Early Career Nurses' Experiences of Engaging in a Leadership Role in Hospital Settings

BACKGROUND

Early career nurses (ECNs) can be expected to assume shift charge nurse leadership roles quickly upon entering practice. Since the emergence of the COVID-19 pandemic, junior nurses may find their leadership capabilities tested further as the challenges of leadership are made increasingly complex in the context of an infectious disease outbreak.

PURPOSE

The purpose of this qualitative study was to explore early career registered nurses' (RNs) experiences of engaging in shift charge nurse roles in hospital settings.

METHODS

This study used an interpretive descriptive (ID) approach. Semi-structured, in-depth interviews were conducted with 14 RNs across Ontario, who had up to three years of experience and who had engaged in a shift charge nurse role in a hospital setting. Recruitment and data collection took place from January to May 2021 during the COVID-19 pandemic. Interviews were recorded, transcribed, and analyzed following the principles of content analysis.

RESULTS

Content analysis of the 14 participant interviews revealed four main themes: nominated and necessitated into leadership, diverse and demanding responsibilities, factors that help and hinder, and leadership as an impactful experience.

CONCLUSIONS

Study findings provide insights into potential strategies to support ECNs in shift charge nurse roles, during the remaining course of the COVID-19 pandemic and beyond. Greater support for nurses who engage in these roles may be achieved by promoting collaborative unit and organizational cultures, prioritizing leadership training programs, and strengthening policies to provide greater clarity regarding charge nurse role responsibilities.

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.

Leading from the bottom: The clinical leaders roles in an HIV primary care facility in Eldoret, Kenya

BACKGROUND

Clinical leaders in health systems play critical roles in making decisions that impact patient care and health system performance. Current literature has focused on the importance of clinical leaders' roles in healthcare settings and has not addressed the leadership aspect that clinical leaders engage in day-to-day decision-making in HIV facilities while providing HIV patient care. Therefore, identifying the leadership roles that wclinical leaders perform at HIV primary facilities is of critical importance.

PURPOSE

The study explored the views of healthcare providers working in AMPATH-MTRH HIV facility on what they perceived as the roles of clinical leaders at the HIV primary care facility.

METHODS

We conducted a qualitative exploratory study between December 2019 to May 2020, involving in-depth interviews with (n = 22) healthcare providers working in AMPATH-MTRH HIV facility, who were purposively and conveniently sampled to participate in in-depth interviews to explore perceptions regarding the leadership roles of clinical leaders. The collected data were analyzed thematically and Nvivo vs.12 software was used for data management.

RESULTS

The following themes were identified from the analysis regarding perceived clinical leaders' roles in an HIV primary care facility: 1) Strategic roles: providing direction and guidance, ensuring goals and objectives of the department are achieved within the set timelines, planning, and budgeting for adequate resources to support patient HIV care 2) Interconnecting health systems levels and supervisory oversight roles: a link between management, staff, and patients, solving problems, organizing and attending departmental meetings, facilitate staff training, accountable, collaborating with other departments and leaders, defines and assigns responsibilities, ensure quality patient service, coordination, and management of daily activities 3) Research roles: data collation, analysis, generation, review and reporting to the management.

CONCLUSION

Clinical leaders in the HIV care system perform leadership roles that are characterized by strategic, middle-level, supervisorial and research which reflects the model of the leadership and management style of the HIV care system. The understanding of these roles contributes valuable insights to HIV leaders and managers to recognize the important contribution of clinical leaders and consider reviewing Standard Operating Procedures to include these leadership roles and strengthen their capacity to maximize clinicians' contribution to improve HIV care and enhance responsive health systems.

Investigating the influence of selected leadership styles on patient safety and quality of care: a systematic review and meta-analysis

BACKGROUND

There is a popular belief that transformational leadership (TL) and servant leadership (SL) styles are influential in establishing a patient safety (PS) culture and improving the quality of care (QC). However, there are very few review articles investigating this phenomenon.

PURPOSE

This study performs a systematic review and meta-analysis to ascertain the influences of TL and SL on PS and QC.

METHODS

Published research work indexed in the two popular databases, that is, Scopus and PubMed, was selected based on the inclusion criteria. The systematic review was performed as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data such as country of publication, year, data type, research design, target population, sample size and conclusion were selected from the studies.

