Nursing and values-based leadership: A literature review

How relational leadership can enhance nurses' well-being and productivity

Leadership is an essential skill in nursing and has a fundamental role in ensuring high-quality patient care and the effective functioning of healthcare systems. Effective nursing leadership is vital to support nursing teams as they negotiate the challenges confronting the profession, such as ageing populations and the increased use of healthcare technology. This article discusses various relational leadership styles that can be used to promote nurses' health and well-being and enhance productivity. The author also explores the benefits and challenges of implementing relational leadership in nursing.

Influences of communication ability, organizational intimacy, and trust among colleagues on job satisfaction of nurses in comprehensive nursing care service units

Background

Communication abilities, organizational intimacy, trust among colleagues, and job satisfaction of nurses in comprehensive nursing care service units are emphasized more than any other ward, and research on this is necessary.

Objective

The study was to examine the influences of communication ability, organizational intimacy, and trust among colleagues on the job satisfaction of nurses in the comprehensive nursing care service units.

Methods

This study used a cross-sectional descriptive design. The participants were 155 nurses caring for patients in the comprehensive nursing care service units in Seoul. Measures included the general characteristics of study participants, communication ability, organizational intimacy, trust among colleagues, and job satisfaction. The data were analyzed using the SPSS/WIN version 27.0 program. The data collection period was from August to September 2022.

Results

Factors influencing the job satisfaction of nurses at the comprehensive nursing care service units were organizational intimacy (β = 0.36), communication abilities (β = 0.26), trust among colleagues (β = 0.22), and the average number of patients assigned to a nurse (β = -0.19), which explained 67% of the variance.

Conclusions

Organizational intimacy was the greatest factor influencing the job satisfaction of nurses in the comprehensive nursing care service units. To increase the job satisfaction of ward nurses working in the comprehensive nursing care service, securing manpower is required, and it is necessary to provide effective nursing care with an average number of patients of 5 or less. In particular, a systematic job training program is needed to increase organizational intimacy among team nurses.

Development and psychometric testing of the Professional Interpersonal Competency Assessment Scale for Novice nurses (PICASN)

Background

Assessing the professional interpersonal competency of novice nurses is crucial for preventing staff turnover and promoting effective work. However, none of the instruments identified in the literature specifically target novice nurses.

Objective

This study aimed to develop and psychometrically test the perception dimension of the Professional Interpersonal Competency Assessment Scale for Novice nurses (PICASN) in Japan.

Methods

The study comprised four steps: 1) concept identification, 2) item construction, 3) validity measure, and 4) reliability measure. A cross-sectional web-based questionnaire was administered from February to April 2023 and was completed by 203 novice nurses. Data quality was assessed using mean, item response, missing values, floor and ceiling effects, internal consistency, and item-rest correlations. Content validity index (CVI) was used to determine the instrument's validity, while exploratory factor analysis (EFA) using maximum likelihood estimation with Promax rotation was employed to assess the factor structure. Cronbach's alpha was used to evaluate reliability.

Results

The 27-item PICASN demonstrated an Item-CVI of 0.94 and a Scale-CVI of 0.88. EFA revealed two factors: 1) Basic competencies as a novice nurse (15 items) and 2) Relationship building skills within the healthcare team (12 items), which explained 80% of the variance. Internal consistency reliability was excellent at 0.94 and 0.91 for the factors, and the overall scale reliability was 0.95. The item-rest (I-R) correlation values exceeding 0.6 were considered acceptable.

Conclusion

The PICASN demonstrates satisfactory psychometric properties, making it an effective tool for measuring professional interpersonal competency among novice nurses in Japan. This instrument serves to assist novice nurses by promoting self-awareness and offering targeted insights into specific areas requiring improvement. Additionally, it provides experienced nurses and nurse managers with valuable insights into team dynamics, guiding interventions for continuous quality improvement.

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.

Accomplished women leaders in informatics: insights about successful careers

We sought to learn from the experiences of women leaders in informatics by interviewing women in Informatics leadership roles. Participants reported career challenges, how they built confidence, advice to their younger selves, and suggestions for attracting and retaining additional women. Respondents were 16 women in leadership roles in academia (n = 9) and industry (n = 7). We conducted a thematic analysis revealing: (1) careers in informatics are serendipitous and nurtured by supportive communities, (2) challenges in leadership were profoundly related to gender issues, (3) "Big wins" in informatics careers were about making a difference, and (4) women leaders highlighted resilience, excellence, and personal authenticity as important for future women leaders. Sexism is undeniably present, although not all participants reported overt gender barriers. Confidence and authenticity in leadership point to the value offered by individual leaders. The next step is to continue to foster an informatics culture that encourages authenticity across the gender spectrum.

Impact of leadership on the nursing workforce during the COVID-19 pandemic

BACKGROUND

The aim was to determine how the learning about protective factors from previous pandemics was implemented and the impact of this on nurses' experience.

