reported adverse events and poorer quality of care in the unit.

IMPLICATIONS FOR NURSING MANAGEMENT

Organizational measure to reduce the occurrence of adverse events and enhance the quality of care provided in medical units may include intervention to develop positive leadership practices among nurse managers.

Exploring the benefits and limitations of transactional leadership in healthcare

Leadership theory is a crucial aspect of nursing and the focus of a large body of literature. However, it remains a challenging concept to define and has been subject to various interpretations. Much of the literature on leadership is contradictory, with some studies claiming particular leadership styles are more effective than others. This article discusses the benefits and limitations of one approach to leadership - transactional leadership - and considers its use in nursing practice. The author suggests that transactional leadership remains useful as an approach to meeting short-term goals and completing tasks, but that it should be combined with other leadership styles to maximise its effectiveness in healthcare settings.

Validity and reliability of the Turkish version of the General Work Stress Scale

AIM

To test the validity and reliability of the Turkish version of the General Work Stress Scale.

BACKGROUND

Nursing is one of the most stressful professions. The primary measure that should be taken to ensure that nurses can cope with stress is determining their stress levels.

METHOD

The General Work Stress Scale was translated into Turkish via back-translation. Its reliability and validity were analysed via item analyses, content and construct validities, exploratory and confirmatory factor analyses, Cronbach's alpha and Spearman-Brown reliability coefficients. Average and standard deviations of the scale items and the overall scale were calculated.

RESULTS

The study was conducted with 276 nurses. The Cronbach's alpha of the whole scale was 0.91, and the Spearman-Brown reliability coefficient was 0.89. According to the resulting one-dimensional structure, the factor loadings of the scale items were between 0.67 and 0.82, and this structure alone explained 58.72% of the total variance. The confirmatory factor analysis revealed perfect and good-fit indices (χ² /df = 1.96; RMSA = 0.06; CFI = 0.99; IFI = 0.99; GFI = 0.97; RMR = 0.04; NFI = 0.99). The mean total score was 2.55 ± 0.87, while the items' means ranged from 2.10 ± 1.15 to 3.33 ± 1.13.

CONCLUSION

The Turkish version of the General Work Stress Scale is a valid and reliable tool for assessing nurses' general work stress. Nurses largely feel that their work makes them so stressed that they wish they had a different job. The items with high means suggest opportunities for improvement.

IMPLICATIONS FOR PRACTICE

The nurses or nursing services and units with low or high stress levels can be determined with the General Work Stress Scale. If necessary, measures aimed at eliminating or reducing the negative effects of those nurses or nursing services and units with high stress levels can be taken in a timely manner.

Strengthening Workplace Well-Being in Research Animal Facilities

In recent years, there has been an increased recognition of the potential cost of caring on the mental well-being of research animal facility personnel. While this issue is considered a normal consequence of caring for others, these stressors must be acknowledged and managed to ensure that the workplace culture remains positive and that employees are engaged. Factors that can contribute to these feelings in those working with animals in research include compassion and moral stress, issues related to staffing and scheduling of work, insufficient communication in the workplace, and public ambivalence toward the use of animals in science. The first step in developing a program is to survey facility personnel about their concerns, either formally (e.g., using a needs analysis) or informally. Two examples are provided to demonstrate different institutional approaches to assessing personnel needs and developing an internal compassion-resiliency program. The best programs are based on the needs and wants of personnel and these can be cost effective and geared at a grassroots level. Social support in the workplace, for example, through peer counseling, can be a highly effective means of helping personnel to build compassion-resiliency. Addressing mental well-being of research animal facility personnel is an important component of ensuring a positive culture of care in the workplace.

The association between supervisor support and ethical dilemmas on Nurses' intention to leave: The mediating role of the meaning of work

AIM

To examine the association between supervisor support and ethical dilemmas on nurses' intention to leave health care organisations, both directly and through the mediating role of the meaning of work.

BACKGROUND

The shortage of nurses makes it vital that organisations retain nurses and so reduce the costs associated with replacing experienced nurses.

