Interventions to support nurses as second victims of patient safety incidents: A qualitative study of nurse managers' perceptions

AIMS

To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them.

DESIGN

A qualitative study using interviews.

METHODS

A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis.

RESULTS

The study identified three main categories: (1) Management of second victim support, which contained three sub-categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub-categories developing practices and developing an open and non-blaming patient safety culture.

CONCLUSION

Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Mitigating the harmful effects of patient safety incidents can improve nurses' well-being, reduce burden and attrition risks and positively impact patient safety.

IMPACT

Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work.

REPORTING METHOD

COREQ checklist was used. What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support. Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work.

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.

A Mixed-Methods Exploration of Competencies and Professional Development Needs Among Chief Certified Registered Nurse Anesthetists

This project sought to explore the experiences, self-perceived preparation, professional development needs, and preferred learning methods of certified registered nurse anesthetists (CRNAs) in a management role. A sample of 10 current chief CRNAs responded to a demographics survey and participated in one-on-one interviews using a 14-question, semi-structured interview framework modified from a previous study. Interview responses were deidentified and qualitatively analyzed for common themes by two content experts and one qualitative analysis expert. Results suggest that CRNAs entering the management field feel somewhat unprepared to perform the administrative tasks associated with their role. Qualitative analysis of interview responses elicited multiple key themes including interpersonal communication and handling crucial conversations, time and organizational management skills, team building and motivation, and financial management skills. Themes related to preferred learning methods of chief CRNAs included mentorship, peer networking, and experiential learning to obtain the required knowledge and skills for the role. The authors recommend incorporating each of the identified themes to guide development of CRNA management-specific educational programs. Establishing such a program will serve to better prepare aspiring CRNA managers and further develop the knowledge and skillset of current chief CRNAs.

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

PURPOSE

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

DESIGN

Qualitative, descriptive design.

METHODS

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

FINDINGS

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

CONCLUSIONS

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

Individual-level positive psychological capital that enhances managers' transformational leadership effectiveness on nurse career success

AIMS

This study investigated the impact of nurse managers' transformational leadership on the subjective career success of staff nurses, particularly through exploring potential variations in this relationship based on nurses' positive psychological capital.

BACKGROUND

Amid a challenging nursing environment, nurses' perceptions of career success affect their individual psychological satisfaction and improve work performance. Human resource strategies often include factors for workers' subjective career success, e.g., managers' transformational leadership and individual-level positive psychological capital.

METHODS

This cross-sectional study collected survey data in 2021 from 348 staff nurses in 40 wards of a Korean tertiary hospital. The survey instruments included the Transformational Leadership tool, the Subjective Career Success Inventory, and the Psychological Capital Questionnaire. Multilevel hierarchical regression analysis and a simple slope test were used to examine moderating effects. The STROBE checklist was used for reporting.

RESULTS

Nurses reported significantly higher subjective career success when they worked in units where unit managers' transformational leadership was greater. This relationship strengthened when nurses had high positive psychological capital.

DISCUSSION

To enhance staff nurses' perceptions of career success, both managers' transformational leadership and individual nurses' positivity should be emphasized in nursing practice and education.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Comprehensive efforts to highlight managers' transformational leadership and staff nurses' positive psychological capital can enhance subjective career success, which in turn improve nurses' job performance and intention to stay. Nursing policymakers should value transformational leadership among managers so nurses can achieve their subjective goals. An organization-wide institutional system should be developed so nurses can receive support to strengthen their positivity. Future research should include interventions to foster managers' leadership and nurses' positive capital.

Experiences of Frontline Managers during the COVID-19 Pandemic: Recommendations for Organizational Resilience

The COVID-19 pandemic caused a global health crisis directly impacting the healthcare system. Healthcare leaders influence and shape the ability of an organization to cope with and recover from a crisis such as the COVID-19 pandemic. Their actions serve to guide and support nurses' actions through unpredictable health service demands. The purpose of this paper was to examine frontline managers' experiences and organizational leadership responses that activated organizational resilience during the COVID-19 pandemic, and to learn for ongoing and future responses to healthcare crises. Fourteen managers participated in semi-structured interviews. We found that: (1) leadership challenges (physical resources and emotional burden), (2) the influence of senior leader decision-making on managers (constant change, shortage of human resources, adapting care delivery, and cooperation and collaboration), and (3) lessons learned (managerial caring behaviours and role modelling, adaptive leadership, education and training, culture of care for self, and others) were evidence of managers' responses to the crisis. Overall, the study provides evidence of managers experiences during the early waves of the pandemic in supporting nurses and fostering organizational resilience. Knowing manager's experiences can facilitate planning, preparing, and strengthening their leadership strategies to improve work conditions is a high priority to manage and sustain nurses' mental health and wellbeing.

Nurse managers' strategies promoting a Fundamentals of Care-based approach among nurses: A scoping review

Introduction

In the last few years, shortcomings in caring for patient needs have promoted a growing interest in the Fundamentals of Care (FoC) to promote the quality of nursing care. However, which strategies nurse managers should implement to facilitate a FoC-based nursing care approach have not been mapped to date; therefore, the intent of this study was to map those strategies related to the nurse manager role that have been documented as being capable of promoting (or hindering), a FoC-based approach among nurses.

Methods

A scoping review following the Preferred Reporting Items for Systematic Review and Meta-Analysis - Extension for Scoping Reviews (PRISMA-ScR) guidelines. The PubMed, CINAHL, Cochrane Library, Scopus and Web of Science databases and the conference proceedings of the International Learning Collaborative 2022 Annual International Conference were consulted. Studies exploring the relationship between FoC and nurse managers using any methodology, published from 2008 (year of birth of the FoC movement) to September 2022, in Italian or English, were eligible for inclusion. Findings were categorized narratively, according to their similarities and differences.

Results

Four qualitative studies, four discussion papers, two reviews and one mixed-method study, published from 2017 to 2021, predominantly in Australia, were included. Several strategies have emerged as promoting a FoC-based care approach by nurse managers. At the macro level, there is a need to disseminate a culture of attention towards patients that should be incorporated in the strategy of the entire system; moreover, synergies and effective leadership styles should be promoted by also providing education both in the undergraduate and continuing education settings. At the micro levels, among others, the required resources should be available, and the quality of the environment promoted.

Conclusion

Nurse managers may facilitate a FoC-based approach among nurses through a set of strategies that should be included and considered in their educational pathways.

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.

Nurse managers' perceptions of nurses' professional autonomy-A qualitative interview study

AIMS

To describe nurse managers' perceptions of nurses' professional autonomy in hospitals and their role in promoting it.

DESIGN

A qualitative descriptive approach.

METHODS

Fifteen nurse managers participated in semi-structured focus group interviews in two university hospitals in Finland between May and June 2022. The data were analysed using inductive content analysis.

RESULTS

Nurses' professional autonomy in hospitals is perceived according to three themes: individual qualities behind independent actions, limited influencing opportunities in the organization and physicians' central effect. The nurse managers perceive that they enhance nurses' professional autonomy by promoting the nurses' independence at work, their sufficient and up-to-date competence, their expert role in multi-professional cooperation and joint decision-making and an open and appreciative work community.

CONCLUSIONS

Nurse managers can enhance nurses' professional autonomy with shared leadership. However, there are still gaps in nurses' equal possibilities to influence multi-professional work, especially outside of patient care. Promoting their autonomy requires commitment and support from leadership at all levels of the organization. The results advise nurse managers and the administration of the organization to maximize the potential of nurses' expertise, along with encouraging nurses towards self-leadership.

IMPACT

This study provides an innovative approach to nurses' roles through their professional autonomy from the perspective of nurse managers. These managers have an important role in enhancing nurses' professional autonomy, empowering and supporting them in their expertise, enabling necessary advanced training, and maintaining an appreciative work community where all have equal participation opportunities. Thus, nurse managers have the opportunity to strengthen high-quality multi-professional teams' ability to jointly develop the patient's care for better outcomes through their leadership.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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

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

The nurse manager support process in the work-family conflict of clinical nurses: a qualitative study

Background

Nurses are exposed to work-family conflict because of the high expectations associated with the workplace and family demands. Nurse managers' support for work-family conflict requires theoretical principles.

Aims

The current study explores managers' experiences of work-life conflict and how they manage this.

Methods

Grounded theory is used to explain the theoretical principles of nursing managers' support to clinical nurses. Participants included 20 managers and 2 clinical nurses working in one hospital. The data collection method used unstructured interviews. Sampling was first purposive and then theoretical, and data analysis was carried out using Corbin and Strauss's approach.

