Health Professional Frontline Leaders' Experiences During the COVID-19 Pandemic: A Cross-Sectional Study

Lessons From Leading During a Pandemic: An Exploratory Study of Public Health Leadership Insights on Training, Preparation, and Experiences From the Field During COVID-19

CONTEXT

The public health workforce encountered challenges during the COVID-19 pandemic that exposed areas for improvement in preparation for future public health threats. Key among these is well-trained public health leaders equipped with an array of crisis leadership skills.

OBJECTIVES

To examine the training background, assess the perceived preparedness, and garner recommendations for training of the future public health workforce from public health leaders who navigated the COVID-19 pandemic.

DESIGN

This exploratory research gleaned information by utilizing an online questionnaire and interviews to provide lessons learned regarding improvements needed for public health leader preparedness.

SETTING

Three California public health departments representing urban, suburban, and rural populations.

PARTICIPANTS

Thirty public health leaders who were directly involved in public health work for ≥3 years in a leadership/management role and involved in COVID-19-related work for at least 6 months participated.

RESULTS

Questionnaire findings revealed gaps in crisis leadership, communication, and collaboration training. Interview results supported and expanded upon the quantitative findings, including the value of various competencies and recommendations to improve the preparedness of future public health leaders.

CONCLUSIONS

The findings suggested that although many of the skills needed are competencies for accredited public health training programs, effective leadership during public health emergencies may require additional training beyond what is generally provided. Recommendations include integrating study findings into public health training programs to address competency gaps, leveraging results to enhance leadership skills, and promoting collaboration between public health departments and academic institutions to develop evidence-informed crisis leadership training. These findings inform strategies to ensure the preparedness of the public health workforce for future crises.

Multidisciplinary First-Line Healthcare Leaders' Roles and Experiences During the COVID-19 Pandemic in Ontario Canada

BACKGROUND

Throughout the COVID-19 pandemic, first-line healthcare leaders across the healthcare system played crucial roles leading, motivating, and supporting staff.

PURPOSE

This study aims to describe multidisciplinary first-line healthcare leaders' experiences during the COVID-19 pandemic in Ontario, Canada using transformational and crisis leadership theory.

METHODS

A descriptive two-phase (quantitative & qualitative) design was conducted in the spring of 2021. Phase 1 employed an online survey sent via email to first-line leaders from various sectors who were members of healthcare professional associations in Ontario. Participants included nurse managers, professional practice leaders (e.g., occupational and physiotherapists), advanced practice nurses, and clinical educators. In Phase 2, a subset (n  =  19) of the Phase 1 participants were interviewed to gain a deeper understanding of these leaders' experiences including role impact and support available. Semistructured individual interviews were conducted and recorded via Zoom©. Inductive and deductive analysis approaches identified key themes. This paper reports the qualitative findings from Phase 2.

RESULTS

Leaders' behaviors were representative of the key dimensions of transformational and complexity leadership theories. Recommendations for leading during a crisis included: engaging in self-care activities to manage the personal impact of the crisis; teamwork and collaborative leadership; and support from fellow first-line leaders and senior leaders. Findings can inform healthcare leadership education programs designed to manage future crises for both academic and practice settings.

CONCLUSION

Descriptions of first-line healthcare leaders' roles and experiences during multiple waves of the COVID-19 pandemic validated their important contributions within various health sectors.

Leading through the COVID-19 pandemic: Experiences of UK Executive Nurse Directors

AIM

To explore the challenges experienced by Executive Nurse Directors during the COVID-19 pandemic, and to inform future nursing leadership strategies.

DESIGN

A qualitative research project involving interviews with 21 Executive Nurse Directors from England and Wales.

METHODS

Participants were purposively sampled and recruited through Chief Nursing Officers and nursing leadership networks. Semi-structured interviews were conducted and recorded online via Teams. Braun and Clarke's approach to thematic reflexive analysis was applied to data analysis.

RESULTS

Executive Nurse Directors played a critical role during the COVID-19 pandemic. Six themes are explored: tensions, and adaptive response to personal leadership styles; uncertainty and support at the board level; responding to national political decision-making; the personal and emotional impact of the role and the sources of effective support; the voice and public profile of nursing; lessons learnt and strategies for future leadership development. Enablers of decision-making included effective multidisciplinary working, freedom from normal organizational constraints, support for innovation, and the development of stronger bonds with colleagues. Barriers to decision-making included limited knowledge of the virus and its impact and lack of guidance, particularly at a national level. Priorities, strategies and actions for recovery include recognizing the emotional impact of being in a high-level decision-making role, protecting staff from burnout and understanding the long-term implications of pandemic work for nurse leaders.

