Factors that act as facilitators and barriers to nurse leaders' participation in health policy development

Pathways to leadership: what accounts for women's (in)equitable career paths in the health sectors in India and Kenya? A scoping review

OBJECTIVES

We aimed to capture evidence on enablers and barriers to improving equal opportunity and effective organisational interventions that can advance women's leadership in India and Kenya's health sectors.

METHODS

We systematically searched JSTOR, PubMed, SCOPUS and Web of Science databases, reference lists of selected articles and Google Scholar using string searches. We included studies that were published in English from 2000 to 2022 in peer-reviewed journals or grey literature, focused on paid, formal health professionals in India or Kenya, described factors relating to women's representation/leadership.

RESULTS

We identified 26 studies, 15 from India and 11 from Kenya. From each country, seven studies focused on nursing. Participants included women and men health sector workers. Seven studies used mixed methods, 11 were qualitative, 5 were quantitative and 3 were commentaries. Factors influencing women's career progression at individual/interpersonal levels included family support, personal attributes (knowledge/skills) and material resources. Factors at the organisational level included capacity strengthening, networking, organisational policies, gender quotas, work culture and relationships, flexibility, and work burden. Nursing studies identified verbal/sexual harassment and professional hierarchies as barriers to career progression. Structural barriers included a lack of infrastructure (training institutes and acceptable working environments). Normative themes included occupational segregation by gender (particularly in nursing), unpaid care work burden for women and gender norms. Studies of interventions to improve women's career progression and sex-disaggregated workforce data in India or Kenya were limited, especially on leadership within career pathways. The evidence focuses on enablers and barriers at work, rather than on organisations/systems to support women's leadership or address gender norms.

CONCLUSIONS

Women in India and Kenya's health sectors face multiple impediments in their careers, which impact their advancement to leadership. This calls for gender-transformative interventions to tackle discrimination/harassment, provide targeted training/mentorship, better parental leave/benefits, flexible/remote working, family/coworker support and equal-opportunity policies/legislation.

Barriers to advancing women nurses in healthcare leadership: a systematic review and meta-synthesis

Background

Women comprise the majority of the nursing profession, yet nurses are underrepresented in healthcare leadership. We aimed to explore barriers for women nurses to advance in healthcare leadership to inform organisational interventions for career advancement.

Methods

In this systematic review and meta-synthesis, studies examining advancing women nurses and midwives in leadership within healthcare and academia in the international literature were included. Six databases (MEDLINE, EMCARE, EMBASE, PsycINFO, PubMed, and CINAHL PLUS) were searched for studies published in English between January 1 2000 and October 17 2023. The Grading of Recommendations Assessment, Development, and Evaluation tools (GRADE) was followed to assess confidence in the findings. Retrieved full texts were assessed for methodological rigour using the Critical Appraisal Skill Programme Qualitative Studies checklist and the Joanna Briggs Institute Cross-sectional and Prevalence Studies checklists. Reported barriers for women nurses' leadership attainment were identified and generated themes were mapped to the Abilities, Motivation, and Opportunities (AMO) framework.

Findings

There were 32 eligible studies; 18 qualitative, 11 quantitative, and 3 mixed-methods. Studies included high-income countries (n = 20), middle-income countries (n = 7) and across countries (n = 3) with two unspecified. Samples included registered nurses, nurse academics, executives, and leaders. The key barriers highlighted were related to: role modelling and leadership development (ability); multiple complex and interacting factors, including gender stereotyping, perception of professionalism, human relations policies, and gender bias (motivation); and systemic issues, such as organisational setting, structure, and support (opportunity).

Interpretation

The prevailing belief in the literature is that caregiving is a feminine occupation and along with societal expectations of women's subordinate position, these present substantial obstacles that limit women nurses from advancing into healthcare leadership. Ultimately, these factors restrict women nurses in career advancement and need to be addressed at a systems and organisational level.

Funding

The National Health and Medical Research Council (NHMRC), Australia.

First-year nursing students' perceptions of health activism and social responsibility - A cross sectional study

BACKGROUND

Social responsibility and health activism both represent key concepts and professional values in nursing practice. Nevertheless, definitions in the nursing literature remain inconsistent, and little is known regarding nursing students' perceptions of these concepts or about the associations between these perceptions.

OBJECTIVES

This research explores: a) the associations between nursing students' perceptions of social responsibility and health activism; and b) the differences in nursing students' perceptions of social responsibility and health activism according to their personal characteristics.

DESIGN AND METHODS

Across-sectional survey design was conducted with a sample of 173 Israeli first-year undergraduate nursing students. Questions were uploaded in the format provided by a commercial Internet survey provider (Qualtrics.com) and distributed through social media groups.

RESULTS

Positive correlations were found between health activism and social responsibility and between health activism and philanthropic and environmental responsibility. Significant differences were found in the research variables according to the students' cultural group and voluntary service. Cultural group and social responsibility explained 25 % of students' variance in health activism.

CONCLUSIONS

Faculty and nurse educators should promote and develop nursing students' knowledge acquisition in health activism and social responsibility throughout all their years of study. It is recommended that nursing students be given meaningful opportunities to discuss, integrate, and apply health activism, guided by role models in clinical practice. Academic settings should also promote the value of social responsibility and support nursing students in taking active roles in social organizations in order to further develop and integrate the social component of their professional role.

Factors associated with the extent of nurses' involvement in promotion of the nursing profession: a cross-sectional study among nurses working in diverse healthcare settings

AIMS AND OBJECTIVES

To examine factors associated with promotion of the nursing profession, to the nursing community, other healthcare professionals and the general public, by nurses employed in diverse healthcare settings.

BACKGROUND

Little is known about the factors that contribute to nurses' involvement in the promotion of the nursing profession.

METHODS

This cross-sectional study comprises a convenience sample of registered nurses (n = 526) with ≥ 3 months' experience in nursing, who are employed in internal and surgical units, pediatric wards, psychiatric wards or in the community across Israel. Participants completed a self-administered questionnaire addressing socio-demographic, occupational and organizational factors relating to the nursing work environment and to the extent of nurses' involvement in promotion of the nursing profession. Descriptive statistics, one-way analysis of variance, Pearson's correlation analysis, and multivariate linear regression were performed.