Results

Participants' primary concern was the threat to their organisational position, and they used a functional-exchangeable conservation strategy to consolidate their own positions. The strategy resulted in the consolidation of managers' and nurses' positions. Two factors were identified as influencing nurse managers' strategies, namely 'the sense of insecurity in the functional position' with a deterrent effect, and 'cooperative atmosphere' as a facilitator with a positive effect.

Conclusion

The most important supportive strategy used by nurse managers in the work-family conflict of clinical nurses was based on 'functional-exchangeable conservation' between themselves and the nursing staff. Functional- exchangeable protection is a type of protection of human resources by the manager. In this exchange, to solve the conflict between work and family for the nurse, the nursing manager wants to maintain their managerial position by solving the nurse's problem. Both of them benefit from this exchange. The theory of functional-exchangeable protection may provide the necessary background for the development of a prescriptive theory to minimise nurses' worries about family matters. Flexible work schedules may help nurses resolve work-family conflict and so provide better care and reduce work errors. The concept of functional-exchangeable protection and its subclasses may be helpful in preparing policies to support clinical nurses through implementing flexible work schedules, increasing nurses' motivation and fulfilling the family role of nurses.

Nurse Manager Span of Control in Hospital Settings: An Integrative Review

BACKGROUND

Nurse managers face great challenges in responding to organizational demands. There exists a general mismatch between managerial span of control and the demands of the job post, which can lead to overburdening and attrition. The aim of this review was to identify the effects of the nurse manager span of control on hospital organizations.

METHODS

An integrative literature review was carried out on nurse manager span of control using the Medline, Embase and Web of Science databases.

RESULTS

21 articles were included. Our findings indicate that the span of control of nursing managers influences outcomes in inpatients, professionals, nurse managers, and the organization.

CONCLUSIONS

The span of control of each nurse manager must be assessed and adjusted to each case. An appropriate span of control will lead to improved outcomes for stakeholders and the organization as a whole.

IMPLICATIONS FOR NURSING MANAGEMENT

Tools must be developed and implemented to measure and evaluate the span of control of nurse managers. This study was not registered.

Nurse managers' leadership styles as an impetus to patient safety in an academic hospital

Background

Successful implementation of patient safety plans in a hospital necessitates, among other things, the leadership capacity of nurse managers. Patient care delivery errors and adverse events continue to occur for a variety of reasons, including a failure to follow recommended patient safety strategies. Certain leadership styles foster interactions with healthcare staff, resulting in work environments that promote positive patient outcomes. It is unclear what nurse managers believe about the type of leadership style that drives patient safety.

Aim

The goal was to explore the nurse managers' perceptions of leadership styles as an impetus to patient safety.

Setting

The study was conducted at an academic hospital in the Tshwane District of Gauteng province.

Methods

A qualitative exploratory and descriptive contextual design was used. Semi-structured face-to-face interviews were conducted with 20 purposefully selected nurse managers. A thematic data analysis method was used to analyse data.

Results

Common leadership styles among nurse managers and challenges affecting the efficiency of nurse managers' leadership styles emerged as themes.

Conclusion

Nurse managers must have appropriate leadership styles to improve patient safety. Human and material resource shortages, as well as a lack of collaborative practice among healthcare professionals, jeopardise nurse managers' ability to maximise patient safety.

Contribution

The article provides insight into nurse managers' perceptions of leadership styles as critical to improving patient safety. Recommendations included the need for a structured ongoing leadership training programme to develop and strengthen the skills of newly appointed and existing nurse managers.

Factors Associated with the Emotional Intelligence Levels of Nurse Managers: A Systematic Review and Meta-Analysis

AIM

The purpose of this study is to determine the emotional intelligence levels of nurse managers and the factors associated with these levels.

METHOD

In this systematic review and meta-analysis, searches were made on the PubMed, EMBASE (OVID), CINAHL (EBSCO), Web of Science, Ulusal Tez Merkezi, Türk Medline, and DergiPark search engines between December 7, 2020, and January 30, 2021, using the key phrases "nurse AND ("manager" OR "nurse manager" OR "administration") AND "emotional intelligence." In this study, the publications were reviewed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide checklist.