CONCLUSION

Future strategies for nursing leadership during public health, national and global emergencies are recommended.

IMPACT

This study contributes to the literature exploring the Executive Nurse Director role and their experiences of leading through the COVID-19 pandemic, and identifies priorities, strategies and actions for recovery and learning for the future of senior leadership.

REPORTING METHOD

The study adhered to the Consolidated Criteria for Reporting Qualitative Research.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Public health leadership in the COVID-19 era: how does it fit? A scoping review

The COVID-19 pandemic has put a lot of pressure on all the world's health systems and public health leaders who have often found themselves unprepared to handle an emergency of this magnitude. This study aims to bring together published evidence on the qualities required to leaders to deal with a public health issue like the COVID-19 pandemic. This scoping literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A search of relevant articles was performed in the PubMed, Scopus and Web of Science databases. A total of 2499 records were screened, and 45 articles were included, from which 93 characteristics of effective leadership were extrapolated and grouped into 6 clusters. The qualities most frequently reported in the articles were human traits and emotional intelligence (46.7%) and communication skills such as transparency and reliability (48.9%). Responsiveness and preparedness (40%), management skills (33.3%) and team working (35.6%) are considered by a significant percentage of the articles as necessary for the construction of rapid and effective measures in response to the emergency. A considerable proportion of articles also highlighted the need for leaders capable of making evidence-based decisions and driving innovation (31.1%). Although identifying leaders who possess all the skills described in this study appears complex, determining the key characteristics of effective public health leadership in a crisis, such as the COVID-19 pandemic, is useful not only in selecting future leaders but also in implementing training and education programmes for the public health workforce.

The ecology of human flourishing embodying the changes we want to see in the world

Flourishing is the highest good of all persons, but hard to achieve in complex societal systems. This challenge is borne out through the lens of the global nursing shortages with its focus on the supply of nurses to meet health system demands. However, nurses and midwives spend a significant part of their lives at work and so the need to pay attention to the conditions that facilitate flourishing at work is important. Drawing on ancient and contemporary philosophies, as well as critical, creative and embodied ways of knowing, enabling a flourishing practice ecosystem will be explored in this paper.

Frontline nurses' experiences of managing visitor restrictions during the COVID-19 pandemic in a Danish university hospital - Lessons learned

BACKGROUND

Worldwide visitor restrictions forced nurses to separate patients from their relatives. However, the experience of implementing shifting restrictions from the frontline nurses' perspectives in a Danish context has yet to be assessed.

AIM

The aim of this descriptive qualitative study was to explore frontline nurses' experiences of managing shifting visitor restrictions in a Danish somatic university hospital during the COVID-19 pandemic.

METHODS

An online questionnaire, including open-ended questions, was developed. Data were analysed using descriptive statistics and content analysis.

FINDINGS

116 nurses from 29 departments participated; they were informed about restrictions primarily by their charge nurses and hospital intranet. Shifting visitor restrictions compelled the nurses to constantly adjust and negotiate their practices. When deciding to suggest deviating from the restrictions, they shared their decision-making with colleagues. Visitor restrictions left the hospital environment quieter, but they also created a lack of overview and predictability, an emotional burden, and a negative impact on the quality of care.

CONCLUSION

Restricting relatives' access challenged the nurses' professional values, and it seems to have affirmed their appreciation of relatives' role as important partners in contemporary hospital-based health care.

Crisis management competencies needed in a hospital setting during the COVID-19 pandemic: A qualitative study of nurse leaders

AIM

To describe the crisis management competencies needed in a hospital setting during the COVID-19 pandemic from the perspective of nurse leaders.

BACKGROUND

The COVID-19 pandemic generated many challenges for nurse leaders in hospitals, and management competencies are highlighted. However, there is little evidence available about nurse leaders' perceptions of the crisis management competencies needed in such situations.

METHODS

A qualitative, descriptive, semi-structured interview study of nurse leaders (n = 20) was conducted between June and October 2021 in one Finnish central hospital. The data were analysed using inductive content analysis.