RESULTS

Nurses in all the surveyed healthcare settings reported relatively low levels of involvement in promotion of the profession, either to the nursing community or to other healthcare professionals and the public. Being a female-nurse was significantly negatively associated with nurses' involvement in promotion of the nursing profession. In contrast, holding a master's degree in nursing, having a managerial role, and working in a supportive organizational nursing work environment were the principal factors associated with positive promotion of the nursing profession.

CONCLUSION

The extent of nurses' involvement in promotion of the nursing profession mainly depends on occupational factors and a supportive organizational nursing work environment.

CLINICAL RELEVANCE

Healthcare managers may advance nurses' involvement in promotion of the profession by modifying the organizational nursing work environment. Specifically, we recommend nurse leaders to dedicate efforts to make professional promotion an integral part of a nurse's role.

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.

Perceived Utilization of Leadership Styles Among Nurses

Background

Nurses´ perceptions of leaders´ leadership styles has a significant impact on their well-being. Effective leadership in health care is crucial for improving and enhancing the effectiveness of health care systems. This study aimed to assess the perceived utilization of leadership styles among nurses at Jimma town public health facilities, Ethiopia.

Methods

This facility-based cross-sectional study was conducted with 403 nurses. Data were collected through a self-administered structured questionnaire. Data were entered into Epi-Data version 4.6 and then exported to SPSS version 25. The strength of association was described using unstandardized adjusted β with a 95% confidence interval (CI) and p-value <0.05.

Results

Of the 422 participants, 403 completed and returned the questionnaire correctly, thus achieving a response rate of 95.5%. Staff nurses perceived that their head nurses fairly often or commonly used transformational leadership styles, with a mean of 2.77±0.60. The multivariable linear regression analysis model indicated that there was a positive relationship between perceived leadership style and gender, overall organizational commitment, overall job-related stress, overall innovative work behavior, and overall leadership practice. However, there was a negative relationship between perceived leadership style and nurses who had not received previous training on leadership.

Conclusion

This study highlights that transformational leadership is a commonly utilized leadership style by leader nurses. Effective and balanced use of various leadership styles requires knowledge (training), organizational commitment, and innovative work behavior from both leaders and staff nurses. Therefore, a transformational leadership style is key to achieving organizational goals and increasing staff nurses' productivity.

The future of cancer nursing in Europe: Addressing professional issues in education, research, policy and practice

Cancer nursing has evolved to meet the demands of rising cancer incidence, newer and more complex treatment options, and the emergence of specialist roles supporting patients from pre-diagnosis, through treatment, survivorship and end of life care. Nurses are involved in direct and in-direct care of people at risk of, and living with and after cancer in diverse contexts. As a result, nurses are positioned to have a significant influence on the processes and outcomes of cancer care, through education, research, policy, practice and leadership. However, nursing and cancer care face challenges, arising from workforce shortages, under-investment in services and under-representation in decision-making. This paper discusses the evolution of cancer nursing across education, policy, research, profession and practice, and sets an agenda for innovation and disruption across these domains to ensure sustainability of cancer care services and care for people living with and after cancer. We argue for the continued advancement of cancer nursing with critical focus on identifying and addressing inequities in role recognition and access to specialist cancer nursing education throughout Europe. Partnership, exchange of learning, and co-design will be central to progressing education, evidence and policy to support future growth in the cancer nursing workforce and embed cancer nurses in research and policy setting at local, national and international levels.

Perceptions of public health nursing Team Leaders (TLs) and Team Supervisors (TSs) on nurse's development in Fiji

BACKGROUND

Nurse team leaders are responsible for contributing to managing the quality of service delivery and facility output of their nurses to ensure there is a high quality of care delivered by the health system. This study aimed to explore the perceptions of public health nursing Team Leaders (TLs) and public health nursing Team Supervisors (TSs) on nurses' development in Fiji.

METHODS

A qualitative study was used to gather information using in-depth phone interviews among TLs and TSs comprising Chief Midwifery Nursing Officer (CMNO), Director of Nursing (DON), Sub-divisional Nursing Managers (SDNMs), acting SDNMs and Nursing Manager (NM) at Central health division in Fiji. The data was collected through semi-structured open-ended questionnaires and were audio recorded. The data was analyzed using manual thematic analysis process.

RESULTS

The study comprised of 26 participants, which included 10 TSs and 16 TLs. Four themes were identified for the results amongst TSs and TLs: ethical development; professional development; psychological development; and recommendations. However, nine sub- themes were identified for TSs and eight sub-themes were identified for the result amongst TLs.

CONCLUSION

This study highlighted that TLs and TSs elaborated on the need for the ethical, professional, psychological development, nursing development and also on the importance of policies and guidelines. Professional ethics should be integrated into the Continuous Profession Development (CPD) points that are used to renew yearly nursing licenses as well as exposing the need for having competencies on professional ethics in nurses' logbooks. Further research is needed to determine the in-depth barriers.

Developing a framework for the participation of nursing managers in the health policy-making process in Iran: A Delphi study

AIMS

The aim of this study was to develop a framework for nursing managers to participate in the health policy-making process.

BACKGROUND

Nursing managers must be involved in the health policy process to provide appropriate health services, focus on nursing professional excellence, and improve the performance of the health system.

METHODS

This multimethod research was based on the Delphi study and experts' panel. Faculty members of the nursing, health policy, health services management, and nursing managers working at hospitals were selected via purposive sampling. The data collection tool was a demographic form and an open-ended questionnaire in the first round and a structured questionnaire in the next round. In the two rounds of Delphi, experts discussed and rated items of nursing managers' participation framework in the health policy-making process. At the expert panel session, the framework was finalized with a 12-part checklist. The data were analysed quantitatively using SPSS software version 22.

RESULTS

A total of 28 items were entered into the Delphi study. Experts who met the inclusion criteria responded to rounds 1 (n = 20) and 2 (n = 16). Following the two rounds of the Delphi study, 27 items were selected and discussed by experts using a 12-part checklist related to the framework. The final participation framework was divided into five sections: Barriers, facilitators, advantages, disadvantages, and factors affecting the participation of nursing managers in the health policy-making process.