RESULTS

The emotional intelligence levels of nurse managers are affected by some personal and institutional factors. Emotional intelligence is important in nurse managers. This study included 21 cross-sectional studies published between 2010 and 2020. In this study, it was concluded that the mean synthesized emotional intelligence level of nurse managers was 105.734±8.826, 18 variables about nurse managers and 2 variables about institutions/employees increased emotional intelligence levels, 2 variables about nurse managers and one variable about institutions/ employees reduced emotional intelligence levels, and 14 variables about nurse managers and 5 variables about institutions/employees did not affect emotional intelligence levels.

CONCLUSION

In this study, it was established that the emotional intelligence levels of nurse managers are influenced by several individual, institutional, and employee-related variables. By considering these variables in the selection of nurse managers, the improvement of their individual success levels, and the evaluation of these levels, the quality and cost-effectiveness of health services can be improved.

Psychometric Properties of the Italian Version of the Leader Member Exchange Scale (LMX-7): A Validation Study

For decades, scholars have studied leader-member exchange (LMX) relationships to understand and explain the effects of leadership on follower attitudes and performance outcomes within work settings. One available instrument to measure these aspects is the LMX-7 scale. This measurement has been widely used in empirical studies, but its psychometric properties have been poorly explored. The aim of this study was to test the psychometric characteristics (content, structural and construct validity, and reliability) of the Italian version of the LMX-7 scale and to support its cultural adaptation. We used a cross-sectional multi-center design. The forward-backward translation process was used to develop the Italian version of the scale. The scale was administered through an online survey to 837 nurses and nurse managers working in different settings. The factorial structure was tested using both exploratory and confirmatory factor analyses (EFA and CFA), and reliability was evaluated using Cronbach's alpha. For the construct validity, we used hypothesis testing and differentiation by known groups. The Italian version of the LMX-7 scale presented one dimension. All the psychometric tests performed confirmed its validity and suggested its usefulness for future research.

Leadership Development Recommendations for Clinical Nurse Managers to Bolster the Postpandemic Workforce

The postpandemic atmosphere has created a perfect storm that has necessitated a renewed prioritization to bolster support for the role of the clinical nurse manager. Role transition, competencies, mentorship, and ongoing development for the clinical nurse manager have been solidly supported in nursing leadership literature for decades. Preparing competent, ready-to-respond, people-oriented, transformational nurse leaders for these positions is essential to survival of our health care workforce. This article includes a summative review of comprehensive published findings related to nurse manager competency, development, and support. Findings have been correlated with one health system's postpandemic internal surveys, focus groups, reaction panels, and gap analysis to validate historic recommendations and prepare for program development. The purpose of this project was to endorse manager support and development recommendations and implement an evidence-based program to better prepare clinical nurse managers in today's health care leadership reality.

The Impact of the Early COVID-19 Pandemic on Registered Nurses' Intent to Stay in Nursing

The COVID-19 pandemic has been difficult for registered nurses. Media reports, most of them anecdotal, have reported upticks in nurse resignations, and plans to resign and/or leave nursing due to COVID-19. This article reports findings from an online anonymous 95-item survey completed by about 1,600 nurses from a New York City metropolitan area health system's (HS) four hospitals and ambulatory care centers about their COVID-19 experience in the spring of 2020, their intent to stay at the HS, and their intent to stay working as a nurse. Conducted early in the pandemic, this survey addresses a major gap in the literature, as there was no timely evaluation of nurses' intent to leave during the "Great Attrition" wave or to stay during the "Great Attraction" trend. Among those nurses completing the survey, 85.7% reported that they planned to work as a nurse one year later and 77.9% reported that they planned to work at the HS one year later. Those nurses who obtained a master's or doctoral degree as their first professional degree in nursing, or had a high level of mastery, were less likely to report an intent to stay at the HS. Those with no children, those who thought the HS was more supportive, and those who thought that registered nurse-medical doctor relations were higher were more likely to intend to stay at the HS. Those nurses who reported worse communication with their nurse manager were less likely to report an intent to stay in nursing. Those who reported lower stress, who were unmarried and had no children were more likely to intend to work as nurses. Our findings on nurses' intent to leave their organization and their intent to leave nursing are much lower than reports in the popular press. Our data were collected early in the pandemic and it may not reflect the accumulated stress nurses experienced from witnessing the death of so many patients.

Cultural Adaptation and Psychometric Properties of the Trust Me Scale-Italian Version: A Validation Study

BACKGROUND

The Trust Me Scale is a widely used instrument to measure trust in healthcare providers. However, no Italian version of the scale exists yet, limiting its use in Italian-speaking populations. The aim of this study is to translate and validate the Trust Me Scale for use in Italian-speaking populations in nurses and nurse managers.

