Leadership Styles and Nurses' Job Satisfaction. Results of a Systematic Review

Predictors of Nurses' Job Satisfaction in Home Care Settings: Findings From the AIDOMUS-IT Study

INTRODUCTION

Nurses' job satisfaction in hospitals is fundamental for the quality of care and the safety of patients. However, sociodemographic trends require moving care to patients' homes, and the predictors of job satisfaction for nurses working in the home care settings remain largely unknown. Therefore, the aim of this study was to investigate job satisfaction of nurses working in Italian home care settings and its determinants.

DESIGN

Multicenter observational cross-sectional study.

METHODS

This study was conducted in the districts of 70 local health authorities in Italy. Data on the characteristics of the organization and nurses were collected. Nursing job satisfaction was evaluated on a four-point scale ranging from "very satisfied" to "very dissatisfied." Additionally, the following variables were assessed: workload, quality of leadership, work-private life conflict, burnout symptoms, possibility for development, staffing and resource adequacy, nurse manager ability, safety climate, and teamwork climate. A logistic regression analysis was conducted to identify factors influencing job satisfaction.

RESULTS

Only organizational variables had a predictive value for nurses' job satisfaction. Workload (OR = 1.01; p = 0.033), work-private life conflict (OR = 1.02; p < 0.001), burnout (OR = 1.02; p < 0.001), and staffing inadequacy (OR = 1.44; p = 0.003) predicted higher levels of nurse dissatisfaction. Instead, high-quality leadership (OR = 0.981; p < 0.001), possibility for development (OR = 0.973; p < 0.001), and good teamwork climate (OR = 0.994; p = 0.003) were predictors of better levels of satisfaction.

CONCLUSIONS

This study suggested that home care nurses are generally satisfied with their jobs. To enhance job satisfaction, it is essential to improve nurses' work environment, the leadership quality and ensure professional development.

CLINICAL RELEVANCE

Our results are globally relevant as they contribute to the limited evidence available on this topic in home care settings. This study emphasizes the need of measuring nurses' job satisfaction and implementing interventions to promote healthy work environments.

High workload and under-appreciation lead to burnout and low job satisfaction among radiographers

INTRODUCTION

Burnout and low job satisfaction in healthcare can impact patient safety and staff retention. This study aims to gain information on the factors influencing burnout and job satisfaction among radiographers in the UK, Ireland and internationally. This can inform strategies for improving the workforce supply and demand imbalance.

METHODS

An online questionnaire was developed, which included demographic questions and two validated instruments, the Maslach Burnout Inventory (MBI) and the Job Satisfaction Survey (JSS). The questionnaire was distributed to diagnostic radiographers through the EFRS Research Hub at the European Congress of Radiology, Vienna, in early March 2023. It was disseminated online through Twitter, Facebook, and email over six weeks.

RESULTS

245 radiographers completed the questionnaire, with the majority (n = 207, 84.5 %) female. Not all respondents responded to all questions. The numbers of respondents for each section were: Pay n = 205, Promotion = 206, supervision = 212, fringe benefits = 211, CR = 212, OC = 214, Co-workers = 213, NoW = 211, Communication = 213 and overall JS = 205. The questionnaire had participants from twenty-one countries, with 66.5 % from Ireland. The mean values for emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) indicate moderate levels of burnout among responding radiographers. 44.2 % of radiographers were dissatisfied, 43.7 % were ambivalent, and 12.1 % were satisfied overall. Workload, under-appreciated work, and time pressures were ranked as the top three factors contributing to burnout. Staff numbers, workload and poor management were the top three factors reducing job satisfaction.

CONCLUSION

Burnout levels were moderate, and overall job satisfaction was very low among radiographers. Workload and under-appreciation were key factors impacting low job satisfaction and high burnout.

IMPLICATIONS FOR PRACTICE

Healthcare policies that address radiographer burnout through wage structure adjustments, targeted human capital investment, and management practices aligned with staff needs are needed. Implementing these strategies is essential for improving healthcare efficiency, staff wellbeing, and patient care outcomes.

"Eat Enough"-A nurse-led intervention to enhance hospitalized older adults' protein and energy nutrition

PURPOSE

To develop an intervention enhancing hospitalized older adults' nutrition.

METHODS

For the first time, a mixed-methods design with data triangulation was applied according to the six-step model of Corry et al. to elaborate on a complex nursing intervention in the form of a logic model. Patients who were aged ≥80 years and hospitalized for at least 5 days were included. Sample size for quantitative practice analysis was 135 older adults, whereas 22 older inpatients participated in interviews and observations for needs analysis and generated data for key principles.

FINDINGS

The intervention "Eat Enough" encompasses nursing team culture and comprises six actionable targets to deliver needs-based support and reach required protein and energy intake for hospitalized older adults by sensitizing nurses and the interprofessional team. Facilitating nutritional intake would be supported by an advanced practice nurse who considers the medical and nursing care plan and therapy.

CONCLUSIONS

The intervention "Eat Enough" demonstrates that nurses play a key role in interprofessional teams to enhance older adults' nutrition in hospital. The pipeline model displays how the actionable targets can be achieved, and how awareness raising can influence the context-leading to raised calories and protein requirement coverages and shorter length of stay.

IMPLICATIONS FOR CLINICAL PRACTICE

By identifying risk factors of malnutrition and strengthening nurses' responsibilities, the intervention "Eat Enough" could significantly enhance nutrition among hospitalized older adults. However, the logic model should be tested and implemented in future research.

"Direct Me or Leave Me": The Effect of Leadership Style on Stress and Self-Efficacy of Healthcare Professionals

This study aims to investigate the influence of leadership on the self-efficacy of healthcare professionals. Additionally, it seeks to explore whether stress mediates the relationship between leadership and self-efficacy. Specifically, our study is focused on both transactional leadership and laissez-faire leadership, which are commonly practiced by healthcare professionals due to the settings of healthcare environments. This study utilized a structured questionnaire for measuring the leadership, stress, and self-efficacy of healthcare professionals. Data collection involved respondents rating these statements on a Likert scale. The sample consisted of 395 participants employed in healthcare organizations in Serbia. The analysis employed partial least squares structural equation modeling (PLS-SEM). The research findings indicate that laissez-faire leadership is positively associated with stress, while no significant negative impact on self-efficacy was observed. Transactional leadership did not demonstrate a significant relationship with reduced stress but was found to positively influence self-efficacy. Moreover, stress was identified as negatively impacting self-efficacy and mediated the association between laissez-faire leadership and self-efficacy, although no mediating effect was found for transactional leadership. This study underscores the critical role of leadership style in shaping the well-being and self-efficacy of healthcare professionals. By understanding how different leadership approaches impact employee stress and job satisfaction, healthcare organizations can tailor their management practices to foster a supportive work environment and enhance overall performance. The results emphasize the need for leaders to balance organizational objectives with employee needs, demonstrating effective communication and adaptability to promote a positive workplace culture.

Exploring the Impact of Transformational and Transactional Style of Leadership on Nursing Care Performance and Patient Outcomes

Background

The form of leadership that can positively influence nursing care performance and patient outcomes remains a crucial subject in the healthcare sector.

Aim

This study examines the effect of leadership style at different managerial levels on nursing care performance and patient outcomes.

Methods

A retrospective cohort study was conducted in a public hospital, focusing on two primary settings: the general ward and the critical care unit. The study sample included 60 nurses and 300 patients. The leadership style is a predictor of this study and was measured using a cross-sectional survey of Jordanian nurses using the Multifactor Leadership Questionnaire (MLQ). Nursing care performance and patient outcomes were measured by surveying patients, observing practice, and reviewing health records. The analysis involved descriptive statistics, chi-square tests, odds ratios, and multivariate regression analysis.

Results

The study found that transformational leadership was predominant in the general ward, while transactional leadership was more common in the critical care unit. Leadership styles significantly influence clinical nursing performance. Nurses under transformational leaders were more likely to follow generic policies like patient surveillance but less consistent with specific care standards. Nurses under transactional leaders were linked to higher adherence to standardized care protocols like fall risk assessment and medication rights. Patient outcomes were similar between units, except for higher readmission rates under transactional leadership.

Conclusion

The study's findings underscore the complexities of nurse leadership styles and clinical nursing performance. Nurse manager should adapt their leadership style to the particular setting and a one-size-fits-all approach to leadership may not be effective in healthcare.

Comparing hospital leadership and front-line workers' perceptions of patient safety culture: an unbalanced panel study

BACKGROUND/AIM

This article examines the relationships between workers' hospital leadership status, hospital front-line status and patient safety culture in hospitals throughout the USA. By identifying possible disparities in perception, targeted interventions can aim at decreasing differences between the two groups to increase the quality of healthcare.

