Leadership Competencies: Knowledge, Skills, and Aptitudes Nurses Need to Lead Organizations Effectively

Business acumen for nursing leaders, optional or essential in today's health system? A discussion paper

Background

Over the last number of years, the healthcare system has become more complex in managing increasing costs and outcomes within a defined budget. To be effective through reform, especially moving forward from the COVID-19 pandemic, healthcare leaders, specifically in nursing, have an increased need for business acumen beyond traditional leadership and management principles.

Aim

This paper examines the concept of business acumen in the profession of nursing, specifically for managers and higher nurse leaders, establishing whether these skills are optional or essential.

Discussion

Nurses learn and develop broad skills in leadership and management, but less specifically about business or the broader system. With a contemporary Australian health system aiming to be more effective, nurses may require a greater level of business acumen to adequately understand the mechanics of business decision making in the system when designing care models, as well as representing the business potential of nursing in balance with clinical outcomes through reform.

Conclusion

The modern nurse, in addition to clinical skills, may need a foundational understanding of business evolving throughout their career, to maximise innovative growth across the system, in meeting the healthcare needs of our community now and into the future. Without a foundation level of business acumen and an understanding of the system across the profession, nurses may not be empowered with their full potential of being a strong voice influencing health system reform.

The factors influencing the innovative performance of leaders in nurses' professional: a developing country perspective

PURPOSE

The health-care services in Iraq currently face many challenges. The most noted is the lack of effective nursing leaders to meet the growing needs of the health-care services. Effective nursing leadership is critical to the health-care system, affecting work performance, quality of care and staff satisfaction. The literature suggests that nursing leaders in Iraq are not adequately trained to provide leadership to improve the nursing profession and have limited involvement in decision-making. The purpose of this study is to explore the views of nurses on what they believe constitutes effective leadership in Iraq.

DESIGN/METHODOLOGY/APPROACH

A qualitative methods approach is used involving 20 semi-structured interviews of senior nurses. The sample of nurses came from two large general hospitals in Iraq. The qualitative data was thematically analyzed and interpreted.

FINDINGS

The study results indicated that there were factors that influence the performance of nurse leader, namely, excessive workload, personal relationship with nursing staff, professional recognition of nursing and selection criteria of leaders. Test results show that there were significant differences in views of the nurses toward nurse leaders' performance. This research concludes that the nurse leader performance in developing countries is affected by excessive workload, personal relationship with nursing staff, professional recognition of nursing and selection criteria of leaders.

ORIGINALITY/VALUE

The relevance of the study stems from the scarcity of research on the leader performance in developing countries, while studies on the factors influencing the innovative performance of leaders in nurses' professional are significantly limited. This study is one of the earliest studies that investigate these factors influencing the nurse leader's performance.

The effects of leadership competencies and quality of work on the perceived readiness for organizational change among nurse managers

Purpose

This paper aims to set a leadership guidance program that can promote nurses’ knowledge of leadership and, at the same time, to enhance their leadership competencies and quality of work to promote their readiness for change in healthcare organizations.

Design/methodology/approach

A pre-experimental, one-group pretest-posttest design was utilized. Out of 90 invited to participate in this study, 61 nurses were accepted to participate.

Findings

The statistical analyses suggested several significant differences between pre- and in-service nurse managers about leadership competencies, quality of work and readiness for change. Yet, findings from the background characteristics were not found to be significant and had no effects on the perceived readiness for change.

Research limitations/implications

The present study highlights the importance of leadership competencies and quality of work that healthcare policymakers identify for the success of organizational change efforts.

Practical implications

Healthcare policymakers, including directors of nursing, should focus on applications that increase leadership competencies and overall satisfaction of the nurse managers to support the changes in hospitals and supporting learning organization. Hence, they should establish policies that decrease the possible negative impact of planned change efforts.

Originality/value

Competent nurse managers enhance their readiness for change, which in turn helps nurses in constructive change processes. A leadership guidance program should be set for nurse managers. This study has important implications for hospital administrators and directors of nursing.

The Role of the Advanced Practice Nurse in the Academic Setting

OBJECTIVES

To explore how advanced practice nurses implement practice change in academic medical centers to support optimal patient and staff outcomes.

DATA SOURCES

Published peer reviewed literature, web-based resources, and professional society materials.

CONCLUSION

Cancer care is rapidly evolving and advanced practice nurses can shape the future of how care is delivered as well as the setting it is delivered in.

IMPLICATIONS FOR NURSING PRACTICE

Advanced practice oncology nurses (Nurse Practitioners and Clinical Nurse Specialists) have an opportunity to significantly shape the patient experience by implementing programmatic changes across the continuum of care by engaging stakeholders in project design. Knowledge of change management and implementation science is critical to success.

Head nurses’ decision-making when managing ethical dilemmas

Purpose

– The purpose of this paper is to characterize issues related to head nurses’ decision making when managing ethical dilemmas.

Design/methodology/approach

– The study is qualitative descriptive, in which researchers stay close to the data. The data were collected in the format of unstructured written reflections. Inductive conventional latent qualitative content analysis was applied to the data.