METHODS

The translation process involved methodological steps of collaborative and iterative translation with cultural adaptation. The validation process included a cross-sectional study enrolling a convenience sample of 683 nurses and 188 nurse managers who completed the Italian version of the Trust Me Scale and measures of intention to leave, satisfaction, and organizational commitment.

RESULTS

Item 5 was removed for poor factor loading, and items 11 and 13 were removed following an a priori strategy focused on deleting items with correlations between residual variables different than expected based on theoretical expectations derived from previous research. The final model fit well to sample statistics with a three-factor structure (harmony, reliability, and concern) and 13 items. A multiple-indicator multiple-cause model showed a measurement invariance between nurses and nurse coordinators. Construct validity was also supported by the evidence that the measured domains of trust align with the theoretical expectations and are related to the intention to leave, job satisfaction, and organizational commitment. Each dimension showed adequate scale reliability.

CONCLUSIONS

The Italian version of the Trust Me Scale is a valid and reliable instrument to measure trust in nurses and nurse managers in Italian-speaking contexts. It can be used for research in nursing and leadership and evaluation of interventions aimed at improving trust in healthcare contexts.

Relationships among nurse managers' job design, work environment, and nurse and patient outcomes

The importance of nurse managers' practice environments in affecting outcomes for direct care nurses and patients has been well-researched. Nonetheless, much remains to be learned about the determinants of the nurse manager practice environment. In this study, 541 US nurse managers' survey responses were matched to unit-level aggregate data of their subordinates' responses on the National Database of Nursing Quality Indicators. A model relating job design and experience to the nurse manager's practice environment and direct care nurse (i.e., job satisfaction, intent to stay, and joy and meaning in work) and patient outcomes (i.e., nurse-reported quality of care and missed nursing care) was evaluated through multilevel path analysis. Nurse manager span of control, support staff, and experience influence nurse managers' perceptions of their practice environment and nurse and patient outcomes. Although support staff can offset some negative effects of wide spans of control, it does not fully compensate for wide spans. Thus, nurse manager job design factors and experience relate to nurse manager practice environments and valued downstream outcomes. The present research emphasizes the importance of a positive nurse manager practice environment and provides guidance for nurse manager hiring and job design decisions.

An interpretive description of nurse managers' experiences across Australia, Denmark, and New Zealand

AIMS

To explore the role of ward-based nurse managers in supporting nurses to undertake high-quality fundamental care.

DESIGN

A qualitative study guided by the principles of interpretive description. Reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ).

METHODS

Nurse managers in three urban, publicly funded hospitals in Australia, Denmark and New Zealand, were invited to participate in group interviews to discuss how they support fundamental care in their clinical areas. Six group interviews were conducted between February 2017 and March 2020 involving 31 participants.

RESULTS

Six interrelated themes were identified: Difficulty expressing how to support the nurse-patient relationship; Establishing expectations for care delivery without clear strategies for how this can be achieved; Role modelling desired behaviours; Significance of being present to support care quality; The importance of engaging and supporting staff in their work; and Recognizing the challenges of prioritizing care needs.

CONCLUSION

This study indicates that nurse managers are not universally clear in explaining how they support their staff to provide fundamental care. If fundamental care is not clearly understood and communicated in the nursing team, then there are risks that fundamental care will not be prioritized, with potential negative consequences for patient care. Nurse managers may benefit from additional resources and guidance to help them to support fundamental care delivery in their clinical areas.

IMPACT

Previous research exploring fundamental care and missed care highlights the importance of the role of the nurse manager in influencing nursing care. This study demonstrates that though nurse managers have a passion for supporting their staff to deliver fundamental care, clear strategies to achieve this are not always evident. This study suggests that scholarship around leadership to promote and facilitate fundamental care is crucial to improving nursing practice and patient outcomes.

Nurse manager intentional rounding and outcomes: Findings of a systematic review

AIM

To summarize the evidence available on Nurse Manager Intentional Rounding (NMIR) describing the main characteristics and methodological quality of studies available, the features of rounding and the outcomes as measured to date.

DESIGN

A systematic review.

DATA SOURCES

Electronic databases, including MEDLINE-EBSCHOST, PubMed, CINAHL, Scopus, Cochrane, Clinicalkey, ScienceDirect, OVID, Sage Journals and Web of Science, were searched up to June 2021.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline was used to summarize methods and report findings. The Joanna Briggs Institute Critical Appraisal tools were used to evaluate the methodology quality of the studies included.

RESULTS

Seven studies were included with pre-post-test (n = 3), longitudinal, two-group post-tests, quasi-experimental, and retrospective study designs (n = 1, respectively). In five studies, the nurse managers were trained to conduct the rounding, which was shaped according to three main features: a structured (n = 4), a semi-structured (n = 1) and an unstructured rounding (n = 2) delivered from high (twice a day 7/7) to low intensity (once a day, 5/7). Two main outcomes have been measured to date, the patient satisfaction and some aspects related to the care quality. Five studies reported that the satisfaction scores of patients who received rounding were significantly higher than that perceived by patients not receiving rounding. About the other aspects of the quality of care, two studies documented significant improvements as a consequence of the NMIR (e.g. information accessibility, discharge instructions, coordination of care after discharge).

CONCLUSION

Studies available report in general a low methodological quality, mainly due to their pragmatic nature as quality improvement projects. Therefore, transforming this field of research by establishing a methodological rigour and a theoretical foundation in both interventions and outcomes and by designing experimental approaches, might expand the evidence available on the effects of nurse managers intentional rounding.

Sleep disturbances in nurse managers during the early and late stages of the COVID-19 pandemic

Introduction

Working conditions during the COVID-19 pandemic have affected health professionals' quality of sleep. To date, most of the studies that assess the impact of the COVID-19 pandemic on sleep have been carried out with front-line health personnel, and almost none of them have been carried out with managers.

Objective

To evaluate the quality of sleep and the level of stress in nurse managers during the early and late stages of the COVID-19 pandemic.

Methods

Cross-sectional studies were carried out at two time points: after the lockdown period (July 2020) and a year and a half after the start of the pandemic (October 2021). A total of 102 nurse managers of a tertiary hospital were invited to participate. The Perceived Stress Scale (PSS-14) and Pittsburgh Sleep Quality Index (PSQI) were administered to assess stress levels and sleep quality.

Results

The response rate was 85.2% in 2020 and 81.3% in 2021. Nursing managers showed alterations in sleep quality throughout the pandemic: 70.1% after confinement and 61.4% at the beginning of the second wave. In addition to stress, the fear of contagion by COVID-19 influenced sleep problems. More than a year after the start of the pandemic, the professionals' fear of contagion decreased. Perceived stress also decreased, but sleep disturbances remained.

Conclusion

High stress and poor sleep quality among nurse managers require special attention, and specific interventions need to be implemented. Hospitals should develop programs that help nurse managers develop skills to mitigate stress levels and thus improve sleep quality and professional quality of life.

Developing a framework for the participation of nursing managers in the health policy-making process in Iran: A Delphi study

AIMS

The aim of this study was to develop a framework for nursing managers to participate in the health policy-making process.

BACKGROUND

Nursing managers must be involved in the health policy process to provide appropriate health services, focus on nursing professional excellence, and improve the performance of the health system.

METHODS

This multimethod research was based on the Delphi study and experts' panel. Faculty members of the nursing, health policy, health services management, and nursing managers working at hospitals were selected via purposive sampling. The data collection tool was a demographic form and an open-ended questionnaire in the first round and a structured questionnaire in the next round. In the two rounds of Delphi, experts discussed and rated items of nursing managers' participation framework in the health policy-making process. At the expert panel session, the framework was finalized with a 12-part checklist. The data were analysed quantitatively using SPSS software version 22.

RESULTS

A total of 28 items were entered into the Delphi study. Experts who met the inclusion criteria responded to rounds 1 (n = 20) and 2 (n = 16). Following the two rounds of the Delphi study, 27 items were selected and discussed by experts using a 12-part checklist related to the framework. The final participation framework was divided into five sections: Barriers, facilitators, advantages, disadvantages, and factors affecting the participation of nursing managers in the health policy-making process.

CONCLUSION

In our findings, the relationship between the components of the framework and policy cycle was shown, which should be considered to lay the groundwork for participation. This can lead to health promotion, accountability, and financial participation in the health system, which can improve the proactive involvement of nursing managers in the health policy-making process.

IMPLICATIONS FOR NURSING MANAGEMENT

The proposed framework can be utilized across the spectrum of nursing, including practice, leadership, and education to enhance the participation of nursing managers in health policy activity.