CONCLUSION

In our findings, the relationship between the components of the framework and policy cycle was shown, which should be considered to lay the groundwork for participation. This can lead to health promotion, accountability, and financial participation in the health system, which can improve the proactive involvement of nursing managers in the health policy-making process.

IMPLICATIONS FOR NURSING MANAGEMENT

The proposed framework can be utilized across the spectrum of nursing, including practice, leadership, and education to enhance the participation of nursing managers in health policy activity.

"We are nurses - what can we say?": power asymmetries and Auxiliary Nurse Midwives in an Indian state

In India, nurses and midwives are key to the provision of public sexual and reproductive health services. Research on impediments to their performance has primarily focused on their individual capability and systemic resource constraints. Despite emerging evidence on gender-based discrimination and low professional acceptance faced by these cadres, little has been done to link these constraints to power asymmetries within the health system. We analysed data from an ethnography conducted in two primary healthcare facilities in an eastern state in India, using Veneklasen and Miller's expressions of power framework, to explore how power and gender asymmetries constrain performance and quality of care provided by Auxiliary Nurse Midwives (ANMs). We find that ANMs' low position within the official hierarchy allows managers and doctors to exercise "power over" them, severely curtailing their expression of all other forms of power. Disempowerment of ANMs occurs at multiple levels in interlinked and interdependent ways. Our findings contribute to the empirical evidence, advancing the understanding of gender as a structurally embedded dimension of power. We illustrate how the weak positioning of ANMs reflects their lack of representation in policymaking positions, a virtual absence of gender-sensitive policies, and ultimately organisational power structures embedded in patriarchy. By deepening the understanding of empowerment, the paper suggests implementable pathways to empower ANMs for improved performance. This requires addressing entrenched gender inequities through structural and organisational changes that realign power relations, facilitate more collaborative ways of exercising power, and create the antecedents to individual empowerment.

Insecure Employment Contracts during the COVID-19 Pandemic and the Need for Participation in Policy Making

Job security influences the ability of nurses to provide high-quality nursing care. The Iranian health system has always faced nursing shortages, and the COVID-19 pandemic has worsened this situation. Although nurses have been labelled 'heroes' across the globe, many of them have been hired using insecure employment contracts. This commentary aims to describe issues surrounding job contracts for Iranian nurses during the COVID-19 pandemic and discusses how the current situation can be improved. Iranian nurses are at the frontline of the fight against COVID-19 and need to receive better support in terms of job security and dignity. They should participate more in policymaking activities to improve their job condition and prevent the development and implementation of the short-term and insecure job contracts that lead to job insecurity.

Nurses' and teachers' perceived barriers and facilitators to the uptake of the Human Papilloma Virus (HPV) vaccination program in Iquitos, Peru: A qualitative study

Globally, over 300,000 women die of cervical cancer annually. Given that human papillomavirus vaccines are highly effective in the primary prevention of cervical cancer, it is important to explore the barriers and facilitators to vaccination uptake in areas where the burden of disease remains high. This study, informed by the socio-ecological model, aimed to qualitatively explore vaccination uptake via in-depth interviews with eleven nurses and ten teachers involved in vaccine delivery in Iquitos, Peru. The results highlighted that vaccine uptake was influenced by multiple factors including individuals' knowledge and attitudes, community beliefs, geography, and policy level variables. Findings suggested that professionals were informed and supportive of the HPV vaccination program but perceived that parents were uninformed about the vaccine. There is a need for community education programs, for a revision of the process of obtaining parental consent, for improved communication between professionals and for involvement of grassroots staff in policy making.

Factors influencing nurses participation in the health policy-making process: a systematic review

Background

Nurses as the majority of the health care workforce help in the health systems strengthening. Nurses’ involvement in health policy making is clear; however, still few are involved in policy-making processes, even in the clinical context. The aim of the present systematic review was to identify factors influencing nurses participation in the health policy-making process.

Methods

The present systematic review was designed on studies conducted between 2000 and 2019. Four online databases including PubMed, EMBASE, SCOPUS and Science Direct were searched using comprehensive terms. Study selection, quality assessment, data extraction, and data analysis were independently done by two reviewers. Inclusion criteria included published studies in English language and between 2000 to 2019, participants such as nurses and the healthcare managers, mentioned influential factors, types of participants were included nurses and the healthcare managers, study designs and methods clearly defined. The methodological quality of included article was appraised using the checklists of CASP and MMAT. Finally the data were analyzed using content analysis.

Results

After quality assessment, 11 studies, according to inclusion criteria, were retrieved. Nine studies had a good, 2 a medium, and non-articles was poor methodological quality. Three main themes include nursing-related factors (4 sub- themes), management and organizational factors (8 sub-themes) and creating a positive work environment (3 sub-themes) identified as affecting factors on nurses participation in health policy.

Conclusion

Nurses can utilize this finding to develop empowering programs to play efficient roles and increase their participation in health policy making. Also, the extracted factors in this review can place nurses in suitable position and make them potential agents in changing the ways of policy-making. Further studies are required to survey the relation between these factors and nursing participation in health policy making.

Involvement of Jordanian Head Nurses' in Health Policy Development: A Cross-Sectional Study

BACKGROUND

Despite the importance of involving nurses in health policy, nurse's involvement faces many challenges. Literature showed that there is a low level of nurses' and nurse leaders' involvement in health policy development.

AIM

The aims of this study were to examine (a) the level of Jordanian head nurses' involvement in health policy development and their perceived benefits and barriers; (b) the relationships between level of knowledge, competence, and interest in health policy and the level of involvement in health policy development; and (c) the relationship between the level of self-efficacy (efficacy expectation and outcome expectation) and the level of involvement in health policy development.

METHODS

A cross-sectional descriptive correlational study design was adopted in this study. A convenience sampling of 250 participants from hospitals affiliated to three health sectors in Jordan (private, governmental, and university) were recruited to complete a self-administered questionnaire. Descriptive statistics and Pearson correlation coefficient were used to answer the study questions.

