Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

Nurses' and nurse leaders' perspectives on a health-promoting work environment: a meta-ethnographic study

PURPOSE

The purpose of this meta-ethnography is to integrate and synthesize nurses' and nurse leaders' perspectives on a health-promoting work environment to enhance understanding of its essential aspects.

METHODS

A meta-ethnographic approach developed by Noblit and Hare was conducted.

FINDINGS

Line of argument synthesis led to the development of an overarching tree metaphor: "cultivating a flourishing environmental tree rooted in values, held stable by leadership, and nurtured by safe working conditions." This metaphor illustrates that a health-promoting work environment is imbued with three interdependent aspects: 1) core values as the roots of the tree, including respect, recognition, community, and engagement 2) value-conscious leadership as the trunk of the tree, meaning a leader who is conscious of their power position and responsibilities and 3) safe working conditions as fertile soil for the tree, comprising the physical and administrative dimensions of the work environment.

CONCLUSIONS

Collaboration between nurses and leaders is crucial for cultivating a health-promoting work environment. However, nurse leaders, due to their influential positions, have the responsibility to facilitate this environment. Consequently, leaders need to receive adequate resources and support from their superiors to foster an environment that enhances nurses' health and job satisfaction.

Personal and work-related factors associated with nurse resilience: An updated systematic review using meta-analysis and narrative synthesis

BACKGROUND

Nursing shortages and increased workforce turnover have significantly increased nurses' workloads, thus increasing the risk of burnout and stress, particularly during the COVID-19 pandemic. A systematic review published in 2019 suggested that resilience could act as a buffer to adversity; however, the factors associated with resilience during and after this global pandemic have not been identified.

OBJECTIVES

To identify personal and work-related factors associated with nurse resilience, including the period during and after the COVID-19 pandemic.

DESIGN

Systematic review.

DATA SOURCES

The search was conducted between January and February 2024 in the following databases: CINAHL Plus, MEDLINE (Ovid), PsycINFO, EMBASE, and Scopus, using the key terms 'resilience', 'hardiness', 'work', 'employ', 'occupation', 'job', and 'nursing'.

REVIEW METHODS

Quantitative studies with English full text, published between 2018 and 2024, were selected if they assessed resilience and its associated factors among nurses providing direct patient care. Two authors independently completed the data selection process. Studies with quality assessment grades of 3 or above were included for final analysis. A meta-analysis was utilised for the mean resilience levels from studies using the same measures of resilience, and a narrative synthesis was performed for the demographic and work-related factors.

RESULTS

Fifty-nine cross-sectional studies with a quality assessment score of 3 or above were included. Forty-seven studies were included in a meta-analysis, which reported an estimated mean resilience level of 20.69 using a random-effects model (95 % CI [18.53, 22.85], z = 18.79, p < 0.0001, I2 = 95.1 %). Twenty studies with the Connor Davidson Resilience Scale (CD-RISC)-25 and five with the CD-RISC-10 were meta-analysed for the mean resilience levels of 62.85 (95 % CI: [55.60, 70.10], z = 16.97, p < 0.0001, I2 = 31.70 %) and 26.34 (95 % CI: [20.85, 31.83], p < 0.0001, I2 = 0 %), respectively. A low mean resilience level was identified. Sixteen demographic factors were identified as associated with resilience. Twenty job demand factors negatively associated with resilience were determined and categorised into exhaustion, psychological factors, and work challenges. Thirty-two job resource factors positively related to resilience were identified and classified into the following categories: psychological factors, leadership, work performance, well-being and quality of life, and social and organisational support.

CONCLUSIONS

Understanding the job demand and resource factors can help organisations minimise the risks and develop institutional strategies to protect nurses from the negative impact of COVID-19 or future pandemics on nurses' well-being.

Registered nurses' perceptions of their leadership close to older adults in municipal home healthcare: a cross-sectional questionnaire study

BACKGROUND

Registered nurses lead the nursing care close to older adults in home healthcare. It is expected that there will be an increased need for home healthcare. In addition, more advanced care is now being performed in home healthcare, leading to increased demands for registered nurses. Therefore, the aims of this study are to explore and compare registered nurses' perceptions of their leadership close to older adults in municipal home healthcare, as well as to correlate their perceptions with age and work experience.

METHODS

This study is a part of a larger web-based questionnaire survey, with a non-experimental and cross-sectional design. Descriptive and analytical statistics were used. A total of n = 71 registered nurses leading close to older adults participated, in seven municipalities in two geographic areas in Sweden.

RESULTS

The registered nurses perceived their ability as leaders close to older adults as high. The registered nurses had neither low or high trust in care staff's competence. They perceived to have space and access neither in a low or high degree in their work to develop sufficient competence in leadership and having nursing responsibility on an organisational level. Registered nurses' perceptions of their leadership differed depending on whether they had a specialist education or not; those with specialist education perceived to a higher degree that they could apply their professional experience in their work; interact with the older adult and their next of kin; assess individual needs and based on a holistic view of the older adult, create good relationships with the older adults' next of kin.

CONCLUSIONS

Registered nurses' specialist education may strengthen their leadership in home healthcare. Further research is needed to gain new knowledge of registered nurses' leadership in home healthcare, as well as care staff's' experiences of registered nurses' leadership in municipal home healthcare.

Transforming Nursing Practices: A Comprehensive Review of Performance Improvement Strategies

Introduction

Nurses play a vital role in healthcare systems, directly influencing patient care quality and outcomes. This study aims to identify and analyze strategies for improving nursing performance in Iran through a systematic review and meta-synthesis, following PRISMA 2020 guidelines.

Methods

Data were collected from four electronic databases: Web of Science, Scopus, PubMed, and Embase. Qualitative studies and mixed methods focused on nursing performance in Iranian healthcare contexts were included. Data management and theme development were facilitated using MAXQDA qualitative analysis software.

Findings

Thirty-seven studies were included, identifying 10 key themes for improving nursing performance: leadership, organizational culture, self-efficacy, mental health support, continuous education, technological integration, working conditions, performance evaluation, recruitment and retention, and service quality improvement.

Conclusions

A holistic approach, including leadership development, supportive work environments, continuous education, and technology integration, is essential for enhancing nursing performance and healthcare outcomes in Iran.

The Effect of Work Environment and Work-Related Characteristics on Perceived Individual Work Performance of Front-Line Nurse Managers: A Cross-Sectional Study

This study aimed to examine the effect of work environment and work-related characteristics of front-line nurse managers on their perceived individual work performance. It was conducted between March and May of 2022 with 219 front-line nurse managers working in a private chain hospital group in Türkiye. The Nurse Manager Practice Environment Scale and the Individual Work Performance Questionnaire were used for data collection. Descriptive statistics, Spearman correlation analysis, and generalized linear model regression analysis were used in data analysis. A positive correlation was found between the scores obtained from the two scales (r = 0.453; p < 0.001). Regression analysis revealed that two independent variables-nurse manager's work environment and duration of managerial experience-predicted nurse managers' perceived individual work performance level, with these variables explaining 28.1% of the total variance. Results showed that a favorable work environment and four or more years of managerial experience enhanced the perceived individual performance of front-line nurse managers. These findings suggest that to improve the individual work performance of front-line nurse managers, their work environment must also be improved. In addition, retention strategies that target experienced front-line nurse managers are critical to maintaining high levels of performance.

Leadership styles and EMR adoption: insights from Bali's primary care clinics

PURPOSE

This study aims to explore the influence of leadership styles, using full-range leadership theory (FRLT), and technology acceptance, guided by the technology acceptance model (TAM), on the implementation of electronic medical records (EMRs) in primary care settings in Bali.

DESIGN/METHODOLOGY/APPROACH

Using a mixed-methods approach, this research analyzes data from 120 primary care clinics in Bali with a total of 1,204 respondents. Quantitative data were collected through structured surveys assessing leadership styles and EMR acceptance, supplemented by qualitative insights from 30 interviews and 6 focus group discussions. Statistical methods, including the Chi-Square Test of Independence and pairwise comparisons using adjusted residuals, were used to examine the relationships between leadership styles, EMR adoption, perceived usefulness and ease of use.

FINDINGS

The Chi-Square Test of Independence revealed a significant association between leadership style and EMR adoption level (χ² = 30.33, p < 0.001). Transformational leadership was strongly associated with higher full EMR adoption rates, while Laissez-Faire leadership showed a significant association with no EMR adoption. Qualitative data supported these findings, emphasizing the critical role of proactive, supportive leadership in enhancing technology acceptance.

