An integrative review on interventions for strengthening professional governance in nursing

The Impact of Professional Governance on Hope, Resilience, and Empowerment

OBJECTIVE

The purpose of this cross-sectional descriptive study was to examine the relationship of professional governance, resilience, and empowerment among RNs in clinical practice in 1 healthcare system.

BACKGROUND

Given the emotional and physical demands of nursing, especially in recent years, exploring ways that hope-inducing and resilience-building models can support professional practice is vital to the current and future nursing workforce.

METHODS

An anonymous survey consisting of demographic questions, the Adult Hope Scale, Connor-Davidson Resilience Scale, and the Conditions for Work Effectiveness Questionnaire II was offered to 1450 RNs in a nonprofit community-based healthcare system for volunteer participation.

RESULTS

Nurses who formally participated in professional governance nursing councils reported higher hope, resilience, and work effectiveness scores compared with nurses who did not participate in professional governance.

CONCLUSIONS

Based on these initial results, encouraging and creating avenues for the participation of RNs in professional governance are paramount to build a resilient, hopeful, and empowered workforce.

Stress as a mediator between abusive supervision and clinical nurses' work outcomes

AIMS

This study aimed to test whether stress could mediate the association between abusive supervision and nurses' work engagement, absenteeism, and turnover intention.

BACKGROUND

Abusive supervision has been attributed to suboptimal work performance and reduced productivity among employees in different sectors. While existing nursing literature links abusive supervision to a wide range of work-related outcomes in the nursing workforce, little is known regarding the mechanism underlying this relationship.

DESIGN

Data for this descriptive study were collected from 770 direct-care nurses from seven acute care hospitals in the Philippines, utilizing five standardized scales.

RESULTS

Abusive supervision had direct positive effects on absenteeism (β = .189, p < .001) and intent to leave (β = .138, p < .001) and a direct negative effect on job engagement (β = -.131, p < .001). The relationships between abusive supervision and absenteeism (β = .175, p < .001), intent to leave (β = .131, p < .001), and work engagement (β = -.122, p < .001) were partially mediated by stress.

CONCLUSIONS

Stress mediated the relationship between abusive supervision and nurses' work outcomes, including turnover intention, absenteeism, and work disengagement.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The evident connection between abusive supervision, stress, and work-related outcomes underscores the importance of focusing on enhancing managerial supervisory styles as a potential organizational strategy to enhance staff retention and well-being.

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.

Valuing Nursing Practice: Laying the Future Foundations for Nursing

Nursing has always been a cost for the institutions within which nurses work. This fact has influenced almost everything that affects how nurses are utilized and valued. As a cost, nurses are closely managed on the margin, always constrained by the resource machinations of organizations and systems with little determination or enumeration of the contributions nurses make to the service and financial value represented by algorithms and metrics that enumerate and demonstrate nurse's impact and contribution to service and financial value. This article further pushes the boundaries of this circumstance, challenging nurse and health leaders to reconceptualize nursing contribution and recalibrate the determination and calculation of nursing value as a sustainable baseline for nursing leadership for the future.

Empowering nursing council implementation science: An appeal to action

BACKGROUND

In most hospitals, nursing councils are responsible for EBP implementation and evaluation. To enhance the perceived value of council participation by frontline nurses, administrators must promote the impact of council projects on healthcare outcomes.

PURPOSE

The purposes of this appeal to action are to describe the role of nursing councils in promoting IS and EBP, and to provide recommendations that enhance the value of IS and/or EBP councils to frontline nurses, thereby incentivizing participation on these councils.

METHODS

Nurse researchers from three metropolitan hospitals partnered with a medical librarian to recommend six strategies aimed at enhancing the perceived value of council participation. An argumentative review was conducted to support these strategies.

DISCUSSION

Recommendations are inclusion of methods experts on councils; support from nursing administrators in the development, implementation, and evaluation of projects; formation of partnerships with nursing academic departments; expansion of publication opportunities and availability; and connection of projects to measurable quality indicators.

CONCLUSION

Enhancing the perceived value of nursing councils by providing tools that optimize time and resource management can result in greater council participation and broader dissemination of IS evidence.

Board talk: How members of executive hospital boards influence the positioning of nursing in crisis through talk

Talk by members of executive hospital boards influences the organizational positioning of nurses. Talk is a relational leadership practice. Using a qualitative-interpretive design we organized focus group meetings wherein members of executive hospital boards (7), nurses (14), physicians (7), and managers (6), from 15 Dutch hospitals, discussed the organizational positioning of nursing during COVID crisis. We found that members of executive hospital boards consider the positioning of nursing in crisis a task of nurses themselves and not as a collective, interdependent, and/or specific board responsibility. Furthermore, members of executive hospital boards talk about the nursing profession as (1) more practical than strategic, (2) ambiguous in positioning, and (3) distinctive from the medical profession. Such talk seemingly contrasts with the notion of interdependence that highlights how actors depend on each other in interaction. Interdependence is central to collaboration in hospital crises. In this paper, therefore, we depart from the members of executive hospital boards as leader and "positioner," and focus on talk-as a discursive leadership practice-to illuminate leadership and governance in hospitals in crisis, as social, interdependent processes.

Lessons learned from nursing crisis meetings: Qualitative study to evaluate nurses' experiences and needs

AIMS

The aim of this study is to evaluate the nurses' experiences with the Nursing Crisis Meetings and to identify nurses' needs regarding the future governance structure.

DESIGN

Qualitative study.

METHODS

Two focus groups were conducted in February 2022 with participants of the Nursing Crisis Meetings (N = 15). We used thematic analysis to describe themes.

RESULTS

We identified five themes: opportunity to speak up, call for nursing leadership, call for control over practice and autonomy, development of a governance infrastructure and development of the professional nurse role.

CONCLUSION

Nurses experienced the Nursing Crisis Meetings to be a positive and empowering infrastructure, which facilitates the unique opportunity to speak up and share experiences and concerns. This new infrastructure is a promising strategy to engage nurses during a pandemic and to build on a professional governance structure.

IMPACT

This paper highlights the need for nurses to speak up and be engaged during the COVID-19 pandemic and gives a practical example of how to put this infrastructure into practice.

Abusive Supervision and Its Relationship With Nursing Workforce and Patient Safety Outcomes: A Systematic Review

Despite efforts to improve management and leadership behaviors among nurse managers, studies have shown the pervasive nature of abusive supervision in nursing practice, with strong evidence linking this type of behavior to reduced work productivity among nurses. This systematic review aimed to appraise and synthesize peer-reviewed studies that examine nurse-related and patient safety outcomes associated with abusive supervision. The review searched nursing literature from five databases (PubMed, CINAHL, Scopus, Web of Science, and PsycINFO) between August and November 2022. A total of 21 relevant studies were identified, with the Abusive Supervision Scale being the most frequently used measurement tool. Through content analysis, the review identified 29 outcomes which were categorized into six groups: (a) affective-based, (b) behavior/performance-based, (c) relationship-based, (d) cognitive-based, (e) health and well-being, and (f) nursing care. In addition, 10 mediators were identified and grouped into three categories: (a) affective-based, (b) motivation-based, and (c) health and well-being. The review findings provide compelling evidence regarding the detrimental effects of abusive supervision in the nursing workforce. Moreover, the review emphasizes the need for further research to explore how such behavior can impact patient safety outcomes. To address abusive supervision, it is crucial to promote positive behaviors among nurse managers through human resource mechanisms, relevant rules and policies, and theory-driven leadership development programs.

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

PURPOSE

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

DESIGN/METHODOLOGY/APPROACH

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

FINDINGS

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

PRACTICAL IMPLICATIONS

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

ORIGINALITY/VALUE

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

Enhancing nursing education to bolster nurse governance: insights from nurse managers

Aim

In South Korea, the level of nursing governance is moving toward shared governance. This study sought to explore nursing education contents in undergraduate nursing programs necessary to improve the governance of nurses from the perspectives of nurse managers.