RESULTS

The results revealed a moderate level of involvement of head nurses in the policy development. The most frequent cited political activity was "providing written reports, consultations, research." "Lack of time" was the most perceived barrier, while "improving the health of the public" was the most perceived benefit. Workshops or sessions at conferences is the most indicated source of knowledge. Participants had an excellent level of skills with positive relationships between the competence and both of the levels of professional and personal involvement in health policy. Participants reported a low level of confidence in performing political activities as well as the impact of such activities on health outcomes. Positive relationship was indicated between self-efficacy and the levels of professional and personal involvement in political activities.Implications: Health policies affect nurses and their practice. Overcoming the barriers and enhancing the levels of head nurses' knowledge and competence regarding health policies can help activating their roles in health policy development process. This will help in activating nurses' role in health policy development, which in turn will have a positive impact on health outcomes.

Views of Bedouin physicians and nurses on nursing as a profession in Israel: There is more to strive for

Bedouin society poses challenges to attempts at modernization. Great efforts are being made to expand the number of nurses coming from the Bedouin population. This cross-sectional study among 201 Bedouin nurses and physicians from southern Israel examined differences in their views on nursing as a profession and its relationship to the working environment, using a self-administered questionnaire. Bedouin physicians demonstrated less positive attitudes towards the nursing profession than did nurses, but perceived the nursing work environment more positively. Compared to nurses, physicians ranked both nurses' involvement in policy practice and their clinical contribution to quality care lower, but scored nurses' dependence on physicians' orders higher. They also ranked teamwork and professional nursing development higher, and the autonomy of nurses lower. In conclusion, the perception of nursing as a profession in Bedouin society is linked to cultural fundamentals, gender, and the social status of women. Managers of multicultural teams, especially those including Bedouin-origin healthcare workers, should be aware of the effect of cultural background and should take care to address social disparities and eliminate differences in perspectives.

Nurses' and midwives' perspectives on participation in national policy development, review and reforms in Ghana: a qualitative study

Background

The World Health Organization has admonished member countries to strive towards achieving universal health coverage (UHC) through actionable health policies and strategies. Nurses and midwives have instrumental roles in achieving UHC via health policy development and implementation. However, there is a paucity of empirical data on nurses and midwives’ participation in policy development in Ghana. The current study explored nurses and midwives’ participation in policy development, reviews and reforms in Ghana.

Methods

A qualitative descriptive exploratory design was adopted for this study. One-on-one individual interviews were conducted after 30 participants were purposefully selected. Data was audiotaped with permission, transcribed and analyzed inductively using the content analysis procedures.

Results

Two main themes emerged from the data: participation in policy development and perspectives on policy reviews and reforms. The findings showed that during health policy development and reviews, nurses in Ghana were overlooked and unacknowledged. Policy reforms regarding bridging the pre-service preparation gap, staff development and motivation mechanisms and influence on admission into nursing schools were raised.

Conclusion

The authors concluded that nurses and midwives are crucial members of the healthcare systems and their inputs in policy development and reviews would improve health delivery in Ghana.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00545-y.

Self-reported competences of public health nurses for developing needs-oriented local healthcare plans: A nationwide cross-sectional survey

AIM

To identify self-reported competencies of public health nurses for reflecting community healthcare needs in local healthcare plans.

DESIGN

We conducted a nationwide cross-sectional survey in Japan from October 7-November 30, 2019.

METHODS

We sent 2,185 self-reported questionnaires to public health nurses in Japan who had developed a local healthcare plan since 2013. Self-reported questionnaires included questions regarding demographic data and the reflection of community healthcare needs in local healthcare plans, and the involvement in local healthcare planning.

RESULTS

We analysed 1,042 questionnaires: 651 (62.5%) were from public health nurses who reported that they elicited and shared community views to be reflected for purposes of local healthcare planning (the reflecting group), and 391 (37.5%) of the remaining public health nurses who reported that they did not do so (the non-reflecting group). The logistic regression analysis revealed that public health nurses in the reflecting group were more likely to be in a managerial position, have colleagues who played an active role in healthcare planning, conduct a questionnaire survey, engage in group work, participate in a municipal healthcare planning committee with community-dwelling people, and identify the opinions of the professional organizations.

CONCLUSIONS

Identifying community healthcare needs through collaboration with community-dwelling people and professional organizations should be essential competencies for public health nurses (the reflecting group) in developing needs-oriented local healthcare plans.

IMPACT

Identification of their related competencies for developing a needs-oriented local healthcare plan as an upstream strategy to mitigate the prevalence of health inequities in each community.

Predictors of nursing leadership in Uganda: a cross-sectional study

Evidence regarding the role of nurses-in-leadership and how to engage nurses in policy decisions is minimal in sub-Saharan Africa. The purpose of this study was: (1) to assess the leadership practices of nurses-in-leadership in Uganda (by self-report) and from the perspective of 'followers' (direct-report, peers, co-workers, other); and (2) to determine factors (positively) associated with leadership practices. We surveyed 480 nurses, 120 in leadership roles (Response Rate 57%) and 360 'followers' (Response Rate 60%), who were recruited from five hospitals in Kampala, Uganda. We used the Leadership Practice Inventory (Self and Observer), a project-specific demographic questionnaire and Denison's Organizational Culture Survey (DOCS). Sixty-three per cent of the respondents held a registered nursing certificate; 79% had received formal leadership training; 47% were based in private for-profit (PFP) hospitals, 28% in private not-for-profit (PNFP) and 25% in public hospitals. Among the five leadership practices, nurses-in-leadership used the practice of Model the Way (M = 8.27, SD = 1.30), Challenge the Process (M = 8.12, SD = 1.30) and Encourage the Heart (M = 8.04, SD = 1.51) more frequently (on a 10-point Likert Scale). Inspire a Shared Vision (M = 7.82, SD = 1.57) and Enable Others to Act (M = 7.62, SD = 1.66) practices were used less frequently. The same rank order was true for leadership scores from the perception of followers. However, leadership scores by followers were significantly lower (P < 0.01) than the nurse leader self-reported scores across all sub-scales. Leadership practice scores were higher in public than private hospitals (P < 0.0001). Organizational culture (OC) was associated (P < 0.001) with leadership practices. Although overall leadership practice scores were generally high, the less frequent use of Inspire and Enable practices suggests opportunities for targeted improvement. Moreover, differences between self-reported and leadership scores by followers suggest perception gaps between leaders and their followers. The positive relationship between public hospital settings and self-reported leadership practices among nurses-in-leadership suggests that important nursing leadership practices are possible even in a low-resource clinical setting.