ORIGINALITY/VALUE

This study uniquely integrates FRLT and TAM within the context of EMR adoption in Bali's health-care system, providing new insights into how leadership and technology perceptions interact to influence implementation outcomes in a diverse health-care environment.

Clinical leadership during the Covid-19 pandemic: a scoping review

PURPOSE

Leadership was a critical component in managing the Covid-19 pandemic. A scoping review of clinical leadership investigates the leadership styles employed by clinicians during times of unprecedented crisis, with the Covid-19 pandemic as a focus.

DESIGN/METHODOLOGY/APPROACH

The scoping review was designed based on a five-stage approach proposed by Arksey and O'Malley (2005). Three key databases were searched: Scopus, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and ProQuest Healthcare Administration between 2020 and 2022.

FINDINGS

Of the 23 papers included in the review, the majority were based on developed countries. Seven leadership approaches were found to be useful in times of crises, with compassionate leadership being particularly effective. Seven key themes relating to the pandemic were also identified.

RESEARCH LIMITATIONS/IMPLICATIONS

This review is limited by the search strategy employed and the possibility some publications could have been missed. However, it is clear from the results that there is limited research on healthcare leadership outside of the acute setting and in developing countries. These are important areas of further research that need to be pursued to inform our learning for other times of unprecedented crisis.

ORIGINALITY/VALUE

Various leadership styles were employed during the pandemic, but compassionate leadership, which fosters a collaborative, caring and kind environment, becomes a necessity when faced with uncertainty and adversity. This review identifies key factors that leaders need to manage during the pandemic. Practically, it sheds light on leadership strategies that may be employed in future unprecedented crises.

Efficacy of tailored educational interventions in changing conflict management strategies among operating room staff

BackgroundWorkplace conflicts, especially in hospital environments, pose significant challenges to both staff productivity and well-being. The complex nature of healthcare environments, combined with diverse team dynamics, makes effective conflict management crucial. Previous studies suggest that structured educational interventions can help mitigate conflicts and foster better working conditions.ObjectiveThis study aims to evaluate the effectiveness of educational interventions, specifically in conflict management and emotional intelligence training, on reducing workplace conflicts and improving coping strategies among hospital nurses.MethodsThe study involved four stages: (1) Problem identification through interviews and literature review, (2) Use of demographic data and conflict assessment tools including the Dobrin Job Conflict, Jehn's Interpersonal Conflict, and Putnam & Wilson's Conflict Management Strategies Questionnaire, (3) Conducting workshops focused on conflict resolution and emotional intelligence, and (4) Assessing the intervention's impact through paired t-tests and statistical analyses.ResultsThe intervention significantly reduced relational, task-related, and procedural conflicts. Following the workshops, the use of non-confrontation and control strategies decreased, while problem-solving strategies became more prevalent. Correlation analysis indicated that demographic factors such as age and work experience significantly influenced the results.ConclusionEducational interventions, particularly in emotional intelligence, proved effective in reducing conflicts and improving conflict management strategies. This highlights the importance of continuous training programs aimed at enhancing workplace relations and productivity in hospital settings.

Relationship between head nurse leadership and nurses' burnout: parallel mediation of job demands and job resources among clinical nurses

BACKGROUND

Many elements in the workplace contribute to nurses' burnout experiences, affecting patient safety and the healthcare organizations' efficiency. Leaders' presence and conduct are the most potent "master" factors in every work setting. Although previous studies have shown that head nurse leadership, job demands, job resources, and job burnout are significantly related, the interaction mechanism remains unclear. This study investigates the parallel mediating roles of job demands and job resources between head nurse leadership and job burnout in nursing staff.

METHODS

A cross-sectional, anonymous, and confidential online survey was conducted from March to June 2024 to collect data from 579 registered nurses in four hospitals in Hunan provinces. The independent variable was head nurse leadership, the mediating variables were job demands and resources, and the dependent variable was job burnout. Parallel mediation analysis was performed using the PROCESS macro in SPSS.

RESULTS

This study found that head nurse leadership negatively relates to nurses' burnout. The parallel mediation analysis suggests that job resources and job demands play parallel roles in the relationship between head nurse leadership and job burnout. As predicted, head nurse leadership weakened job burnout through job resources and contributed to job burnout through job demands.

CONCLUSION

This study finding highlights the importance of head nurse leadership in decreasing nurses' job burnout and reveals two potential mechanisms through which head nurse leadership is related to nurses' burnout. By understanding the role of head nurse leadership, job demands, and job resources, interventions can be targeted to improve nurses' mental health.

Health-oriented leadership in specialized outpatient palliative care teams in Germany: a qualitative study with palliative care professionals

BACKGROUND

Palliative care leadership is characterized by diversity and collaboration, with an emphasis on interdisciplinary teamwork and shared responsibility. In the context of palliative care, the leadership role is subject to a distinctive set of stressors, which in turn necessitates the implementation of strategies that are conducive to the well-being of the team. The implementation of the Health-oriented Leadership approach (HoL) appears to be a crucial step in advancing the field and addressing the emotional aspects of end-of-life care. Given the growing global need for palliative care, the study aims to provide initial insights into how health-oriented leadership is understood in the field of specialized outpatient palliative care (SAPV),its potential benefits and the challenges to its implementation. Furthermore, the perceived advantages of this approach in the given context will be discussed, and the challenges inherent to its implementation will be presented.

METHODS

In this qualitative study, a total of 30 semi-structured interviews were conducted with palliative care professionals working in Northern Germany. The participants were distributed equally between leaders and employees, and the interviews were conducted in person. The participants included medical practitioners, nursing staff and a health scientist in palliative care. The data were subjected to an inductive analysis and interpretation in accordance with the qualitative content analysis proposed by Mayring. Exploratory analyses were conducted to identify and examine the differences between leaders and employees.

RESULTS

The findings of the study indicate that employees and managers in palliative care hold comparable yet distinct perspectives on the advancement of occupational health (HoL). Both groups emphasised the relevance of a supportive working environment, health promotion measures and effective communication. Employees focused on work-life balance and immediate benefits such as job satisfaction, while managers prioritised adaptive structures and long-term goals such as reducing absenteeism. Communication barriers and resource management were identified as challenges. Both groups emphasised the importance of appreciation, mental health and professional boundaries for a healthy working environment.

CONCLUSION

This study emphasizes the important role of health-oriented leadership in addressing unique challenges in SAPV and fostering a supportive work culture. It highlights the diverse approaches of leaders and employees towards health management and underscored the increasing emphasis on self-care and mental well-being in high-stress healthcare environments.

Enhancing the retention of newly qualified nurses

The retention of newly qualified nurses (NQNs) is a pressing issue in healthcare systems, particularly in high-pressure environments such as acute care. This article explores the key challenges faced by NQNs, including lack of career development opportunities, negative workplace cultures and burnout, all of which contribute to high turnover rates. Strategies such as structured preceptorship and mentorship programmes, emotional wellbeing initiatives, and leadership support are examined. The article underscores the importance of building a positive work environment to retain NQNs, thereby improving workforce sustainability and patient care. Additionally, recommendations are provided to enable a proactive approach to improving NQN retention.

The development of the Postdoctoral Nurses Competence Scale: A Delphi consensus and content validity study

BACKGROUND

PhD prepared nurses advance nursing science through research and integration of findings into practice. They demonstrate expertise in research, education, patient care, and policy. Various professional competencies are required for success in research, clinical practice, and education. Assessment of professional competencies is expected to stimulate competence and career development.

AIM

To reach consensus on professional competencies, develop an instrument to measure professional competencies of PhD prepared nurses and assess the content validity of the instrument.

METHOD

A Delphi consensus and content validity study was conducted using online questionnaires completed by international PhD prepared nurse researchers. The relevance of and agreement with the competencies were measures using Likert-scales and open-ended questions to determine consensus. The Postdoctoral Nurses Competence Scale was developed, and its content validity evaluated.

RESULTS

Initially, four of 15 competencies were deemed 'very' or 'fairly' important by 18 PhD prepared nurses. In the second round with 13 adjusted competencies, eight competencies were rated 'very' or 'fairly' important. The content validity index scored 0.91.

CONCLUSION

Consensus was reached on most professional competencies, and the 13-item self-assessment instrument demonstrated excellent content validity. Further research is recommended to evaluate additional clinimetric properties before use of the instrument.