Methods

The study employs thematic analysis following the guidelines outlined in the Consolidated Criteria for Reporting Qualitative Research utilizing a qualitative research design. Our investigation involves general or tertiary hospital nurse managers intending to gain valuable insights and perspectives.

Results

Interview data from 14 nurse managers were analyzed. A total of one main and four sub-themes were derived from the qualitative data analysis. Analysis revealed the main theme, "occupational socialization." The four sub-themes were education on "nurse-patient and nurse-colleague communicative interaction," "humanity," "career development," and "nurses as politicians."

Conclusion

The findings are valuable in suggesting critically needed educational content in undergraduate nursing programs to improve nursing governance. Future research should investigate the effects of the abovementioned themes on nursing governance among clinical nurses or nursing students for several years of follow-up data collection.

Shared governance council to engage advanced practice registered nurses in a hospital setting

BACKGROUND

Health care organizations use advanced practice registered nurses (APRNs) to expand patient access and support high-quality care. However, turnover, often exacerbated by inadequate engagement, has steep financial and experiential costs.

LOCAL PROBLEM

The project site, a large urban academic institution with quaternary care capabilities, employs more than 300 APRNs to provide patient care. Due to variations in hiring entity, leadership structure, and organizational visibility, efforts to maintain APRN engagement were complex. In addition, inconsistencies in standardization of clinical, credentialing, and privileging procedures created organizational risk.

METHODS

Quality improvement principles informed the implementation of a shared governance council for APRNs that included nurse practitioners and certified registered nurse anesthetists. Data were collected pre and postintervention using validated engagement questions.

INTERVENTION

Implementation of a shared governance council to support the organizational engagement of APRNs through decisional involvement in professional practice issues.

RESULTS

Analysis included the percentage of change in aggregate scores and the Wilcoxon rank-sum test to obtain p values of the 2 independent samples. There was an 8.9% increase in aggregate postintervention scores and statistical improvement in measures of quality improvement involvement.

CONCLUSION

Participation in the shared governance council increased APRN engagement through enhanced opportunities to communicate professional and clinical practice issues, decisional involvement, and collaboration. Statistically significant improvements in quality improvement involvement values potentially affirm the council's role in facilitating work environment improvements. Potential long-term gains include improved job satisfaction, retention, and organizational cost savings.

Knowing, relating and the absence of conflict: relational leadership processes between hospital boards and chairs of nurse councils

Purpose

This study aims to enhance understanding of the collaboration between chairs of nurse councils (CNCs) and members of executive hospital boards (BM) from a relational leadership perspective.

Design/methodology/approach

The authors used a qualitative and interpretive methodology. The authors study the daily interactions of BM and CNCs of seven Dutch hospitals through a relational leadership lens. The authors used a combination of observations, interviews and document analysis. The author’s qualitative analysis was used to grasp the process of collaborating between BM and CNCs.

Findings

Knowing each other, relating with and relating to are distinct but intertwined processes that influence the collaboration between BM and CNC. The absence of conflict is also regarded as a finding in this paper. Combined together, they show the importance of a relational process perspective to understand the complexity of collaboration in hospitals.

Originality/value

Collaboration between professional groups in hospitals is becoming more important due to increasing interdependence. This is a consequence of the complexity in organizing qualitative care. Nevertheless, research on the process of collaborating between nurse councils (NCs) and executive hospital boards is scarce. Furthermore, the understanding of the workings of boards, in general, is limited. The relational process perspective and the combination of observations, interviewing and document analysis proved valuable in this study and is underrepresented in leadership research. This process perspective is a valuable addition to skills- and competencies-focused leadership literature.

