The Impact of Servant Leadership on Proactive Service Behavior: a Moderated Mediation Model

As the implementers of government policies, junior civil servants bear the responsibility of providing services to the public. Whether they can put themselves in the people's shoes and show more active service consciousness directly reflects the government's management ability and the realization of service-oriented government goals. Although proactive service behavior has been studied, it has not been brought into the field of government administration. Hence, from the perspective of servant leadership, this study attempts to introduce proactive service behavior (PSB) into the field of government administration, and discusses the promotion strategies of junior civil servants' PSB in China. Through the statistical analysis of 416 junior civil servants collected in the two stages, this study verifies that servant leadership has a significant positive impact on public service motivation and PSB of junior civil servants. Public service motivation (PSM) can partially mediate the promotion effect of servant leadership on junior civil servants' PSB. Role identity can positively moderate the relationship between servant leadership and junior civil servants' PSM, and then affect their PSB. Therefore, this study suggests that leading cadres should integrate servant leadership into daily life, take the lead in providing quality services to their subordinates, and then inspire more proactive service to the masses.

Exploring advanced clinical practitioner perspectives on training, role identity and competence: a qualitative study

BACKGROUND

Advanced Clinical Practitioners (ACPs) are a new role that have been established to address gaps and support the existing medical workforce in an effort to help reduce increasing pressures on NHS services. ACPs have the potential to practice at a similar level to mid-grade medical staff, for example independently undertaking assessments, requesting and interpreting investigations, and diagnosing and discharging patients. These roles have been shown to improve both service outcomes and quality of patient care. However, there is currently no widespread formalised standard of training within the UK resulting in variations in the training experiences and clinical capabilities of ACPs. We sought to explore the training experiences of ACPs as well as their views on role identity and future development of the role.

METHODS

Five online focus groups were conducted between March and May 2021 with trainee and qualified advanced clinical practitioners working in a range of healthcare settings, in the North of England. The focus groups aimed to explore the experiences of undertaking ACP training including supervision, gaining competence, role identity and career progression. Thematic analysis of the focus group transcripts was performed, informed by grounded theory principles.

RESULTS

Fourteen advanced clinical practitioners participated. Analysis revealed that training was influenced by internal and external perceptions of the role, often acting as barriers, with structural aspects being significant contributory factors. Key themes identified (1) clinical training lacked structure and support, negatively impacting progress, (2) existing knowledge and experience acted as both an enabler and inhibitor, with implications for confidence, (3) the role and responsibilities are poorly understood by both advanced clinical practitioners and the wider medical profession and (4) advanced clinical practitioners recognised the value and importance of the role but felt changes were necessary, to provide security and sustainability.

CONCLUSIONS

Appropriate structure and support are crucial throughout the training process to enable staff to have a smooth transition to advanced level, ensuring they obtain the necessary confidence and competence. Structural changes and knowledge brokering are essential, particularly in relation to role clarity and its responsibilities, sufficient allocated time to learn and practice, role accreditation and continuous appropriate supervision.

Physical therapists' professional role identity in the clinician to leader transition

PURPOSE

The purpose of this study is to investigate how physical therapists make meaning of their professional role identity when transitioning from clinician to leadership positions. Despite the importance of professional role identity in the transition from health-care provider to health-care leader, research on this topic in physical therapy remains almost nonexistent.

DESIGN/METHODOLOGY/APPROACH

A qualitative, phenomenological research approach was used in this study. Data was collected through a three-part, semistructured interview process. An open coding to focused coding process was used to analyze data and develop themes which answered the research question.

FINDINGS

Physical therapists in this study engaged in identity work, making meaning of their professional role identity by referencing a professional role identity focused on more than clinical skills, accepting the role of discomfort, focusing on relationships, exercising agency over the construction of their leader identity, recognizing consistency between clinical and leader roles and establishing a professional role identity informed but no longer bound by their physical therapist identity.

ORIGINALITY/VALUE

To the best of the author's knowledge, this study is the first to investigate how physical therapists make meaning of their professional role identity when transitioning into leadership positions. The findings of this study highlight uniquities in the physical therapy professional role identity and the manner in which physical therapists navigate this work role transition.

The systems psychodynamic role identity of nursing students during their preceptorship

BACKGROUND

Existing research on nursing students' preceptorship experiences focusses mainly on conscious and rational behaviour, evidencing experiences of personal and professional development. This study argues that the exploration of their unconscious experiences could add important information towards an in-depth understanding of their role identity during this experience.

OBJECTIVE

The research objective was to describe the unconscious role identity of nursing students during their preceptorship from a systems psychodynamic stance.

DESIGN

A qualitative design, a collective case study and hermeneutic phenomenology were utilised as methodologies.

SETTING

Set in the School of Nursing of a Canadian University, the research focussed on students in the fourth year Consolidation in Nursing Practice Course.

PARTICIPANTS

The sample included 41 nursing students, 37 females, 22-28 years of age.

FINDINGS

The manifesting themes were high levels of anxiety, defensive structures, boundary and authority matters, and role dynamics. The nursing students experienced high levels and different kinds of anxiety, which they defended against using introjections, projections and regression to their child ego state. They experienced the preceptorship as being in a middle position between past and future as well as between knowing and not knowing. The discussion was presented in relation to the macro (organisational), meso (group), and micro (individual) levels.