Factors influencing work engagement of nurses in general hospitals: A cross-sectional study

AIM

This study aimed to examine the level of work engagement and to identify the factors influencing the work engagement of nurses.

BACKGROUND

Work engagement plays a crucial role in enhancing the efficiency of outcomes and the standard of care in nursing and healthcare services.

METHODS

A descriptive predictive design and stratified random sampling was used to select 206 nurses from three general hospitals in Naypyitaw, Myanmar.. Research instruments consisted of the demographic data form, the Utrecht Work Engagement Scale, the Global Transformational Leadership Scale, the Survey of Perceived Organizational Support, and the Psychological Capital Questionnaire. The results were explored by applying descriptive statistics and stepwise multiple regression.

RESULTS

Overall work engagement was at an average level. Transformational leadership and psychological capital could affect work engagement, explaining 19.34% of the total variance; however, perceived organizational support, age, and work experience did not show any impact on it.

CONCLUSIONS

The findings recommend that nurse administrators should focus on transformational leadership and psychological capital in formulating strategies to increase nurses' work engagement.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The outcomes might provide baseline information for nurse administrators and policymakers by formulating management strategies to enhance nursing leaders' awareness, knowledge, and skills about transformational leadership behaviors and to keep nurses holding self-efficacy, hope, optimism, and resilience of psychological capital in healthcare organizations, which ultimately increase nurses' engagement at work.

Exploring critical care nurses' experiences of redeployment to general medical-surgical wards for covering staff shortages: A qualitative research study

BACKGROUND

The impact of redeployment on staff was not widely recognized before the COVID-19 pandemic. The redeployment of critical care nurses is frequently employed in health care organizations as a last-minute staffing management approach without proper infrastructure. Studies exploring the feelings and experiences of redeployed critical care nurses in this manner are sparse.

AIM

The aim of this study was to develop an understanding of the experiences of critical care nurses during their redeployment to cover shifts in the general wards.

STUDY DESIGN

This study adopted a qualitative research design to explore critical care nurses' experiences of redeployment. Ten critical care nurses attending a postgraduate critical care course in one university were recruited between January and April 2019. Data were collected using a focus group which was thematically analysed.

RESULTS

Three themes were identified: 'challenges in transitioning to ward settings', 'concerns regarding patient safety and satisfaction' and 'insufficient infrastructure and support'. Participants expressed concerns about patient and staff safety during redeployment, describing feelings of anxiety and undervaluation.

CONCLUSIONS

The study illuminates the intricate challenges experienced by redeployed critical care nurses, highlighting the crucial need for comprehensive support, targeted training and strategic planning to safeguard patients' care and nurses' well-being during periods of staff shortages in health care settings. These findings emphasize the importance of proactive measures in fostering a resilient and adaptable health care workforce. This is a small study involving only one focus group of 10 critical care nurses, which may limit the transferability of the findings. As a result, the findings may not fully reflect the experiences of critical care nurses from other sites.

RELEVANCE TO CLINICAL PRACTICE

The study reveals that critical care nurses experience challenges and stress when redeployed to general wards because of insufficient support and infrastructure. It emphasizes the need for comprehensive strategies, such as job rotation, tailored training and collaborative efforts to address redeployment challenges. Research could focus on developing and testing different models of job rotation between critical care and general wards, evaluating their impact on nurse satisfaction, confidence, competence and overall experience. The findings highlight the importance of organizational support, leadership and local guidelines for effective teamwork. Conducting longitudinal studies to track the experiences of redeployed critical care nurses over an extended period would be beneficial. This approach would provide insights into the long-term effects of redeployment on job satisfaction, burnout and retention.

Self-leadership and why it matters to nurses: A scoping review

AIM

To synthesize the previous findings of nurses' self-leadership in hospital settings.

BACKGROUND

Self-leadership is a process of comprehensive self-influence. People direct themselves toward optimal performance with self-motivation and take responsibility for their actions. Self-leadership has been found to have a connection with the experience of meaningfulness of work, commitment, and job satisfaction.

METHODS

The scoping review was conducted by following the PRISMA-ScR reporting checklist. PubMed, CINAHL, Scopus, and PsycINFO databases were searched, and 1831 articles were identified and screened. Multiple study designs were included while specific inclusion and exclusion criteria regarding population, concept, and context were addressed. Narrative data synthesis was conducted.

FINDINGS

The search identified a total of 13 relevant studies published between 2013 and 2023. Four themes were found to describe nurses' self-leadership: Self-leadership is nurses' internal skill that increases with experience (n = 8); self-leadership improves nurses' work performance (n = 8); self-leadership supports work well-being (n = 5); and self-leadership thrives in favorable nursing work environments (n = 6).

CONCLUSION

Self-leadership has a positive connection to nurses' work performance and well-being. Nursing students should be introduced to self-leadership skill development in their nursing education programs, and nurses should be offered continuing education opportunities to develop self-leadership skills throughout their careers. Further studies are necessary to fill the information gap about explaining self-leadership in the context of professional nursing and offering recommendations for how to strengthen nurses' self-leadership skills.

IMPLICATIONS FOR NURSING EDUCATION, PRACTICE, AND POLICY

Self-leadership encourages nurses to work proactively to improve patient care and enhance work environments. Self-leadership includes behaviors that can be encouraged through each developmental stage of a nurse's career. Faculty, nurse leaders, and organizational structures play an important role in identifying self-leadership behaviors and supporting their positive development.

Enablers and inhibitors of nursing and midwifery leadership in Pacific Island collectivist cultures

AIM

To identify and explore inhibitors and enablers of nursing and midwifery leadership in the Pacific; to develop context-specific recommendations for policy and practice.

BACKGROUND

Many Pacific Island countries experience poor health outcomes and are vulnerable to climate-related health emergencies. Nursing and midwifery leadership is essential to improve regional health outcomes through influencing policy decisions, strengthening health systems and ensuring optimal health workforce utilisation. Understanding factors affecting health professional leadership facilitates action to remove obstacles and stimulate professional development for emerging leaders.

METHODS

This qualitative study utilised a culturally sensitive co-designed approach and follows the COREQ criteria. The PARcific research methodology synthesised Participant Action Research with Pacific methodologies for culturally safe interviews with 136 stakeholders.

RESULTS

Major enablers of leadership identified were professional development, particularly skills in communication, project planning and data literacy; adequate workforce resources; effective workforce management; support from peers and managers; and personal confidence and courage. Participants identified main inhibitors: inadequate workforce resources; limited cultural sensitivity;  and poor understanding of national and regional strategies. However, perspectives varied between different participant groups. International and regional policy makers did not recognise the critical importance of workforce resources and individual agency to fostering nursing and midwifery leadership.

DISCUSSION

Joint action to enhance health professional leadership will promote better policymaking leading to improved health outcomes.

IMPLICATIONS FOR HEALTH POLICY

Professional development should specifically include leadership training using culturally appropriate methods and mechanisms for management and peer support. Leadership development also requires adequate workforce resources to support training; regional standards for accreditation and professional development; improved formal and informal communication pathways; established regional policy directions; and a regional taskforce with health professionals trained to provide crisis leadership.

Integrating internationally qualified nurses: a qualitative exploration of nurse managers' influence from nurses' experiences

BACKGROUND

Healthcare systems globally are confronted with a shortage of nurses. Various strategies to address this have been applied, including active recruitment of internationally qualified nurses. Nurse managers may have a central role in supporting workplace integration. This study aimed to explore how domestically qualified nurses and internationally qualified nurses viewed the role of nursing management and its impact on workplace integration.

METHOD

Semi-structured interviews with 21 domestically and 14 internationally qualified nurses were conducted. Nurses were selected using purposive sampling. Snowball sampling was applied to reach a sufficient sample size. Interviews were pseudonymized and transcribed. Transcripts were coded according to Qualitative Content Analysis with data structured into themes and subthemes.

RESULTS

Five key themes related to impact of nursing management on workplace integration were identified: (a) Appropriate Placement, (b) Recruitment Process, (c) Leadership Support, (d) Workforce Shortage, and (e) Additional Burden/ Increased Workload. Active support by nursing leadership and the opportunity for shared-decision making was seen as a key factor. Increased workload, additional time and resources requirements associated with orientation of internationally qualified nurses and pressures from staff shortages were highlighted as hindrances. Inappropriate placement of internationally qualified nurses was perceived as key hindrance that could be addressed by nursing management. An imbalanced ratio between domestically and internationally qualified nurses was perceived as challenging by domestically qualified nurses.