METHOD

Data from 1 739 083 individuals, spreading across 1810 hospitals between 2008 and 2017 were collected. 115 228 (6.63%) self-identified as leaders, and 772 505 (44.42%) self-identified as front-line workers. The participants also filled in information describing their demographics in reference to the hospital, such as how long they have worked at the facility, their working unit and their occupation.

RESULTS

Results showed that leaders responded more positively to items that are directly related to management, such as 'my supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures' (0.33, p<0.01), where 0.33 signifies that leaders had an average response more positive by 0.33 compared with all other occupations on a Likert scale of 1-5. Based on multiple F-tests, all items have shown a statistical significance between leadership and front-line groups.

CONCLUSION

The findings highlight a compelling link between leadership roles and patient safety culture in hospitals, as well as between front-line worker status and patient safety culture. Moreover, a pronounced divergence in viewpoints regarding patient safety culture exists between hospital leaders and front-line staff. An in-depth investigation is necessary to comprehend the ramifications of these outcomes.

Evidence-Based Leadership in Nursing: An Evolutionary Concept Analysis

AIM

To conduct a concept analysis of evidence-based leadership in a nursing context.

METHODS

Rodgers' evolutionary method was employed to identify attributes, antecedents, consequences, definitions and surrogate and related terms.

DATA SOURCE

We systematically searched three databases (PubMed, Cumulative Index to Nursing and Allied Health Literature and Scopus) for relevant publications. The databases were searched from their inception to 4 February 2024.

RESULTS

We included 12 papers published between 2005 and 2022. The attributes include leadership attributes (personality, developing common goals and visions and influencing others) and evidence-based attributes (valuing evidence-based practice, integrating evidence and adapting evidence). The antecedents include individual internal factors (commitment to growth and proficiency in implementation science) and individual external factors (growing need for evidence-based practice, training support and available resources), while the consequences are personal growth, organisational benefit and disciplinary development. Based on the concept analysis, evidence-based leadership can be defined as a process whereby individuals, based on their personality and values towards evidence-based practices, integrate the best evidence into practice, adapt the evidence integration process based on evaluations and influence others towards achieving a common goal and vision.

CONCLUSIONS

This concept analysis enhances our understanding of evidence-based leadership, guiding nurses to integrate evidence into their leadership practices to achieve specific goals and visions within the healthcare context. Future studies could consider developing instruments to evaluate evidence-based leadership based on this refined concept, ultimately promoting nurses' leadership competencies in real-world settings.

IMPLICATION FOR NURSING PRACTICE

This concept analysis not only raises awareness of the responsibilities of nurses as healthcare professionals, including the provision of evidence-based practice, but also facilitates their effective execution of these responsibilities. Empowering nurses to actively incorporate evidence into their leadership practices can further enhance the quality of healthcare delivery.

REPORTING METHOD

Not applicable.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

The effect of lean leadership on workload and job satisfaction: the moderating effect of workload and gender

PURPOSE

The first aim of this study is to determine the effect of lean leadership on the workload and job satisfaction of healthcare workers, and the second aim is to reveal the moderating role of workload and employee gender in this relationship.

DESIGN/METHODOLOGY/APPROACH

In this study, we created a comprehensive model to determine the effect of lean leadership on the workload and job satisfaction of healthcare employees and to reveal the moderating role of workload and employee gender in this relationship. We collected 1,207 valid questionnaires among Turkish health workers.

FINDINGS

The results indicate that: (1) Lean leadership reduces perceived workload, (2) Lean leadership increases job satisfaction, (3) Workload moderates the effect of lean leadership on job satisfaction and (4) Employee gender moderates the effect of lean leadership on job satisfaction and workload. These findings have provided theoretical and practical suggestions for reducing the workload and increasing the job satisfaction of healthcare employees. Finally, we will make some suggestions for the future.

RESEARCH LIMITATIONS/IMPLICATIONS

As with other studies, there are some limitations in this study. The data used in this study were collected in Turkey. Turkish culture has a more collectivist culture than Western countries (Koksal 2011). In addition, the research was carried out with the participation of health employees. Due to Turkish cultural characteristics and the characteristics of health services, the generalization of research results may be limited. Therefore, it is recommended that the research be repeated across different cultures and different sectors to determine whether our results are culture-specific, sector-specific or generalized.

PRACTICAL IMPLICATIONS

Healthcare managers can reduce the perception of employees' workload by showing lean leadership behavior. Healthcare managers can increase their job satisfaction by valuing employees, inviting them to participate in business processes and providing them with the resources they need.

SOCIAL IMPLICATIONS

In order to maintain and increase health workers' job satisfaction, we recommend that health managers should ensure fair job sharing. In addition, health managers should take into account that female employees are more sensitive about the workload.

ORIGINALITY/VALUE

This research is the first study to examine the effect of lean leadership behavior on healthcare professionals' workload perception and job satisfaction. Therefore, it offers important theoretical and practical implications.

Resonant Leadership in Army Nursing: A Concept Analysis

INTRODUCTION

Leadership development is of the utmost importance as the Army Medical Department prepares for future conflicts. All Army Medical Department leaders, including nurses, need to be prepared to lead in a high-tempo, complex environment. Nurse leader effectiveness is paramount to military readiness as well as for recruitment and retention within the Army Nurse Corps (ANC). Both Army talent management and Defense Health Agency documents recognize the importance of Emotional Intelligence principles for successful leadership. Resonant Leadership (RL) is informed by Emotional Intelligence principles and is well-studied within nursing literature. Additionally, the body of evidence examining RL demonstrates a positive impact on the nurse work environment. The purpose of this concept analysis is to define RL within the context of Army nursing, to clarify how this concept relates to Army leadership doctrine, and to propose innovative application(s) of RL within the ANC.

METHODS

Rodgers' evolutionary concept analysis method was used to define the attributes, antecedents, and consequences of RL. The concept elements were then cross-referenced with published Army leadership doctrine, applying RL to the context of Army nursing.

RESULTS

The outcome of this analysis defines RL as a way of being, with attributes including strong, trusting relationships, the leader being in tune with followers, and mutual optimism. Antecedents of RL in Army nursing center on individual leader behavior and include emotional intelligence, technical/management skills and intellect, and acting on follower worries/concerns. Consequences of RL for Army nursing impact followers/staff and include improved job satisfaction, empowerment, and decreased burnout/emotional exhaustion.

DISCUSSION

The defining characteristics of RL complement the competencies and attributes outlined in Army leadership doctrine. Additionally, the outcomes of RL positively influence the nursing work environment. There has been extensive research on the effect of RL within the civilian nursing workforce. However, to date, no studies have researched RL Army nursing. Leaders within the ANC can apply this analysis to their own leadership practice and integrate RL into leadership development education. Policy decisions within the ANC should promote RL to support positive nursing workforce outcomes including improved satisfaction and retention.

CONCLUSION

Resonant Leadership bridges the gap between frontline nursing leadership development, the Army leadership model, and the DHA's Joint Professional Practice Model for nurses. By focusing on developing resonance, Army nurse leaders can simultaneously demonstrate many of the attributes and competencies the Army describes within its leadership doctrine. Although further research is needed to determine the prevalence of RL within Army nursing, RL has applicability to practice and military education. RL is one tool at the disposal of ANC senior to leaders to promote healthy work environments while preparing competent leaders for the complexities of future combat operations.

The relationship between organizational trust and voice behavior among neonatal intensive care unit nurses in tertiary A hospitals in Sichuan Province: the mediating role of career resilience

Background

Neonatal intensive care unit (NICU) nurses face immense pressure, yet research on their voice behavior and the motivational mechanisms behind it is limited. Specifically, the impact of organizational trust and career resilience on this behavior has not been thoroughly explored.

Aim

This study aims to examine the relationship between organizational trust and voice behavior in NICU nurses, with career resilience acting as a mediating factor, providing empirical evidence for nursing management.

Methods

A multicenter cross-sectional survey was conducted from January to June 2023, involving 422 neonatal nurses from tertiary hospitals in Sichuan Province, China. Data were collected using a self-designed questionnaire, a voice behavior scale, an organizational trust scale, and a career resilience scale. Hierarchical regression and structural equation modeling (SEM) were employed to analyze the relationships among the variables.