Findings

– The issues of head nurses’ management of decision making in ethical dilemmas relate to the following aspects: taking risks in deviating from the formalities, balancing power and humaneness, maintaining the professional hierarchy, managing resistance to change, managing with limited options, and experiencing the decline of nurse’s professional and/or human dignity.

Research limitations/implications

– Reflections in written form were preferred to semi-structured interviews and the researchers were unable to contact the participants directly and to ask additional questions. All the reflections were produced in a language other than English.

Practical implications

– The issues of head nurses’ management of decision making in ethical dilemmas reveal the gap between societal expectations and the opportunities to improve nursing leadership in health care organizations.

Social implications

– The issues of head nurses’ decision making when managing ethical dilemmas are related to contexts that reflect the attitudes of society and health care system toward nursing management.

Originality/value

– The study adds to the understanding of issues of the management of decision making in ethical dilemmas. It is an ongoing systematic process that encourages head nurses to learn from practice and manage the quality of care by empowering themselves and nurses to take responsibility for leadership.

Planning for a smooth transition: evaluation of a succession planning program for prospective nurse unit managers

The current and projected nurse workforce shortage has created significant pressure on health care organizations to examine their approach to managing talent. This includes the need for strategic development of new formal leaders. This article reports on a succession planning program for prospective nursing unit managers. Eight prospective management candidates participated in a Future Nursing Unit Managers program. The effectiveness of the program was measured through a comparison of pre- and postprogram surveys relating to participants' perception of personal managerial and leadership skills. Significant differences in scores from baseline to 6-month follow-up surveys were observed in the participants' confidence in undertaking the nursing unit manager role and in their management skills. Investment in structured programs to prepare nurses for leadership roles is strongly recommended as a management workforce strategy.

Skills for Nurses in the Field of Management and Administration: Contemporary Challenges to the Profession

Las competencias laborales de enfermería permiten disminuir inequidades, acceso limitado a los servicios y favorecen una atención segura y de calidad. La formación de enfermeras/os es fundamental en la composición y dinámica de la fuerza de trabajo en enfermería, la calidad y pertinencia de los cuidados y el desarrollo de la capacidad institucional en salud. Objetivo: responder dos interrogantes: ¿Cuá- les son los requerimientos actuales para el/la enfermero/a en el ámbito de la gestión y administración?, y ¿cuáles son las competencias de gestión de enfermería más importantes y su relación con la gestión de cuidado? Método: revisión de la literatura que parte con una exploración de campo desde los contextos y desafíos actuales de la profesión. La búsqueda bibliográfica se realizó en las bases de datos Cochrane Library, Lilacs, CINHAL, Dialnet, Universidad de la Rioja, ProQuest, Web of Science, Science Direct, PubMed, Business Source Premier, SciELO, Scopus. Se encontraron 4.697 artículos. Precisando la búsqueda se seleccionaron 51 artículos y documentos técnicos. Resultados: los estudios que priorizan las competencias de gestión coinciden en colocar entre las más importantes: comunicación, tra- bajo en equipo, resolución de conflictos y habilidades interpersonales y de liderazgo. En liderazgo priorizan dominio personal, efectividad interpersonal, gestión financiera y de recursos humanos. Conclusiones: las habilidades de gestión y liderazgo se deben basar en conoci- mientos sólidos y en la experiencia. Asimismo, la concepción de gestión y liderazgo ocupa un lugar complementario al rol de cuidado que tiene la enfermera/o. El liderazgo transformacional y relacional son necesarios para mejorar la satisfacción de las/os enfermeras/os.

Advancing leadership capacity in nursing

To address the potential shortage of nurse leaders, the profession must evaluate current strategies in both education and practice. While many new graduates dream of becoming a nurse practitioner or nurse anesthetist, few transition into practice with the goal of becoming a nurse leader. To increase the number of nurses capable of leadership, the profession must address 2 critical issues. First, effort must be made to augment faculty and students' conceptualization of nursing such that leadership is seen as a dimension of practice for all nurses, not just those in formal leadership roles. In so doing, leadership identity development would be seen as a part of becoming an expert nurse. Second, a comprehensive conceptual framework for lifelong leadership development of nurses needs to be designed. This framework should allow for baseline leadership capacity building in all nurses and advanced leadership development for those in formal administrative and advanced practice roles. The knowledge and skill requirements for quality improvement and patient safety have been explored and recommendations made for Quality and Safety Education for Nurses, but parallel work needs to be done to outline educational content, objectives, and effective pedagogy for advancing leadership development in nursing students at all levels.

Preliminary clinical nursing leadership competency model: a qualitative study from Thailand

This qualitative study explored the clinical nursing leadership competency perspectives of Thai nurses working in a university hospital. To collect data, in-depth interviews were undertaken with 23 nurse administrators, and focus groups were used with 31 registered nurses. Data were analyzed using content analysis, and theory development was guided by the Iceberg model. Nurses' clinical leadership competencies emerged, comprising hidden characteristics and surface characteristics. The hidden characteristics composed three elements: motive (respect from the nursing and healthcare team and being secure in life), self-concept (representing positive attitudes and values), and traits (personal qualities necessary for leadership). The surface characteristics comprised specific knowledge of nurse leaders about clinical leadership, management and nursing informatics, and clinical skills, such as coordination, effective communication, problem solving, and clinical decision-making. The study findings help nursing to gain greater knowledge of the essence of clinical nursing leadership competencies, a matter critical for theory development in leadership. This study's results later led to the instigation of a training program for registered nurse leaders at the study site, and the formation of a preliminary clinical nursing leadership competency model.

Elaboration of Leadership and Culture in High-Performing Nursing Units of Hospitals as Perceived by Staff Nurses

The leadership–culture phenomenon, a known explanatory construct for organizational performance, is understudied in nursing. Building on our previous work, we further addressed this knowledge gap through explorations of demographics and hospital variables which may have a significant influence on staff nurses’ (SNs) perceptions of their nurse managers’ (NMs) leadership and nursing unit culture. Furthermore, we explored the extent to which the NMs’ leadership predicted specific cultures which typify nursing unit effectiveness. Using dissertation data provided by 278 SNs, we found that SNs educated at the baccalaureate level or higher had favorable perceptions of their nursing unit performance and viewed their NMs’ leadership differently than the SNs with diploma or associate degrees. The frequent portrayals of transformational (TFL) leadership behaviors (e.g., visionary) by the NMs were paramount in shaping culture traits which exemplify high performance outcomes. TFL leaders were more likely to shape unit cultures which are flexible and adaptive to the environmental challenges within and outside the nursing unit. Thus, the type of NMs’ leadership and unit culture may provide an added value in explaining the performance level in patient care units which consequently affects the overall hospital/organizational outcomes. Implications for research and leadership practices are presented.

Enhancing Leadership Orientation Through Simulation

Many novice managers feel unprepared to handle some of the situations that occur as a daily part of their job. It is important to provide an environment through which novice managers can receive training and develop skills in effective communication in complex nursing environments. Simulation-based training can provide a safe, interactive way for new managers to develop their communication and leadership skills. This type of training allows novice managers to increase their confidence and improve their job satisfaction and their management skills.

A systemic approach to developing frontline leaders in healthcare

PURPOSE

The purpose of this case study is to extend the understanding of leadership development in healthcare by documenting the impact of a systemic approach to developing frontline leaders in a large Canadian healthcare organization.

DESIGN/METHODOLOGY/APPROACH

A total of 92 participants working in acute and community settings participated in an eight-day certificate program that combined classroom instruction, practical skill development, and applied projects. Program content was based on a learning needs assessment conducted with potential participants and their supervisors.

FINDINGS

Frontline leaders and their supervisors rated the program positively in terms of its impact on participants' confidence and willingness to lead, awareness of leadership opportunities, communication, problem solving, response to conflict, and the ability to support their teams through change. It was also found, however, that supervisors' ratings were generally lower than those of participants.

PRACTICAL IMPLICATIONS

Systemic approaches to leadership development offer healthcare the best chance of addressing the current leadership crisis. The challenge is finding innovative ways to demonstrate sustainable benefits in an industry that is struggling to address cost pressures. In the present study, personal and supervisor evaluations were used in conjunction with completion of applied change projects to demonstrate a tangible return on investment.

ORIGINALITY/VALUE

Leadership can be learned and there is no better point of entry for development than those in frontline leadership positions. However, developing future leaders requires the commitment of an entire leadership community. Healthcare organizations that are experiencing leadership gaps must be prepared to make a long term investment if they want to achieve lasting healthcare reforms.

Nurses' perceptions of leadership in an adult intensive care unit: a phenomenology study

The purpose of this research was to explore ICU nurses' perceptions of nursing leadership in the adult intensive care unit (ICU). The nursing profession needs leaders at all levels; ward, administration and executive and in an era in which there is a shortage of ICU nurses, nursing leadership is important, as positive leadership skills correlate with enhanced recruitment and retention of these specialist nurses. Six ICU nurses with at least 5 years experience in ICU nursing were recruited from a metropolitan hospital in Australia. Qualitative phenomenological methodology was used to depict the lived experiences of nurses' leadership in the adult ICU. Data were collected through individual semi-structured interviews using open-ended questions and analysed using Giorgi's [Giorgi A. Toward phenomenologically based research in psychology. J Phenomenol Psychol 1970;1:75-98] descriptive method for data analysis. Five themes emerged and these were all inter-related: leading by example, communication, ability to think outside the management square, knowing your staff and stepping up in times of crisis. These findings highlight the importance of nursing leadership in the adult ICU and the need to ensure that all current and future nursing ICU leaders are adequately prepared and educated for this role. This information may also be used to assist in the development of leadership skills in ICU nurses.

Assisting critical care nurses in acquiring leadership skills: development of a leadership and management competency checklist

Critical care nurses need to be more effective leaders and managers in healthcare. Delivering quality and cost-effective patient outcomes have become goals of all nurses. To achieve these goals, nurses must practice and attain leadership ability. This article describes a program to help nurses gain quality leadership skills.