METHODS

Secondary data analysis of semistructured interview transcripts exploring the barriers and facilitators to changes implemented to support the surge of COVID-19 related admissions in wave 1 of the pandemic. Participants represented three-levels of leadership: whole hospital (n=17), division (n=7), ward/department-level (n=8) and individual nurses (n=16). Interviews were analysed using framework analysis.

RESULTS

Key changes that were implemented in wave 1 reported at whole hospital level included: a new acute staffing level, redeploying nurses, increasing the visibility of nursing leadership, new staff well-being initiatives, new roles created to support families and various training initiatives. Two main themes emerged from the interviews at division, ward/department and individual nurse level: impact of leadership and impact on the delivery of nursing care.

CONCLUSIONS

Leadership through a crisis is essential for the protective effect of nurses' emotional well-being. While nursing leadership was made more visible during wave 1 of the pandemic and processes were in place to increase communication, system-level challenges resulting in negative experiences existed. By identifying these challenges, it has been possible to overcome them during wave 2 by employing different leadership styles to support nurse's well-being. Challenges and distress that nurses experience when making moral decisions requires support beyond the pandemic for nurse's well-being. Learning from the pandemic about the impact of leadership in a crisis is important to facilitate recovery and lessen the impact in further outbreaks.

How Does Servant Leadership Nurture Nurses’ Job Embeddedness? Uncovering Sequential Mediation of Psychological Contract Fulfillment and Psychological Ownership

Aim. This research aimed to explore how servant leadership nurtures nurses’ job embeddedness by uncovering the sequential mediation of psychological contract fulfillment and psychological ownership. Background. The healthcare of Pakistan is undergoing an acute shortage of 1.3 million nurses. The gap is widening due to unprecedented natural uncertainties (floods, earthquakes, COVID-19, dengue, polio, and monkeypox) and the large-scale brain drain of nurses. Therefore, exploring the underlying factors that could facilitate nurses’ job embeddedness is imperative. Methods. A cross-sectional research design was employed, wherein data were gathered in three rounds, two months apart, from 587 nurses employed in public hospitals in Pakistan, and analysis was performed with Smart-PLS. Results. Servant leadership positively influences nurses’ job embeddedness and psychological contract fulfillment. Besides, psychological contract fulfillment positively affects psychological ownership, and psychological ownership enhances nurses’ job embeddedness. Finally, psychological contract fulfillment and psychological ownership sequentially mediate the relationship between servant leadership and job embeddedness. Conclusions. This research emphasized the vitality of servant leadership in nurturing nurses’ job embeddedness. Implications for Nursing Management. Healthcare authorities should keenly focus on promoting servant leadership that shapes the positive perception of nurses about their psychological contract fulfillment and psychological ownership, which are essential resources to cherish nurses’ job embeddedness.

Advanced-level paramedics' support needs for developing and utilising competence

INTRODUCTION

Paramedic competence plays a vital role in emergency medical services (EMS), as the pre-hospital setting demands a wide variety of competencies from paramedics. The aim of the study was to examinethesupportthatadvanced-level paramedics need from their supervisors to develop and utilise their competence.

METHODS

Qualitative essay material was collected from a group of experienced advanced-level paramedics (n = 41). The material was analysed with inductive content analysis.

RESULTS

Twenty-eight sub-categories emerged, forming 6 categories further leading to the grouping of two main categories: 1) the enablement of human resource (HR) management and leadership; and 2) guidelines on how to operate EMS adequately.

CONCLUSIONS

Supervisors can and should support advanced-level paramedics in their competence utilisation and development. This can be achieved by enabling professional growth by recognising competencies and generating supportive leadership in EMS. Paramedics would also benefit from clear operative guidelines. Overall, supporting paramedics' competence utilisation and development is strongly connected with leadership standards in daily practices.

Effect of motivating language on employee performance: mediating role of organisational citizenship behaviour and employee engagement in the healthcare sector

Purpose

This study aims to examine the effect of motivating language on employee performance and assesses the mediating roles of organisational citizenship behaviour and employee engagement between motivating language and employee performance in the Indian health-care sector, which is a highly demanding work environment, wherein employee burnout is high.

Design/methodology/approach

The study was in the context of COVID-19 pandemic set for health-care workers in India. To collect data and test the proposed research model, 328 questionnaires were respondent by multi-level health-care professionals from private and government hospitals in North India.

Findings

The findings suggest that leader’s motivating language is crucial for health-care leaders, inducing employee’s performance in context to patientcare, safety and satisfaction. Underpinning theory of leader member exchange substantiates that the role of leader is pivotal in daily interaction with the stakeholders. Self-determination theory of motivation is determined by psychological needs satisfaction inducing employee engagement and organisational citizenship behaviour, amplified through the leader’s motivating language, resulting into improved patientcare and patient safety. The findings state that leader’s motivating language impacts the high culture context like health-care professionals, as observed in the Indian health-care sector during COVID-19. The findings are indicative of developing non-cognitive personality traits for managerial skills.