Results

Hierarchical regression analysis revealed that organizational trust (β = 0.28, p < 0.001) and career resilience (β = 0.45, p < 0.001) significantly predicted voice behavior. Mediation analysis using structural equation modeling confirmed that career resilience mediated the relationship between organizational trust and voice behavior, with a mediation effect of 0.340, accounting for 44.8% of the total effect. The structural model demonstrated good fit indices (CFI = 0.962, RMSEA = 0.045), indicating the robustness of the proposed model.

Conclusion

Organizational trust significantly influences NICU nurses' voice behavior, with career resilience playing a critical mediating role. Enhancing organizational trust and fostering career resilience among NICU nurses can improve their willingness to engage in voice behavior, ultimately leading to better healthcare outcomes.

Implications for nursing management

Nursing managers should foster a trusting and supportive work environment to improve nurses' job satisfaction and organizational commitment. This can be achieved by enhancing psychological empowerment and promoting positive interactions between nurses, the organization, and leadership. Such an environment helps reduce burnout and strengthens career resilience. Increased resilience enables nurses to better manage clinical pressures and challenges, elevating their career expectations and enhancing their willingness to engage in work. This, in turn, promotes innovation, active participation, and improved voice behavior, ultimately contributing to organizational success.

Challenges and Strategies in Nursing Leadership: A Qualitative Study on Leaders in Mental Health Care

AIM

To explore the challenges and strategies among new and experienced nursing leaders in mental healthcare; furthermore, to identify factors that support or hinder their leadership roles.

BACKGROUND

Strong nursing leadership is crucial for the quality of patient care and is associated with higher job security and better patient outcomes. Understanding what factors contribute to effective leadership is essential for the development of future leaders.

METHODS

A qualitative study was conducted through interviews with 20 nursing leaders in mental healthcare in Norway, including 10 new leaders (<2 years in the role) and 10 experienced leaders (>10 years in the role). Data were analyzed using a six-step thematic analysis.

RESULTS

New leaders set high standards and faced demanding tasks, which made the role stressful. They experienced uncertainty and self-doubt about their effectiveness and expressed a need for support from mentors or colleagues. Experienced leaders focused on strategic leadership, task prioritization, and employee motivation, emphasizing the importance of being inspirational, patient, and accessible.

DISCUSSION

This study highlights the different challenges faced by new and experienced leaders in mental healthcare. New leaders need support to build confidence and manage the demands of their roles, while experienced leaders benefit from their strategic approach and ability to motivate staff. Conclusions and implications for nursing and/or health policy: The findings suggest that mentoring programs and support networks are essential for developing and motivating nursing leaders. New leaders should receive support to overcome self-doubt and stress associated with their roles. Experienced leaders can, through being mentors, expand their strategic skills and increase own insight and abilities regarding leadership. These insights have significant implications for health policy, which should include resources and programs aimed at supporting leadership development in nursing.

Assessing the Effect of Transactional Leadership and Empowerment on Nursing Staff's Satisfaction: A Cross-Sectional Study

Aim

The present study aimed to explore the impact of transactional leadership and psychological empowerment on Greek nurses' job satisfaction.

Methods

Α cross-sectional study was conducted in five Greek public general hospitals between January 1 and March 30, 2022. Participants were 608 nurses. The study was conducted using a self-administered questionnaire that included: a) demographic and occupational characteristics, b) the Multifactor Leadership Questionnaire (MLQ), c) the Psychological Empowerment Instrument (PEI), and d) the Kuopio University Hospital Job Satisfaction Scale (KUHJSS).

Results

Mean scores indicated positive perceptions of transactional leadership (3.55 ± 0.72), high levels of empowerment (3.94 ± 0.49), and job satisfaction (leadership 3.92 ± 1.07, working environment 3.34 ± 0.78, motivating factors 4.11 ± 0.89, and team spirit 4.08 ± 0.37). Younger nurses with secondary education exhibited higher satisfaction. Multiple regression analyses identified nurses' level of education, transactional leadership, and psychological empowerment as main predictors of leadership satisfaction (F=4.343, p=.002, R2 =.28, adjusted R2 =.22). Younger nurses with higher empowerment levels and positive attitudes toward transactional leadership reported greater satisfaction from motivating factors (F=6.925, p=.000, R2 =.44, adjusted R2 =.38).

Conclusion

The results of the study showed that nurses' satisfaction from work is mainly derived from leadership, despite the potent effect of psychological empowerment.

The impact of leadership style in team-based primary care - staff satisfaction and motivation

BACKGROUND

Leadership styles, beliefs, and behaviours are an important and critical component to the delivery of quality care in any primary care organisation. The human resource crisis in health care has resulted in greater investments in team-based care; however, some leaders may not have experience working in team-based settings.

AIM

To explore what leadership characteristics, styles, and behaviours were most conducive to employee satisfaction, motivation, and delivery of care in a team-based primary care setting.

DESIGN & SETTING

A qualitative study involving 16 community health centre (CHC) staff from six CHCs across Ontario, Canada.

METHOD

Thematic analysis of qualitative interviews using a framework based on transformational leadership (TL) theory.

RESULTS

The following three themes emerged from our findings as having a noticeable impact on staff motivation, morale, delivery of care, and client outcomes: transparent and open communication; opportunities to collaborate in decision making; and staff recognition and appreciation. The results of our study indicate it is critical that leaders adopt leadership styles and approaches in which every team member is informed, heard, and appreciated.

CONCLUSION

This study described the leadership styles and characteristics that lead to improved employee satisfaction, motivation, and morale in a team-based primary care setting, and the impact this could and does have on quality and delivery of care. Future research is needed to better understand the impact of leadership in a variety of roles within a team-based environment, specifically in a multidisciplinary setting.

Nursing leadership style and error management culture: a scoping review

PURPOSE

This paper aims to assess the influence of nursing leadership style on error management culture (EMC).

DESIGN/METHODOLOGY/APPROACH

This scoping review was conducted following the integrative review methodology of the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, CINAHL, Scopus, Web of Science, Embase and EBSCO databases were systematically searched to identify studies on nursing leadership, error management and measurement, and error management culture. The studies' methodological quality was then assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies.

FINDINGS

Thirteen manuscripts were included for review. The analysis confirmed that nursing leadership plays an important role in EMC and nurses' intention to report errors. Three emerging themes were identified: 1) leadership and EMC; 2) leadership and the intention to report errors; and 3) leadership and error rate.

RESEARCH LIMITATIONS/IMPLICATIONS

A major limitation of the studies is that errors are often analyzed in a transversal way and associated with patient safety, and not as a single concept.

PRACTICAL IMPLICATIONS

Healthcare managers should promote training dedicated to head nurses and their leadership style, for creating a good work environment in which nurses feel free and empowered to report errors, learn from them and prevent their reoccurrence in the future.

ORIGINALITY/VALUE

There is a positive relationship between nursing leadership and error management in terms of reduced errors and increased benefits. Positive nursing leadership leads to improvements in the caring quality.

Unveiling nurses' perspectives on decent work: A qualitative exploration

AIM

This study explores nurses' perspectives on the concept of "decent work" and the factors influencing their viewpoints.

DESIGN

This qualitative study employed a conventional content analysis approach using face-to-face interviews.

METHODS

In-depth interviews were conducted with 20 registered nurses at two tertiary hospitals in Hangzhou, China, from October to November 2023.

FINDINGS

Decent work for nurses refers to their engagement in a profession within a secure, fair, and friendly practice environment where they could receive respect, support, reasonable compensation, social security, and opportunities for career development, all of which could enable nurses to recognize their intrinsic values and achieve a state of professional and personal fulfillment. Key factors that influence decent work for nurses include the work environment, societal perceptions, and individual characteristics.

CONCLUSIONS

The concept of decent work holds paramount importance for nurses, necessitating collaborative efforts at the individual, family, institutional, and societal levels to promote the professional dignity of nurses and enhance the quality of nursing care.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policymakers should establish regional minimum wage standards for nurses, promote flexible scheduling, and support professional development through subsidized training programs. Additionally, national media campaigns and comprehensive mental health support can enhance the public image and resilience of nurses, respectively, improving their decent work perception.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

A systematic review of leadership styles in healthcare sector: Insights and future directions

In light of the ongoing global health crisis, the significance of leadership within the healthcare sector has intensified. Given this consideration, the significance of appropriate leadership styles cannot be overstated. The objective of this paper is to critically review published studies on leadership elements in the healthcare sector. Using Bibliometrix R package and VOS viewer, we conducted bibliometric and network analyses on publications retrieved from the Web of Science (WOS) database, with content analysis integrated throughout the paper to deepen understanding. Ultimately, 243 articles were identified as relevant. The findings revealed transformational leadership emerges as the most extensively discussed leadership style. 91% of the articles' theme focus on quantitative research methods. This study synthesizes the influencing factors of the three most frequently discussed leadership styles-transformational, authentic, and ethical leadership-emphasizing the importance of job satisfaction and organizational citizenship behavior. And provides direction for future research through thematic analysis.

