Confidence in delegation and leadership of registered nurses in long-term-care hospitals

Effects of work environments on satisfaction of nurses working for integrated care system in South Korea: a multisite cross-sectional investigation

BACKGROUND

Nurses' satisfaction has an impact on organizational and patient outcomes. Integrated care system in South Korea was established in 2015 to improve care quality and decrease caregiving burden. Since then, nurses' satisfaction has increased due to an increase in nursing staffing. However, besides nurse staffing, various work environments still affect nurse satisfaction.

METHODS

Individual online surveys were conducted with participants to determine their personal characteristics, work environments, and hospital characteristics. We used mixed-effects linear regression equation contained both fixed and random effects.

RESULTS

This study included 2,913 nurses from 119 hospitals. Their average job satisfaction was less than 6 points out of 10 points. Age, shift type, perceived workload, and delegation criteria were significant factors influencing nurses' satisfaction. There was no significant factor among hospital characteristics. The satisfaction level of nurses was high for no-night rotating shift, low perceived workload, and clear delegation criteria.

CONCLUSIONS

Nurses' satisfaction is affected by several work environmental factors. Low nurse satisfaction has a substantial impact on both patients and nurses. Therefore, nurse managers and hospitals should determine factors influencing their satisfaction and develop strategies to improve their satisfaction.

Delegating care as a double-edged sword for quality of nursing care: a qualitative study

BACKGROUND

Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care.

METHODS

This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985).

RESULTS

In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword".

CONCLUSIONS

The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.

Development and psychometric evaluation of the Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND) scale

AIMS AND OBJECTIVES

To develop and evaluate the psychometric properties of an instrument that measures nurses' Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND).

BACKGROUND

General ward nurses play an important role in recognising patient deterioration. However, their attitudes towards early recognition of clinical deterioration have not been adequately explored due to the lack of a valid and reliable scale.

DESIGN

An instrument development and validation study.

METHODS

A three-phase structure that followed the STROBE checklist was used: (1) item generation, (2) content and face validity assessment and (3) psychometric properties evaluation. The scale items were developed based on a comprehensive literature review and content validity assessment by 15 international experts from five countries. The psychometric properties of the ATREND scale were tested on 434 registered nurses, with retest evaluations (n = 100) at two hospitals. Exploratory and confirmatory factor analyses were used to examine the factor structure of the scale. The scale was also evaluated for its internal consistency, test-retest reliability and convergent validity.

RESULTS

The scale's content validity was 0.95. A 3-factor solution was identified from the final 11 items: (1) beliefs about importance of patient observation, (2) use of broader patient assessment skills and (3) confidence in recognising clinical deterioration. The internal consistency reliability of the scale was supported with an acceptable Cronbach's alpha value of 0.745. Test-retest reliability of the scale was excellent, with an intraclass correlation coefficient of 0.825. The ATREND scale shows evidence of good convergent validity.

CONCLUSION

The final 11-item ATREND scale demonstrates adequate initial evidence of reliability and validity for use in acute ward settings.

RELEVANCE TO CLINICAL PRACTICE

Nursing educators and clinicians may use this scale to assess ward nurses' attitudes and practices towards early recognition of clinical deterioration and then enhance their competencies and behaviours in the recognition of clinical deterioration.

Leadership competencies of first-line nurse managers: a quantitative study

PURPOSE

This paper aims to examine the leadership competencies of first-line nurse managers (FLNMs) at the unit level in the eastern region of Ghana.

DESIGN/METHODOLOGY/APPROACH

The paper is a quantitative cross-section design.

FINDINGS

Nurse managers exhibited a moderate level of knowledge and ability to apply leadership competencies. Gender, rank, qualification, professional experience, management experience and management training jointly predicted the leadership competencies of FLNMs [(R² = 0.158, p = 0.016]. However, only management training was a significant predictor in the model.

PRACTICAL IMPLICATIONS

Inappropriate leadership competencies have severe consequences for patients and staff outcomes. This situation necessitates a call for a well-structured program for the appointment of FLNMs based on competencies.

ORIGINALITY/VALUE

This study is the first in Ghana which we are aware of that examined the leadership competencies at the unit level that identifies predictors of leadership competencies.

Evaluation of the Impact of an Education Program on Self-Reported Leadership and Management Competence Among Nurse Managers

Background

Developing leadership and management competencies for nursing managers is critical to the effective leadership of others and driving team and organizational performance. This paper aimed to evaluate the impact of a system-wide nursing leadership quality improvement initiative in a network of four public hospitals and one specialized outpatient center in the United Arab Emirates (UAE). The initiative was designed to enhance nursing middle managers’ leadership and managerial competencies.