Practical implications

The study substantiates the pivotal role of the leader’s communication with stakeholders such as patients/attendants and health-care staff. The findings, which are an indicator of patientcare, as an outcome of patient compliance, will be indicative of developing the non-cognitive skills in the personality traits of managerial skills, inducing patients’ trust in their health-care providers, using motivating language. Therefore, the health-care professionals must be trained in the application of motivating language with stakeholders, namely, patients/attendants and staff.

Originality/value

The findings state that leader’s motivating language impacts on employees of high culture context like health-care professionals, as observed in the Indian health-care sector during the recent global medical emergency of COVID-19, whereas the earlier studies posited leader’s motivating language to be effective on employees with low-cultural context. The role of leader is pivotal in daily interaction with the stakeholders, namely, patients/attendants and health-care staff.

Registered nurses' perceptions of their career - an interview study

AIM

To explore registered nurses' perceptions of their career.

BACKGROUND

Career development options have been found to increase attraction to nursing and support nurses' engagement with their organisation and profession.

METHODS

Qualitative individual interviews with 23 registered nurses; data analysed with thematic analysis and reported according to the COREQ criteria.

RESULTS

Three themes emerged: career choices, career engagement, and career development. Participants had chosen a nursing career because they perceived it as humane, people-oriented, meaningful, diverse and secure work. Participants' engagement in their career was connected to the content of the work, in which direct patient care was central. Nurses connected career development with high competency, independence, influence and meaningful working life experience. However, they perceived career development opportunities as minute within direct patient care.

CONCLUSIONS

Career development opportunities for nurses in direct patient care are needed to foster their career engagement and the attractiveness of the nursing profession. Further research is needed on the career planning and development of nurses working in patient care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers must play a central role in engaging nurses in their careers and promoting their competency and career planning and development in organizations.

Exploring the role of authentic leadership in nursing

Authentic leadership is a relatively new concept in nursing, with limited studies undertaken into its application in healthcare. Authentic leadership emphasises the importance of the leader being true to their personal core values and developing honest relationships with team members, valuing their contributions, and behaving ethically and transparently. Trust is a central tenet of authentic leadership that aims to lead to increased staff engagement, and enhanced individual and team performance. This article explores the principles, benefits and challenges of authentic leadership, as well as examining its potential role in nursing.

Using coaching and action learning to support staff leadership development

During the coronavirus disease 2019 pandemic, nurse leaders and managers have been compelled to prioritise immediate issues in their clinical areas and put aside the professional development of staff. However, leadership development for individuals and teams is essential to ensure nurses feel valued and develop the skills required for team cohesion, problem-solving, decision-making and innovation. Simple and effective approaches to staff leadership development are needed. Two such approaches are coaching and action learning. This article provides an introduction to coaching and action learning as approaches nurse leaders and managers can use to promote leadership development among individual team members and within the team. It describes how coaching and action learning work and their potential benefits and challenges. It explains how the two approaches can be used to underpin effective problem-solving and goal setting, and support nurses in their professional development, the ultimate aim being to deliver safe and effective patient care.

The context, contribution and consequences of addressing the COVID-19 pandemic: A qualitative exploration of executive nurses' perspectives

AIMS

To explore (1) the context in which nursing executives were working, (2) nursing's contribution to the healthcare response and (3) the impact from delivering healthcare in response to the pandemic.

DESIGN

Retrospective, constructivist qualitative study.

METHODS

Individual interviews using a semi-structured interview guide were conducted between 12 February and 29 March 2021. Participants were purposively sampled from the Victorian Metropolitan Executive Directors of Nursing and Midwifery Group, based in Melbourne, Victoria the epi-centre of COVID-19 in Australia during 2020. All members were invited; 14/16 executive-level nurse leaders were participated. Individual interviews were recorded with participant consent, transcribed and analysed using thematic analysis.

RESULTS

Four inter-related themes (with sub-themes) were identified: (1) rapid, relentless action required (preparation insufficient, extensive information and communication flow, expanded working relationships, constant change, organizational barriers removed); (2) multi-faceted contribution (leadership activities, flexible work approach, knowledge development and dissemination, new models of care, workforce numbers); (3) unintended consequences (negative experiences, mix of emotions, difficult conditions, negative outcomes for executives and workforce) and (4) silver linings (expanded ways of working, new opportunities, strengthened clinical practice, deepened working relationships).

CONCLUSION

Responding to the COIVD-19 health crisis required substantial effort, but historical and industrial limits on nursing practice were removed. With minimal information and constantly changing circumstances, nursing executives spearheaded change with leadership skills including a flexible approach, courageous decision-making and taking calculated risks. Opportunities for innovative work practices were taken, with nursing leading policy development and delivery of care models in new and established healthcare settings, supporting patient and staff safety.

IMPACT

Nursing comprises the majority of the healthcare workforce, placing executive nurse leaders in a key role for healthcare responses to the COVID-19 pandemic. Nursing's contribution was multi-faceted, and advantages gained for nursing practice must be maintained and leveraged. Recommendations for how nursing can contribute to current and future widespread health emergencies are provided.