Impact of authentic leadership on nurses' well-being and quality of care in the acute care settings

INTRODUCTION

Both nurses' well-being and quality of care are top priorities of the healthcare system. Yet, there is still a gap in understanding the extent and how authentic leadership influences them. This information is needed to inform the development of effective interventions, organizational practices, and policies. Thus, this study aimed to test the mechanism by which nurses' perception of their managers' authentic leadership impacts nurses' well-being and perception of quality of care, given the role of the nursing practice environment and nurses' psychological capital.

DESIGN

A cross-sectional design was used.

METHODS

This study recruited a random sample of 680 nurses from six hospitals in Saudi Arabia. A final sample of 415 completed the surveys, with a response rate of 61%. Structural equation modeling was performed to test the hypothesized model.

RESULTS

The study showed that nurses' perceptions of authentic leadership in their managers positively and directly affect their perceptions of quality of care but do not directly affect nurses' well-being. Both the nursing practice environment and psychological capital fully mediated the relationship between authentic leadership and nurses' well-being. However, the nursing practice environment partially mediated the relationship between authentic leadership and perceptions of quality of care.

CONCLUSION

The findings contribute to understanding the crucial role of authentic leaders' style in nurses' well-being and quality of care through its positive impact on the nursing practice environment and psychological capital.

CLINICAL RELEVANCE

Designing interventions and policies that specifically target nursing managers' authentic leadership style has implications for enhancing nurses' well-being and the quality of patient care. Institutional measures are needed to help leaders practice an authentic leadership style to create a positive nursing practice environment and cultivate nurses' psychological capital, both of which contribute to nurses' well-being and attaining a better quality of care. Further work is required to highlight the outcomes of implementing an authentic leadership style relevant to other leadership styles.

Relevant factors affecting nurse staffing: a qualitative study from the perspective of nursing managers

Objective

To understand the current situation of nursing manpower allocation, explore the factors affecting nurse staffing, improve nurse staffing level, and provide reference for better formulation of nursing human resources staffing standards.

Methods

A descriptive research method was used to conduct semi-structured interviews with 14 nursing managers. The data were analyzed and refined by content analysis. The sample size was subject to content saturation.

Results

Nine themes and twenty sub-themes of influencing factors for nursing staffing were identified across four levels: hospital level, department level, patient level, and nurse level.

Conclusion

Hospital and department managers need to comprehensively consider the factors of affecting nurse staffing. Adopting multidimensional optimization measures, improving relevant systems, optimizing nurse structure, and establishing flexible and mobile nurse database to cope with public emergencies, so as to effectively improve nurse staffing and nursing service quality.

Mapping ward managers' core competencies using the Balanced Scorecard model

BACKGROUND

Nurse ward managers have a crucial role in the effective functioning of hospital wards and in organising the work of the nursing team. The Balanced Scorecard model is a management framework that enables strategy to be translated into action by setting goals that lead to measurable outcomes. Few studies have used the Balanced Scorecard model to map the competencies of healthcare professionals.

AIM

To use the Balanced Scorecard model to map the core competencies of nurse ward managers and determine relevant key performance areas (KPAs) and key performance indicators (KPIs).

METHOD

This mixed-methods study was conducted in the surgical department of an Italian hospital using a qualitative and quantitative exploratory sequential approach. For the quantitative part, the authors asked a convenience sample of various clinical staff to rate a list of nine competencies in terms of their importance for the work of nurse ward managers. For the qualitative part, two focus group discussions were held with nurse ward managers.

FINDINGS

Responses to the questionnaires showed that all nine competencies were important to respondents, with no statistically significant differences between roles. Findings from the focus group discussions broadly confirmed the relevance and importance of the nine competencies. Based on these findings, the authors formulated a strategic map of the nurse ward manager role, with core competencies and associated objectives mapped against the four dimensions of the Balanced Scorecard model.

CONCLUSION

A strategic map of the nurse ward manager role informed by the Balanced Scorecard model can help measure nurse ward managers' performance and provide a benchmark for them to improve their competencies.

Nurse managers' managerial innovation and it's relation to proactivity behavior and locus of control among intensive care nurses

BACKGROUND

The nursing profession is undergoing rapid transformation, requiring innovation in management approaches and proactive behaviors among staff. Nurse Managers play a vital role through managerial innovation, but its impacts on intensive care nurses' proactivity and locus of control remain underexplored.

OBJECTIVES

This study aimed to assess the levels of Nurse Managers' managerial innovation and relate it to proactivity behaviors and locus of control orientations among intensive care nurses.

METHODS

A cross-sectional correlational design was adopted, recruiting 242 intensive care nurses from Tanta University Hospital, Egypt. Participants completed standardized questionnaires measuring perceived managerial innovation, proactivity behavior, and locus of control.

RESULTS

Nurse Managers demonstrated moderately high innovation across all dimensions, especially in continuous learning and development (mean = 4.65) and advanced technology use (mean = 4.56). Nurses exhibited sound proactivity levels, particularly in adaptability (mean = 4.40) and planning (mean = 4.35). The majority of nurses showed an internal locus of control (64.5%). Managerial innovation had significant positive correlations with nurses' proactivity (r = 0.45, p < 0.001) and internal locus of control (r = 0.42, p < 0.001). Regression analysis revealed age, gender, experience, education, and ICU type as significant predictors of proactivity and locus of control.

CONCLUSION

Innovative nursing leadership positively influences staff's proactivity levels and perceived control over their practice. This underscores the vital role of nurse managers in creating empowering environments in intensive care.

[Sistematic review on the influence of leadership style on job satisfaction of health professionals]

INTRODUCTION AND OBJECTIVES

Healthcare organisations are highly complex entities that live with a high risk of instability. In order to minimise this instability, interactions and personal relationships play a major role and accordingly the figure of the leader gains full significance. The leadership style used can produce different reactions and lead to multiple outcomes, including job satisfaction. The aim of the present review is to correlate leadership style with job satisfaction in healthcare professionals.

MATERIAL AND METHODS

A systematic review was carried out in BVS, Cochrane plus, CINAHL, ApaPsycinfo and Pubmed, selecting publications that mentioned leadership styles and job satisfaction in healthcare professionals. Publications search strategy were limited for the 5-10last years, full text availability and language of writing: English, French and Spanish. Review-type publications were excluded. Of the 1566 initial titles, 15 were selected for analysis.

RESULTS AND CONCLUSIONS

The transformational style showed the highest number of positive correlations, followed by the authentic and transactional styles. On the other hand, the passive and laissez-faire styles showed a negative correlation regardless of the professional category to which they belonged. The results of this study provide a starting point for adopting effective leadership styles to optimise the recruitment and training processes of staff in management and coordination roles.

Leading and managing a multidisciplinary team in health and social care: a critical and personal reflection

This article presents a synthesis of the leadership and management knowledge and experience gained while participating in project work in health and social care. The first part presents a critical evaluation of leadership and management across health and social care services, with a focus on a multidisciplinary team in a ward setting. The second part presents a critical reflection on a personal leadership and management experience during the project using an appropriate model of reflection, a synthesis of lessons learnt and application to future practice as a registered nurse. A range of theories and frameworks related to leadership, management and team working are critically evaluated and a critical understanding of both political and economic perspectives within today's healthcare system is presented.

Interventions to support nurses as second victims of patient safety incidents: A qualitative study of nurse managers' perceptions

AIMS

To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them.

DESIGN

A qualitative study using interviews.

METHODS

A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis.

RESULTS

The study identified three main categories: (1) Management of second victim support, which contained three sub-categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub-categories developing practices and developing an open and non-blaming patient safety culture.

CONCLUSION

Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Mitigating the harmful effects of patient safety incidents can improve nurses' well-being, reduce burden and attrition risks and positively impact patient safety.

IMPACT

Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work.

REPORTING METHOD

COREQ checklist was used. What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support. Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work.

Is the National Early Warning Score able to identify nursing activity load? A prospective observational study

BACKGROUND

The National Early Warning Score scale correlates well with the intensity of the patient's acute condition. It could also correlate with the nursing activity load and prove useful in defining and redistributing nursing resources based on the acuity of patients.

AIM

To assess whether patients' National Early Warning Score at hospital admission correlates with objective nursing demands and can be used to optimize the distribution of available care resources.