RESULTS

The analysis yielded five main categories of crisis management competencies needed in a hospital setting during the pandemic: interactive communication competence, psychological resource management competence, systematic and proactive organising competence, active networking abilities and practices and change management approach in crisis management.

CONCLUSIONS

Nurse leaders need new and different crisis management competencies in hospital organisations. The COVID-19 pandemic changed the working culture of nurse leaders, as they faced challenges that needed knowledge and skills beyond their previous management competence.

IMPLICATIONS FOR NURSING MANAGEMENT

Additional training for nurse leaders in crisis management is needed. This training should reflect the competencies identified as necessary in crisis situations so that nurse leaders will be able to manage crisis situations effectively in future.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used in reporting the findings.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Leading well and staying psychologically healthy: the role of resources and constraints for managers in the healthcare sector

PURPOSE

Maintaining a healthy and productive workforce is a challenge for most organizations. This is even truer for health organization, facing staff shortages and work overload. The aim of this study is to identify the resources and constraints that influence managers' mental health and better understand how they are affected by them.

DESIGN/METHODOLOGY/APPROACH

A qualitative approach was chosen to document the resources, the constraints as well as their consequences on managers in their day-to-day realities. The sample included executive-, intermediate- and first-level managers from a Canadian healthcare facility. A total of 62 semi-structured interviews were conducted. The coding process was based on the IGLOO model of Nielsen et al. (2018) to which an employee-related level was added (IGELOO).

FINDINGS

Results highlight the importance of considering both resources as well as constraints in examining managers' mental health. Overarching context, organizational constraints and the management of difficult employees played important roles in the stress experienced by managers.

PRACTICAL IMPLICATIONS

The results offer a better understanding of the importance of intervening at different levels to promote better organizational health. Results also highlight the importance of setting up organizational resources and act on the various constraints to reduce them. Different individual strategies used by managers to deal with the various constraints and maintain their mental health also emerge from those results.

ORIGINALITY/VALUE

In addition to addressing the reality of healthcare managers, this study supplements a theoretical model and suggests avenues for interventions promoting more sustainable organizational health.

Embracing relational competencies in applying the LEADS framework for health-care leaders in transformational change and the COVID-19 pandemic

PURPOSE

The purpose of this paper is to assess the extent to which the LEADS Framework guided health-care leaders through organizational change and the COVID-19 pandemic in a western Canadian province.

DESIGN/METHODOLOGY/APPROACH

A qualitative exploratory inquiry assessed the extent to which health leaders applied competencies that aligned with the LEADS Framework. A purposeful sample of 22 health-care leaders participated in the study representing senior, mid-level and front-line health-care leaders in various health-care organizations to ensure diverse representation of leader competencies. The authors conducted semi-structured interviews to collect the data and used Braun and Clarke's (2006) six-phase approach to guide data analysis.

FINDINGS

The analysis suggests that health-care leaders found Engaging with Others and Developing Coalitions were the most critical themes of the LEADS Framework for change management and for navigating the COVID-19 pandemic. Findings reveal that during transformational change and a crisis context, leaders embrace relational approaches to adapt and improve performance in dynamic organizations.

PRACTICAL IMPLICATIONS

These findings have implications for a relational approach to improve teamwork and decrease emotional strain; a focus on mobilizing and sharing power with nurses; and educational programs to advance relational and self-management skills, shared leadership, communication, change management, human resource and talent development as critical learning components for current and future health-care leaders.

ORIGINALITY/VALUE

The LEADS Framework is used to examine how health-care leaders responded to transformational change in the organization while situated in a pandemic context.

Management behaviors during the COVID-19 pandemic: The case of healthcare middle managers

Background

The spread of COVID-19 has disrupted the lifestyles of the world’s population. In the workplace, the pandemic has affected all sectors and has changed the way work is organized and carried out. The health sector has been severely impacted by the pandemic and has faced enormous challenges in maintaining healthcare services while providing care to those infected by the virus. At the heart of this battle, healthcare managers were key players in ensuring the orchestration of operations and the physical and mental availability of employees during the crisis. Although few studies have been conducted to identify organizational practices or leadership skills to be adopted in a crisis context, the concrete behaviors of managers have not been documented yet. Therefore, this study aims at filling this gap by studying middle managers’ behaviors facing COVID-19 crisis in the healthcare sector.