RESULTS

There are pieces of evidence suggesting a medium to strong effect of TL on PS. At the same time, the effect of TL on QC is not direct but indirect and is mediated through variables such as fostering positive organisational culture and enhancing organisational outcomes such as job satisfaction, leader effectiveness and willingness of nurses to spend some extra effort. A total of 27 studies were selected for final evaluation and 11 reported a relationship between TL and PS. The 'Fisher r-to-z transformed correlation coefficients' ranged from 0.3769 to 0.8673. Similarly, a total of four studies reported the relationship between TL and QC, 'Fisher r-to-z transformed correlation coefficients' ranged from 0.0802 to 0.5101, with most estimates being positive (80%).

CONCLUSION

TL has a strong and positive effect on PS but a positive and weak effect on the QC. There is not much evidence to establish SL's influence on PS and QC.

The Relationship between Nursing Leadership and Patient Readmission Rate: A Systematic Review

BACKGROUND

Nurse leaders play a fundamental role in improving patient quality care delivery, thus improving patient clinical outcomes.

PURPOSE

This systematic review examined the knowledge to date of nursing leadership on reducing patient readmission rates.

METHODS

A literature review was conducted using seven electronic databases: Medline Ovid, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Emerald, PsycINFO, ABI/INFORM collection, and EBSCO, with the addition of references for relevant papers reviewed.

FINDINGS

The search resulted in a total of 15 articles. Findings revealed that leadership practices of nurses have an impact on reducing patient readmission rates.

CONCLUSIONS

The results suggest a need for further rigorous studies investigating the mechanism of how nursing leadership relates to patient readmission rates and how to translate this into practice across diverse cultures.

Coping Mechanisms of Psychiatric Nurses in Child Mental Health Environments in North West Province, South Africa: A Qualitative Call for Urgency

There is currently a growing understanding of child mental health. However, with little attention and investment from decision-makers, the prevalence of child mental health challenges shows no signs of diminishing. Psychiatric nursing is a process in which the major knowledge and skills dealing with the interpersonal and intrapersonal dynamics of human beings are practised. These nurses have to cope with this demand in a scant clinical child psychiatric environment. An exploratory, descriptive, and contextual research design was used to postulate the coping mechanism of these nurses in a clinical child psychiatric environment. This study comprised psychiatric nurses, and data were collected through focused group interviews. The findings emphasised the importance of clinical support to enhance quality nursing care and adjustment related to the demands on psychiatric nurses to participate fully in the service. Conclusion: Child and mental health services ought to enable nurses to better deal with the service demands and quality of psychiatric health care. An increased understanding of child mental health challenges is needed so that nurses' roles and functions in child psychiatric practice can be defined. Effective management and support ought to enable psychiatric nurses and health care teams to make decisions that support international development targets.

Relationship between Structural Empowerment and Nurse and Patient-Reported Outcomes: The Mediating Role of Control over Nursing Practices

Practices that strengthen nurse work environments and enable them to have control over nursing practices have gained importance in recent years as they increase nurses' retention and patient care quality. This study aimed to examine the relationships between structural empowerment and nurse and patient-reported outcomes and the mediating role of control over nursing practices in these relationships. This correlational and cross-sectional study was carried out from September 2018 to May 2019 at two public hospitals in Turkey. We recruited staff nurses (n = 319) working in the inpatient units of these hospitals and their patients (n = 319). Data were collected using self-report measures from staff nurses and patients. It was determined that structural empowerment and control over nursing practices had a positive relationship with job satisfaction and nursing care quality, as well as a negative relationship with intention to turnover; however, there was no relationship with patient-reported outcomes. Control over nursing practices partially mediated the relationship between structural empowerment and outcomes of job satisfaction and nursing care quality. This study indicates that promoting the structural empowerment of nurses and ensuring that they have control over practice will increase job satisfaction and quality of care. Nurse managers can increase nurses' job satisfaction and quality of care by creating supportive work environments and ensuring they have control over nursing practices.

Safer Care for Older Persons in (residential) Environments (SCOPE): a pragmatic controlled trial of a care aide-led quality improvement intervention

BACKGROUND

The increased complexity of residents and increased needs for care in long-term care (LTC) have not been met with increased staffing. There remains a need to improve the quality of care for residents. Care aides, providers of the bulk of direct care, are well placed to contribute to quality improvement efforts but are often excluded from so doing. This study examined the effect of a facilitation intervention enabling care aides to lead quality improvement efforts and improve the use of evidence-informed best practices. The eventual goal was to improve both the quality of care for older residents in LTC homes and the engagement and empowerment of care aides in leading quality improvement efforts.

