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.

Determinants of Nurse Managers' Transformational Leadership: The Role of Individual Unit and Organizational Characteristics

OBJECTIVE

The aim of this study was to examine the relationship between various factors and self-perceived transformational leadership among a sample of Filipino nurse managers (NMs).

BACKGROUND

Transformational leadership plays a crucial role in promoting positive outcomes in healthcare settings, particularly for NMs. Understanding the factors that influence NMs' self-perceived transformational leadership is essential for improving leadership practices and enhancing organizational effectiveness.

METHODS

A cross-sectional research design was used to collect data from 260 NMs using standardized measures.

RESULTS

Employment status, the number of units managed, the type of hospital employment, psychological distress, and job satisfaction were factors that significantly influenced their leadership perceptions.

CONCLUSION

By addressing the identified factors, nursing organizations can create an environment that promotes effective leadership practices, ultimately enhancing patient outcomes, staff satisfaction, and overall organizational performance.

Role-Related Value Conflicts: A Qualitative Study of the Experiences of Perianesthesia Nurse Managers

PURPOSE

Value conflicts with the potential to elicit moral distress are among the factors that contribute to burnout and threaten nurse manager retention. Little is known about the value conflicts faced by nurse managers working in the perianesthesia environment. Using the process model of managerial dissonance and responsibility attribution as a framework of inquiry, this study explored the types of value conflicts experienced by perianesthesia nurse managers and how they worked to reduce the accompanying distress.

DESIGN

Qualitative, descriptive design.

METHODS

Data were collected by means of semi-structured interviews from 14 participants meeting inclusion criteria. Thematic analysis was used to analyze data.

FINDINGS

Eleven subthemes were identified and mapped onto the four phases of process model of managerial dissonance: Phase 1 Harm Doing Event: (1) Operational management strategies, (2) Patient care management strategies, (3) Standardized organizational practices; Phase 2 Dissonance: (4) Questioning my leadership, (5) Altered well-being, (6) Just do something; Phase 3 Attribution, (7) Consider organizational viewpoint, (8) Consider role and responsibilities, and Phase 4 Outcomes, (9) Commit to act, (10) Value the organization, and (11) Forgotten by leadership.

CONCLUSIONS

Perianesthesia nurse managers experience similar types of value conflicts as inpatient nurse managers; however, some aspects of their experiences reflect the uniqueness of their practice environment. The process model of managerial dissonance and responsibility attribution serves as a useful framework for understanding the psychological difficulties and processes by which nurse managers seek to resolve the distress associated with mandated actions likely to induce harm in employees. Executive leaders must act to implement strategies to mitigate the associated psychological difficulties and prevent the increased potential in nurse managers for work-role disengagement and potential exit from the organization.

Nurse Managers' Professional Quality of Life During the COVID-19 Pandemic

BACKGROUND

Health systems cannot effectively support nurse managers without understanding psychosocial effects of the COVID-19 pandemic.

OBJECTIVE

The objective of this study was to describe the professional quality of life of frontline nursing management during the COVID-19 pandemic.

METHODS

A cross-sectional online survey of 54 nurses in management positions at a large Midwest academic medical center during 2022 was conducted. Participants completed an electronic survey including demographics, Professional Quality of Life Measure Version 5, and items assessing past consideration of and future intent to leave their position, organization, or profession.

RESULTS

Most participants had previously considered changing roles (80%) or leaving the organization during the pandemic (76%). Fewer respondents reported that changing role (24%) or organization (20%) was likely during the upcoming 6-12 months. Most participants scored in moderate ranges of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress scales (85%, 89%, and 74%, respectively). Higher Compassion Satisfaction was associated with extreme unlikelihood of leaving for an internal non-management role. Higher Burnout scores were associated with more time working and past consideration or future likelihood of leaving for an external non-nursing position. Secondary Traumatic Stress scores were higher for nurse managers and house operation managers than assistant nurse managers and associated with past consideration of moving to an internal non-management role or external non-nursing position and future likelihood of moving to an external non-nursing position.

CONCLUSIONS

Nurse management occupies a demanding position between frontline staff needs and administrative requirements, profoundly impacted by COVID-19. Health care researchers, administration, and policymakers must learn how to support, retain, and sustain nursing management in a post-pandemic world.