Methods

Using a qualitative approach, eight focus groups were conducted online during the pandemic with 37 middle managers from the healthcare community of a Quebec health establishment (Canada) from April to June 2020. Thematic analyses were conducted, and a mixed-methods approach was used to analyse the data based on Viitala’s hierarchical model of management skills.

Results

Based on the six managerial skills proposed in the model of Viitala, 21 specific management behaviors were identified as having been deployed by middle managers at the beginning of the pandemic. Considering that the health sector has been profoundly shaken by this health crisis, in addition to being an environment likely to experience other crises, managers need to develop practical skills in various crisis management situations. Thus, the results guide practitioners by highlighting the importance of team-oriented management behaviors (leadership, supervisory competencies), especially in a crisis context.

An investigation of the level of burnout and resilience among hospital based nurse managers after COVID 19 - A cross-sectional questionnaire-based study

AIM

We aim to investigate burnout and resilience among hospital based nurse managers post COVID-19 in order to suggest appropriate person-centred leadership support.

BACKGROUND

Nurse leaders are central to establishing safe and caring environments for patients and staff. Therefore, their own wellbeing is crucial, particular in times of crisis where they must provide support and guidance.

METHODS

Cross-sectional questionnaire included ward managers. Data collected were burnout inventory, brief resilience score and demographic data. To analyse data, we used descriptive statistics.

RESULTS

51.2% answered the questionnaire. Of those, 32.3% displayed symptoms of high personal burnout and 29% of work-related burnout. 6.5% showed signs of high employee-related burnout. As a group, ward managers showed moderate to high resilience.

CONCLUSION

Personal and work-related burnout was highly prevalent among ward managers. Results suggest that the cause of their burnout symptoms cannot be attributed to low individual resilience. We thus suggest a shift in focus from strengthening individual leadership resilience to the establishment of healthful and resilient cultures in accordance with person-centred leadership.

IMPLICATIONS FOR NURSING MANAGEMENT

Person-centred leadership has the potential to shift the focus from the resilience of individual leaders to that of collective responsibility for creating a healthful and resilient culture.

Leading in a time of crisis: exploring early experiences of health facility leaders during the COVID-19 pandemic in Nigeria's epicentre

PURPOSE

The COVID-19 pandemic has had a disruptive effect on the health system. Health facility leaders were at the forefront of maintaining service delivery and were exposed to varied stressors in the early phase of the pandemic. This study aims to explore the leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in Nigeria's epicentre.

DESIGN/METHODOLOGY/APPROACH

This study conducted an exploratory descriptive qualitative study. To achieve this, 33 health facility leaders of different cadres across primary, secondary, and tertiary levels of the public health care system in Lagos, Nigeria, were remotely interviewed. The key informant interviews were transcribed verbatim and were analysed by using thematic analysis.

FINDINGS

The health facility leaders experienced heightened levels of fear, anxiety and stressors during the early phase of the pandemic. They also had genuine concerns about exposing their family members to the virus and had to manage some health-care workers who were afraid for their lives and reluctant. Coping mechanisms included psychological and social support, innovative hygiene measures at health facility and at home, training and staff welfare in more ways than usual. They were motivated to continue rendering services during the crisis because of their passion, their calling, the Hippocratic oath and support from the State government.

ORIGINALITY/VALUE

The experiences of health facility leaders from different parts of the world have been documented. However, to the best of the authors' knowledge, this is one of the first studies that specifically report multi-layer leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in sub-Saharan Africa.

Psychologic wellness of PA, NP, and physician hospitalists during the COVID-19 pandemic

OBJECTIVES

Hospitalists, comprising PAs, NPs, and physicians, manage patients hospitalized with COVID-19. To guide the development of support programs, this study compared the psychologic wellness of hospitalist PAs, NPs, and physicians during the COVID-19 pandemic.

METHODS

We surveyed hospitalists in 16 hospitals at Mayo Clinic, from May 4 to 25, 2020. We used PROMIS surveys for self-reported global well-being (two single-item measures), anxiety, social isolation, and emotional support, before and during the pandemic. Linear and logistic regression models were adjusted for personal and professional factors.