METHODS

This single-center prospective study included patients admitted to the Department of Internal Medicine at the Civil Hospital in Altovicentino (Italy) between September 1 and December 31, 2022. Nursing activities were recorded for the first three days after admission and standardized to the daily mean as performance/5 min/patient/day. Linear regression was used to assess the correlation between nursing demands for different National Early Warning Scores.

RESULTS

This study included 333 patients. Their mean National Early Warning Score was 3.9 (standard deviation: 2.9), with 61 % (203/333) in the National Early Warning Score <5 category, 19.5 % (65/333) in the National Early Warning Score 5-6 category, and 19.5 % (65/333) in the National Early Warning Score >6 category. Their average daily care requirements increased from 22 (16-30) activities/5 min/patient/day in the low National Early Warning Score category to 30 (20-39) activities/5 min/patient/day in the intermediate National Early Warning Score category (p < 0.001) and 35 (23-45) activities/5 min/patient/day in the high National Early Warning Score category (p < 0.001).

CONCLUSION

The National Early Warning Score correlates with nursing care activities for patients with an acute condition and can be used to optimize the distribution of available care resources.

Effects of Length of Employment and Head Nurse Leadership Style on the Clinical Competency of Staff Nurses in Taiwan

BACKGROUND

High-quality patient care requires nurses with strong clinical competency. Thus, it is essential to examine the factors associated with clinical competency.

PURPOSE

This study was designed to (a) investigate head nurse leadership, staff nurse demographics, and clinical competency; (b) examine the impact of demographics on the clinical competency of staff nurses; (c) analyze the correlation between head nurse leadership and staff nurse clinical competency; and (d) examine the effects of demographics on clinical competency after controlling for the head nurse leadership.

METHODS

A cluster sampling method was used to collect data from 200 staff nurses at a national medical center in Taiwan. Questionnaires were used to gather information on head nurse leadership style and staff nurse clinical competency. Descriptive and inferential statistical analyses were conducted, including Mann-Whitney U test, Kruskal-Wallis test, Spearman's rank correlation coefficient, and multivariate analysis of covariance.

RESULTS

The average score for transformational leadership style among the head nurses was 2.89, whereas transactional leadership style scored an average of 2.49. The average scores for the components of clinical competency, listed from highest to lowest, were as follows: patient care (3.35), professionalism (3.28), communication skills (3.18), management (2.84), and knowledge (2.73). In addition, statistically significant differences were found in clinical competency based on demographic factors, including age, marital status, educational level, job title, and length of employment. Also, a statistically significant, positive correlation between the head nurse transformational leadership style and nurse clinical competency was found. The main effect of length of employment on the five competency components was statistically significant after controlling for transformational leadership. Furthermore, post hoc analysis of covariance revealed a significant effect of length of employment on patient care, knowledge, communication skills, and management.

CONCLUSIONS

The findings of this study indicate transformational leadership and employment length impact the clinical competency of staff nurses, particularly in terms of patient care, communication skills, management, and knowledge. Providing education and training in leadership and management to current and prospective head nurses may be expected to enhance clinical competency in staff nurses and create a more nurturing work environment. Moreover, targeted training may help current head nurses gain insight into their leadership styles and acquire skills to promote transformational leadership. In addition, leadership development may help equip prospective head nurses with critical competencies before assuming leadership responsibilities.

Personal and organisational attributes that support transformational leadership in acute healthcare: scoping review

Objective Transformational leadership benefits both patients and staff. The objective of this scoping review was to explore personal and organisational attributes that support transformational leadership in acute health care. Methods A scoping review was undertaken using Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Medline Complete, PsycInfo and Emerald Insight databases. Search terms were related to transformational leadership and acute care hospitals. Results A total of 18 studies were included: 14 reported personal attributes and 8 reported organisational attributes supporting transformational leadership. The most common personal attributes were manager educational preparation (n  = 5), years of management experience (n  = 4), age (n  = 3) and emotional intelligence (n  = 3). The most common organisational attributes reported were larger organisational size (n  = 2) and culture (n  = 2). Personal (manager) attributes were synthesised into the following categories: demographics, role characteristics, leadership preparation and traits. Organisational attributes were categorised as manager support, organisational characteristics and organisational processes. Conclusions Despite the beneficial outcomes of transformational leadership for patients, staff and organisations, the personal and organisational attributes supporting transformation leadership are not well understood.

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

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

Organizational Climate for Inclusion Among Nurses: A Mixed-Methods Analysis

OBJECTIVE

The aim of this study was to answer the research question: What factors predict sense of belonging among nurses?The connection between inclusion (an element of diversity and equity) and a nurse's sense of belonging is poorly understood.

METHODS

In this mixed-methods research, regression analysis of Climate for Inclusion Scale subscales and Sense of Belonging score plus thematic content analysis of questions assessing sense of belonging were conducted. Nurses (n = 131) attending a research conference in June to July 2022 were invited to participate; 131 (72%) participated.

RESULTS

Climate for Inclusion Scale was positively associated with and predictive of sense of belonging (F3,113 = 71.7, P < 0.001). Themes reflecting actions to enhance sense of belonging were as follows: authentic leadership, embracing social justice, team unification, feeling heard, being seen, professional development, developing a healthier work environment, and integration of differences.

CONCLUSIONS

Leaders can promote a sense of belonging among nurses by focusing on actions reflected in the themes.

[Shortage of nurses in Spain: from the global case to particular situation. SESPAS Report 2024]

The nursing shortage is a multi-causal phenomenon that affects all countries and currently a global concern. The shortage of nurses jeopardizes the sustainability of health systems and the population health outcomes. Spain has historically had no difficulties in attracting new generations of nurses. The shortage of nurses is caused by the precarious working conditions and lack of professional development that have led to episodes of high international migration and abandonment of the profession. In this paper we focus on the evolution of different indicators of the working conditions of non-specialist nurses, who make up the bulk of the profession. These indicators allow us to analyse the abandonment of the profession, the duration of contracts, their full-time or part-time dedication and the excessive hiring. We have analysed the effect of COVID-19 and the labour reform on these indicators. COVID-19 reduced the abandonment of the profession and is currently at its lowest level, it has also accelerated the need to improve working conditions by increasing the percentage of permanent contracts and reducing the multiplicity of contracts in the same month. The labour reform has helped reduce the percentage of temporary contracts until reaching around 80% of the total contracts, and has reduced the number of nurses in Spain with more than one contract in the same month to below 3000 nurses on a sustained basis.

Transformational nurse leadership attributes in German hospitals pursuing organization-wide change via Magnet® or Pathway® principles: results from a qualitative study

BACKGROUND

Budget constraints, staff shortages and high workloads pose challenges for German hospitals. Magnet® and Pathway® are concepts for implementing organization-wide change and redesigning work environments. There is limited research on the key elements that characterize nurse leaders driving the implementation of Magnet®/Pathway® principles outside the U.S. We explored the key attributes of nurse leaders driving organization-wide change through Magnet®/Pathway® principles in German hospitals.

METHODS

Using a qualitative study design, semi-structured interviews (n = 18) were conducted with nurse leaders, managers, and clinicians, in five German hospitals known as having started implementing Magnet® or Pathway® principles. The interviews were recorded and transcribed verbatim. Data were analyzed in Atlas.ti using content analysis. For the analysis, a category system was created using a deductive-inductive approach.

RESULTS

Five leadership attributes and eleven sub-attributes were identified as main themes and sub-themes: Visionary leaders who possess and communicate a strong vision and serve as role models to inspire change. Strategic leaders who focus on strategic planning and securing top management support. Supportive leaders who empower, emphasizing employee motivation, individualized support, and team collaboration. Stamina highlights courage, assertiveness, and resilience in the face of challenges. Finally, agility which addresses a leader's presence, accessibility, and rapid responsiveness, fostering adaptability.

CONCLUSIONS

The study demonstrates leadership attributes explicitly focusing on instigating and driving organization-wide change through Magnet®/Pathway® principles in five German hospitals. The findings suggest a need for comprehensive preparation and ongoing development of nurse leaders aimed at establishing and sustaining a positive hospital work environment.

Areas of professional life and job satisfaction of nurses

Introduction

Job satisfaction among nurses is closely related to work environment as well as organizational and professional commitment. Satisfaction is a concept derived from Latin, where "satis" means "enough," as much as is needed to fully satisfy expectations, needs, aspirations, in such a way that there is no room for complaint. Job satisfaction, on the other hand, is formulated as a positive attitude of employees toward the duties of the job, the work environment and other employees. The aim of this paper was to demonstrate how the different areas of nurses' professional life, i.e., workload, control, rewards, community, sense of justice and values, correlate with their perceived job satisfaction.