CONCLUSION

Integration of internationally qualified nurses to clinical practice brings several challenges that may be positively impacted by nursing management through appropriate placement of internationally qualified nurses, supportive nurse managers and adequate preparation of domestically qualified nurse mentors/preceptor.

IMPLICATIONS FOR PRACTICE

Nurse managers should ensure that internationally qualified nurses' work experience matches local clinical unit vacancies before hiring them. Peer support is a supportive factor for internationally qualified nurses. Nurse managers should find a balanced ratio between internationally and domestically qualified nurses in the roster. Introducing mentors or preceptors at ward level may be a strategy decrease work-related stress in both nursing groups.

REGISTRATION NUMBER

The study has been prospectively registered (27 June 2019) at the German Clinical Trial Register (DRKS00017465).

The effect of ambidextrous leadership on knowledge sharing behavior among nurse specialists: a chain mediation role of perceived organizational support and organizational commitment

BACKGROUND

Knowledge sharing behavior of nurse specialists can cultivate nurses' core abilities, improve the quality of healthcare system services, and enhance people's well-being. Ambidextrous leadership can increase the level of knowledge sharing behavior, but the exact mechanism in nurse specialists remain unclear. This study investigated the relationship between ambidextrous leadership and knowledge sharing behavior among nurse specialists, with a specific focus on the mediation roles played by perceived organizational support and organizational commitment.

METHODS

An anonymous cross-sectional survey with a convenience sampling among nurse specialists was conducted in Anhui Province, east China from July to September 2024. Sociodemographic information questionnaire, Multifactor Leadership Questionnaire, Perceived Organizational Support Scale, Chinese Employees Organizational Commitment Scale and Knowledge Sharing Behavior Scale were used to collect data. SPSS23.0 and AMOS 26.0 were used for statistical analysis.

RESULTS

A total of 298 nurse specialists participated in this study. The average score of nurse specialists' knowledge sharing behavior was 55.00(10.65). Knowledge sharing behavior was positively correlated with ambidextrous leadership (r = 0.562, p<0.01), perceived organizational support (r = 0.575, p<0.01), and organizational commitment (r = 0.413, p<0.01). The total effect (β = 0.635) of ambidextrous leadership on knowledge sharing behavior consisted of a direct effect (β = 0.320) as well as an indirect effect (β = 0.315) mediated through perceived organizational support and organizational commitment. Perceived organizational support and organizational commitment have a chain-mediated effect (β = 0.056) between ambidextrous leadership and knowledge sharing behavior among nurse specialists, bootstrap 95% confidence interval (0.018,0.131), which represented 8.8% of the total effect.

CONCLUSIONS

This study confirms that ambidextrous leadership has a significant positive predictive effect on knowledge sharing behavior. Ambidextrous leadership was first associated with an increase in perceived organizational support, followed by a sequential ascend of organizational commitment, which associated with an improvement in knowledge sharing behavior among nurse specialists at last. Hospital managers can increase the levels of knowledge sharing behavior among nurse specialists by improving ambidextrous leadership, perceived organizational support and organizational commitment.

Concept, Influencing Factors, and Interventions of Nursing Health Leadership: A Scoping Review

Background: With increasing burnout and turnover rates among nurses, health leadership can effectively improve the health and well-being of both leaders and staff. However, in the nursing field, the definition and mechanisms of health leadership remain unclear and require further research. Aim: The main objective of this study was to define the concept of health leadership in nursing, construct a nursing model program, and promote the formation of normative nursing health leadership theories and strategies. Evaluation: We searched the PubMed, CINAHL, Embase, Web of Science, PsycINFO, and Scopus databases. The following themes were extracted from the included articles: the concept, assessment tools for health leadership, influencing factors, intervention measures, and health effects. Key Issues: A systematic search of the relevant databases yielded 3161 initial search results. Thirty-two studies were eligible for inclusion. Research shows that the concepts and measurement tools of health leadership are rarely applied in the field of nursing. Health leadership is influenced by personal factors (e.g., leadership qualities such as care, support, courage, patience, tolerance for uncertainty, persuasion skills, work ethic, pressure, experience, effort-reward imbalance, etc.; specific knowledge; self-awareness; psychological capital; leadership style; motivation; consideration; and a commitment to health issues) and organizational factors (e.g., work environment, attention to subordinates, job expectations, and relationship transparency). Several studies have demonstrated that interventions, such as personal development planning, leadership training, face-to-face communication, self-directed learning, and reflection, are effective in promoting healthy leadership styles and improving the well-being of leaders and employees. Conclusions: We constructed a health leadership model as a reference for the development of relevant measurement tools and intervention strategies for the nursing field. Implications for Nursing Management: Nursing leaders should focus on their health and that of their subordinates, develop and implement health leadership, and aim for improvement in employees' well-being and nursing quality.

Exploring nurses' leadership and resilience in a complex daily work environment: a qualitative study

BACKGROUND

The contemporary healthcare system is inherently complex, necessitating organizational and ward-level changes to address challenges. Continuous adaptations in daily practices are essential to meet unexpected patient needs. These dynamic changes require resilience from healthcare staff, including nurses. This paper explores how nurses show leadership in response to changes within a complex work environment that demands resilience in their daily practices.

METHODS

An empirical qualitative study was employed. Non-participatory observations were conducted in February and March 2022 (n = 60 h), providing thick descriptions of nurses working across various shifts. Subsequently, two semi-structured group interviews were held: the first with nurses only and the second with multidisciplinary healthcare professionals. The interview transcripts and thick descriptions were analyzed using thematic analysis. Descriptive statistics were used to summarize participant characteristics.

RESULTS

Responding to a changing work environment requires resilience from nurses who exhibit leadership showing four distinct behaviors: proactive, patient-centered care; investigative problem-solving; reflective learning; and profession-based approaches.

CONCLUSION

Collaboration is a key factor in resilient nurse leadership, both among nurses, and in interaction with patients, other healthcare professionals, and management. This research highlights how nurses' considerations, beliefs, and interactions, make their leadership behavior visible in a context that demands situated, structural, and social resilience.

Investigation of the Relationship Between Perceived Leadership Behaviours of Nurses and Hospital Safety Culture: A Study With the Structural Equation Model

BACKGROUND

Work environments that support patient safety initiatives are important for quality service and patient outcomes. The relationship between the leadership behaviours of nurse managers and safety culture, which has the potential to support these initiatives, constitutes one of the most important knowledge gaps.

OBJECTIVES

The study aimed to determine the relationship between nurses' perceived leadership behaviours and hospital safety culture and the factors affecting them.

DESIGN

We tested the theoretical model using structural equation modelling with the AMOS 21 program.

METHODS

The research was conducted with 134 nurses in two public hospitals in the south of Türkiye. Data were collected between October and December 2021 using the Leadership Behaviour Questionnaire and the Patient Safety Culture Hospital Questionnaire. Descriptive statistical analysis used to evaluate the data of the study. Structural equation modelling analysis and confirmatory factor analysis performed to test the research hypotheses.

RESULTS

The study found that non-punitive attitudes towards the mistakes had a full mediating effect on overall perception of safety interaction with employee-oriented leadership and high-level hospital interventions (β = -0.510, 95% CI -1.006/-0.076), and change had partly mediating effect on overall perception of safety interaction with change-oriented leadership (β = -0.510, 95% CI -1.043/-0.053).

CONCLUSIONS

It is clear that if nurse managers are to improve the staff's patient safety culture, they should develop change-oriented leadership skills by identifying adverse events and risks and motivating staff to learn from errors without taking punitive measures. In this context, healthcare organizations should evaluate the leadership qualities of managers. Managers at all levels can make plans to develop leadership behaviours that will play a facilitating role in improving patient safety.

Network of job demands-resources and depressive symptoms in critical care nurses: a nationwide cross-sectional study

BACKGROUND

Critical care nurses are vulnerable to depression, which not only lead to poor well-being and increased turnover intention, but also affect their working performances and organizational productivity as well. Work related factors are important drivers of depressive symptoms. However, the non-liner and multi-directional relationships between job demands-resources and depressive symptoms in critical care nurses has not been adequately analyzed. Understanding these relationships would be helpful for reducing depression, increasing nurses' well-being and retain healthcare forces.