RESULTS

The response rate was 52.2% (N = 154/295). In adjusted linear regression models, the change in scores (before minus during pandemic) for anxiety, social isolation, and emotional support was similar for PAs and NPs compared with physicians. In adjusted logistic regression models, physicians, compared with PAs and NPs, had a higher odds of top global well-being for mental health (adjusted odds ratio [95% confidence interval]: 2.82 [1.12, 7.13]; P = .03) and top global well-being for social activities and relationships (adjusted odds ratio 4.08 [1.38, 12.08]; P = .01).

CONCLUSIONS

During the COVID-19 pandemic, global well-being was lower for PAs and NPs compared with physician hospitalists. These results can guide support programs for hospitalists.

Wellness of hospitalists and hospital medicine advanced practice providers during the COVID-19 pandemic, 2020-2021

BACKGROUND

The early phase of the coronavirus disease 2019 (COVID-19) pandemic had a negative impact on the wellness of hospitalists and hospital medicine advanced practice providers (APPs). However, the burden of the pandemic has evolved and the change in hospitalist and hospital medicine APP wellness is unknown.

OBJECTIVE

To evaluate the longitudinal trend in wellness of hospitalists and hospital medicine APPs during the COVID-19 pandemic and guide wellness interventions.

DESIGN, SETTING AND PARTICIPANTS

Between May 4, 2020, and June 6, 2021, we administered three surveys to Internal Medicine hospitalists (physicians) and hospital medicine APPs (nurse practitioners and physician assistants) at 16 Mayo Clinic hospitals in four U.S. states.

MEASUREMENTS

We evaluated the association of hospitalist and hospital medicine APP characteristics with PROMIS® measures of global wellbeing-mental health, global wellbeing-social activities and relationships, anxiety, social isolation, and emotional support, using logistic and linear regression models.

RESULTS

The response rates were 52.2% (n=154/295; May 2020), 37.1% (n=111/299; October 2020) and 35.5% (n=114/321; May 2021). In mixed models that included hospitalist and hospital medicine APP characteristics and survey period, APPs, compared with physicians, had lower odds of top global wellbeing-social activities and relationships (adjusted odds ratio 0.42 [0.22-0.82]; p = .01), whereas survey period showed no association. The survey period showed an independent association with higher anxiety (May 2020 vs. others) and higher social isolation (October 2020 vs. others), whereas profession showed no association. Concern about contracting COVID-19 at work was significantly associated with lower odds of top global wellbeing-mental health and global wellbeing-social activities and relationships, and with higher anxiety and social isolation. Hospitalist and hospital medicine APP characteristics showed no association with levels of emotional support.

CONCLUSIONS

In this longitudinal assessment of hospitalists and hospital medicine APPs, concern about contracting COVID-19 at work remained a determinant of wellness. The trend for global wellbeing, anxiety, and social isolation may guide wellness interventions.

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

AIMS

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

DESIGN

Retrospective, constructivist qualitative study.

METHODS

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

RESULTS

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

CONCLUSION

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

IMPACT

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

Healthcare professionals' experiences during the initial stage of the COVID-19 pandemic in the intensive care unit: A qualitative study

BACKGROUND

The COVID-19 pandemic called for rapidly considerable changes in the healthcare system. Healthcare professionals from different departments within the hospital settings were enrolled in the emergency preparedness. This study, therefore, aimed to explore the healthcare professionals' experiences attending the ICU-preparedness and caring for patients with COVID-19 during the initial stage of the pandemic.

METHODS

A descriptive explorative qualitative study was conducted by interviewing healthcare professionals during spring 2020, exploring their experiences as part of the ICU-preparedness team and caring for patients with COVID-19 in the ICU. Healthcare professionals from different departments were recruited by purposive sampling. The interviews were transcribed verbatim and analysed using content analysis.

FINDINGS

Sixteen nurses and four physicians from a university hospital in Denmark participated. The analysis revealed three main themes and eight sub-themes. The main themes were (1) Professionalism in work-life (adaption, the patient's welfare, insecurity, and security), (2) Community Spirit (responsibility and contribution), and (3) Institutional organisation (the role of management, loss of freedom, and information).

INTERPRETATION

Despite work specialities and professions, the participants reported a uniformity of similar experiences of uncertainties, but also a sense of community arose during the first phase of COVID-19.