Materials and methods

A cross-sectional study was conducted in a group of 509 nurses working in a public hospital in Poland. Data were collected using a survey questionnaire, which consisted of a section containing sociodemographic data and standardized instruments: The Minnesota Satisfaction Questionnaire (MSQ) and The Areas of Worklife Survey (AWS) developed by Maslach and Leiter. Correlations were made using Spearman's rho coefficient. The calculations also used stepwise linear regression analysis after checking certain assumptions, including checking the assumption of normality of residuals and the Durbin-Watson Test.

Results

The mean score for the 20 items of the MSQ questionnaire ranged from 3.05 to 3.43 on a 5-point Likert scale. Support from the interdisciplinary team, which concerned assessing the quality of the social environment in the workplace, cooperation and showing positive feelings received the highest rating among respondents (3.51 ± 0.76). The sense of fair treatment at work averaged 3.26 ± 0.58. The area of value conflict within the organization itself or between the employee's values and those of the organization, respondents rated an average of 3.26 ± 0.65. The mean score for all areas of professional work in the surveyed group was 3.09 ± 0.45.

Conclusion

As satisfaction in particular areas of work life increases, so does the level of satisfaction in such aspects of work as achievement and a sense of fairness. The higher the level of satisfaction in the area of control, the more the sense of satisfaction with independence increases. The higher the satisfaction of respondents in the areas of values, workload and control, the higher the level of satisfaction with working conditions occurs.

Different but Synergistic Effects of Union and Manager Leadership on Member Job Satisfaction

Existing research has tended to overlook the diverse roles of union leadership in contributing to member attitudes. Drawing on the social information processing theory, this study examines how union leaders' (shop stewards) service-oriented leadership relates to member job satisfaction. To clarify the mechanism underlying this relationship, this study focuses on union instrumentality as a mediator. The research also examines managers' ethical leadership as a conditional factor in the relationship between union leaders' service-oriented leadership and member job satisfaction through union instrumentality. To test our hypothesis, this study analyzed the results of a survey of 603 respondents from two branches of the Korean Metal Workers' Union. The findings of this study indicate that union instrumentality is the link between service-oriented union leadership and member job satisfaction. Additionally, the strength of the mediated relationship between the aforementioned factors through union instrumentality is contingent on managerial ethical leadership. This study contributes to an integrated understanding of the way in which service-oriented union stewards and ethical managers influence member job satisfaction through their leadership.

Evidence behind the exhortation? A rapid review of servant leadership's influence and claims in healthcare over the last decade

Servant leadership is an other-oriented approach to leadership with multiple positive outcomes. However, its influence in the context of medicine, particularly on healthcare leaders, is less clear. We conducted a rapid review to examine the impact of servant leadership in healthcare over the last decade. We included a total of 28 articles, 26 of which described beneficial organisational, relational and personal outcomes of servant leadership. However, most of these were either conceptual or opinion-based articles. Moreover, most quantitative studies were cross-sectional, precluding causal inferences. Our review demonstrates that the purported positive association between servant leadership and healthcare outcomes lacks a strong evidence base. We conclude by calling for more rigorous empirical research to examine the effects and potential challenges of implementing servant leadership in healthcare contexts.

Exploring collaboration reasons and leadership styles in Dutch primary oral healthcare practices

AIMS

To outline the extent to which practice owners in Dutch oral healthcare practices (OHPs) use a directive and supportive leadership styles, to map out which goals practice owners in Dutch OHPs consider most important when choosing collaboration within the practice and to identify the reasons why oral healthcare professionals choose to engage in collaborative practice.

MATERIALS AND METHODS

A survey involving 802 general dental practitioners, dental hygienists, and prevention assistants was conducted. The questionnaire covered, among other subjects, leadership styles and reasons for collaboration. Data analysis included descriptive statistics, chi-square tests, one-way ANOVA, linear regression, and logistic regression.

RESULTS

Compared to employees, practice owners ascribe to themselves more characteristics of both directive and supportive leadership. The most frequently mentioned reasons for choosing a practice form that involves collaboration were the possibilities to provide the best care and the desire to focus on prevention. Healthcare providers chose to work in a collaborative practice for several reasons, which were associated with profession, age and gender.

CONCLUSIONS

The degree of directive and supportive leadership among practice owners in dental care practices in the Netherlands showed a strong correlation. The most frequently mentioned reasons for choosing collaboration were related to healthcare content.

Factors associated with health professionals' stress reactions, job satisfaction, intention to leave and health-related outcomes in acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organisations

The aim of this study is to identify (1) the extent of work-related stress and (2) stressors associated with cognitive and behavioral stress reactions, burnout symptoms, health status, quality of sleep, job satisfaction, and intention to leave the organization and the profession among health professionals working in acute care /rehabilitation hospitals, psychiatric hospitals, nursing homes, and home care organizations.

BACKGROUND

Health professionals are faced with various stressors at work and as a consequence are leaving their profession prematurely. This study aimed to identify the extent of work-related stress and stressors associated with stress reactions, job satisfaction, and intention to leave and health-related outcomes among health professionals working in different healthcare sectors (acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organizations).

METHODS

This study is based on a repeated cross-sectional design, which includes three data measures between 2017 and 2020 and 19,340 participating health professionals from 26 acute care / rehabilitation hospitals, 12 psychiatric hospitals, 86 nursing homes and 41 home care organizations in Switzerland. For data analysis, hierarchical multilevel models (using AIC) were calculated separately for hospitals, nursing homes, and home care organizations, regarding health professionals' stress symptoms, job satisfaction, intention to leave the organization / profession, general health status, burnout symptoms, and quality of sleep.

RESULTS

The main findings reveal that the incompatibility of health professionals' work and private life was significantly associated (p < 0.05) with their stress reactions, job satisfaction, intention to leave, and health-related outcomes in all the included work areas. The direct supervisor's good leadership qualities were also associated with health professionals' job satisfaction regarding all work areas (B ≥ 0.22, p = 0.000). In addition, a positive perceived bond with the organization (B ≥ 0.13, p < 0.01) and better development opportunities (B ≥ 0.05, p < 0.05) were associated with higher job satisfaction and a lower intention to leave the organization and profession among health professionals. Also, a younger age of health professionals was associated with a higher intention to leave the organization and the profession prematurely in all the included work areas. High physical (B ≥ 0.04, p < 0.05) and quantitative demands (B ≥ 0.05, p = 0.000) at work were also associated with negative health-related outcomes.

Real requirements of nursing activities and patient-related factors related to nursing overload in an internal medicine department

Adequate nursing care can be decisive for the outcome of a patient admitted to an internal medicine ward. Individual prediction of nursing activity at the time of a patient's admission could improve the work process. This study aimed to assess the objectively assessed nursing requirements of patients admitted to a medical setting and to identify clinical factors that correlate with high demands. This is a prospective and pragmatic observational study that enrolled patients admitted to the Internal Medicine ward at the Altovicentino Civil Hospital (Italy) between September 1 and December 31, 2022. Nursing activities were recorded for the first 3 days of hospitalization and standardized as performance/5 min/patient. Patients requiring more than the 75th percentile of performance/5 min/patient were considered nursing over-activities. Multivariable models were used to assess patient-related risk factors associated with nursing over-activity. This study enrolled 333 patients (mean age: 74.2; 55.6% male). Their mean Charlson Comorbidity Index (CCI), Clinical Frailty Scale (CFS), Chronic Barthel Index, and Sistema Informtativo della Performance Infermieristica (SIPI) scores were 5.3, 4.2, 62.4, and 53.7, respectively. Mean National Early Warning System (NEWS) on admission was 3.9 (standard deviation: 2.8). A median of 73 (interquartile range [IQR]: 54-109) nursing care activities/5 min/patient were performed. NEWS score (odds ratio [OR]: 1.372, 95% confidence interval [95%CI]: 1.216-1.547, p < 0.001) and Acute Barthel Index (OR: 0.983, 95%CI: 0.967-0.999, p = 0.041) were independent risk factors for nursing over-activities. NEWS and the Acute Barthel Index could help reorganize nursing resources within internal medicine wards, allowing for an equal distribution between patients who require more resources and those who require less.

Assessment of management styles among top nursing leaders in Slovenian primary health centers: a cross-sectional analysis

PURPOSE

This study aims to endeavor to discern the predominant leadership styles used by nursing managers within the framework of Slovenian primary health centers. Using a quantitative research approach, the study was conducted through the administration of a structured questionnaire.