METHODS

Intervention teams participated in a year-long facilitative intervention which supported care aide-led teams to test changes in care provision to residents using a combination of networking and QI education meetings, and quality advisor and senior leader support. This was a controlled trial with random selection of intervention clinical care units matched 1:1 post hoc with control units. The primary outcome, between group change in conceptual research use (CRU), was supplemented by secondary staff- and resident-level outcome measures. A power calculation based upon pilot data effect sizes resulted in a sample size of 25 intervention sites.

RESULTS

The final sample included 32 intervention care units matched to 32 units in the control group. In an adjusted model, there was no statistically significant difference between intervention and control units for CRU or in secondary staff outcomes. Compared to baseline, resident-adjusted pain scores were statistically significantly reduced (less pain) in the intervention group (p=0.02). The level of resident dependency significantly decreased statistically for residents whose teams addressed mobility (p<0.0001) compared to baseline.

CONCLUSIONS

The Safer Care for Older Persons in (residential) Environments (SCOPE) intervention resulted in a smaller change in its primary outcome than initially expected resulting in a study underpowered to detect a difference. These findings should inform sample size calculations of future studies of this nature if using similar outcome measures. This study highlights the problem with measures drawn from current LTC databases to capture change in this population. Importantly, findings from the trial's concurrent process evaluation provide important insights into interpretation of main trial data, highlight the need for such evaluations of complex trials, and suggest the need to consider more broadly what constitutes "success" in complex interventions.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT03426072, registered August 02, 2018, first participant site April, 05, 2018.

Nurses' work engagement: The influences of ambidextrous leadership, clinical nurse leadership and workload

AIM

To test the relationships among staff nurses' work engagement, nurse managers' ambidextrous leadership and staff nurses' clinical leadership and workload.

DESIGN

A multicentre cross-sectional survey design was used.

METHODS

The study was conducted in eight medical centres from six representative provinces of China in October 2019. The participants completed electronic questionnaires that measured ambidextrous leadership, clinical nurse leadership, workload and work engagement. We used structural equation modelling to test a hypothetical model.

RESULTS

The hypothetical model had a good fit to the actual data. Ambidextrous leadership was positively associated with clinical nurse leadership and work engagement, and clinical nurse leadership had a significant positive relationship with work engagement, which partially mediated the path from ambidextrous leadership to work engagement. In addition, workload moderated the relationship between ambidextrous leadership and clinical nurse leadership.

CONCLUSION

This study makes a timely contribution to the nursing literature by demonstrating that nurse managers' ambidextrous leadership and clinical nurse leadership are important determinants of work engagement. Improving the level of ambidextrous leadership and clinical nurse leadership helps to enhance work engagement.

IMPACT

This study provides a new strategy to increase nurses' work engagement from a new perspective of nursing leadership. Enhancing nurse managers' ambidextrous leadership and clinical nurse leadership can increase work engagement. Nurse managers should value the role of ambidextrous leadership and clinical nurse leadership in promoting work engagement, especially when nurses perceive they have a low workload.

Nurse performance: A path model of clinical leadership, creative team climate and structural empowerment

AIMS AND OBJECTIVES

This study aimed to: (a) identify and examine the influence of clinical leadership, creative team climate (CTC) and structural empowerment (SE) on the nurse performance (NP) of clinical nurses in hospitals in Turkey, and (b) establish a model designed to verify the fit and effect of these factors.

BACKGROUND

Nurse performance is a significant indicator of work efficiency, patient care quality and patient safety. Existing studies explaining the mechanisms that lead to higher nurse performance have been limited.

DESIGN

This descriptive, cross-sectional study used relation prediction modelling and adhered to STROBE guidelines.

METHODS

This study used an online survey to collect data from volunteered 664 clinical nurses working in hospitals in Turkey. The data were analysed using SPSS version 26.0 and the AMOS 24.0 program. Path analysis was used to verify/test the hypothetical model, and the fit was evaluated by χ² /df, GFI, AGFI, NFI, CFI, IFI, RFI, TLI, RMR and RMSEA.