Emerging roles for research intensive PhD prepared nurses: Beyond faculty positions

Research-intensive PhD programs need to prepare nurse scientists to bridge the chasms between research, and practice and policy in an increasingly complex healthcare system. In practice, nurse scientists are critical to building capacity for research, promoting excellence in patient-centered care, and achieving or exceeding national quality benchmarks. Moreover, they provide methodological expertise and insight to address pressing clinical questions. PhD-prepared nurses also leverage their research expertise and practice knowledge to transform health policy in roles as organizational executives and leaders, advocates, and communicators. Re-envisioning nursing PhD curricula is required to ensure that PhD students are capable of not only conducting rigorous and impactful science, but launching careers across sectors of healthcare. Here, we summarize viewpoints of a special session from the October 2019 PhD Summit "Re-Envisioning PhD Programs of the Future" sponsored by the University of Pennsylvania School of Nursing and literature to invigorate thinking about ways to promote career transitions into nontraditional vital positions for nurse scientists. Advancing the health of patients and communities depends on preparing the next generation of nurse scientist to pursue career trajectories outside of traditional academic institutions.

Nursing Judgment: A Concept Analysis

Charged with making decisions to protect and enhance patient well-being, a nurse relies on nursing judgment to render effective patient care. Nursing judgment is the culmination of education, experience, and insight that allows nurses to execute the best action possible on behalf of patients. This concept analysis uses the Walker and Avant method to demonstrate the role of nursing judgment in assessments and interventions, delegation of tasks, and prioritization of care. Nurses, other health care collaborators, and recipients of health care should be aware of the role played by nursing judgment to improve patient care and the health care system.

The Related Factors of Nurses' Participation and Perceived Benefits and Barriers in Health Policy Making

BACKGROUND

Nurses play a critical role in providing good health services.

PURPOSE

The aim of this study was to examine the factors related to the participation of nurses in the provision of health services and the perceived benefits and barriers to their participation in health policy making.

METHODS

A cross-sectional descriptive study was conducted in several hospitals affiliated with the Iran University of Medical Sciences during the first half of 2018 on a sample size of 220 people. A standard, self-management questionnaire was used to collect the data, and SPSS 21.0 software was used for data analysis. None of the demographic characteristics were found to be significantly associated with nurse participation in or the perceived barriers and benefits to health policy making.

RESULTS

The results of this study show that the participants were involved only moderately in health policy making. "Providing written reports on problems or receiving consultation from a related official" was the performance item most frequently cited by the participants in terms of involvement, whereas "Disappointment in work procedures" was the most frequently cited barrier item affecting involvement.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Despite the importance of the nursing role in health polices, this study indicates that nurses participate at only a moderate level in health policy-making activities. Providing more information to nurses regarding health policies, enhancing nurses' image of their job and their perceptions about the importance of their participation in the health policy, increasing partnerships with nurses at the upper levels of health services management, and supporting nursing professional organizations in the field of health policy are potential strategies for encouraging greater nursing participation in health policy making.

Reimagining the role of the nursing workforce in Uganda after more than a decade of ART scale-up

BACKGROUND

The expanding roles and increasing importance of the nursing workforce in health services delivery in resource-limited settings is not adequately documented and sufficiently recognized in the current literature. Drawing upon the theme of 2020 as the International Year of the Nurse and the Midwife, we set out to describe how the role of nurses expanded tremendously in health facilities in Uganda during the era of anti-retroviral therapy (ART) scale-up that commenced in June 2004.

METHODS

We employed a mixed-methods sequential explanatory research design. Phase I entailed a cross-sectional health facility survey (n = 195) to assess the extent to which human resource management strategies (such as task shifting) were common. Phase II entailed a qualitative multiple case study of 16 (of the 195) health facilities for an in-depth understanding of the strategies adopted (e.g. nurse-centred HIV care). Descriptive analyses were performed in STATA (v 13) while qualitative data were analysed by thematic approach.

RESULTS

We found that nurses were the most represented cadre of health workers involved in the overall leadership of HIV clinics across Uganda. Most nurse-led HIV clinics were based in rural settings; however, this trend was fairly even across setting (rural/urban/peri-urban). While 181 (93%) health facilities allowed non-physician cadre to prescribe ART, a number of health facilities (n = 36) or 18% deliberately adopted nurse-led HIV care models. Nurses were empowered to be multi-skilled with a wide range of competencies across the HIV care continuum right from HIV testing to mainstream clinical HIV disease management. In several facilities, nursing cadre were the backbone of ART service delivery. A select number of facilities devised differentiated models of task shifting from physicians to nurses in which the latter handled patients who were stable on ART.

CONCLUSION

Overall, our study reveals a wide expansion in the scope-of-practice of nurses during ART scale-up in Uganda. Nurses were thrust in roles of HIV disease management that were traditionally the preserve of physicians. Our study underscores the importance of reforming regulatory frameworks governing nursing workforce scope of practice such as the need for developing a policy on task shifting which is currently lacking in Uganda.

Nurses' Experiences of Promoting Healthy Aging in the Municipality: A Qualitative Study

The purpose of this study was to describe nurses’ experiences of promoting healthy aging in municipalities. A descriptive qualitative research design based on semi-structured interviews with 13 nurses was employed. The nurses described the importance of giving older adults the possibility to live as individuals, but also that the organization matters as too does the nurses’ own desire to work professionally and with passion. Nurses in the municipality noticed that in today’s world, there is a changing perspective of older adults. They more often want to continue their previous life and care greatly about quality of life and because of this, they also expect more service from their health care. Our study suggests that nurses should be supported to specialize in elderly care and measures should be taken to reduce the gap between vision and reality when it comes to team work.