METHODS

This was a cross-sectional study using baseline data from the Nurses' mental health study (NMHS), a prospective cohort study on nurses from 67 tertiary hospitals in 31 province-level administrative regions in China. Only clinical nurses working in the ICU were included (n = 13,745). Data were collected using online questionnaires, and analyzed using network analysis and structural equation model. Job demands (average working hours per week, average number of night shifts per month, paperwork burden and work-life balance), job resources (supervisor support, co-worker support, leader justice, organizational climate satisfaction, work meaning, and career prospect), personal resource (resilience) and depressive symptoms were main variables in the networks, while demographic data and social health (social-emotional support and loneliness) were covariates.

RESULTS

The prevalence of severe, moderately severe, moderate, mild, and none or minimum depressive symptoms in critical care nurses of this study were 1.21, 3.42, 9.76, 42.88, and 42.07% respectively. In the final network, 132 of 210 possible edges (62.8%) were not zero. "Fatigue" had the highest expected influence, followed by "Motor", and "Appetite". Meanwhile, in terms of job demands-resources and personal resources, the node with the highest expected influence was "Supervisor support", followed by "Work meaning" and "Co-worker support". Three bridge variables were identified: "Resilience-adaptation", "Average working hours per week", and "Co-worker support". The final structural equation model basically supported the results of network analysis with an acceptable model-fit (GFI = 0.918, AGFI = 0.896, PCFI = 0.789, PNFI = 0.788, NFI = 0.909, IFI = 0.911, CFI = 0.911, SRMR = 0.040, and RMSEA = 0.064).

CONCLUSIONS

There was a rather strong interconnectedness between depressive symptoms and job demands-resources. Fatigue, motor, and appetite were core depressive symptoms of critical care nurses. Close attention to those symptoms could help recognize depression in critical care nurses. Supervisor support, work meaning, and co-worker support played vital roles as job resources in reducing depression, while negative impact of long average working hours per week were more contagious. Resilience, as personal resources, could help mediate the associations between job demands-resources and depression. In clinical practice, it's recommended for nursing managers to (1) encourage critical care nurses to find their "meaning in work", (2) implement resilience enhancing programs for nurse, (3) build and maintain meaningful relationships with nurses and support them in daily work, and (4) create a harmonious and dedicated working environment where co-workers are willing to help and support each other. Improvements in those modifiable aspects could help reduce risk and prevent exacerbations of depressive symptoms in critical care nurses.

Coping Measures for Hospital Nurses' Turnover: A Qualitative Meta-Aggregation (2018-2023)

AIM

To identify and synthesise the qualitative evidence that is available regarding reducing the turnover of hospital nurses from their own perspectives.

DESIGN

A qualitative systematic review using the meta-aggregation design.

DATA SOURCES

Qualitative studies either in English or in Chinese, dating from 2018 to 2023, were obtained from eight databases, including CINAHL, PubMed, Web of Science, Embase, Ovid, and Chinese National Knowledge Infrastructure (CNKI), Wanfang Database and the China Biomedical Database.

METHODS

Studies were screened using pre-determined inclusion and exclusion criteria. Quality assessment was done using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines.

RESULTS

Sixteen papers were included that explored nurses' perspectives on enhancing their retention or reducing staff turnover. We developed three synthesised findings and 12 categories from 64 identified findings, including (1) individual adjustment strategy: professional pride, self-growth and psychological adjustment; (2) social support strategy: constructive workplace relationships, balancing work life and recognition of nursing and (3) organisational change strategy: embracing management and leadership, promote nursing professionalisation, workload management and support, flexible work patterns and opportunities, supporting personal career development and competitive salary.

CONCLUSION

This review provides an in-depth and meaningful understanding of nurses' own perceptions and suggestions for enhancing nursing turnover, which will call for a wide range of measures targeting the individual, social and organisational levels.

IMPLICATIONS FOR NURSING MANAGEMENT

This study contributes important knowledge to help improve hospital nurse's turnover, which can provide evidence to support nurse managers, other stakeholders and policymakers in correspondingly developing effective measures to address nurse turnover.

PATIENT OR PUBLIC CONTRIBUTION

There was no direct contribution from patient or caregiver to this study because the data of this study originated from published papers.

Perceived doctor-patient relationship, authentic leadership and organizational climate on physician burnout: job satisfaction as a mediator

BACKGROUND

This study aims to investigate the direct associations among perceived doctor-patient relationship, authentic leadership, organizational climate, and job burnout, as well as the indirect pathways through job satisfaction, with the aim of offering potential preventive strategies at the organizational level.

METHODS

A total of 399 physicians from six tertiary hospitals in Anhui Province were enrolled by purposive sampling method. Structural equation modeling was performed to examine the proposed model.

RESULTS

The average score of the participants' job burnout was 35.22 (SD: 12.14), and the burnout rate was found to be 55.7%. Perceived doctor-patient relationship, organizational climate directly influenced job burnout. Perceived doctor-patient relationship, authentic leadership and organizational climate also indirectly influenced burnout through job satisfaction.

CONCLUSIONS

The present study underscores the significant influence of the perceived doctor-patient relationship, authentic leadership and organizational climate in mitigating burnout, and further reveals that job satisfaction serves to alleviate burnout. It is crucial to emphasize the importance of both internal and external psychosocial and organizational environmental factors. Additionally, the study highlights the pivotal role of job satisfaction in influencing physician burnout.

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.

Nursing home managers' quality of work life and health outcomes: a pre-pandemic profile over time

AIM

To examine trends in quality of work life and health outcomes of managers in nursing homes in Western Canada pre-pandemic.

METHODS

A repeated cross-sectional descriptive study using data collected in 2014-2015, 2017 and 2019-2020, in the Translating Research in Elder Care Programme. Self-reported measures of demographics, physical/mental health and quality of work life (eg, job satisfaction, burnout, work engagement) were administered and completed by nursing home managers. We used two-way analysis of variance to compare scores across times, controlling for clustering effects at the nursing home level.

RESULTS

Samples for data collection times 1, 2, 3, respectively, were 168, 193 and 199. Most nursing home managers were nurses by profession (80.63-81.82%). Job satisfaction scores were high across time (mean=4.42-4.48). The physical (mean=51.53-52.27) and mental (mean=51.66-52.13) status scores were stable over time. Workplace engagement (vigour, dedication and absorption) scores were high and stable over time in all three dimensions.

CONCLUSIONS

Nursing home managers were highly satisfied, had high levels of physical and mental health, and generally reported that their work was meaningful over time pre-COVID-19 pandemic. We provided a comparison for future research assessing the impacts of the pandemic on quality of work life and health outcomes.

First-line managers' experiences of and reflections on structural conditions for management practice in hospital settings

PURPOSE

The purpose of this paper is to describe first-line managers' (FLMs') experiences and reflections on structural conditions for management practice within hospital settings using Kanter's theory of structural empowerment.

DESIGN/METHODOLOGY/APPROACH

A qualitative deductive approach with a descriptive design was used. Interviews were conducted with 11 FLMs in charge of medical or surgical hospital units spread across Sweden. Data were analyzed using a directed content analysis, based on Kanter's theory of structural empowerment, encompassing such as access to necessary and sufficient resources, information, support and opportunities to learn and develop.

FINDINGS

Findings of this study from the FLMs' descriptions and reflections shed light on the impact of power dynamics on the structural conditions for management practice. The availability of nursing staff was a fundamental resource in the FLMs' work performance, ensuring delivery of care to patients and a sound work environment for staff. Additionally, the other structural elements outlined in Kanter's theory were evident in the findings, as the FLMs wished for structured information flow, identified potential and challenged opportunities for development and emphasized the importance of receiving support from people with a genuine understanding of their work situation.

ORIGINALITY/VALUE

The results of this study contribute to the understanding of FLMs' structural conditions for management practice in hospital settings. The paper's originality stems from the use of a deductive approach, providing a structured lens with the potential to inform future research and practice in the field of health-care management.

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.

Authentic Nursing Leadership and Safety Climate Across Hospital Settings During the COVID-19 Pandemic: A Cross-Sectional Study

AIM

To analyse the relationship between authentic nursing leadership and safety climates across hospital settings during the COVID-19 pandemic.

BACKGROUND

Authentic nursing leadership shapes the safety climate by fostering positive perceptions of workplace policies, processes, procedures and practices that influence how safety is prioritised and addressed within an organisation.

DESIGN

A cross-sectional study.