RESULTS

The fit index of the modified path model was χ² /df = 3.730, GFI = 0.904, AGFI = 0.892, NFI = 0.907, CFI = 0.923, IFI = 0.923, RFI = 0.906, TLI = 0.912, RMR = 0.078 and RMSEA = 0.064. Through creative team climate and structural empowerment, clinical leadership had the greatest standardised direct (β = .35) and indirect (β = .17) effects on clinical nurse performance, the final outcome variable. Creative team climate (β = .23) and structural empowerment (β = .19) also had a significant standardised direct effect on nurse performance. Clinical leadership, creative team climate and structural empowerment explained 39% of the total variance of nurse performance.

CONCLUSIONS

This study shows that clinical nurse performance in hospitals was significantly influenced by clinical leadership, creative team climate and structural empowerment. The results suggest that intervention programmes considering these factors could be implemented to enhance nurse performance.

RELEVANCE TO CLINICAL PRACTICE

Improved nurse performance requires strong clinical leadership, creative team climate and structural empowerment. Therefore, healthcare organisations may implement initiatives to enhance nurse performance by taking these factors into account.

Attributes, skills and actions of clinical leadership in nursing as reported by hospital nurses: a cross-sectional study

Background

Research shows a significant growth in clinical leadership from a nursing perspective; however, clinical leadership is still misunderstood in all clinical environments. Until now, clinical leaders were rarely seen in hospitals’ top management and leadership roles.

Purpose

This study surveyed the attributes and skills of clinical nursing leadership and the actions that effective clinical nursing leaders can do.

Methods

In 2020, a cross-sectional design was used in the current study using an online survey, with a non-random purposive sample of 296 registered nurses from teaching, public and private hospitals and areas of work in Jordan, yielding a 66% response rate. Data were analysed using descriptive analysis of frequency and central tendency measures, and comparisons were performed using independent t-tests.

Results

The sample consists mostly of junior nurses. The ‘most common’ attributes associated with clinical nursing leadership were effective communication, clinical competence, approachability, role model and support. The ‘least common’ attribute associated with clinical nursing leadership was ‘controlling’. The top-rated skills of clinical leaders were having a strong moral character, knowing right and wrong and acting appropriately. Leading change and service improvement were clinical leaders’ top-rated actions. An independent t-test on key variables revealed substantial differences between male and female nurses regarding the actions and skills of effective clinical nursing leadership.

Conclusions

The current study looked at clinical leadership in Jordan’s healthcare system, focusing on the role of gender in clinical nursing leadership. The findings advocate for clinical leadership by nurses as an essential element of value-based practice, and they influence innovation and change. As clinical leaders in various hospitals and healthcare settings, more empirical work is needed to build on clinical nursing in general and the attributes, skills and actions of clinical nursing leadership of nursing leaders and nurses.

Leadership Practices as Perceived by Emergency Nurses During the COVID-19 Pandemic: The Role of Structural and Psychological Empowerment

INTRODUCTION

To our knowledge, no studies have explored leadership practices in relation to structural and psychological empowerment among nurses during COVID-19. Therefore, the purpose of this study was to examine those relationships in Jordanian nurses working in emergency departments during the COVID-19 pandemic.

METHODS

A descriptive, correlational cross-sectional design was used in this study. The participants were emergency nurses working at 3 large hospitals in Jordan. The participants were surveyed via an online questionnaire between September 2021 and January 2022. A total of 3 valid scales were included in the questionnaire to assess the nurses' clinical leadership practices in relation to perceived structural and psychological empowerment.

RESULTS

A total of 193 emergency nurses were surveyed, of which 116 participants (60.1%) were male, and their average age was 29.64 (SD 4.74) years. Nurses had a moderate level of clinical leadership practices 12.50 (SD 1.65), moderate level of perceived structural empowerment 3.67 (SD 0.44), and a high-moderate level of perceived psychological empowerment 5.96 (SD 0.65). Clinical leadership practices were shown to have a significant positive relationship with structural (r = 0.65; P < .01) and psychological (r = 0.74; P < .01) empowerment. Predictors of clinical leadership practices of the Jordanian emergency nurses during COVID-19 were ranked in order of significance; structural and psychological empowerments were the highest significant predictors. However, patient to nurse ratio (>6 patients/nurse) was the lowest significant predictor.