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

AIM

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR NURSING MANAGEMENT

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

REPORTING METHOD

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

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring the role of the nurse unit manager in forensic mental health inpatient units: A qualitative study

Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting.

Acute care nurse managers' definitions of and barriers to well-being: A thematic analysis of open-ended survey questions

BACKGROUND

During the COVID-19 pandemic, acute care nurse managers functioned in a critical role by helping to advance the mission and goals of their organization while navigating a rapidly evolving healthcare landscape. This resulted in high levels of ongoing job-related stress which is linked to negative physical, psychological, and job-related outcomes. Little is known about the perceptions regarding their own professional well-being during this time.

AIM

The aim of this study was to qualitatively describe acute care nurse managers' perceptions of and barriers to their professional well-being.

METHODS

Using a qualitative descriptive approach, nurse managers from a hospital system in the southwestern United States responded to two short-answer, survey-based questions in 2022: (1) "Describe the definition of nurse-manager well-being in your own words" and (2) "What do you feel is your biggest barrier to professional well-being?" Reflexive thematic analysis was utilized to analyze participant responses (N = 80).

RESULTS

Professional well-being is a complex concept influenced by the nurse manager's ability to navigate work-life balance; care for their own physical, emotional, and spiritual selves; give and receive support from stakeholders; and manage feelings of thriving vs. struggling in the role. Barriers most cited as influencing well-being included having too little time to get things done coupled with increasing workloads, feeling stuck in the middle among stakeholders, and coping with ongoing staffing challenges.

LINKING EVIDENCE TO ACTION

The definition of and barriers to well-being are influenced by the specific needs and experiences of the nurse manager. While not all barriers can be immediately removed, the identification of individual and organization-specific barriers needs to be taken seriously, reviewed by those who can promote change, and evidence-based solutions for improvement piloted or implemented when feasible.

Nurse managers' experience during the COVID-19 pandemic in China: A qualitative study

AIMS

The aim of the study was to explore the experiences of female new nurse managers during the COVID-19 pandemic.

DESIGN

This was a phenomenological study, and qualitative descriptive analysis was used.

METHODS

New nurse managers were defined as new nurse managers with less than 3 years of management experience in this study. During November and December of 2021, 18 female new nurse managers were interviewed face-to-face with a semi-structured interview guide in three municipal hospitals. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for evaluating qualitative research reports. Data analysis was performed using Colaizzi's seven-step method.

RESULTS

Four main themes and 10 sub-themes were extracted from the collected data. The four major themes were as follows: (1) a shift in stress; (2) work-related physical and psychological discomfort; (3) reflection on the cause; (4) coping and struggles.

CONCLUSIONS

New nurse managers were experiencing great stress and exhaustion in their roles. It is important that they are helped to handle situations. Providing them with readily accessible support, addressing their psychosocial needs and addressing exhaustion is necessary. Considering their short management time, the hospital should provide adequate support in human, financial and material areas and provide training to help new nurse managers better adapt to their new roles. In addition, nurse directors should create a culture of mutual respect, identify workplace bullying and create a harmonious and cooperation-oriented work environment for new nurse managers.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Toxic leadership and its relationship with outcomes on the nursing workforce and patient safety: a systematic review

PURPOSE

This study aims to appraise and synthesize evidence examining the effects of toxic leadership on the nursing workforce and patient safety outcomes.

DESIGN/METHODOLOGY/APPROACH

This is a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases (SCOPUS, PubMed, Web of Science, CINAHL and Psych INFO) were searched to identify relevant articles. Two independent researchers conducted the data extraction and appraisal. A content analysis was used to identify toxic leadership outcomes.

FINDINGS

The initial literature search identified 376 articles, 16 of which were deemed relevant to the final review. Results of the content analysis identified 31 outcomes, which were clustered into five themes: satisfaction with work; relationship with organization; psychological state and well-being; productivity and performance; and patient safety outcomes. Seven mediators between toxic leadership and five outcomes were identified in the included studies.

PRACTICAL IMPLICATIONS

Organizational strategies to improve outcomes in the nursing workforce should involve measures to build and develop positive leadership and prevent toxic behaviors among nurse managers through theory-driven strategies, human resource management efforts and relevant policy.

ORIGINALITY/VALUE

The review findings have provided modest evidence suggesting that working under a leader who exhibits toxic behaviors may have adverse consequences in the nursing workforce; however, more research examining if this leadership style influences patient safety and care outcomes is warranted.