METHODS

This cross-sectional study samples 2,946 registered nurses from a selected health region in Norway. Structural equation modelling was used to test a hypothesized model.

RESULTS

Social support from the supervisor and ethical dilemmas is associated with nurses' intention to leave, both directly and indirectly through the mediating role of the meaning of work.

CONCLUSION

Health care organisations should enhance social support from supervisors and the meaning of work, and reduce the level of ethical dilemmas in hospitals.

IMPLICATIONS FOR NURSING MANAGEMENT

Health care organisations should continuously develop and offer training in nurse manager skills, such as being empathic, understanding employees' needs and how to communicate and handle ethical dilemmas. Managers should value staff contributions, encourage staff involvement in ethical questions and highlight the impact of nurses' work on improving the welfare of others.

Leading unique cultures in departments with low turnover of nurses. A positive deviance approach study

AIM

To investigate nurse leaders' experiences and strategies for turnover in relation to culture and work environment in hospital departments with low nurse turnover.

BACKGROUND

Nursing shortage is a global problem, and numerous turnover strategies have been utilized to attempt to address this shortage.

DESIGN/METHODS

Four regional hospital departments with the lowest nurse turnover were included. Data were constructed with nine nurse leaders through individual interviews and were analysed using directed content analysis.

RESULTS

The findings presented in two categories, 'The culture is unique' and 'Maintaining, protecting or re-establishing a unique culture', summarize how leaders navigated authentically in different contexts, operationalizing clear values and visions both for their departmental culture and in turnover strategies.

CONCLUSION

Even though all the nurse leaders interviewed were concerned about the current recruitment situation, they were confident in their leadership roles, targeted towards supporting the unique culture in their departments.

IMPLICATIONS FOR NURSING MANAGEMENT

Leaders with clear cultural awareness and visions for the context in which they operate may be positively associated with lower turnover of nurses. Including the perspectives of leaders from departments with low turnover of nurses has the potential to create new knowledge about improving nurse retention.

Competencies of military nurse managers: A scoping review and unifying framework

Aim(s)

To identify competencies of military nurse managers and develop a unifying framework of military nurse managers’ competencies.

Background

Military nurse managers shoulder multiple responsibilities because of duality roles, and they should possess competencies that enable them to manage human and material resources during peacetime and wartime. Therefore, nursing management within military context is demanding, such that a comprehensive understanding of their competencies is needed for effective military nursing management. Although relevant studies have focused on different military branches and different levels of managers, there is no standard evaluation framework.

Evaluation

A scoping review of studies focusing on competencies of military nurse managers from seven databases was carried out.

Key issues

Nine studies were included in this review, and a framework consisting of six domains of military nurse managers’ competencies was identified: clinical expertise, role model, leadership competencies, human competencies, financial competencies and deployment competencies.

Conclusion

Existing knowledge of competencies of military nurse managers is limited, and a comprehensive understanding of this topic can provide direction for future work.

Implications for Nursing Management

Military nurse managers play substantial roles within the military nursing context. A unifying framework can facilitate personnel recruitment and competency measurement, as well as training protocol development.

Factors related to the patient safety climate in an emergency hospital

Objective:

to verify the relationship between the socio-demographic and work profile of the nursing professionals and the patient safety climate in a public emergency hospital.

Method:

a cross-sectional study carried out with 177 nursing professionals from a public emergency hospital. For data collection, the Safety Attitudes Questionnaire - Short Form 2006 was used, validated and cross-culturally adapted to the Portuguese language. To check the factors related to the instrument’s domains, bivariate and multivariate analyses were performed.

Results:

working in the medical and surgical clinic or emergency room, on a night shift, and having the intention to leave nursing, reduced the general safety climate in the multiple regression analysis. The younger professionals, with less than four years in the institution, and those who worked in the night shift had a lower safety climate related to the perception of the management. On the other hand, having a work contract with a hired worker improved the general safety climate and workplace satisfaction.

Conclusion:

identifying predictors on patient safety scores is an important management tool that allows diagnosing, planning and executing activities from the domains that need to be improved.