DISCUSSION

Although structural and psychological empowerments play a pivotal role in predicting the leadership practices of the emergency nurses in Jordan, the nurses should enhance their leadership style for better management and effective communication during critical situations such as pandemics.

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

AIM

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

BACKGROUND

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR NURSING AND HEALTH POLICIES

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

Clinical leadership behaviors among critical care nurses in private and governmental hospital: A cross-sectional survey

Objectives

This study aimed to investigate clinical leadership behaviors among critical care nurses and compare the differences between nurses in private and public hospitals.

Methods

A cross-sectional survey including 365 critical care nurses with a bachelor’s degree in nursing science were recruited in two Egyptian hospitals (a government teaching hospital and one private hospital from January to March 2019. A socio-demographic characteristics form and the Clinical Leadership Behaviors Questionnaire (CLB-Q) were used to collect data. For comparison and analysis, the mean score was calculated and converted to a percentage value.

Results

Results showed that the overall mean score of nurses’ clinical leadership behaviors was 77.11 ± 11.87, the level was higher, and the highest score of the communication dimension was 91.84 ± 7.38. The mean score of nurses at a private hospital (90.48 ± 5.53) was higher than that at a government teaching hospital (68.29 ± 4.21) (P < 0.001). On nursing experience, nurses with 5–10 years had higher mean score in self-awareness, advocacy and empowerment, decision making, quality and safety, teamwork, and clinical excellence dimension of clinical leadership behavior than those who worked less than 5 years or more than 10 years (P < 0.01). Single nurses had higher mean score in advocacy and empowerment, decision making, quality and safety, and clinical excellence dimension of clinical leadership behavior than those who married (P < 0.01).

Conclusions

Nurse managers should foster clinical leadership by enabling critical care nurses to practice clinical excellence and encouraging their attendance in training programs on quality and safety. Nurses in government hospitals need improvement in clinical leadership behaviors regarding all dimensions.

Predictors of patient safety competency among emergency nurses in Iran: a cross-sectional correlational study

AIMS

This study aimed to assess predictors of patient safety competency among emergency nurses.

BACKGROUND

The role of emergency nurses is to provide high-quality health care to patients and ensure their safety. The patient safety competency includes the absence of unnecessary or potential harm when providing health care to patients. In providing health care, effective teamwork can affect patient safety and outcomes. Psychological safety is essential to effective teamwork. Psychological safety allows health care workers to accept the interpersonal risks needed to perform effective teamwork and maintain patient safety.

METHODS

This study was cross-sectional correlational research. Using convenience sampling methods, 254 emergency department nurses from five educational hospitals were enrolled in the study. Patient Safety in Nursing Education Questionnaire was used to measure the patient safety competency, the teamwork questionnaire to examine the teamwork, and Edmondson psychological safety questionnaire was used to measure psychological safety. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's r correlation coefficient, and multivariate stepwise linear regression analysis were applied using SPSS 14.0.

RESULTS

Participants' mean patient safety competency score was 2.97 (1-4). Between 18 independent variables evaluated in the multiple regression analysis, seven had a significant effect on the patient safety competency of emergency nurses (R²: 0.39, p < .001).

CONCLUSIONS

The patient safety competency of emergency department nurses was primarily related to the structure and leadership of the team and secondary to psychological safety and experience in patient safety activity. The results demonstrated that policymakers and hospital managers should improve and enhance team structure and leadership via supervision and cooperation with the nursing staff. The development of training programs in patient safety activities, improvement, and increase of psychological safety at the levels of the nursing units is essential to increase patient safety competencies in the emergency nursing program.

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.

Is leadership of nurses associated with nurse-reported quality of care? A cross-sectional survey

Background

Nurses need to exhibit stronger leadership by taking more responsibility and accountability to improve healthcare quality and patient safety.

Aims

The aim of this study was to determine the association between quality of care and leadership styles and practices, and whether the characteristics of nurses influence this interaction.

Methods

We conducted a multicentre cross-sectional survey of 655 nurses working on clinical wards in Dutch university medical centres in 2018.

Results

Transformational leadership was significantly associated with quality of care which explained 5.9% of the total variance (R²= 0.059 F = (11,643) = 3.726, p = 0.011), and the nurse characteristics gender, profession and type of practice area were significant influencing factors. Nurses rated the quality of care (mean (M) = 7.7, standard deviation (SD) = 1.3) as moderate and they showed moderate levels of transformational leadership style (M = 3.7, SD = 0.5) and transformational leadership practices (M ≥ 6.2 and ≤ 7.6).