METHODS

Our study was conducted from December 2021 to December 2022 in six Brazilian hospitals. Participants were nursing staff working in General Medicine Units, Intensive Care Units (ICU) and Emergency Departments (ED) who provided care to patients with COVID-19. The Authentic Leadership Questionnaire and the Safety Attitudes Questionnaire were used to measure nursing staff perceptions of authentic leadership and safety climates. Data were analysed using descriptive and inferential statistics.

RESULTS

391 nursing staff across six hospitals participated. Self-awareness significantly enhanced perceptions of the safety climates. Additionally, being a Registered Nurse and working in the ICU were positively associated with achieving safe climates in the working environment. In contrast, working in EDs was significantly negatively related to safety climates.

CONCLUSIONS

The COVID-19 pandemic underscored a lack of authentic nursing leadership and unsafe climates. Therefore, it is critical to implement educational strategies that foster authentic leadership, particularly focusing on self-awareness, to promote more positive safety climates. Ensuring that leadership and safety climates are relationship-focused is critical to enhancing patient outcomes.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nursing staff's perceptions of authentic leadership and safety climates are important in making more informed decisions about patient management.

IMPACT

Since self-awareness increases positive perceptions of safety climates, nursing staff should exercise it to guide their actions in facing future health crises.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Higher self-awareness in relationships with others is a predictor of safety climates and can lead to enhanced patient outcomes.

Does Structural Empowerment of Nurse Leaders Moderate the Relationship Between Destructive Leadership and Nursing Outcomes?-A Cross-Sectional Study

AIM

To describe how nursing staff assess their superiors' destructive leadership and nurse leaders' structural empowerment. A further aim is to examine the associations between destructive leadership and staff outcomes and how nurse leaders' structural empowerment moderates these associations.

DESIGN

A cross-sectional study.

METHODS

The data were collected during November 2022-April 2023. Nursing staff assessed their work well-being, commitment, decision-making and career advancement. Destructive leadership was evaluated using the Employment Precariousness Scale and some additional questions. Nurse leaders' structural empowerment was assessed using the Conditions For Work Effectiveness Questionnaire-II. The data were analysed using statistical methods including linear regression.

RESULTS

Nursing staff (n = 381) assessed destructive leadership as rare, but it negatively associated with their commitment, decision-making, career advancement and work well-being. Nurse leaders' (n = 97) structural empowerment had a positive association with nursing staff outcomes. The interaction between destructive leadership and nurse leaders' structural empowerment positively affected the work well-being and commitment of nursing staff. The models explained 32% of nurses' work well-being and 19% of their commitment.

CONCLUSION

Destructive leadership undermines nursing staff outcomes. Structural empowerment of nurse leaders should be enhanced to protect against destructive leadership and other protective factors should be explored in the future to identify and prevent destructive leadership.

IMPLICATIONS FOR THE PROFESSION

Organisations should provide nurse leaders with appropriate resources and support to enhance their empowerment and opportunities to improve their leadership skills and expertise and should develop ways of identifying destructive leadership patterns and policies to resolve situations in which destructive leadership occurs.

IMPACT

A work environment that empowers nurse leaders may reduce the effect of destructive leadership on staff well-being, commitment, decision-making and career advancement. The significance of protective factors against destructive leadership should be explored using more robust methods in future research.

REPORTING METHOD

A STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

None.

Factors influencing nurse manager retention, intent to stay or leave and turnover: A systematic review update

AIMS

To understand factors influencing nurse manager retention or intention to leave, develop a preliminary theoretical model and identify strategies and interventions for workforce planning.

DESIGN

Systematic review update of literature with integrated design of mixed research synthesis.

METHODS

We included peer-reviewed articles examining factors influencing retention or intention to leave for front-line, middle or patient care nurse managers. Authors independently screened articles for inclusion and assessed included articles for quality. We adhered to a convergent synthesis approach.

DATA SOURCES

Nine databases included MEDLINE, EMBASE, PsychINFO, CINAHL Plus with Full Text, ERIC, Health Source Nursing/Academic Edition, Scopus, ProQuest Dissertations and Theses and LILACS in January 2023.

RESULTS

Thirty-five studies published between 1990 and 2022, 22 quantitative and 13 qualitative or mixed methods, were included. 155 factors influencing nurse manager retention, intention to stay, or turnover were reported. Job satisfaction was most frequently examined (n = 7), followed by factors such as empowerment (n = 3), decision-making (n = 3) and resilience (n = 2). We developed a preliminary theoretical model demonstrating staff relations and leadership, organizational and job characteristics, socio-demographics, personal characteristics, well-being and nurse manager relationship with work influence managers' intention to stay or to leave.

CONCLUSIONS

Nurse managers who were empowered, satisfied with their work, received constructive feedback and found meaning in their roles showed greater intent to stay.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurse administrators can ensure managers are provided with authority to make decisions that promote autonomy. Work cultures that allow for regular meaningful constructive feedback from staff and leaders may contribute to nurse managers feeling valued.

IMPACT

Understanding factors that influence job retention or intention to leave may help nurse managers and their supervisors identify areas for strategy and intervention design to ensure sustainability of this workforce.

REPORTING METHOD

PRISMA 2020 Guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Nursing department directors' perspectives on leadership training programme: A descriptive qualitative study

BACKGROUND

Leadership training is crucial for nurses to navigate changes, but research on nursing department directors' views of such programmes is limited.

AIM

To explore the perspectives and experiences of nursing department directors regarding a national leadership training programme for mid-level nurse managers.

DESIGN

Descriptive Qualitative Study.

SETTINGS

A national nurses association in Taiwan.

PARTICIPANTS

A purposive sample of 11 nursing department directors who recommended mid-level nurse managers for the programme.

METHODS

Eleven individual face-to-face interviews were conducted and analysed thematically between November 2022 and April 2023.

RESULTS

Three themes and eight subthemes emerged, including directors' strategies for identifying potential successors, providing coaching and guidance, and observing changes in trainees. Directors reported the programme broadened perspectives, fostered responsibility, and enhanced leadership skills in mid-level managers.

CONCLUSIONS

The engagement of nursing department directors and their adoption of a coaching style, such as fostering a growth mindset, were instrumental in the programme's success.

Mediating Effect of Felt Obligation Between Inclusive Leadership and Caring Behavior of Chinese Nurses

PURPOSE

It aims to validate the mediating role of felt obligation between inclusive leadership and the caring behavior of clinical nurses using a structural equation model.

METHODS

All of the nurses were assessed with the general information questionnaire, caring behavior scale, felt obligation scale and inclusive leadership questionnaire. AMOS 21.0 was used to construct the structural equation model and analyze the mediating effect of felt obligation, and Bootstrap method was used to test the mediating effect model.

RESULTS

The total scores of caring behavior, felt obligation and inclusive leadership were 125.25 ± 18.31, 21.38 ± 3.36 and 62.95 ± 11.95 respectively. Felt obligation played a partial mediating role in the relationship between inclusive leadership and caring behavior of nurses, and the mediating effect accounted for 43.5%.

CONCLUSIONS

Felt obligation plays a partial mediating effect between inclusive leadership and caring behavior of nurses. Nursing managers can adopt the leadership concept of inclusive leadership to enhance the level of felt obligation of nurses, so as to better improve the caring behavior of nurses.

Individual and unit level insights from hospital staff ratings on structural empowerment, leadership-management performance, well-being, and quality of care

BACKGROUND

Leadership and access to structural empowerment are known to influence the work life experiences of staff and quality of care. Knowledge about relationships between specific factors of structural empowerment, leadership and management, staff well-being and quality of care at both an individual and unit level is scarce.

AIM

To study the relationship between staff-rated access to empowering structures, leadership and management performance, well-being, and quality of care in hospital settings measured at the individual level and aggregated at the unit level.

METHODS

A cross-sectional correlative design was applied. Questionnaire data from 331 randomized hospital nursing staff working at 38 units in 25 hospitals in Sweden were analyzed using bivariate correlations and general estimation equation (GEE) models.

RESULTS

Results from the bivariate analysis of relationships confirmed earlier research. In the GEE models, some unexpected results were found and differences between the individual and unit levels. Adding management and leadership as independent factors in the second model showed few relationships of significance to the outcome variables.

CONCLUSION

Results confirm the importance of staff access to empowering structures in relation to well-being and quality of care. Differences and similarities were shown when studying these relationships at both the individual and unit level. The findings feature implications for hospital management to promote staff access to empowering structures. The findings provide information on how these structures relate to the individual and the unit; information that could be useful when planning or implementing strategies with the aim to promote staff well-being and care quality. The non-significant results for leadership and management in relation to staff outcomes in the GEE-models, raise questions for further research where a shift from individual to organizational focused performances within the field of leadership is implied.

Healthcare Top Management's Transformational Leadership Behaviors and Nurses' Occupational and Organizational Turnover Intention: On the Role of Work Engagement and Autonomous Motivation

Aims: This study examines the contribution of top management's transformational leadership behaviors on two targets of nurses' turnover intention (organization and occupation) by focusing on the indirect (through vigor and dedication) and conditional indirect associations (involving autonomous motivation as a moderator). Background: Although the issue of nurse turnover has received growing scientific attention, the research is currently silent about the specific targets of turnover intention and more importantly, the potential pathways through which top management's transformational leadership behaviors relate to each target. Method: Cross-sectional data from a sample of 426 French-Canadian nurses and structural equation modeling were used to test the proposed model. Results: Top management's transformational leadership behaviors distinctly predicted organizational and occupational turnover intention through specific nurses' states of engagement. While perceived transformational leadership positively predicted vigor, its indirect associations (via dedication) with organizational and occupational turnover intention depend on nurses' level of autonomous motivation at work. Conclusion: In times of nurse shortage, the present findings provide insights into how and when top management's transformational leadership behaviors relate to nurses' organizational and occupational turnover intention. Implications for Nursing Management: Healthcare organizations are advised to foster top management transformational leadership behaviors and autonomous motivation to sustain the nursing workforce.

Leadership in federally qualified health centers: examining recruitment and retention in rural Oklahoma

PURPOSE

Healthcare workforce shortages, particularly in rural areas, present a global challenge. The purpose of this study is to explore the leadership dynamics within federally qualified health centers (FQHC) in rural Oklahoma, focusing on recruitment, retention, job satisfaction and development practices.

DESIGN/METHODOLOGY/APPROACH

Eighteen managers with five or more years of tenure from Oklahoma FQHCs were interviewed. Leadership's role in influencing job satisfaction, recruitment, retention and development practices was analyzed using a multilevel ecological framework through qualitative content analysis with NVivo.

FINDINGS

The analysis includes ten key themes including the critical role of leadership in addressing recruitment and retention challenges, the importance of aligning organizational culture, rural culture, access challenges, trainings and values with workforce development initiatives, and the impact of leadership practices on job satisfaction.

ORIGINALITY/VALUE

This study uniquely examines leadership strategies in rural FQHCs, integrating ecological considerations for cultural, logistical and community-specific factors. It emphasizes the pivotal role leadership plays in shaping workforce development. As rural healthcare evolves, refining these approaches is crucial for addressing workforce challenges, improving healthcare access and ensuring that rural FQHCs remain sustainable, driving positive outcomes for healthcare professionals and communities.

Nurses' Relational Leadership Struggles on Positioning in Strategic Hospital Crisis Management: A Qualitative Interpretive Study

Aim(s): To understand how nurses experience their positioning amidst hospital crises. Background: Nursing leadership literature is predominantly focused on the skills and competencies of nurses and less on the relations in practice with nurses. Nurses are often valued for bedside care but are overlooked in strategic decision-making during crises. Foundational research emphasizes the need for nurses' equal participation in interprofessional healthcare practices and governance. Methods: We conducted a qualitative interpretive interview and focus group study, amidst the COVID-19 crisis. We interviewed 64 chairs of nurse councils and deepened our understanding of our initial findings in four focus groups with 34 participants. Results: Nurses differ widely on (a) what is important to them in crisis management, (b) how they can contribute to crisis management, and (c) how they value their involvement or lack of it. Furthermore, we uncovered three relational leadership struggles for nurses concerning (1) navigating, (2) positioning, and (3) collaborating, in crisis management structures. Conclusion: The ailing positioning and representation of nurses in crisis management result from their limited participation in strategic decision-making, and the lack of intervention on this by board members, physicians, and managers. Implications for Nursing Management: This study highlights the need for agents such as board members, managers, physicians, and nurses themselves to create clear frameworks and policies that define nurses' roles in crisis situations, emphasizing the importance of addressing power dynamics and enhancing communication and collaboration in hospital settings. Effective crisis management requires involving nurses from the start, providing regular training, and promoting a more equal approach to teamwork. Understanding relational leadership and its impact during crises can empower nurses and improve overall hospital crisis response.

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.

Leading care close to the patient in community home care for older persons: A lifeworld hermeneutic study from nurses' perspectives

AIM

To explain and understand leading care close to older persons in community home care from the perspective of registered nurses (RNs).

BACKGROUND

Leading care close to older persons in home care is an overlooked and not well-described phenomenon. In home care, specific demands are placed on the registered nurse, as responsible for leading care guided by the older person's expectations and desires.

DESIGN

A reflective lifeworld hermeneutic approach grounded in the philosophy of phenomenology and hermeneutics. The study followed the COREQ checklist.

METHODS

Individual interviews were conducted with nine RNs working in community home care in a community in western Sweden. The data were analysed with a lifeworld hermeneutic approach.

RESULTS

The findings present four partially interpreted themes: leading with respect in a shared space, leadership that involves existential questions of life, balancing responsibility enables preservation of autonomy and challenges in maintaining a patient perspective. The partially interpreted themes conclude in a main interpretation: The patient perspective as an anchor when balancing responsibility for another person in an existential vulnerability of life.

CONCLUSION

Leading care means being both close to the patient and at a distance when caring is performed through the hands of others. Ethical demands are placed on RNs as they encounter the vulnerability of the older person.

RELEVANCE TO CLINICAL PRACTICE

The findings can contribute to a greater understanding of the meaning of RNs as leaders and may have an impact for decision makers and policies to create conditions for leadership that contributes to dignified care for older persons in community home care.

PATIENT OF PUBLIC CONTRIBUTION

Registered nurses working in community home care participated in data collection.

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.

Exploring the relationship between patient safety culture and the full-range leadership theory in primary care settings: a conceptual analysis

PURPOSE

This study aims to investigate the conceptual relationship between full-range leadership theory (FRLT) and patient safety culture in primary care settings, aiming to understand how leadership styles influence the development and sustainability of a culture prioritizing patient safety.

DESIGN/METHODOLOGY/APPROACH

Using a conceptual analysis approach, the study builds a theoretical framework that integrates FRLT - which includes transformational, transactional and laissez-faire leadership styles - with the elements of patient safety culture. This framework serves as the basis for a comprehensive literature review, allowing for the formulation of hypotheses regarding the impact of each leadership style on patient safety culture.

FINDINGS

The analysis demonstrates that transformational leadership bolsters patient safety culture by fostering open communication, encouraging error reporting and facilitating continuous improvement. Transactional leadership yields mixed effects, effectively supporting compliance and operational outcomes but showing limitations in promoting a proactive safety culture. Conversely, laissez-faire leadership is associated with negative outcomes for patient safety culture, mainly due to its passive and detached approach.

ORIGINALITY/VALUE

The originality of this study is rooted in its focused examination of FRLT's impact on patient safety culture within primary care settings, the development of a unique conceptual framework and its contribution of actionable insights for health-care leadership. These elements collectively advance the understanding of how leadership can enhance patient safety culture, providing a solid foundation for future research and practical application in primary care environments.

Determinants of First-Line Nurse Managers' Span of Control: A Delphi Study

Aims: The main goal of this research is to identify, through expert consensus, the key factors that determine the span of control (SOC) of first-line nurse managers (FLNMs) in the Spanish healthcare system. Background: The SOC is a management concept which has usually been defined as the number of subordinates reporting to a superior. In nursing, however, it is much more complex. This complexity is shaped by various factors related to patients, healthcare professionals and organisational structures. Nursing leaders must thoroughly consider these factors and their determinants, which necessitate a comprehensive assessment. Given the significant impact an inadequate SOC can have on patients, professionals and the organisation, it would be beneficial to address this issue. In nursing, studies on this subject are practically nonexistent and focus solely on the number of subordinates, highlighting the need for research in this area. Methods: Between September and December 2022, a Delphi study was conducted. Forty-five experts were invited to participate. The study involved nurse administrators, FLNMs, university professors, renowned researchers and other non-health professionals related to health management. The participants completed an online survey over three phases. Factor analysis was performed on the items for which consensus was reached. The jamovi software version 2.3.15 was used for data analysis. Results: A total of 35 experts participated in at least one of the three phases of the Delphi study. Following a comprehensive analysis of the identified factors, a consensus was reached on 31 of them. These were subsequently grouped into four categories: unit category (16 items, including complexity, resource management, conflicts and protocolisation and monitoring of activities), professional category (five items: number of staff, staffing stability and skill level and diversity of staff), FLNM category (four items: autonomy, experience and education and leadership style) and organisation category (six items: digitisation and information systems, education, research and implementation evidence-based practice and performing guards). Conclusions: Our research shows a high degree of consensus amongst participants in identifying the determinants and degree of relevance of SOC-related aspects. Although SOC is not currently assessed, all stakeholders agree that there are a large number of variables that should be considered when appointing a FLNM. Implications for Nurse Managers: Nursing managers can better assess the health of the organisation and improve performance by understanding the factors that influence the SOC of FLNMs. Due to the lack of previous studies, understanding these factors will allow the development of methods and tools tailored to the characteristics of different health systems.