DESIGN/METHODOLOGY/APPROACH

The investigation encompassed 67 nursing managers, representing the entire spectrum of primary health centers in Slovenia. A stratified representative subset comprising 53 top nursing managers actively participated in this study.

FINDINGS

The prevailing leadership style among nursing managers predominantly manifests as the "integrated" style, characterized by a balanced emphasis on both interpersonal relationships and task-oriented elements. These nursing leaders exhibited a proclivity for fostering collaborative teamwork, with their leadership approach notably shaped by traits such as positive thinking, self-assuredness, comprehensive leadership knowledge and an intrinsic motivation to guide and inspire individuals. Notably, leadership knowledge emerged as the most influential factor in determining the selected leadership style. The study's findings recognize specific areas in which leadership competencies among nurse managers may require further enhancement and development.

ORIGINALITY/VALUE

The study's findings are based on a specific subset of nursing leaders in a particular region, which can add to the originality, especially as there is limited prior research in this specific context. The study's exploration of leadership styles is original in the sense that it provides insights into the leadership behaviors and traits of nursing managers in the given context. The emphasis on factors such as positive thinking and leadership knowledge as influential elements adds originality to the study.

Entrepreneurial leadership, nurses' proactive work behavior, and career adaptability: a structural equation model

BACKGROUND

Healthcare organizations with practitioners who exhibit proactive work behavior and career adaptability acquire a competitive advantage in the face of many adversities. Entrepreneurial leadership (EL) is a new leadership approach that has a huge impact on followers' behavior, although research into its theory and empirical evidence is still in its infancy.

METHODS

A non-probability convenience sample methodology (n = 450) was utilized to choose study participants, who were equally dispersed among the two private hospitals in Alexandria. A cross-sectional study was carried out in all departments of the hospitals, which were chosen at random using a simple random procedure. Three validated scales were used in this study to measure the study variables and establish a structural equation model.

RESULTS

The result of this study revealed that nurses perceived moderate mean scores of all variables; entrepreneurial leadership (140.84 ± 11.94), proactive work behavior (46.02 ± 5.85), and career adaptability (85.55 ± 10.35). In addition, the structured equation model revealed a goodness fit index and presents that entrepreneurial leadership significantly affects nurses' proactive work behavior with an estimated β of 0.555, coefficient of regression C.R. of 4.006, at P value < 0.001. Also, it significantly affects career adaptability with an estimated β of .834, a coefficient of regression C.R. of 3.491 at P value < 0.001.

CONCLUSIONS

The developed structural equation model confirmed the significant impact of entrepreneurial leadership (EL) on nurses' proactive work behavior (PWB) and career adaptability (CA)". Therefore, this study offers important implications for nurse managers, staff nurses, hospital human resources management practice, and academics.

The moderating effect of perceived organizational support on presenteeism related to the inclusive leadership

AIM

This study aimed to assess inclusive leadership and presenteeism among clinical nurses and to examine the moderating effect of perceived organizational support on presenteeism related to the inclusive leadership among nurses.

BACKGROUND

Nurses' presenteeism has become common. In hospitals, inclusive leadership is an acknowledged leadership style that has a positive influence on nurses. However, little emphasis has been paid to research on their relationships and moderating effect.

METHODS

A cross-sectional study was undertaken to assess 2222 nurses using a general information questionnaire, Stanford Presenteeism Scale (SPS-6), Perceived Organisational Support Scale, and Inclusive Leadership Scale. Study variables were analyzed using descriptive statistics, correlation, and structural equation modelling (SEM).

RESULTS

Presenteeism was relatively severe among clinical nurses. There were correlations between inclusive leadership, perceived organizational support and presenteeism. Perceived organizational support moderated the relationship between inclusive leadership and presenteeism.

DISCUSSION AND CONCLUSION

Nursing managers should actively adopt an inclusive leadership style and improve nurses' sense of perceived organizational support to improve clinical nurses' presenteeism behaviors.

IMPLICATIONS FOR NURSING POLICY AND PRACTICE

Healthcare organizations and nursing managers should pay attention to the psychological needs of their nurses, provide complete understanding and support, encourage staff to actively participate in their work and contribute new ideas and opinions, reduce the incidence of presenteeism, and improve nurses' sense of well-being at work.

Nurses' Workplace Perceptions in Southern Germany-Job Satisfaction and Self-Intended Retention towards Nursing

Our cross-sectional study, conducted from October 2022 to January 2023, aims to assess post-COVID job satisfaction, crucial work dimensions, and self-reported factors influencing nursing retention. Using an online survey, we surveyed 2572 nurses in different working fields in Bavaria, Germany. We employed a quantitative analysis, including a multivariable regression, to assess key influence factors on nursing retention. In addition, we evaluated open-ended questions via a template analysis to use in a joint display. In the status quo, 43.2% of nurses were not committed to staying in the profession over the next 12 months. A total of 66.7% of our surveyed nurses were found to be dissatisfied with the (i) time for direct patient care. Sources of dissatisfaction above 50% include (ii) service organization, (iii) documentation, (iv) codetermination, and (v) payment. The qualitative data underline necessary improvements in these areas. Regarding retention factors, we identified that nurses with (i) older age, (ii) living alone, (iii) not working in elder care, (iv) satisfactory working hours, (v) satisfactory career choice, (vi) career opportunities, (vii) satisfactory payment, and (viii) adequate working and rest times are more likely to remain in the profession. Conversely, dissatisfaction in (ix) supporting people makes nurses more likely to leave their profession and show emotional constraints. We uncovered a dichotomy where nurses have strong empathy for their profession but yearn for improvements due to unmet expectations. Policy implications should include measures for younger nurses and those in elderly care. Nevertheless, there is a need for further research, because our research is limited by potential bias from convenience sampling, and digitalization will soon show up as a potential solution to improve, e.g., documentation and enhanced time for direct patient time.

Advancing our understanding of humble leadership in healthcare: a scoping review

PURPOSE

This study aims to advance the understanding of humble leadership (HL) in health care.

DESIGN/METHODOLOGY/APPROACH

This study presents a scoping review to explore and synthesize the existing knowledge in the literature. The search process encompassed three main online databases, PubMed, Scopus and Web of Science. Due to the novelty of the topic of HL in health care and the lack of research in this area, all articles published until the end of February 2023 were considered in this study.

FINDINGS

A total of 18 studies were included. The results showed that in the period of 2019-2023 more attention was paid to HL in health care than in previous years. The research design used in these articles included quantitative (n = 13) and qualitative (n = 5) methods and the statistical population included nurses, hospital employees and health-care department managers. Based on the results obtained, the definition of HL can be divided into two general approaches, including self-evaluation and the way one treats others. In addition, humble leaders in the health-care sector should exhibit certain behavioral characteristics and finally, the results indicated that HL has several positive consequences; however, little attention has been paid to the factors influencing HL in health care.

PRACTICAL IMPLICATIONS

This research will help practitioners gain a deeper understanding of the various applications of HL in health care.

ORIGINALITY/VALUE

To the best of the authors' knowledge, no comprehensive research review has yet been conducted on the application of HL in health care.

Engaging, Binding and Retaining Nurses: The Success Formula of an Exemplary Ward

Background

Nurse staffing remains an ongoing issue in healthcare worldwide. However, a Dutch urology ward has hardly any staffing difficulties. Nevertheless, it remains challenging to grasp what exactly is the success formula of the ward. Investigating a practical example of a successful ward will facilitate a deeper understanding of the application of current knowledge. Furthermore, novel concepts offer potential solutions to current problems. There is a need of putting the knowledge into practice.

Objective

The objective is to identify the factors that contribute to the success of the urology ward in engaging, binding, and retaining nurses, to provide practical insights and opportunities for other wards.

Methods

The Dutch Model for Excellent Care forms the basis of a prospective, qualitative research study with focus groups. Twelve nurses were divided into three focus groups, based on work experience. They were asked about why they love working on the ward. Analysis was performed using Braun and Clarke's method for thematic analysis. Emerged themes were presented, substantiated by quotes.

Results

Four themes and twelve subthemes became apparent: (a) Supportive structures: nursing governance, professional development, and quality of leadership. (b) Optimal work environment: working with skilled nurses, a professional relationship with physicians and professional autonomy. (c) Team culture: feeling seen, good ambiance, and equality. (d) Specialty of urology: variation in work, workload, and the type of patient.

Conclusions

Nurses are uniquely positioned to provide invaluable insight into their needs. They illuminated the crucial importance of fostering a work environment that prioritizes both professional as well as personal needs.