Conclusions

When considering quality improvement on clinical wards strategic managers need to be aware of the fact that leadership is associated with quality of care and that nurse characteristics influence this association. The findings indicate a pressing need for education and training for nurses in how to develop leadership and raising the awareness among strategic managers about the importance of leadership in health care is recommended.

Impact of a patient safety leadership program on head nurses and clinical nurses: a quasi-experimental study

Objective:

to evaluate the impact of a patient safety leadership program on head nurses and clinical nurses in the same nursing unit.

Method:

a pre-post quasi-experimental study that included 60 head nurses and 240 clinical nurses was conducted. Only the head nurses received patient safety leadership program training for 12 months. Before and after the training, the General Self-Efficacy Scale was completed by the head nurses, and the General Self-Efficacy Scale, the Hospital Leadership Behavior Assessment Scale, the Safety Behavior Scale and the Maslach Burnout Inventory were completed by the clinical nurses. Descriptive and inferential analyses of the data were performed using absolute and relative frequencies, means and standard deviations, and paired t-tests to assess the effect of the training.

Results:

both the head nurses’ and the clinical nurses’ self-efficacy increased significantly (p <0.01) after the training. The leadership behavior of the head nurses and the safety behavior of the clinical nurses also improved significantly (p<0.05). We observed a statistically significant reduction in “emotional exhaustion” and an increase in “personal accomplishment” among the clinical nurses (P<0.001).

Conclusion:

the patient safety leadership program had a positive impact on the head nurses’ self-efficacy and leadership behavior and the clinical nurses’ self-efficacy, safety behavior and job burnout.

Strategies and interventions that foster clinical leadership among registered nurses: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify and describe strategies and interventions aimed at fostering registered nurses' clinical leadership in any clinical setting, identify the theories and/or frameworks that guide registered nurses' clinical leadership development, and describe the types of research conducted on this topic.

INTRODUCTION

Registered nurse clinical leaders may be defined as staff nurses in clinical settings who influence and coordinate patients, families, and health care team members for the purpose of integrating care for positive patient outcomes. They have been described as expert clinicians, effective decision-makers, and relationship-focused professionals who build trust among patients, families, and health care colleagues to ensure the best possible patient care. Clinical nursing is the cornerstone of the nursing profession. Registered nurses' clinical leadership is considered critical to the health of patients and to the advancement of nursing practice. Hence, it is important to understand strategies and interventions for fostering this leadership.

INCLUSION CRITERIA

This scoping review will include any quantitative, qualitative, or mixed methods studies that have registered nurse participants practicing in any clinical setting globally and that examined strategies and interventions to foster registered nurses' clinical leadership. Besides primary research studies, we will also include reviews.

METHODS

This scoping review will be conducted using JBI methodology. Academic databases and sources of gray literature will be searched for published and unpublished studies. Screening and full-text review of accessed records will be conducted to determine alignment with the inclusion criteria. For records that meet the inclusion criteria, data will be extracted, mapped, and presented in a table. A narrative summary will describe how the tabulated results addressed the review questions.

SCOPING REVIEW REGISTRATION

Open Science Framework Registration: https://osf.io/hjfkd.

Creating Empowering Conditions for Nurses with Workplace Autonomy and Agency: How Healthcare Leaders Could Be Guided by Strengths-Based Nursing and Healthcare Leadership (SBNH-L)

The COVID-19 pandemic had the unintended consequence of placing nurses in the spotlight because their knowledge and skills were in desperate need. While it will be years until we fully understand the impact that this pandemic has exacted on the nursing workforce, early studies have found that nurses have been traumatized by this event and many intend to leave the profession This seismic event only further exacerbated an already vulnerable and strained nursing workforce that pre-existed worldwide prior to COVID-19. The pandemic also highlighted the many challenges facing nursing leadership, in particular, how to create conditions to maintain and sustain a healthy nursing workforce. Nurses’ job satisfaction has emerged as an important predictor of whether nurses remain in an organization and stay in the profession. When examined more closely, job satisfaction has been related to nurses feeling empowered to exercise autonomy over their own practice and having agency. Autonomy and agency, in turn, are affected by their managers' leadership styles. Leaders are instrumental in setting the tone and creating the climate and culture that either values or devalues autonomy and agency. To help leaders create empowering conditions, we have developed a guide for leaders. This guide, based on the value-driven philosophy of leadership called Strengths-Based Nursing and Healthcare Leadership (SBNH-L), is founded on principles of person-centered, empowerment, relationship-focused, and innate capacities (ie, strengths) that are operationalized in eight core values. This guide can be used by leaders as their roadmap to create empowering workplace conditions that value and facilitate nurses’ autonomy and agency.