Methods

This is a quantitative evaluation following the Standards for Quality Improvement Reporting Excellence (SQUIRES) guidelines. Secondary Data analysis of a pre- and post-course self-assessment for 105 middle nursing managers who attended a nursing leadership quality improvement training program between December 2017 and April 2019.

Results

Following participation in this quality improvement initiative, the paired sample t-test analysis demonstrated a statistically significant difference between the pre- and post-assessments total and individual leadership domains mean scores.

Conclusion

Attending well-structured nursing leadership quality improvement programs positively enhances nurse managers’ professional abilities and perception of their management and leadership competencies. Leadership development programs should equip managers with the skills and tools to achieve their professional goals effectively and support their transition to becoming expert nurse leaders. Healthcare institutions’ ethical obligation is to provide them with the necessary resources and training to achieve this goal.

How pre-registration nursing students acquire delegation skills: A systematic literature review

AIM

To discover what is known about how nursing students acquire delegation skills.

DESIGN

A systematic search was conducted utilising databases: CINAHL, AMED, MedLine, PsycINFO, Web of Science, PsychArticles, PubMed Central and Science Direct. The objectives were to: conduct a systematic literature review of the available literature on how nursing students acquire delegation skills; to identify factors that promote synthesis of delegation skills into clinical practice and understand how students learn these skills; and to identify any gaps in the literature.

RESULTS

Fifteen papers, which use a range of methodologies, were included in the review. The author identified that acquiring delegation skills is an ongoing process and cannot be fully learnt during a single intervention. Furthermore that there are multiple factors that may promote the acquisition of this skill. These include simulation, clinical practice and theoretical curriculum. Delegation links to other skills such as critical thinking, decision making, prioritisation and communication.

CONCLUSION

Delegation should not be considered in isolation to these underpinning skills. Furthermore, it is evident that delegation is an often-misunderstood concept and something that newly qualified nurses feel unprepared for. It is therefore vital that preregistration nursing education (as well as other pre- and post-qualification training) incorporate the development of this essential skill.

The factor of affecting head nurse's delegation: A cross sectional study

Nursing delegation is one component that can improve the quality of nursing services. This study was to identify the factors associated with delegating the head nurse, as perceived by implementing nurses at the Military Hospital in Jakarta. This cross-sectional study with 227 nurses who were selected using the purposive sampling technique. The data was analyzed using the Pearson correlation test, ANOVA, and T-tests to determine the relationship between variables influencing the head nurse delegation and linear regression tests to assess the variables related most. Factors related to nurses' perceptions of head nurse delegation were age (p=0.045), education level (p=0.002), management function (p=0.020), planning function (p=0.043), workforce function (p=0.002), control function (p=0.019), leadership style (p=0.02) and communication (p=0.030). Education level emerged as the most dominant variable. This result was to provide a reference for developing standard operating procedures regarding nursing delegation based on related factors.

The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership

BACKGROUND

Nursing leadership plays a vital role in shaping outcomes for healthcare organizations, personnel and patients. With much of the leadership workforce set to retire in the near future, identifying factors that positively contribute to the development of leadership in nurses is of utmost importance.

OBJECTIVES

To identify determining factors of nursing leadership, and the effectiveness of interventions to enhance leadership in nurses.

DESIGN

We conducted a systematic review, including a total of nine electronic databases.

DATA SOURCES

Databases included: Medline, Academic Search Premier, Embase, PsychInfo, Sociological Abstracts, ABI, CINAHL, ERIC, and Cochrane.

REVIEW METHODS

Studies were included if they quantitatively examined factors contributing to nursing leadership or educational interventions implemented with the intention of developing leadership practices in nurses. Two research team members independently reviewed each article to determine inclusion. All included studies underwent quality assessment, data extraction and content analysis.

RESULTS

49,502 titles/abstracts were screened resulting in 100 included manuscripts reporting on 93 studies (n=44 correlational studies and n=49 intervention studies). One hundred and five factors examined in correlational studies were categorized into 5 groups experience and education, individuals' traits and characteristics, relationship with work, role in the practice setting, and organizational context. Correlational studies revealed mixed results with some studies finding positive correlations and other non-significant relationships with leadership. Participation in leadership interventions had a positive impact on the development of a variety of leadership styles in 44 of 49 intervention studies, with relational leadership styles being the most common target of interventions.