Barriers and Facilitators Perceived by Spanish Experts Concerning Nursing Research: A Delphi Study

The identification of research priorities in line with current health needs and nursing competencies is a priority. Nevertheless, barriers and facilitators perceived by nurses to performing nursing research have scarcely been investigated. The main aim of this study was to explore the situation in nursing research in Spain, as perceived by Spanish experts. A Delphi study technique in two phases was applied using an online survey tool. A panel of 20 nursing experts in nursing, teaching and management positions participated. The strengths highlighted were the possibility of reaching the PhD level, the possibility of receiving continuous training in research methodology, and access to scientific knowledge through the Internet. The weaknesses identified were the lack of Spanish nursing journals in which to publish the research results, the lack of funding in nursing care research, and the lack of connection between the healthcare institutions and the university. According to the experts, elements that could enhance leadership in research are the creation of nursing research units in hospitals, the economic recognition of nurses with PhDs, and considering research work as part of their daily tasks in clinical settings. The idea of being subordinated to physicians still remains in nurses’ ways of thinking.

Recommendations to prevent nursing errors: Content analysis of semi-structured interviews with intensive care unit nurses in a developing country

AIM

To elicit intensive care unit (ICU) nurses' recommendations to prevent nursing errors.

BACKGROUND

Errors are usually induced by faulty systems, and managers play a key role in building a safe health care system.

METHOD

A qualitative research design was used. Semi-structured interviews with 112 Egyptian ICU nurses were conducted, and responses were analysed using qualitative content analysis.

RESULTS

Responses from 108 nurses were analysed. Six themes of recommendations were identified: improvement and better organisation of resources, policy modification, education and training, likeness minimization, use of technology and work environment changes.

CONCLUSION

Nurses' recommendations reflect the poor-resource context in developing countries. Several recommendations, however, are relatively cheap to implement strategies.

IMPLICATIONS FOR NURSING MANAGEMENT

All reported recommendations are organisational issues. Improvement and better organisation of human and non-human resources is a priority issue to prevent or minimize nursing errors. Policy modification, education and training, and likeness minimization are relatively cheap, easy-to-implement strategies to tackle the occurrence of nursing errors in developing countries. Staff nurses should be actively involved in policy reform. Patient safety education should be supported by adopting modern technology and work environment reform.

Advocating for Pasteurized Donor Human Milk: The Journey for Medicaid Reimbursement in New York State

BACKGROUND

The American Academy of Pediatrics and the National Association of Neonatal Nurses recognize that federal policies fail to reimburse for the provision of pasteurized donor human milk (PDHM) to the very low birth-weight neonate, and have encouraged members to advocate for the inclusion of PDHM into their respective state Medicaid programs.

PURPOSE

This article describes what occurred in New York State as advocates worked for reimbursement of PDHM reimbursement by Medicaid.

METHOD

Tactics utilized in New York have been presented with an advocacy framework to illustrate the necessary strategic foresight required for productive engagement within the healthcare policy arena.

RESULTS

Examination of employed advocacy efforts targeted to remove known cost barriers associated with PDHM.

IMPLICATIONS FOR PRACTICE

Full utilization of PDHM within intensive care.

IMPLICATIONS FOR FUTURE RESEARCH

The necessity to engage in scholastic/evidence-based advocacy work.

Assessing the impact of a partnership-based work/study nursing upgrade programme in a low- and middle-income setting

AIMS AND OBJECTIVES

To evaluate the 15-year impact of the work/study nursing upgrading programme in East Africa.

BACKGROUND

Working nurses in Africa are often primary family income earners, with limited ability to leave jobs and upgrade qualifications. In 2001, the university established a work/study upgrade programme for enrolled- and diploma-level nurses, allowing them to upgrade their qualifications while continuing to work and support families. Donor partnerships provided scholarships to further increase programme access.

DESIGN

A mixed-method design was used involving an online alumni survey and 24 interviews and 23 focus groups with 172 purposively selected representatives of nursing graduates, employers, regulatory bodies, professional associations and senior nursing officials.

METHOD

Quantitative data were analysed using frequencies and percentages. Inductive thematic analysis was used for qualitative data. Equator guidelines informed reporting of both qualitative and quantitative results.

RESULTS

Of the 549 graduates who completed the survey, 81.2% (n = 446) were female, 93.1% were currently employed and 98% worked within East Africa. They reported improved professional competence (69.4%), nursing practice (25.9%) and patient outcomes (4.6%) on graduation. Extracted themes included the following: flexible/accessible programme; friendly learning environment; effective teaching and learning strategies; acquisition of nursing knowledge, skills and competencies; stakeholders' role in the programme; career/professional advancement; and strengthened health systems.

CONCLUSION

The work/study programme was an effective nursing workforce capacity development strategy. Programme access was strengthened via the supporting donor partnership. Positive outcomes were achieved with respect to the university's values of quality, access, relevance and impact.

RELEVANCE TO CLINICAL PRACTICE

Long-term sustainable development of nurses and midwives is fundamental to achieving sustainable development goals. Work/study programmes and private-public partnerships are effective mechanisms to strengthen the development of nursing and the overall healthcare workforce in low-resource settings.

Setting the agenda for nurse leadership in India: what is missing

Background

Current policy priorities to strengthen the nursing sector in India have focused on increasing the number of nurses in the health system. However, the nursing sector is afflicted by other, significant problems including the low status of nurses in the hierarchy of health care professionals, low salaries, and out-dated systems of professional governance, all affecting nurses’ leadership potential and ability to perform. Stronger nurse leadership has the potential to support the achievement of health system goals, especially for strengthening of primary health care, which has been recognised and addressed in several other country contexts. This research study explores the process of policy agenda-setting for nurse leadership in India, and aims to identify the structural and systemic constraints in setting the agenda for policy reforms on the issue.

Methods

Our methods included policy document review and expert interviews. We identified policy reforms proposed by different government appointed committees on issues concerning nurses’ leadership and its progress. Experts’ accounts were used to understand lack of progress in several nursing reform proposals and analysed using deductive thematic analysis for ‘legitimacy’, ‘feasibility’ and ‘support’, in line with Hall’s agenda setting model.

Results

The absence of quantifiable evidence on the nurse leadership crisis and treatment of nursing reforms as a ‘second class’ issue were found to negatively influence perceptions of the legitimacy of nurse leadership reform. Feasibility is affected by the lack of representation of nurses in key positions and the absence of a nurse-specific institution, which is seen as essential for creating visibility of the issues facing the profession, their processing and planning for policy solutions. Finally, participants noted the lack of strong support from nurses themselves for these policy reforms, which they attributed to social disempowerment, and lack of professional autonomy.

Conclusions

The study emphasises that the nursing empowerment needs institutional reforms to facilitate nurse’s distributed leadership across the health system and to enable their collective advocacy that questions the status quo and the structures that uphold it.

Strengths-Based Nursing: A Process for Implementing a Philosophy Into Practice

Strengths-Based Nursing (SBN) is both a philosophy and value-driven approach that can guide clinicians, educators, manager/leaders, and researchers. SBN is rooted in principles of person/family centered care, empowerment, relational care, and innate health and healing. SBN is family nursing yet not all family nursing models are strengths-based. The challenge is how to translate a philosophy to change practice. In this article, we describe a process of implementation that has organically evolved of a multi-layered and multi-pronged approach that involves patients and families, clinicians, educators, leaders, managers, and researchers as well as key stakeholders including union leaders, opinion leaders, and policy makers from both nursing and other disciplines. There are two phases to the implementation process, namely, Phase 1: pre-commitment/pre-adoption and Phase 2: adoption. Each phase consists of distinct steps with accompanying strategies. These phases occur both sequentially and concurrently. Facilitating factors that enable the implementation process include values which align, readiness to accept SBN, curiosity-courage-commitment on the part of early adopters, a critical mass of early adopters, and making SBN approach both relevant and context specific.

Using social media to engage nurses in health policy development

AIMS

To explore nurses' views on future priorities for the profession and to examine social media as an engagement tool to aid policy discussion and development.

BACKGROUND

Nurses are often not directly involved in policy creation and some feel it is a process they cannot easily influence.

METHODS

A descriptive mixed methods study of a Twitter chat hosted by the Chief Nursing Officer for Scotland was undertaken. Data were gathered using an analytics platform and NCapture software. The framework approach aided thematic analysis to draw out themes.

RESULTS

Sixty-four people took part in the Twitter chat (#CNOScot) and posted 444 tweets. Nurses called for investment in technology, nursing research, education and mental health. Primary care and advanced practice roles to support older adults with complex health and social care needs were also seen as vital to develop further.

CONCLUSION

Social media can help reach and engage nurses in policy discussion and ensure there is better continuity between policy and practice but some groups risk being excluded using this digital medium.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing leaders should consider social media as one of many engagement strategies to ensure nurses and other stakeholders participate in policy debate that informs health strategy development.

Impact of International Quality Improvement Collaborative on Congenital Heart Surgery in Pakistan

BACKGROUND

The International Quality Improvement Collaborative (IQIC) was formed to reduce mortality and morbidity from congenital heart disease (CHD) surgeries in low/middle-income countries.

OBJECTIVES

We conducted this study to compare the postoperative outcomes of CHD surgeries at a centre in Pakistan before and after joining IQIC.

METHODS

The IQIC provides guidelines targeting key drivers responsible for morbidity and mortality in postoperativepatients with CHD. We focused primarily on nurse empowerment and improving the infection control strategies at our centre. Patients with CHD who underwent surgery at this site during the period 2011-2012 (pre-IQIC) were comparedwith those getting surgery in 2013-2014 (post-IQIC). Morbidity (major infections), mortality and factors associated with them were assessed.

RESULTS

There was a significant decrease in surgical site infections and bacterial sepsis in the post-IQIC versus pre-IQIC period (1% vs 30%, p=0.0001, respectively). A statistically insignificant decrease in the mortality rate was also noted in post-IQIC versus pre-IQIC period (6% vs 9%, p=0.17, respectively). Durations of ventilation and intensive care unit (ICU) and hospital stay were significantly reduced in the post-IQIC period. Age <1 year, malnutrition, low preoperative oxygen perfusion, Risk Adjustment for Congenital Heart Surgery score >3, major chromosomal anomalies, perfusion-related event, longer ventilation and ICU/hospital stay durations were associated with greater odds of morbidity and mortality.

CONCLUSION

Enrolling in the IQIC programme was associated with an improvement in the postsurgical outcomes of the CHD surgeries at our centre.

An integrative review of pursing policy and political competence

INTRODUCTION

For several decades, there have been repeated calls for nurses to become more involved in policy and political processes.

AIMS

The purpose of this article is to conduct an integrative review to identify and assess the current state of the science relating to supporting the pursuit of greater involvement by the nursing profession in policy and political processes.

DESIGN

Standard integrative review procedures were used to identify studies that examined how policy competence could be achieved. A comparative thematic approach to synthesis was used. Both published and grey literature written in English between January 1965 and January 2015 were identified via a structured search of CINAHL, SCOPUS, Science Direct and Google Scholar.

RESULTS

Forty-five primary studies were identified with literature from North America dominating, but contributions from low- and middle-income countries have recently started to feature. Studies tended to focus on the immediate impact of didactic and action learning-based approaches. The majority of articles were descriptive survey designs utilizing small convenience samples.

CONCLUSIONS AND POLICY IMPLICATION

Many programmes of education have focused on developing an understanding of legislative policy and political processes, but the development of policy and political competencies at team and institutional levels has been ignored. Existing research have looked at the short-term effects of educational programmes. At this time, there are conflicting reports on the impact of variables such as gender and educational preparation on policy and political competence. There is an urgent need to address these major gaps if nurses at all levels are to play a full role in shaping policy and political process.

Jordanian Nurses' involvement in health policy: perceived benefits and barriers

AIM

To examine (1) the level of involvement of Jordanian nurses in health policy development and (2) perceived benefits, barriers and impacts on health outcomes of involvement in health policy process.

BACKGROUND

Lack of nurses' political involvement may result in self-serving policies by policymakers who are in power and passing policies that are less than optimum.

METHOD

A descriptive cross-sectional design was adopted in this study. A convenience sample of 231 nurses was recruited with a response rate of 77%. The instrument of Registered Nurses' Involvement in Health Policies was used in this study.

RESULTS

The results revealed that participants were most frequently involved in the health policy activity 'voting for a candidate or a health policy proposal'. The mean scores for involvement of participants as nurses and as citizens were low. The most perceived frequent barrier to involvement in health policy was lack of time.

DISCUSSION

The low rate of Jordanian nurses' involvement in health policy could be explained by the fact that most participants had family roles in addition to work roles, which might leave little time for health policy activities. Lack of mentoring for nurses by nursing leaders could also negatively affect their involvement in health policy development.

CONCLUSION AND IMPLICATIONS FOR HEALTH POLICY

Results of this study could be baseline information for Jordanian nurse leaders to enhance the level of nurses' involvement in health policy development. Such findings could also add knowledge to the existing literature about nurses' involvement in health policy.

Empowerment model for nurse leaders' participation in health policy development: an east African perspective

BACKGROUND

Nurses comprise the largest portion of the health care workforce in most countries; they interact closely with patients and communities, they work throughout the day and within all sectors of health care. Their breath of practice gives them a broad understanding of requirements of the health care system, of how factors in the environment affect the health outcomes of clients and communities. Nurses' involvement in health policy development ensures that health services are: safe, effective, available and inexpensive.

METHODS

A Delphi survey was utilized and included the following criteria: expert panelists, three iterative rounds, qualitative and quantitative analysis, and building consensus. The overall aim of the study was to develop "An Empowerment Model for Nurse Leaders' participation in Health Policy Development". The study included purposively selected sample of national nurse leaders from the three East African countries of Kenya, Tanzania and Uganda. The study was conducted in three iterative rounds. Data collection tools were questionnaires. Data analysis was done by examining the data for the most commonly occurring concepts in the first round and descriptive statistics in the second and third rounds.

RESULTS

The findings of the study support the development of the "Empowerment Model for Nurse Leaders' Participation in Health Policy Development". Further the study identified that there was a significant gap in and barriers to participation in health policy activity and that an opportunity seems to exist to enable and develop nurse leaders' role and involvement in this respect. There was consensus on factors considered to be facilitators and barriers to nurse leaders' involvement in health policy development. Furthermore, consensus was achieved on essential leadership attributes that enhance nurse leaders' participation in health policy development. The model was validated a small sample of the nurse leaders' who participated in the study.

CONCLUSION

The model provides a framework with an aim of facilitating involvement in health policy activity. Nurses need to be strategic in ensuring that they place themselves and others on the forefront of the policy development arena. The empowerment model suggests proactive and strategic involvement of nurses and nurse leaders in health policy development activities.

A Delphi survey of leadership attributes necessary for national nurse leaders' participation in health policy development: an East African perspective

BACKGROUND

Nurses' involvement in health policy development ensures that health services are: safe, effective, available and inexpensive. Nursing history reveals several legendary nurse leaders who have influenced policy and the course of nursing and health care. In the recent times there have been concerns regarding the availability of effective leaders physically, symbolically and functionally at clinical, organizational and national levels, who can effectively influence health policy. Exerting influence in the policy arena requires that nurse leaders acquire attributes that enable them to be effective in policy development activity. This paper reports part of a larger study whose purpose included: "build consensus on leadership attributes necessary for nurse leaders' participation in health policy development in East Africa".

METHOD

A Delphi survey was utilized and included the following criteria: expert panelists, three iterative rounds, qualitative and quantitative analysis, and building consensus. The study included purposively selected sample of national nurse leaders (expert panelists) from the three East African countries of Kenya, Tanzania and Uganda. The study was conducted in three iterative rounds. Seventy eight (78) expert panelists were invited to participate in the study and 37 (47%) participated in the first round of these; 24 (64.8%) participated in the second round and all invited in the third round 24 (100%) participated. Data collection was done using questionnaires and collected qualitative and quantitative data. Data analysis was done utilizing the principles of qualitative analysis in the first round and descriptive statistics in the second and third rounds.

RESULTS

The study achieved consensus on the essential leadership attributes for nurse leaders' participation in health policy and include being able to: influence; communicate effectively; build relationships; feel empowered and demonstrate professional credibility.

CONCLUSIONS

For nursing to participate in influencing the health policy and the health of the population, it will need to develop nurses with leadership attributes who are able to inspire change and influence the policy development process within the context where it exists. The leadership attributes identified in this study can be utilized to develop programmes geared to support nurses' participation in health policy activity.

Contestations and complexities of nurses' participation in policy-making in South Africa

Background

There has been increased emphasis globally on nurses’ involvement in health policy and systems development. However, there has been limited scholarly attention on nurses’ participation in policy-making in South Africa.

Objective

This paper analyses the dynamics, strengths, and weaknesses of nurses’ participation in four national health workforce policies: the 2008 Nursing Strategy, revision of the Scope of Practice for nurses, the new Framework for Nursing Qualifications, and the Occupation-Specific Dispensation (OSD) remuneration policy.

Design

Using a policy analysis framework, we conducted in-depth interviews with 28 key informants and 73 frontline nurses in four South African provinces. Thematic content analysis was done using the Atlas.ti software.

Results

The study found that nurses’ participation in policy-making is both contested and complex. The contestation relates to the extent and nature of nurses’ participation in nursing policies. There was a disjuncture between nursing leadership and frontline nurses in their levels of awareness of the four policies. The latter group was generally unaware of these policies with the exception of the OSD remuneration policy as it affected them directly. There was also limited consensus on which nursing group legitimately represented nursing issues in the policy arena. Shifting power relationships influenced who participated, how the participation happened, and the degree to which nurses’ views and inputs were considered and incorporated.

Conclusions

The South African health system presents major opportunities for nurses to influence and direct policies that affect them. This will require a combination of proactive leadership, health policy capacity and skills development among nurses, and strong support from the national nursing association.