The impact of nurse leadership education on clinical practice: An integrative review

AIM

The aim of this paper is to critically evaluate the literature investigating the impact of nurse leadership education on clinical practice.

BACKGROUND

Effective leadership is vital for high-quality patient care. Leadership education is designed to support nurses to develop the appropriate skills and behaviors to become clinical leaders. However, to date, the impact of such education on subsequent clinical practice is unclear.

EVALUATION

An integrative review was conducted. Ten papers were included related to the experiences of nurses undertaking leadership education.

KEY ISSUE

Analysis of the included papers indicated that leadership education contributed to improving clinical practice in two ways. These two key themes were; impact on the individual and impact on others.

CONCLUSION

While there is a plethora of literature reviewing nurse leadership and clinical practice, there is a gap in understanding how nurse leadership education can contribute to changed practice.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can use this information to guide future leadership education programs to ensure that they promote positive work environments and high-quality care that improves clinical outcomes.

The Impact of Transformational Leadership on Physicians' Performance in China: A Cross-Level Mediation Model

Transformational leadership has been becoming increasingly vital to the provision of high-quality health care, particularly during major public health emergencies. The present study aims to investigate the impact of transformational leadership on physicians’ performance and explore the cross-level underlying mechanisms with achievement motivations and coping styles among Chinese physicians. During 2017–2019, 1,527 physicians of 101 departments were recruited from six hospitals in China with a cluster random sampling method. Participants completed several questionnaires regarding their job performance, achievement motivations, coping styles, and transformational leadership. Multilevel mediation effects were tested using cross-level path analysis. The result of this study indicated that transformational leadership was applied well in Chinese medical settings with a score of 101.56 ± 6.42. The hierarchical linear model showed that transformational leadership had a cross-level direct positive effect on physicians’ performance (β = 1.524, p < 0.05). Furthermore, results of cross-level path analyses revealed that transformational leadership contributed to physicians’ performance by sequentially influencing achievement motivations first and then coping styles. In addition, the path “transformational leadership → positive coping (PC) style → physicians’ performance” showed the strongest cross-level indirect effect. In summary, public health leaders should enhance physicians’ performance by promoting individual development, especially achievement motivation and PC style.

Leadership self-perception of clinical nurses at the bedside: A qualitative descriptive study

AIM & OBJECTIVE

Explore leadership self-perception of clinical nurses at the bedside and their perception of leadership on patient care and outcomes.

BACKGROUND

According to Institute of Medicine Future of Nursing Report, nurses are called to exhibit leadership at every level. Published research on nursing leadership is primarily focused on formal leaders. Research examining leadership at the clinical nurse level has either tested application of a particular leadership model or studied nurses who have been identified as informal clinical leaders. We took an inductive approach without any prior knowledge if participating clinical nurses viewed themselves as leaders.

DESIGN

Descriptive qualitative method was used.

METHODS

Four focus groups were conducted with a total of 20 clinical nurses from 2 hospitals within an integrated health system using a convenience sampling method until saturation was reached. The Consolidated criteria for Reporting Qualitative research (COREQ) was used to report findings.

RESULTS

All participants identified qualities they admired in leaders. Fifty percent did not initially view themselves as leaders until they realised that they often demonstrated those same leadership qualities in providing nursing care to patients and families. Participants struggled to make a connection between their leadership at the bedside and patient outcomes.

CONCLUSIONS

Clinical nurses assume a formal title is required to be a leader. Findings from this study imply that leadership attributes required at point of care are embedded in the nursing practice and look similar to servant leadership.

RELEVANCE TO CLINICAL PRACTICE

Leadership is in the nature of nursing practice, and more work is required to increase awareness that every nurse is a leader. Further efforts need to be pursued to help clinical nurses become self-aware they are leaders in order to impact patient outcomes and transform health care from bottom-up and inside-out.