Structural and Psychological Empowerment of Learners Enrolled in Continuing Nursing Leadership Education in Finland: A Quasi-Experimental Longitudinal Study

BACKGROUND

This study was conducted to assess structural and psychological empowerment among learners enrolled in a continuing leadership education program. Although the number of nurse leadership development interventions has increased, there is little evidence on how they influence leaders' empowerment.

METHOD

A longitudinal study was employed, with learners (N = 85) enrolled in a continuing leadership education program as the participants. Data were collected in the beginning, at the end, and 8 months after the completion of the program using internationally validated instruments. Data were analyzed statistically.

RESULTS

A total of 25 learners (29%) responded to the questionnaire at all three data collection points. The education significantly increased psychological and structural empowerment across all dimensions except formal power. These increased levels of empowerment were partially sustained at the 8-month follow-up time point.

CONCLUSION

Continuing education seems to benefit nurse leaders, and the continuing nursing leadership education program was positively associated with learners' perceived empowerment. [J Contin Educ Nurs. 2023;54(10):462-471.].

The effect of talent management on the job satisfaction and organizational commitment of nurses

AIM

To determine the effect of talent management on job satisfaction and organizational commitment of nurses and the mediating role of job satisfaction.

BACKGROUND

Talent management plays a critical role in attracting, developing, and retaining nurses and is effective in the formation of job satisfaction and organizational commitment.

METHODS

This correlational study sample consisted of 482 volunteering nurses who were selected through a convenience sampling method. Data were collected using an information form, the Talent Management Scale, the Minnesota Satisfaction Questionnaire, and the Organizational Commitment Scale. The data were analyzed using descriptive statistics, Pearson correlation analysis, single linear regression, and hierarchical regression analysis. The Baron and Kenny model was used to determine the mediation effect.

FINDINGS

Talent management affected the intrinsic, extrinsic subdimensions of job satisfaction and the total score and the affective commitment, normative commitment, and continuance commitment significantly and positively. Job satisfaction had a full mediating role in the effect of talent management on affective commitment and continuance commitment and a partial mediating role in affecting normative commitment.

CONCLUSION

Talent management in organizations can increase nurses' job satisfaction and organizational commitment and nurses' job satisfaction can play a mediating role in the effect of talent management on organizational commitment.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study demonstrates that nurse managers and decision-makers should adopt talent management practices in nursing. Desired results such as nurses' job satisfaction and organizational commitment can be achieved by focusing on the development of nurses' talents.

Reflections From the Middle: Exploring the Experience of Nurse Managers Across the United States During the COVID-19 Pandemic

OBJECTIVE

The objective of this multisite study was to explore the professional and personal experiences of US nurse managers (NMs) during the COVID-19 pandemic.

BACKGROUND

NMs are the most accessible and visible nurse leaders to the frontline staff during this pandemic.

METHODS

Thirty-nine NMs from 5 health systems across the US participated in focus groups in this qualitative study. Data were analyzed using a constant comparative method.

RESULTS

Three major themes were identified: challenges, feelings and emotions, and coping. Subthemes emerged within each major theme.

CONCLUSION

NMs across the country accepted considerable responsibility at great professional and personal consequence during the pandemic. NMs experienced challenges, ethical dilemmas, and expressed negative emotions. As the usual coping strategies failed, NMs reported that they are considering alternative career choices. This work provided evidence to help senior leaders strategize about mechanisms for reducing managerial dissonance during times of stress.

In the Eye of the Storm: Leadership Lessons From the Front

New York City (NYC) was in the eye of the COVID-19 pandemic storm in the spring of 2020. Since that time, the country has seen wave after wave of outbreaks and concurrent psychosocial crises. Clinical nurses and nurse leaders delivered extraordinary care with grit, innovation, agility, and resilience. When in the eye of the storm, staff have to feel safe and have a voice even in command-control, adaptive modes. Nurses and nurse leaders have been resilient, and organizations have to play their part in decreasing work burden and creating positive work environments. Non-value-added work as well as barriers to practice should be eliminated permanently. This article describes the many challenges including intensive care unit capacity, staffing, well-being, and lack of visitation, as well as leadership lessons such as the importance of presence, based on the NYC experience of a chief nursing officer in a large academic medical center. These lessons and their implications for our workforce, for public health, and for leadership development and competencies and have taught us how to lead into the future.