CONCLUSIONS

The findings of this review make it clear that targeted educational interventions are an effective method of leadership development in nurses. However, due to equivocal results reported in many included studies and heterogeneity of leadership measurement tools, few conclusions can be drawn regarding which specific nurse characteristics and organizational factors most effectively contribute to the development of nursing leadership. Contextual and confounding factors that may mediate the relationships between nursing characteristics, development of leadership and enhancement of leadership development programs also require further examination. Targeted development of nursing leadership will help ensure that nurses of the future are well equipped to tackle the challenges of a burdened health-care system.

What implies registered nurses' leadership close to older adults in municipal home health care? A systematic review

BACKGROUND

Registered nurses are key figures in municipal home health care for older adults. Thus, registered nurses' leadership is crucial to a successful and preventive care process as well as a supportive organization in order to achieve safe care. However, there is limited research on what registered nurses' leadership implies close to older adults in municipal home health care. Thus, the aim is to compile and critically evaluate how international research results describe registered nurses' leadership close to older adults in municipal home health care.

METHODS

A systematic literature review was performed in accordance with a qualitative research study. The main search was conducted on 20 April 2018. The review was reported according to the PRISMA guidelines and is registered in the PROSPERO database (ID# CRD42019109206). Nine articles from PubMed and CINAHL meet the quality criteria. A synthesis of data was performed in four stages according to qualitative research synthesis.

RESULTS

Ten themes describe what registered nurses' leadership close to older adults in municipal home health care entails: trust and control; continuous learning; competence through knowledge and ability; nursing responsibility on an organizational level; application of skills; awareness of the individual's needs and wholeness; mutual support; mutual relationships; collaborating on organizational and interpersonal levels; and exposure to challenges.

CONCLUSIONS

Registered nurses leading close to older adults in municipal home health care implies being multi-artists. Nursing education, including specialist education for registered nurses, should prepare individuals for their unique and complex leadership role as a multi-artist. Municipal employers require knowledge about what registered nurses' leadership implies in order to create adequate conditions for their leadership objectives to achieve safe care. Further research is warranted to explore registered nurses' leadership close to older adults in municipal home health care from different perspectives, such as older adults and next of kin.

Efficiency Losses in Healthcare Organizations Caused by Lack of Interpersonal Relationships

Abstract Despite all quality management and integration literature prescriptions to implement strategies for a better organizational performance, healthcare organizations support a model that is inefficient, expensive, and unsustainable over time. This work aims to examine the interpersonal relationships in three large hospitals located in Southern Brazil and its relation with organizational efficiency. Through a qualitative and explanatory research, semi-structured interviews were applied to 32 professionals, in addition to a document analysis. The data analysis shows that integration occurs at the formal leadership level only in one of the organizations and does not involve the medical and operational professionals. Quality management seems not to be fully incorporated into care routines, and are related to efficiency losses. This scenario is probably related to the lack of integration among the professionals and the consolidation of trust, leadership, and communication.

Interpersonal relationships and safety culture in Brazilian health care organisations

AIM

To examine the association between interpersonal relationships, nursing leadership and patient safety culture and the impact on the efficiency of hospitals.

BACKGROUND

Hospitals are still affected by the increased complexity of the treatments offered and by the diverse knowledge of professionals involved, which has made this assistance model ineffective, expensive and unsustainable over time.

METHOD

A qualitative study of 32 professionals from three large hospitals in Southern Brazil was made. Semi-structured interviews, document analysis and analysis of electronic records were used.

RESULTS

All the hospitals had infection rates and an average stay higher than their goal. Lack of interpersonal relationships and physicians failing to commit to organisational objectives were demonstrated.

CONCLUSION

Nursing leadership styles are not definitive factors to improving patient safety and efficiency. The flaws in consolidating interpersonal relationships seem to be related to difficulties in consolidating patient safety culture, which prevented hospitals reaching their efficiency indicators.

IMPLICATIONS FOR NURSING MANAGEMENT

Professionals who work at the patients' bedside should be involved in the development of strategies, in order to commit them to the organisational objectives. The consolidation of interpersonal relationships of nursing professionals can lead to improvements with medical professionals, with positive impacts on patient safety and efficiency.

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

BACKGROUND

Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.

METHODS

The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers.

RESULTS

A total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.

CONCLUSIONS

The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings.