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

Organizational characteristics of nursing practice environments related to registered nurses' professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: structural equation modeling study

BACKGROUND

Nurses are leaving their profession because of poor personal job satisfaction, heavy workload, and unfavorable work environments with low professional autonomy. Professional autonomy involves the possibility to influence one's work and have a sense of control - the ability to contribute to a workplace culture and influence how decisions are made. This study explores registered nurses' perceptions of the nursing practice environment, using the Nursing Work Index-Revised (NWI-R), and its relationships with professional autonomy and job satisfaction.

METHODS

A cross-sectional study along with instrument re-validation was conducted using a web-based survey for nurses in two Magnet-aspiring hospitals in Finland in September 2021 (n = 586). Structural equation modeling was used to find out the relationships of the NWI-R components with professional autonomy and job satisfaction.

RESULTS

Principal component analysis and confirmatory factor analysis supported seven components with 34 items. Collegial nurse-doctor relationships, organization's quality standards, and nursing involvement and expertise sharing (means of 3.23, 2.96, and 2.66, respectively) demonstrated a favorable nursing practice environment; professional nursing standards, nurse management and leadership, staffing and resource adequacy, and professional advancement (means of 2.38, 2.18, 2.15, and 2.13, respectively) demonstrated an unfavorable nursing practice environment. The presented model (RMSEA 0.068, CFI 0.987, TLI 0.946) indicated that nursing involvement and expertise sharing, organization's quality standards, nurse management and leadership, and collegial nurse-doctor relationships were related to professional autonomy. Nurse management and leadership, staffing and resource adequacy, and organization's quality standards were related to job satisfaction. Moreover, professional autonomy was related to job satisfaction.

CONCLUSION

Nurses' professional autonomy is important due to its relationship with job satisfaction. When factors that increase professional autonomy are taken into account and attention is paid to the promotion of autonomy, it is possible to improve nurses' job satisfaction. These issues cannot be solved at the unit level; investment is needed at the organizational and political levels. The results introduce nurses, managers, researchers, and stakeholders to improvements in the nursing practice environment toward an organizational culture where nurses may utilize their professional autonomy to its full potential.

Nurse managers' perceptions of nurses' professional autonomy-A qualitative interview study

AIMS

To describe nurse managers' perceptions of nurses' professional autonomy in hospitals and their role in promoting it.

DESIGN

A qualitative descriptive approach.

METHODS

Fifteen nurse managers participated in semi-structured focus group interviews in two university hospitals in Finland between May and June 2022. The data were analysed using inductive content analysis.

RESULTS

Nurses' professional autonomy in hospitals is perceived according to three themes: individual qualities behind independent actions, limited influencing opportunities in the organization and physicians' central effect. The nurse managers perceive that they enhance nurses' professional autonomy by promoting the nurses' independence at work, their sufficient and up-to-date competence, their expert role in multi-professional cooperation and joint decision-making and an open and appreciative work community.

CONCLUSIONS

Nurse managers can enhance nurses' professional autonomy with shared leadership. However, there are still gaps in nurses' equal possibilities to influence multi-professional work, especially outside of patient care. Promoting their autonomy requires commitment and support from leadership at all levels of the organization. The results advise nurse managers and the administration of the organization to maximize the potential of nurses' expertise, along with encouraging nurses towards self-leadership.

IMPACT

This study provides an innovative approach to nurses' roles through their professional autonomy from the perspective of nurse managers. These managers have an important role in enhancing nurses' professional autonomy, empowering and supporting them in their expertise, enabling necessary advanced training, and maintaining an appreciative work community where all have equal participation opportunities. Thus, nurse managers have the opportunity to strengthen high-quality multi-professional teams' ability to jointly develop the patient's care for better outcomes through their leadership.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Nurse leaders' experiences of how culturally and linguistically diverse registered nurses integrate into healthcare settings: An interview study

AIM

To describe nurse leaders' experiences of how culturally and linguistically diverse registered nurses integrate into healthcare settings.

DESIGN

A qualitative descriptive study design.

PARTICIPANTS

A total of 13 nurse leaders were recruited from four primary and specialized healthcare organizations in Finland.

METHODS

Data were collected through individual semi-structured interviews and analyzed using inductive content analysis.

RESULTS

Nurse leaders' experiences were categorized into seven main categories as follows: leadership, which concerns a leader's roles, style, and experience; organizational strategy and culture, which includes structure, policies, and intra-organizational culture; support strategies, including workplace and outside-of-work integration strategies; relationships and interactions, which considers interpersonal relationships and interactions; nurse competence requirements and development, which concerns both organizational and ward level competence demands, and support for competence development; language competence, which concerns challenges relating to language proficiency and development of language competence; and cultural diversity, which considers the importance of competence development brought about through experiences of being in a multicultural workplace.

CONCLUSIONS

Culturally and linguistically diverse nurses are important within healthcare systems. These nurses constitute additional human resources, bring diverse experiences and expertise, and add to organizational cultural capital. Nurse leaders require competencies that are suitable for leading a diverse workforce, utilizing its competencies, establishing staff members' needs, and ensuring their continuous development. Resourcing, planning, and structuring the integration process affects nurses' experiences of the organizational socialization process.

IMPACT

The findings of our study can offer guidance to healthcare organizations with regard to structural integration strategies at an institutional level. Leadership and management educators can benefit from the findings towards developing a curriculum that supports leaders' diversity, equity and inclusion, knowledge management and formal leadership competencies. Finally, nurse leaders may benefit from this study through being more aware towards supporting a multicultural, cohesive, and competent workforce through strong social capital.

Nurse leaders' perceptions of future leadership in hospital settings in the post-pandemic era: a qualitative descriptive study

PURPOSE

Coronavirus disease (COVID-19) has challenged leadership in hospitals worldwide. The experiences of leadership during the pandemic changed leadership significantly. This study aims to describe nurse leaders' perceptions of what future leadership in hospital settings in the post-pandemic era needs to be like.

DESIGN/METHODOLOGY/APPROACH

A qualitative descriptive study was used. A total of 20 nurse leaders from the Finnish central hospital were interviewed from June to October 2021. The data were analysed using inductive content analysis.

FINDINGS

The analysis revealed five main categories describing nurse leaders' perceptions of future leadership in hospital settings in the post-pandemic era: digitalisation and hybrid working culture, development of sustainable working conditions, moving smoothly to the post-pandemic era, dissolution of traditional regimes of organisation and flexibility in leadership.

PRACTICAL IMPLICATIONS

In the post-pandemic era, the constantly changing demands and challenges currently facing healthcare systems have significantly increased the complexity of hospital organisations. This requires critical evaluation and change to traditional leadership. Enhancing flexibility and authenticity in leadership, strengthening competencies, implementing a wide range of digital resources and increasing the appeal of the nursing profession to build the next generation of nurses - all of these are needed to provide sustainability in future healthcare.

ORIGINALITY/VALUE

The results identify the critical points of leadership that need to be developed for future challenges and for maintaining a sufficient supply of qualified professionals. Acting on this information will enhance flexibility in organisations and lead to acceleration of changes and the development of new kinds of leadership in the future.

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.

Why Shared Decision Making Matters

Shared decision making is a hallmark of Magnet® organizations. Although the terminology can vary, the essence is the same: nurses at all levels, and in all settings, need to be a part of the decision making structure and process. Their voices, along with those of their interprofessional colleagues, ensure a culture of accountability. During times of financial challenges, trimming shared decision making councils may seem an easy place to save money. However, eliminating the councils may lead to increased unintentional costs. This month's Magnet Perspectives takes a closer look at the benefits of shared decision making and its enduring value.

The Impact of Leadership in the Autonomy and Engagement of Nurses: A Cross-sectional Multicenter Study Among Nurses Outside the United States

OBJECTIVE

To add to the body of evidence regarding nurse engagement and related factors from a non-US sample of nurses.

BACKGROUND

Leadership has a positive impact on nurses' autonomy and engagement experiences. It is necessary to explore the factors that explain the relationships between leadership, autonomy, and engagement level.

METHODS

Nurses (n = 4393) from 9 hospitals participated in a survey in March 2020. Multivariable logistic regression analysis was performed to identify engagement and autonomy predictors.

RESULTS

Of the respondents, 9% were engaged, 28% content, 29% ambivalent, and 34% disengaged. Respondents' separate background variables were not significant predictors in multivariate models, whereas the leadership- and autonomy-related variables were.

CONCLUSIONS

A manager's responsiveness, an organization's readiness to follow nurse suggestions for performance improvement, and receiving recognition and regular feedback promote engagement. Furthermore, engagement is enhanced when nurses have an active role in decision-making and their contributions are respected. Visible nurse managers and leaders who are effective advocates for nurses strengthen nurses' autonomy.