A Survey of Interim Nurse Managers to Understand the Role and the Impact on Nurse and Patient Outcomes

OBJECTIVE

The aim of this study was to describe the current state of the interim manager (IM) role and the impact of the role on job performance.

BACKGROUND

Interim managers provide leadership during organizational change, yet little is known about the role and its impact on outcomes.

METHODS

An electronic survey was completed by 179 IMs working in acute care hospitals. Instruments included the Nurse Manager Practice Environment Scale, Decision Involvement Scale, Subjective Stress Scale, Maslach Burnout Inventory, and Brief Resilience Scale.

RESULTS

The average tenure for IMs was 10 months. Despite moderately high levels of stress and exhaustion, IMs were resilient, positively viewed their work environment, and perceived their job performance as positively impacting nurse and patient outcomes. Interim managers were generally satisfied in their roles and likely to pursue nursing leadership as a career.

CONCLUSION

Interim managers desire permanent leadership opportunities providing a pool for replacing exiting nurse managers. Support is needed to be successful.

Understanding Inpatient Surgical Nurses' Meaningful Recognition Preferences

Nurse leaders have a responsibility to nurture a work environment that prioritizes meaningful recognition. This quality improvement project explored the perceptions of meaningful recognition of inpatient pediatric surgical nurses. Meaningful recognition provides a chance to honor all voices, particularly those that have not been previously heard. To be heard is to be honored and to be recognized is to be valued.

A 4-Part Strategy to Engage Frontline Nurses in Cultural Humility

Although many clinical leaders use the cultural competency model to help clinicians deliver equitable care, evidence on the model's effectiveness is mixed. In this article, the authors propose that nursing leaders adopt cultural humility as a framework that better positions nurses to build trust, engage patients in their care, and improve health outcomes. This article outlines 4 strategies that leaders can use to actively engage staff in cultural humility and support the cultural transformation required to mitigate the impact of clinician bias in care delivery.

Qualifications of Executive Nurses for Service on Hospital Boards

OBJECTIVE

The purpose of this qualitative survey was to document executive nurse leaders' perception of their own leadership qualities in the context of the American Hospital Association (AHA) recommended membership requirements for executive hospital board appointment.

BACKGROUND

Hospital boards of trustees are increasingly responsible for the quality of care and its impact on financial performance. High-performing boards are focused on the accountability of chief executive officer for quality metrics. Nurse leaders have valuable insight into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight.

METHODS

Fifty senior-level nurse executive members polled from the American Organization of Nurse Leaders, the Texas Organization of Nurse Leaders, and the Texas Nurse Practitioners Association completed an online quantitative survey using The Center for Healthcare Governance (CHG) Assessment Tool© of the AHA, which details a list of skills, experience, and personal qualities for executive hospital board placement. Respondents ranked their individual knowledge and skills on a 4-point Likert scale.

RESULTS

Participant responses indicated that senior-level nurse executives have significant expertise in the key areas of quality, patient safety and performance, healthcare administration and policy, and business management. Areas ranking lower are those associated with organizational specialties: legal, construction project management, and finance.

CONCLUSION

This information can be used to educate executive hospital boards regarding the qualifications of nurse leaders members. Nursing leaders, professional organizations, and academia can use this information to assess the skills of senior nursing leaders as it relates to potential board appointments.

Impact of Evidence-Based Charge Nurse Education on Charge Nurse Skills and Nurse-Specific Metrics

OBJECTIVE

This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics.

BACKGROUND

Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience.

METHODS

University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program.

RESULTS

The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction.

CONCLUSIONS

Interventions targeting frontline leaders positively impact CN performance.

Rethinking Resilience: Nurses and Nurse Leaders Emerging From the Post-COVID-19 Environment

Nurses and nurse leaders are working in unprecedented intense and demanding environments, and the COVID-19 pandemic continues to place strain on their mental well-being. If stressful work conditions remain at extraordinary high levels, nurses and leaders may ultimately leave their positions, creating even more uncertainty in the workforce. Enhancing individual resilience has become a superficial response in retaining nurses during a global nursing shortage. We argue that resilience is not solely an individual responsibility. Rather, resilience it is a mutual responsibility between the individual and the organization. In this article, we discuss how nurse leaders can foster organizational resilience while also enhancing their own individual resilience within the current pandemic environment, and as we transition to a post-COVID environment.

Chief Nursing Officer Perspectives on Nursing Theory-Guided Practice

OBJECTIVE

The purpose of this study was to identify what guides nursing practice.

BACKGROUND

Change occurred when the Magnet Recognition Program® no longer required a nursing theory.

METHODS

This was a mixed-methods study to identify the process used to implement nursing theory-guided practice and the relationship to professional practice recognition. Deidentified quantitative data were collected from 36 chief nursing officers (CNOs). Seventeen CNOs participated in the qualitative interview.

RESULTS

Thirteen CNOs were from a Magnet®-designated facility. Ten CNOs were on the Magnet journey, and 2 had no intent to seek Magnet recognition. Two CNOs were from a Pathway to Excellence®-designated facility. One CNO was on the Pathway to Excellence journey. The majority of respondents who were Magnet® recognized who participated in the survey used Watson's Theory of Human Caring. Themes were identified that share the benefits and strategies to integrate nursing-guided theory into nursing processes, structures, and outcomes.

CONCLUSION

Findings will benefit CNOs as they make decisions related to pursuing Magnet status recognition.

Nurse Leaders' Assumptions and Attitudes Toward Residency Programs for New Graduate Nurses

The Future of Nursing Report from 2010 offered key recommendations for the practice of nursing, including the need for nurse residency programs for all new graduate nurses. Although numerous articles can be found about the programs themselves, finding information about the support of nurse leaders for such programs is more challenging. In the spring of 2019, a small group of invited nurse leaders from across the United States met during a "Think Tank." The purpose of this gathering was to discuss a policy brief offered by the American Academy of Nursing requiring all new graduate registered nurses to participate in a nurse residency program as part of their transition into practice. To determine nurse leaders' assumptions and attitudes toward nurse residency programs, the think tank planners conducted a national survey. Over 500 members of the American Organization for Nursing Leadership participated in this survey. In this article, the authors offer that nurse leaders are supportive of residency programs for new graduate nurses although some are still struggling with demonstrating the value proposition. In addition, nurse leaders are not in support of a national mandate.

Using Data from a 360° Leadership Assessment to Enhance Nurse Manager Transformational Leadership Skills

OBJECTIVE

The aim of this study was to compare self-perception of leadership practices among nurse managers (NMs), day shift nurses, and night shift nurses (NSNs).

BACKGROUND

Nurse managers have complex roles in healthcare, with clinical, administrative, and 24-hour accountability for unit activities. Transformational leadership inspires performance beyond expectations, while transcending self-interest for the good of the organization.

METHODS

A comparative, secondary data analysis study of the Leadership Practices Inventory (LPI) 2018.

RESULTS

Day shift nurses' and NSNs' mean scores had lower perceptions of leadership practices than NMs' self-assessment. Day shift nurses, NSNs, and NMs identified the highest mean scores in "enable others to act" (8.57, 8.62, and 8.82, respectively).

CONCLUSIONS

The LPI assessment, the defined observer groups, and unique data visualization informed development of a comprehensive follow-up plan supporting individual and group leadership development. Research examining differences in perceptions of LPI practices across observer groups, particularly direct report staff nurses, is warranted.

The Relationship Between Staff Nurses' Perceptions of Nurse Manager Caring Behaviors and Patient Experience: A Correlational Study

OBJECTIVE

The objective of this study was to explore the relationship between staff nurses' perceptions of nurse manager caring behaviors and patient experience.

BACKGROUND

Despite numerous interventions aimed at changing the provision of patient care to improve care quality, patient experience scores have remained moderate. Little research has been conducted exploring how caring relationships in the professional practice environment might play a role in the patient experience of care.

METHODS

A cross-sectional, correlational design was used to examine the relationship between staff nurses' perceptions of nurse manager caring behaviors as measured by the Caring Assessment Tool-Administration (CAT-Adm) and acute-care patient experience using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

RESULTS

There was a positive relationship between the staff nurses' perceptions of nurse manager caring behaviors and patients' HCAHPS overall hospital rating. There also was a positive relationship between the CAT-Adm scores and nurse manager visibility.

CONCLUSION

Departments had higher HCAHPS overall hospital rating when the staff nurses perceived their unit manager as caring. In addition, the more staff nurses actually visualized their nurse manager during a shift, the more they perceived their nurse manager as caring.

The Dual Epidemics of 2020: Nursing Leaders' Reflections in the Context of Whole Person/Whole Systems

The Greater Boston Nursing Collective, a consortium composed of university nursing deans and chief nursing officers within academic medical centers and specialty hospitals in Boston, Massachusetts, was formed in 2014. Since the group's inception, our mission has been to create and reinforce whole-person/whole-system healing environments to improve the health of all communities. Through our collaboration in navigating the dual epidemics of COVID-19 and structural racism within our respective organizations, and across the United States and the world, we share experiences and lessons learned. Our common mission is clearer than ever: to create safe and joyful work environments, to protect the dignity of those we are privileged to serve, and to generate policies to advance health equity to rectify societal forces that have shaped this dual epidemic. We are humbled by the many who persist despite limited rest and respite, and whose stories, innovations, and leadership we are honored to witness and share. They have defined our generation, just as nurses in earlier crises have done: leading through service to others as our purpose and privilege.

The Value of Including the Nursing Perspective in the Boardroom

In response to the Future of Nursing Report, the Nurses on Boards Coalition promotes the health of communities and the nation by engaging nurses in board service. Nurses possess knowledge and skills that when leveraged in boardroom discussions and decisions may impact the health of the populations served by the board. This article highlights the insights of organizational board leaders, as they describe the impact and influence of nurse board members within their organizations.

Wisdom Shared: Health System Nurse Executives Share Success Strategies for Building High-Performing Nursing Organizations

With the evolution from single healthcare entities to health systems, the role of the system chief nurse executive (SCNE) has evolved. The SCNE leads at the highest executive level in the system and has continuum of care accountability. To effectively support the scope and breadth of the SCNE role, the organizational structure must contain key elements to ensure success. This article outlines the key elements of a system nursing organization and serves to aid in the development, improvement, and sustainability of successful system nursing structures.

The Nurse Manager's Experience of Moral Distress

The purpose of this study was to describe the moral distress experiences of nurse managers. Moral distress has been studied among direct patient care providers including nurses and physicians. The moral distress experience among nurse managers is less understood. We conducted a qualitative descriptive study with 19 nurse managers from 5 healthcare institutions in Virginia. Interview data were analyzed using a directed content analysis, as the structural components of the moral distress phenomenon are already known. Participants suffered moral distress when they were unable to achieve or maintain effective unit function and felt caught in the middle between their units' and employees' needs and organizational directives. System-level causes of moral distress are common among nurse managers. Future research should involve measurement of moral distress among nurse managers and exploration of effective interventions.

The Reality for Minorities Exploring Nurse Executive Leadership

Practices to increase diversity in nursing have had little effect at the executive leadership level. Lack of diversity in leadership threatens efforts to improve patient care and reduce disparities. This article advocates for formal mentorship as an evidence-based pathway to expand diversity in nurse executive leadership.

Perceptions of Authentic Nurse Leadership and Work Environment and the Pandemic Impact for Nurse Leaders and Clinical Nurses

OBJECTIVE

The aim of this study was to determine the pandemic impact on the relationship between nurses' perception of the authentic nurse leadership (ANL) of their manager and their perception of the work environment.

BACKGROUND

Both ANL and healthy work environment (HWE) contribute to staff and patient outcomes. Our 1st study of these 2 variables revealed a positive relationship. Will this be upheld in a pandemic year?

METHODS

More than 5000 nurses from a national sample participated in a cross-sectional, correlational, descriptive study using the Authentic Nurse Leadership Questionnaire, the Critical Elements of a Healthy Work Environment Scale, and a pandemic impact on practice question.

RESULTS

Overall, nurses perceived ANL and HWE were present despite a high level of pandemic impact; however, when clinical nurses were separated from managers/directors, HWE was not present for frontline nurses. The moderate correlation of ANL and HWE was replicated in this larger study.

CONCLUSIONS

This is the 2nd study of the positive relationship between ANL and HWE using these models, supporting ANL as an essential standard of a HWE. ANL was present for clinical nurses in a pandemic year signaling that nurse leaders rose to meet frontline leadership needs. HWE was present overall, but not for clinical nurses. Leadership is essential to work environments and outcomes especially in times of crisis and significant change.

What Lies Ahead for Nursing

This is the last of three articles exploring ways in which frontline nurses may be affected by recommendations of the forthcoming National Academy of Medicine Future of Nursing 2020-2030 study. For this third article, interviews were conducted with nurse leaders from diverse practice areas to see how their thinking about the future had shifted as 2020 drew to a close.

[Novel Coronavirus: Applying Transformational Leadership to the Combat of COVID-19 in Nursing Practice]

Cases in the current novel coronavirus (COVID-19) pandemic continue to increase, bringing tremendous psychological pressures to frontline caregivers and threating the ability of existing medical care systems in many countries to cope with related demands. In this situation, nursing leaders have a heightened responsibility to assist nursing staff to remain at their jobs and feel secure, to strengthen safety systems, to provide adequate equipment and personnel training, and to proactively lead nursing staff. In this article, leadership strategies implemented under the COVID-19 pandemic are presented from the perspective of transformational leadership in nursing practice. This article is divided into the following five themes: 1. Leadership makes the vision more vivid; 2. Demonstrating charismatic leadership; 3. Leaders who stimulate intellectual potential; 4. Paying attention to spiritual inspiration; 5. Providing individualized sincere care. Leaders should promote the professional role of nursing staff and provide a safe and secure practice environment.

Managing capability in specialist nursing practice

Raising concerns over another nurse's clinical practice and capability presents significant challenges, particularly in specialist clinical nursing roles. However, the support provided to nurses who raise such concerns is not always optimal. While compassionate leadership in healthcare has been stated as a priority to develop safer workplaces for staff, it must be balanced against the need to manage staff undergoing capability management processes. This article discusses how enhanced training and support for both line managers and staff can improve the capability management processes.

Nurse Leaders Employ Contemplative Practices to Promote Healthcare Professional Well-being and Decrease Anxiety

OBJECTIVE

The purpose of this study was to test the effectiveness of a daylong resilience retreat on healthcare professionals' anxiety levels, intention to engage in mindfulness practices, and self-efficacy around mindfulness.

BACKGROUND

Caregiver burnout is a concern that needs to be addressed at the organizational level so that professionals can reduce their risk of psychological injury while providing high-quality care. The COVID-19 (novel coronavirus) pandemic has exacerbated symptoms of burnout among nurses nationally.

METHODS

Ten sessions of daylong resilience retreats were delivered to independent groups of nurses, nurse practitioners, and other healthcare professionals. Preretreat and postretreat assessments were completed using a 19-item survey developed by the research team to assess state anxiety, intention to engage in mindfulness practices, and self-efficacy around mindfulness.

RESULTS

One hundred six healthcare professionals completed the resilience retreats. There was a statistically significant decrease in state anxiety scores following the retreat. The majority of the participants reported high intentions to engage in mindfulness practices and felt confident about incorporating mindfulness in their lives.

CONCLUSIONS

Brief resilience retreats endorsed by nurse leadership can reduce perceived anxiety and facilitate engagement in contemplative practices, which are associated with a decrease in the risk of burnout.

Advice for aspiring nurse leaders

ABSTRACT

Advice from current nurse leaders can offer valuable insight for aspiring leaders. This article discusses how the collective wisdom of practicing nurse leaders can assist new leaders as they transition into the role.

Signposts on the road to recovery

Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on ways in which nurse leaders can help their staff recover from the stresses of working during the COVID-19 pandemic.

Compassionate leadership: how to support your team when fixing the problem seems impossible

Stress, suboptimal mental health and an inadequate work-life balance are underlying and serious issues in the nursing profession, affecting staff recruitment and retention and potentially having a detrimental effect on patient care. While compassion towards patients is central to the nursing role, often 'compassion towards the compassionate' is lacking. The need for compassion is even more important now, and in the months ahead, due to the additional stressors experienced by nurses during the COVID-19 pandemic, whether they are on the front line, furloughed or shielding. This article includes reflections from nursing staff and uses their stories to encourage reflection on ethical and moral dilemmas experienced during the pandemic. The Compassion in the Workplace model is suggested as a tool that can be used by nurse managers to examine their compassion levels and to support the development of a compassionate workplace. In addition, this article offers some practical ideas on what compassionate leadership might look like in day-to-day practice.