CONCLUSIONS

Unconsciously, the nursing students experienced difficulty in effectively taking up their professional role. They defended against their discomfort by splitting their experiences into what they introjected and projected. They introjected incompetence in coping with the emotional demands of the role and projected their anger onto authority figures. Their professional role identity got stuck in a de-authorised position where they could survive but not develop their selves in their new role. These experiences inhibited their authenticity and learning ability.

Motivations, experiences and aspirations of trainee nursing associates in England: a qualitative study

Background

The nursing associate role was developed in England in response to the ‘Shape of Caring’ review. It has been implemented to fulfil two aims; to bridge the gap between registered nurses and healthcare assistants, and to provide an alternative route into registered nursing in light of workforce shortages.

Other high income countries deploy second level nurses within their healthcare systems, however the UK has a turbulent history with such roles. The previous state enrolled nurse was phased out in the 1990s, and more recently the assistant practitioner (AP) role has faced wide variation in titles, scope and pay. Little is known about those who have embarked on the new nursing associate training course and their experiences of the role.

Methods

An exploratory qualitative study was undertaken using focus groups of trainee nursing associates to generate in-depth discussion about their motivations, experiences of training, and career aspirations.

Three focus groups (n = 15) took place in December 2018 using a purposive sample of trainee nursing associates registered at a University in the North of England. Two researchers facilitated each group discussion at a time and place convenient for participants. The discussions were audio recorded, transcribed and data was analysed thematically.

Results

This study found that trainee nursing associates are motivated by affordable, local, career development. During training they face challenges relating to clinical support, academic workload and uncertainty about future career opportunities. They experience role ambiguity both individually and across the wider organisation. Trainee nursing associates rely on broad support networks to build their occupational identity.

Conclusions

The barriers and facilitators of trainee nursing associate personal development have implications for policy and practice relating to recruitment and retention. The results increase our understanding of this emerging role, and have informed the development of a larger longitudinal cohort study. Further research is required to evaluate the impact of this new role.

Facilitating smoking cessation in patients who smoke: a large-scale cross-sectional comparison of fourteen groups of healthcare providers

Background

Although healthcare providers are well placed to help smokers quit, implementation of smoking cessation care is still suboptimal. The Ask-Advise-Refer tasks are important aspects of smoking cessation care. We examined to which extent a large and diverse sample of healthcare providers expressed the intention to implement smoking cessation care and which barriers they encountered. We moreover examined to which extent the Ask-Advise-Refer tasks were implemented as intended, and which determinants (in interaction) influenced intentions and the implementation of Ask-Advise-Refer.

Methods

Cross-sectional survey among addiction specialists, anaesthesiologists, cardiologists, general practitioners, internists, neurologists, paediatricians, pulmonologists, ophthalmologists, surgeons, youth specialists, dental hygienists, dentists, and midwives (N = 883). Data were analysed using multivariate linear and logistic regression analyses and regression tree analyses.

Results

The Ask-Advice-Refer tasks were best implemented among general practitioners, pulmonologists, midwives, and addiction specialists. Overall we found a large discrepancy between asking patients about smoking status and advising smokers to quit. Participants mentioned lack of time, lack of training, lack of motivation to quit in patients, and smoking being a sensitive subject as barriers to smoking cessation care. Regression analyses showed that the most important determinants of intentions and implementation of Ask-Advise-Refer were profession, role identity, skills, guideline familiarity and collaboration agreements for smoking cessation care with primary care. Determinants interacted in explaining outcomes.

Conclusions

There is much to be gained in smoking cessation care, given that implementation of Ask-Advise-Refer is still relatively low. In order to improve smoking cessation care, changes are needed at the level of the healthcare provider (i.e., facilitate role identity and skills) and the organization (i.e., facilitate collaboration agreements and guideline familiarity). Change efforts should be directed towards the specific barriers encountered by healthcare providers, the contexts that they work in, and the patients that they work with.

The role of the assistant practitioner in the clinical setting: a focus group study

Background

Assistant practitioners have knowledge and skills beyond the level of traditional support workers, and work in many clinical settings. However, some assistant practitioners lack a clearly defined role and may be under-used due to issues around accountability and uncertainty about their purpose. This paper explores the assistant practitioner role from the perspectives of assistant practitioners and registered nurses.

Methods

This study aimed to explore the role of the assistant practitioner from the perspectives of assistant practitioners and registered nurses in two NHS hospital trusts in Oxfordshire, United Kingdom. Six qualitative focus groups were undertaken between February–March 2017. Ethical approval was obtained (FREC 2016/05) and written consent was provided by participants. Data was analysed thematically analysed using the Framework method.

Results

Nineteen participants (assistant practitioners, n = 12; registered nurses, n = 7) were recruited using convenience sampling. Emerging themes related to ‘fluctuating roles and responsibilities of assistant practitioners’, ‘role differences between registered nurses and assistant practitioners’, ‘working relationships’, ‘supervision’ and ‘redefining nursing pathways’.

The Results and Discussion sections highlight a lack of role clarity and blurring of boundaries between the roles of assistant practitioners and registered nurses, with many tasks undertaken by both. This lack of ownership of ‘nurse-specific’ roles by registered nurses was evident and clear differences were only encountered with regard to accountability. The development of the Nursing Associate role provides managers with the opportunity to redefine staff banding hierarchies to ensure that clinical staff are aware of their role capabilities and limitations and are practicing safely, whilst promoting career development and progression pathways.

Conclusion

Addressing issues around role clarity can benefit professional development, satisfaction, role identity and ownership for registered nurses and assistant practitioners, by recognising the individual and collective value they bring to the clinical team. The findings can help inform the development of the Nursing Associate role.