Why time matters when it comes to resilience: how the duration of crisis affects resilience of healthcare and public health leaders

The relevance of leader-member exchange during a crisis: assessing the mediating role of social exchange relationships to predict intention to leave

PURPOSE

The purpose of this study is to explore how the strength of relations between organization, leader and nursing staff influences the intention to leave one's job during crisis conditions. Drawing on social exchange theory, this study analyzes how perceived organizational support and leader-member exchange (LMX) mediate the effect of informational justice and personal protective equipment (PPE) on intention to leave among nurses.

DESIGN/METHODOLOGY/APPROACH

The research uses partial least squares structural equation modeling with a sample of 159 surveys from nurses gathered in Argentina during April-November 2020.

FINDINGS

The study finds that the LMX has a mediating effect between informational justice, the provision of PPE and the intention to leave. Perceived organizational support was not significantly related to the intention to leave due to COVID-19.

PRACTICAL IMPLICATIONS

Even during crises like COVID-19, high-quality relationships between supervisors and supervisees can reduce the likelihood of leaving an organization, while organizational support may be less important during such times. The findings suggest that organizations and health-care managers should pay attention to having effective planning and provision of PPE and provide clear and accurate information during crisis periods.

ORIGINALITY/VALUE

The study contributes to social exchange theory literature during crises. The findings suggest that in times of crises in nursing, the LMX takes on greater significance and becomes central in explaining the connection between resources, information and the decision to leave one's organization.

Trust: an essential component in nursing crisis leadership; a hybrid concept analysis

BACKGROUND

Given the increasing trend of disasters, terrorist attacks, pandemics and other crises, crisis leadership is crucial for nurses who lead others and for those working in such situations. There is a need to define and explore the concept of trust as a component of crisis leadership in nursing. This concept analysis aimed to explore the concept of trust in crisis leadership from a nursing perspective.

METHODS

A hybrid concept analysis was conducted. The method consisted of three phases: (I) a theoretical phase relying on a structured literature search, including 11 scientific publications; (II) a field-work phase, in which qualitative thematic analysis of interviews with 30 nurses who had been deployed and/or had led others during crises, was conducted and (III) a final analytic phase, where the results from these data collections were merged.

RESULTS

The analysis suggested that the fundamentals of trust included a perceived intention to do good, the capabilities of both the leader and the team and the perceived predictability of the leader's behaviour. Trust was found to be built on a perceived forward-looking direction, self-trust and the personal attributes of the leader, such as ethical conduct, the ability to predict the development of crises and an intention to take responsibility and be honest. The social attributes of the relationship between the leader and the team included the intention not to leave anyone behind, loyalty and fostering a sense of belonging among team members. The organisational attributes included a clear organisational structure and clarity of mandate.

CONCLUSIONS

Trust is an essential component of crisis leadership that depends on a leader's perceived intention to do good, predictability of the leader's behaviour and the capabilities of both the leader and the team. The development of trust relies on the personal attributes of the leader, the social relationship between the leader and the team and organisational attributes. Nurses appointed to lead others during a crisis need to understand the fundamentals of trust as part of leadership in highly demanding situations. Thus, it can be argued that being a leader in a crisis situation requires distinct personal and professional attributes and skills compared to those used to meet routine demands.

In the eye of the storm: Hospital leaders' resilience during the COVID-19 pandemic

BACKGROUND

Although hospital leaders were already at a high risk for psychological and physical illnesses long before the pandemic, the COVID-19 pandemic exacerbated this situation.

PURPOSE

Recognizing the crucial role of leaders in organizational crises and building on the conservation of resources theory, our study examines how hospital leaders cope with difficulties that endure over an extended period of time. By using the COVID-19 pandemic as an example for prolonged adversity in hospitals, we provide insight into the different responses to a given adversity and further expand knowledge about the role of time in crisis and for resilience.

METHODOLOGY/APPROACH

Qualitative expert interviews were conducted with 44 hospital leaders in Austria between December 2020 and November 2021. For data analysis, we used a hybrid approach, consisting of both deductive and inductive coding.

RESULTS

By extending Bardoel and Drago's (2021) conceptual approach on acceptance and strategic resilience, our empirical study shows that during enduring adversity, hospital leaders use both types of resilience. The choice between them and their suitability depends on both the duration of exposure and severity of the adversity.

CONCLUSION

Our findings further show that when immediately confronted with adversity, leaders tend to rely on resource-preserving acceptance resilience, whereas when dealing with enduring adversity, leaders are more likely to use resilience-enhancing strategic resilience.

PRACTICAL IMPLICATIONS

Even though leaders rely on both types of resilience, our findings also imply that if opportunities to build strategic resilience are limited, higher burnout and turnover rates might be the consequence.

A resilience perspective on healthcare personnels' experiences of managing the COVID-19 pandemic: a qualitative study in Norwegian nursing homes and come care services

BACKGROUND

The COVID-19 pandemic led to new and unfamiliar changes in healthcare services globally. Most COVID-19 patients were cared for in primary healthcare services, demanding major adjustments and adaptations in care delivery. Research addressing how rural primary healthcare services coped during the COVID-19 pandemic, and the possible learning potential originating from the pandemic is limited. The aim of this study was to assess how primary healthcare personnel (PHCP) working in rural areas experienced the work situation during the COVID-19 outbreak, and how adaptations to changes induced by the pandemic were handled in nursing homes and home care services.

METHOD

This study was conducted as an explorative qualitative study. Four municipalities with affiliated nursing homes and homecare services were included in the study. We conducted focus group interviews with primary healthcare personnel working in rural nursing homes and homecare services in western Norway. The included PHCP were 16 nurses, 7 assistant nurses and 2 assistants. Interviews were audio recorded, transcribed and analyzed using thematic analysis.

RESULTS

The analysis resulted in three main themes and 16 subthemes describing PHCP experience of the work situation during the COVID-19 pandemic, and how they adapted to the changes and challenges induced by the pandemic. The main themes were: "PHCP demonstrated high adaptive capacity while being put to the test", "Adapting to organizational measures, with varying degree of success" and "Safeguarding the patient's safety and quality of care, but at certain costs".

CONCLUSION

This study demonstrated PHCPs major adaptive capacity in response to the challenges and changes induced by the covid-19 pandemic, while working under varying organizational conditions. Many adaptations where long-term solutions improving healthcare delivery, others where short-term solutions forced by inadequate management, governance, or a lack of leadership. Overall, the findings demonstrated the need for all parts of the system to engage in building resilient healthcare services. More research investigating this learning potential, particularly in primary healthcare services, is needed.