Exploring mediating effects between nursing leadership and patient safety from a person-centred perspective: A literature review

AIMS

To evaluate the mechanism through which nursing leadership impacts patient safety.

BACKGROUND

Patient safety has received considerable attention among policymakers, governments and public sectors with the emphasis in health care settings on minimizing the risk to patients. Claims are made leadership plays a crucial role in patient safety. However, the incidents of adverse events are consistently high in hospitals.

EVALUATION

Published English-only research articles that examine the mechanism by which nursing leadership impacts patient safety were selected from seven electronic databases and manual searches. Data extraction, quality assessments and analysis were completed for ten research studies.

KEY ISSUES

There is evidence of significant mediating effects between nursing leadership and decreased adverse patient outcomes specifically with regard to workplace empowerment, leader-nurse relationship and the quality of the care environment.

CONCLUSION

The findings suggest that nursing leadership has a significant indirect impact on patient safety outcomes. From a person-centred perspective, the care environment requires workplace empowerment and effective relationships between leaders and nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

To improve patient safety outcomes, managers must strive to emphasize workplace empowerment, leader-nurse relationship and the quality of the care environment. Managers must consider these domains as part of an effective workplace culture.

How transformational leadership impacts innovative work behaviour among nurses

This study examines the impact transformational leadership has among nursing staff. The link between transformational leadership and innovative work behaviour and the mediating impact it has on psychological empowerment and the moderating role of attachment anxiety were also examined. Data were gathered from 367 registered nurses and 69 nurse managers based in 69 work groups from 7 hospitals. It was found that transformational leadership positively impacted innovative work behaviour among nurses, and that psychological empowerment mediated this link. Nurses' attachment anxiety positively moderated the relationship between transformational leadership and innovative work behaviour; as a result, the relationship was stronger when attachment anxiety was high rather than low. Nurses' attachment avoidance negatively moderated the relationship between transformational leadership and innovative work behaviour and consequently the relationship was weaker when attachment avoidance was high rather than low.

Emergence of informal clinical leadership as a catalyst for improving patient care quality and job satisfaction

AIMS

To analyse the critical attributes of clinical leadership and test a model linking clinical leadership behaviours of staff nurses to patient care quality and job satisfaction.

BACKGROUND

Research has historically proclaimed the beneficial effects of clinical leadership for optimizing care and improving patient outcomes. Few studies, however, have assessed the influence of clinical leadership at the staff nurse level and empirically tested the concept.

DESIGN

A predictive cross-sectional design was used in this study.

METHODS

Data were collected during January 2016 using a survey questionnaire. A random sample of Registered nurses working in direct care positions in acute care hospitals was surveyed. The hypothesized model was tested using structural equation modeling in the analysis of a moment structures software.

RESULTS

Nurses reported higher levels of clinical leadership skills in their practice. Staff nurses' use of clinical leadership behaviours directly and positively influenced the quality of care they given to patients and their satisfaction in the workplace.

CONCLUSION

The findings indicate that informal leadership at the clinical level may be an underused asset in health care and if identified and developed, staff nurse clinical leaders have potential to improve the delivery of patient care and may offer a tangible solution to the patient safety conundrum.

Exploring the impacts of personal factors on clinical leadership in a university hospital

Background

Clinical leadership is one of the important issues that should be carefully discussed with clinicians in the health sector.

Aims

The aim of this study was to investigate the clinical leadership qualities of physicians and nurses and to examine effect variables such as age, gender, marital status, total working time, educational level, profession, working unit, formal education on management, leadership and clinical leadership on the subdimensions of clinical leadership.

Methods

Participants included physicians and nurses working in a university hospital in Ankara, Turkey, and 261 participants responded to the research instrument. Data were collected from January to March 2016. Descriptive statistics, the significance test of difference between two means, and one-way analysis of variance were used in the data analysis.

Results

The findings revealed that total working time in the health sector and in the current working unit affect all subdimensions of clinical leadership (p < 0.05). Whereas the subdimension of managing services has the highest mean score, the subdimension of personal qualities has the lowest mean score in clinical leadership.

Conclusion

Clinicians must aspire to achieve professional and managerial levels, which can improve their clinical expertise and clinical leadership skills.