Leadership styles on job satisfaction and security among healthcare workers during the COVID-19 pandemic

BACKGROUND

Hospitals employ many social workers, whose tasks are complicated and arduous. Quality of life assessments by healthcare professionals (HCWs) are essential for better healthcare and skillful health service delivery. HCWs have been under tremendous mental and psychological strain and at high risk of virus acquisition since the COVID-19 pandemic outbreak.

OBJECTIVE

This study evaluated public hospital efficiency issues and remedies in the Kingdom of Saudi Arabia.

METHODS

The study examined leadership styles and job satisfaction among Saudi Arabian healthcare workers (HCWs). Between September 1 and December 31, 2021, a descriptive cross-sectional investigation was conducted. During the COVID-19 pandemic, a verified web-based survey reached the appropriate sample and data was collected. A web-based self-administered survey collected demographic data, leadership style using Multifactor Leadership Questionnaire Form 6-S (MLQ-6S), and health care employee satisfaction (SEHC) from HCWs.

RESULTS

Leadership styles affected HCW job satisfaction, according to this study. Individual concern, idealized influence, contingent compensation, and inspiring motivation were negatively correlated with work satisfaction ratings.

CONCLUSION

Creating a special training programme for new leaders should cover leadership styles and approaches, the skills needed to foster a productive workplace with high-quality care, and the creation of motivated work opportunities that can boost worker engagement and satisfaction.

Recruiting Nurse Participants in Ambulatory Care Nursing Research

Patient care needs in ambulatory care (AC) settings continue to grow and evolve in the United States, with commensurate growth of nursing responsibilities in AC. Conducting research on the nursing workforce and nursing practice is essential to understanding and meeting the needs of nurses and patients in this setting. However, the structures and characteristics of AC settings pose challenges for conducting research on AC nursing practice. This article explains unique barriers to participation in research for nurses in AC, describes recruitment challenges for nurse researchers in AC, and provides strategies to increase recruitment of nurses for AC research. Researchers in AC must find ways to recruit representative participant samples, be clear and precise in defining terms, and report robust demographic information about participants and their practice settings.

The role of the nursing coordinator and the leadership style in the Italian healthcare organizations

BACKGROUND AND AIM

The leadership of the Nursing Coordinator is essential to ensure quality care and to empower the nursing staff. To identify the leadership style used by the coordinator as nurses and the support staff perceive the leadership behaviors of the coordinator.

METHODS

Data were collected through an online questionnaire including the Empowering Leadership Questionnaire.

RESULTS

Positive associations were recorded between participants' satisfaction levels and high standards of job performance (p<0.001), being a good example for the whole group (p=0.004) and to encourage sharing ideas and suggestions (p=0.003), hearing ideas and suggestions (p=0.013), giving the opportunity to express their opinions (p=0.046); in the "Coaching" dimension, according to attitudes to help the group to become aware (p<0.001), among all group members (p=0.044); by focusing on their goals (p<0.001); in the "Informing" dimension according to levels and attitudes to explain decisions (p<0.017) and rules and expectations (p=0.046); in the "Showing Concern/Interacting with the Team" dimension according to attitude in personal problems (p<0.028); to discuss concerns (p=0.033); to show interest (p<0.040) and to chat with members (p=0.003). Negative association was registered between the ability to make decisions based solely on the coordinator's ideas (p=0.010), ability to pay attention to the group's efforts (p<0.015).

CONCLUSIONS

The role of the Nursing Coordinator within the work setting is very fundamental. The latter must be able to guarantee, through good leadership, a serene work environment so that professionals can provide optimal care to patients and safeguard their profession.

Ethical leadership in physical therapy: a developing construct that demands consideration

PURPOSE

This paper aims to introduce the Theory of Ethical Leadership as a possible means of actualizing the mission and vision statements of the American Physical Therapy Association as well as individual professional objectives. Specific examples of how this can be applied directly to the profession of physical therapy will be presented.

DESIGN/METHODOLOGY/APPROACH

Leadership influences can profoundly affect a profession, an organization and an individual. This has led to exploring which leadership style would be most effective in moving their organization forward. Through a review of the literature, this viewpoint paper compares leadership theories present in the health-care literature, as well as why they may fall short of actualizing the mission and vision statements of the American Physical Therapy Association as well as individual professional objectives.

FINDINGS

Most research has separated ethics from leadership, but all agree that to be successful, the leader needs to exhibit a strong moral compass and demonstrate positive ethical behavior. At the intersection of ethics and leadership is the emerging theory of ethical leadership. Ethical leadership is based on the premise that employees look outside of themselves for ethical guidance and that leaders have an opportunity to provide this moral awareness by making an ethical message sufficiently salient to be recognized in the organizational context as well as allowing the leader to stand out against an ethically neutral ground.

ORIGINALITY/VALUE

This paper is an original work and has not been published previously, either in whole or in part. Additionally, this paper is not under consideration for publication by any other journal.

An explorative and confirmative factor analysis of the Leadership and Management Inventory-II among staff working in elderly care

PURPOSE

The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden.

DESIGN/METHODOLOGY/APPROACH

Questionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis (n = 1,149), and the second collection, one year later, was for confirmatory factor analysis (n = 1,061).

FINDINGS

The explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results.

ORIGINALITY/VALUE

The instrument measures both leadership and management performance and can be used to continually measure managers' performances as perceived by staff to identify areas for development.

Evaluation of the Impact of Management Changes on Midwives' Attitudes: A Questionnaire-Based Comparative Study in a a Women's and Children's Hospital in China: A Questionnaire-Based Study

BACKGROUND Change management has become an important tool for hospitals to continuously improve themselves in a competitive market. This questionnaire-based study aimed to compare the attitudes of 78 midwives before and after management changes in work schedules and performance-related pay between March and October 2022 at a women's and children's hospital in China. MATERIAL AND METHODS The survey utilizing a job involvement scale and a self-designed questionnaire was distributed through WeChat group chat for all midwives of the hospital. The hospital has 87 midwives. A total of 78 midwives participated in the questionnaire survey. RESULTS The midwives' score ranges of work initiative, work attitude, work value, work recognition, and work enthusiasm and focus before change management were 21-39, 19-37, 23-29, 12-18, and 12-20, respectively, but that after change management they were 22-39, 19-37, 23-30, 13-18, and 14-23, respectively. After change management, both of the P values for work attitude and work enthusiasm and focus were less than 0.05, 80.23% of the midwives were willing to work across the 2 campuses, and all surveyed midwives agreed on unified accounting of performance pay under the condition of working across the 2 campuses. Their views changed from "maintaining the status quo: taking the initiative - passive resistance" to "questioning" to "openness to change: acceptance". CONCLUSIONS The change management implemented within our department is feasible and the clinical risk is controllable. More attention was paid to the midwives' perceptions and humanized management was applied during change management, leading to a success of change.

Ethical Leadership in LTC: From Caregivers' Customer Orientation to Senior's Satisfaction and Well-Being

Background

In response to the growth of the world's senior population, an investigation of ethical leadership on LTCs is needed, in particular in the impact it may have on customer orientation and on seniors' well-being.

Objective

We propose a model to identify the relationship between ethical leadership in LTCs and caregivers' customer orientation, and its influence on satisfaction with the service, satisfaction with life, and the quality of the interaction between caregivers and seniors.

Sampling

We present a matched sample of 277 caregivers and 277 elderly Brazilians, workers and seniors' in LTCs in Brazil. The minimum sample size was 222, determined using G-Power software version 3.1.9.2, based on the desired statistical power parameters and the number of predictors. Two structured questionnaires were developed, one for caregivers and the other for the elderly. 69 LTCs were contacted and 29 participated in the survey (10 nonprofit, 34.48%). Data were treated statistically using SEM modelling.

Results

We identified a positive influence of ethical leadership on caregivers' attitudes, favoring their orientation towards the seniors'. A positive relationship between customer-oriented caregivers and customer satisfaction, life satisfaction, and the quality of the senior's interaction. A customer-oriented caregiver exerts a mediating effect between ethical leadership and the seniors' related outcomes, making ethical leadership beneficial to seniors and their family members.

Conclusion

Ethical leadership favors successful management of LTCs, increasing customer orientation, and provides clues to establish a better causality and a chain of effects between leadership and senior-related outcomes. Therefore, LTCs may be the appropriate outlet for the role of ethics in leadership.

Practical Implications

This study provides managers with an understanding of the effects of ethical leadership in the context of LTCs, for both caregivers and seniors. The powerful effects of ethical leadership can be a stimulus to increase the role of ethics in LTCs, improving the quality of care, the well-being of the seniors, and, therefore, the human and financial performance of these institutions.