cuidado de Enfermería en cáncer infantil

Introducción: en Enfermería el reconocimiento de los patrones emancipatorio y sociopolítico en la práctica no es evidente. Esta identificación permite la cualificación del cuidado en áreas de gran complejidad como la oncológica, que afecta a población infantil y a sus familias. Objetivo: conocer el significado de los patrones de conocimiento sociopolítico y emancipatorio en los profesionales de Enfermería durante el cuidado de los niños con cáncer y sus familias. Metodología: estudio cualitativo etnográfico en el que se realizaron entrevistas semiestructuradas a diez enfermeros con experiencias entre los seis meses y diecisiete años trabajando con población oncológica pediátrica. Y observaciones no participantes en dos instituciones de salud, una privada y otra pública. Los datos se estudiaron bajo el procedimiento de análisis propuesto por Michael Angrosino, que consta de las fases: gestión de datos, lectura general y clasificación de temas. Resultados: como producto del análisis de la información se establecieron tres grandes temas: contexto de cuidado; cuidado de enfermería; y expresiones de los patrones sociopolítico y emancipatorio en el cuidado. En la discusión se articularon los resultados con la teoría de Sistemas de Imogene King. Conclusiones: a partir de la interacción de los enfermeros con los pacientes y sus familias se logró identificar que estrategias como la educación, el seguimiento, la gestión de casos y de trámites administrativos son formas de fortalecer la gobernanza compartida y la equidad social, los cuales son índices de credibilidad de los patrones sociopolítico y emancipatorio.

The predicting effects of professional governance and structural empowerment on job satisfaction among Jordanian nurses: A cross-sectional study

AIM

This study aimed to investigate the role of professional governance and empowerment in predicting nurses' job satisfaction.

BACKGROUND

Nurses can lead the way to enhance health care quality for all if they work in safe, satisfying and empowering environments. Professional governance and structural empowerment are associated with favourable work conditions and environments. However, studies addressing the predicting effects of professional governance and structural empowerment on job satisfaction are still limited.

METHODS

A cross-sectional design was applied. Online self-reported questionnaires were completed by 126 nurses. The analysis consisted of descriptive statistics, Pearson r correlation and hierarchical multiple regression to address the research aim.

RESULTS

Job satisfaction moderately correlated with structural empowerment (r = .40, p < .001) and professional governance (r = .30, p < .001). The final regression model revealed that 30% of the variation in job performance scores can be predicted by professional governance, structural empowerment and some demographic characteristics (R²  = .30, F = 8.67, p < .001).

CONCLUSIONS

Working in an environment that incorporates empowerment conditions, genuine support and valuable opportunities will increase the nurse's job satisfaction. Additionally, nurses will have higher job satisfaction if they have their voices heard.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should properly assess the existing situation in each institution, implement already-tested-for-effectiveness and efficiency interventions and create new ones based on nurses'-specific needs.

A comprehensive evaluation of factors affecting nurse leaders' work-related well-being

PURPOSE

This study aims to describe nurse leaders' experiences of work-related well-being and its association with background variables, working conditions, work engagement, sense of coherence and burnout.

DESIGN/METHODOLOGY/APPROACH

An electronic survey design was used. Data was collected between December 2015 and May 2016 with an instrument that included demographic questions and four internationally validated scales: the Utrecht Work Engagement Scale, QPS Nordic 34+, the shortened Sense of Coherence scale and the Maslach Burnout Inventory. Data was analysed using statistical methods.

FINDINGS

A total of 155 nurse leaders completed the questionnaire, giving a 44% response rate. Most of them worked as nurse managers (89%). Participants' work-related well-being scores ranged from 8 to 10. Statistically significant relationships were found between participants' work-related well-being and their leadership skills, current position, sense of coherence and levels of burnout. In addition, there were statistically significant relationships between work-related well-being and all dimensions of working conditions.

ORIGINALITY/VALUE

This study underlines the fact that work-related well-being should not be evaluated based on a single factor. The participants' perceived work-related well-being was high, although almost half of them reported always or often experiencing stress. The results suggest that nurse leaders may have resources such as good leadership and problem-solving skills, supportive working conditions and a high sense of coherence that prevent the experienced stress from adversely affecting their work-related well-being.