Healthcare-associated infections and nursing leadership: A systematic review

Background

Healthcare-associated infections are strictly related to healthcare practices. A head nurse stimulates and motivates nurses, boosts nurses' job performance and satisfaction, and can influence adverse event development.

Aim

To explore the relationship between healthcare-associated infections and head nurse leadership style.

Methods

A systematic review was conducted. The search was conducted from 1973 until March 2022 on PubMed, Cochrane Library, Scopus, CINAHL, Web of Science, Embase, and APA PsycInfo databases. The review followed the Joanna Briggs Institute Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A thematic synthesis and critical appraisal of the included studies have been conducted.

Results

Eight articles were included in this review. Head nurses' leadership, supported by the organization, can positively influence the job performance and job satisfaction of nurses by reducing infection rates associated with vascular access and urinary catheters.

Discussion

Authentic and transformational nurse leadership styles can foster targeted interventions and improvements tailored to preventing and controlling healthcare-associated infections. Even if there is limited evidence, the results support that the occurrence of infections can be reduced by leadership strategies implemented by head nurses.

Factors related to self-care in Korean patients with tuberculosis: A systematic review and meta-analysis

BACKGROUND

Tuberculosis (TB) remains a major public health challenge in South Korea which has one of the highest TB incidence rates among the Organisation for Economic Co-operation and Development (OECD) countries. Effective self-care, including medication adherence and regular hospital visits, is crucial for successful TB treatment and the prevention of drug resistance. TB self-care in South Korea is influenced by cultural, social, and systemic factors. This study aimed to systematically review and conduct a meta-analysis of factors influencing self-care among Korean patients with TB, providing evidence-based insights for developing effective self-care promotion programs.

METHODS

A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on quantitative studies published since 2000 involving Korean patients with TB. Twenty studies were included in the final analysis, and 44 factors related to self-care were categorized into sociodemographic, TB-related, psychological, environmental, and educational characteristics. Effect sizes were calculated using Comprehensive Meta-Analysis (CMA) 4.0, with the assessment of heterogeneity and publication bias.

RESULTS

The meta-analysis ranked the effect sizes of the different characteristic categories as follows: environmental > educational > psychological. Among the individual factors, social support had the greatest influence on self-care, followed by quality of life, self-efficacy, nonfamily support, family support, and perceived health benefits. These findings underscore the critical role of sustained social support from the community, medical staff, and family in enhancing self-care among TB patients.

CONCLUSION

Effective self-care strategies for patients with TB should focus on interventions that strengthen the environmental, educational, and psychological aspects. These findings suggest that similar approaches can be applied in other countries facing comparable healthcare challenges. This study acknowledges limitations including potential publication bias and the exclusion of older studies and non-Korean patient studies, highlighting the need for further research across diverse settings and populations.

Bridging the generational gap between nurses and nurse managers: a qualitative study from Qatar

BACKGROUND

The nursing workforce comprises multiple generations, each with unique values, beliefs, and expectations that can influence communication, work ethic, and professional relationships. In Qatar, the generational gap between nurses and nurse managers poses challenges to effective communication and teamwork, impacting job satisfaction and patient outcomes.

AIM

This study investigates the generational gap between nurses and nurse managers in Qatar, aiming to identify strategies to enhance collaboration and create a positive work environment.

METHODS

A qualitative research design was used, involving semi-structured interviews with 20 participants, including frontline nurses and senior nurse managers. Participants were purposively sampled to represent different generations. Data were collected through face-to-face and virtual interviews, then transcribed and thematically analyzed.

FINDINGS

Four key themes emerged: Optimizing the Work Environment: Older generations preferred transformational and situational leadership, while younger nurses valued respect, teamwork, accountability, and professionalism. Strengthening Work Atmosphere through Communication and values: Older nurses favored face-to-face communication, while younger nurses preferred digital tools. Cultivating Respect and Empathy: Younger nurses emphasized fairness in assignments and promotions, while older nurses focused on empathy and understanding. Dynamic Enhancement of Healthcare Systems: Younger nurses were more adaptable to technology and professional development, while older nurses prioritized clinical care and patient outcomes.

CONCLUSION

The study reveals significant generational differences in leadership preferences, communication styles, and adaptability to technology. Addressing these gaps through effective leadership, ongoing education, and open communication can improve job satisfaction and patient care.

Setting new priorities for nursing research: The updated Swiss Nursing Research Agenda-a systematic, participative approach

AIM

To identify current key areas for nursing research in Switzerland, we revised the Swiss Research Agenda for Nursing (SRAN) initially published in 2008.

BACKGROUND

By developing a research agenda, nursing researchers internationally prioritize and cluster relevant topics within the research community. The process should be collaborative and systematic to provide credible information for decisionmakers in health care research, policy, and practice.

SOURCES OF EVIDENCE

After a participative, systematic, and critical evaluation within and outside of the Swiss Association for Nursing Science, the updated SRAN 2019-2029 defines four research priorities (new models of care, nursing care interventions, work and care environment, and quality of care and patient safety) and four transversal themes (organization of research, research methodologies, research in health care policy and public health perspectives).

CONCLUSION

Adding to other national nursing research agendas, the categories are organized in a framework of key research priorities and transversal themes. They relate to the importance of global and local foci of research as well as challenges in health care services and policy systems. The agenda is an important prerequisite for enhancing the influence of nursing research in Switzerland and provides guidance for the next decade.

IMPLICATIONS FOR NURSING PRACTICE

The revised agenda ensures that research projects target key knowledge gaps and the discipline's core questions in respective countries.

IMPLICATIONS FOR HEALTH POLICY

Nursing research should inform and influence health policy on all institutional and political levels. Therefore, the integration of public health perspectives in research is one of the most important new aspects of SRAN 2019-2029.

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.

Nurse practitioner affecting systems change in the context of a LEADS leadership framework: Experience from the field

AIM

This paper highlights a new role of Advanced Practice Nurse/Nurse Practitioner as the clinical planning lead in the development of a unique model of care and service delivery for children living with health complexity, in the context of a LEADS leadership framework and related capabilities.

BACKGROUND

The LEADS in a Caring Environment Framework is an effective tool for leadership development and systems change. An experienced Advanced Practice Nurse/Nurse Practitioner hired into a leadership role contributes to system change for a complex population across a large geographic area.

SOURCES OF EVIDENCE

World Health Organization, Canadian Nurses Association and other websites, academic databases (PubMed and CINAHL) and relevant books were explored, and the expertise and knowledge of the authors and the redevelopment project team were utilized.

DISCUSSION

The Advanced Practice Nurse/Nurse Practitioner (first author) shares and reflects on her own lived experience as a leader in the planning for programmes and services at the new centre utilizing the five LEADS domains and related capabilities.

CONCLUSION

The utilization of the LEADS in a Caring Environment Capabilities Framework showcases the strengths and skills of an Advanced Practice Nurse/Nurse Practitioner shifting from direct clinical care to successfully leading system-level change. By incorporating the LEADS framework into practice, in any setting or role, Advanced Practice Nurse/Nurse Practitioners can both evaluate and develop their leadership skills while positively effecting system transformation.

IMPLICATIONS FOR NURSING PRACTICE

The LEADS framework fosters ongoing professional development and can be used to measure the added value of Advanced Practice Nurses within an organization.

IMPLICATIONS FOR NURSING POLICY

Advanced Practice Nurses improve outcomes within the health care system. Leaders must consider this evidence in health workforce planning, ensuring that Advanced Practice Nursing roles become fully integrated and are supported in the context of national and regional health systems.