RECOMMENDATIONS

To ensure resilience and mental health, and well-being for the healthcare professionals, comprehensive support should be provided. Guidelines for interventions and training are necessary to promote preparedness and reduce psychological stress.

The Differences in Experiences Among Multi-Level Healthcare Leaders, Between the First and the Second Wave of the COVID-19 Pandemic: Two Cross-Sectional Studies Compared

PURPOSE

To identify the differences in experiences during wave I and II of the COVID-19 pandemic among healthcare leaders.

BACKGROUND

It is expected, that working conditions for COVID-19-pandemic frontline staff will change, as health care organizations have gained experience with handling the consequences of the disease.

METHODS

An online survey was sent out to Danish health care leaders during the first and the second pandemic wave. Comparative analyses were performed in relation to three key characteristics: management level, management education and experiences as a leader.

RESULTS

Eighty-nine health care leaders completed both surveys. Significant differences were found within the entire group across the key characteristics as they felt more prepared for each stage of the situation, they had more influence on the decisions taken, and they felt more concerned about the quality of treatment and care and their own health. Further significant results related to the three key characteristics were found at 1) Management level: The heads of department experienced being better informed, having more overview of their tasks and that these were meaningful. The ward managers experienced being more able to work in consistency with own beliefs and values, though they felt more overloaded. 2) Level of management education: Leaders, without a formal management education, experienced being more supported by staff. 3) Years of experiences as leader: Leaders with more than five years of experience, experienced being more prepared and informed, had more influence on decision-making, and were more worried about their own health.

CONCLUSION

The learning from experience that happens naturally in crisis situations is the reason why the leaders feel more prepared. However, there is a need for further leadership and practice development, to create contexts where leaders feel more ready for all aspects of their role.

Improving Person-Centred Leadership: A Qualitative Study of Ward Managers' Experiences During the COVID-19 Crisis

Purpose

In order to provide guidance and prepare ward managers for future crisis situations similar to the COVID-19 pandemic, the aim of this study was to reflect and learn how person-centred nursing leadership may be strengthened in such situations.

Background

The pandemic has forced nurse leaders to face new challenges. Knowledge about their experiences may contribute to advancing leadership practices in times of future crises.

Methods

A qualitative directed content analysis was chosen. The theoretical perspective was person-centred leadership. Thirteen ward managers from a Danish university hospital were included and interviewed using telephone interviews three months after the first national COVID-19 case was confirmed.

Findings

The main findings of the study revealed that the ward managers often experienced a lack of timely, relevant information, involvement in decision-making and acknowledgement from the head nurse of department and the executive management. This was caused by the existing organizational cultures and the traditional hierarchy of communication. This meant that the ward managers' sense of own competences and leadership values and beliefs came under high pressure when they had to balance different stakeholders' needs.

Conclusion

When the experience of ward managers results in them being unable to lead authentically and competently in a crisis like the COVID-19 pandemic, lack of engagement can occur, with serious consequences for patients, staff and the ward managers themselves. Traditional organizational cultures that are hierarchical and controlling needs to be challenged and reoriented towards collaborative, inclusive and participative practices of engagement and involvement. Leadership development must be an established and integrated component of organizations, so that ward managers are able to sustain person-centred ways of being and doing in times of crisis.

The experience of nursing leadership in a crisis: A hermeneutic phenomenological study

AIM

This study aimed to understand nursing leaders' experience during the pandemic.

BACKGROUND

COVID-19 is a public health crisis that affects every nation in the world.

METHODS

Purposeful sampling was used to recruit 28 leaders in a large health care system. Data were collected via semi-structured audiotaped interviews. Results were analysed using hermeneutic phenomenology.

RESULTS

The structure in which leaders worked was described as: from the day-to-day grind to derailment and from manning the hospital to manning the frontlines. Five phenomenological themes were as follows: embodied leadership, navigating differently, trusting and earning trust, being the calm voice and envisioning the future.

CONCLUSION

Disaster policies and procedures are needed that will alleviate leadership angst, maximize nursing resources, heighten trust and enhance communications.

IMPLICATIONS FOR NURSING MANAGEMENT

In 2020, we witnessed a previously inconceivable media and public focus on the value of nursing care. Leaders can use this pivotal moment in time as a catalyst towards securing the support needed in planning for the next pandemic.