Exploration of knowledge, attitudes, and perceived benefits towards nurse managers' participation in the health policy-making process: a qualitative thematic analysis study

Background

Participation of nurse managers in policy-making could help policy-makers to propose relevant and effective policies and support other policy actors involved with these processes.

Objective

This study aimed at exploring the attitudes and perceived benefits of nurse managers' participation in the health policy-making process.

Methods

In this descriptive qualitative research, semi-structured interviews were conducted with 16 nurse managers, government officials, and faculty members. Recruitment was based on purposive sampling from different regions across Iran. A thematic analysis was performed in MAXQDA (version 2012).

Results

After analysis of the qualitative data, four themes and 13 sub-themes emerged. The themes were feelings about nurse managers' participation, advantages of nurse managers' participation, problems due to the non-participation of nurse managers, and recommendations for improvement of the policy-making process.

Conclusion

The outcomes provided new insights into the perceived benefits of and attitudes towards nurse managers' participation in health policy making in the Iranian setting. It is crucial to strengthen the capacity for nurse managers' participation in health policy making to develop effective healthcare policies.

Nurse leaders' and digital service developers' perceptions of the future role of artificial intelligence in specialized medical care: An interview study

AIM

To describe nurse leaders' and digital service developers' perceptions of the future role of artificial intelligence (AI) in specialized medical care.

BACKGROUND

Use of AI has rapidly increased in health care. However, nurse leaders' and developers' perceptions of AI and its future in specialized medical care remain under-researched.

METHOD

Descriptive qualitative methodology was applied. Data were collected through six focus groups, and interviews with nurse leaders (n = 20) and digital service developers (n = 10) conducted remotely in 2021 at a university hospital in Finland. The data were subjected to inductive content analysis.

RESULTS

The data yielded 25 sub-categories, 10 categories and three main categories of participants' perceptions. The main categories were designated AI transforming: work, care and services and organizations.

CONCLUSIONS

According to our respondents, AI will have a significant future role in specialized medical care, but it will likely reinforce, rather than replace, clinicians or traditional care. They also believe that it may have several positive consequences for clinicians' and leaders' work as well as for organizations and patients.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders should be familiar with the potential of AI, but also aware of risks. Such leaders may provide betters support for development of AI-based health services that improve clinicians' workflows.

Nurse managers' challenges and opportunities in the COVID-19 pandemic crisis: A qualitative descriptive study

AIM

The study was conducted to understand the experiences of nurse managers with regard to the difficulties and opportunities they encountered during the pandemic.

BACKGROUND

Although many studies have been carried out to understand how nurses were affected in the COVID-19 pandemic, there are few studies that treat the experiences of nurse managers.

METHODS

In this qualitative descriptive study with 19 nurse managers working in pandemic management at a university hospital in Turkey during the first three waves of the pandemic, data were collected between April and July 2021 using the semi-structured interview method. Content analysis was performed to analyse the data.

RESULTS

Six themes were identified with respect to the experiences of nurse managers during the pandemic. These themes were initial reactions to the crisis, ineffective crisis management, excessive workload, the moral burden in decision-making, support of colleagues and other multidisciplinary team and nurse manager empowerment.

CONCLUSIONS

The nurse managers had difficulties in their managerial roles during the pandemic. However, they also viewed the crisis as an opportunity because they were able to note the deficiencies in management at all levels of the hospital and their leadership and decision-making roles took on more importance.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers may use the results of this study to be prepared for the continuing COVID-19 pandemic and any other emergency circumstances that they may have to face in the future.

Nurse leaders' work-related well-being - relationships to a superior's transformational leadership style and structural empowerment

AIMS

To describe how nurse leaders' work-related well-being is related to a superior's transformational leadership style and structural empowerment.

BACKGROUND

The demanding role of nurse leader means that these professionals experience emotional exhaustion and challenges with work-life balance and can be influenced by the leadership style of their own superiors.

METHODS

A cross-sectional questionnaire using two internationally validated scales, namely, the Transformational Leadership Scale and Conditions For Work Effectiveness Questionnaire-II. Statistical methods were applied during data analysis.

RESULTS

A total of 155 nurse leaders participated fulfilled the questionnaire. The participants' work-related well-being scores ranged from 8-10. The participants felt that their superiors employ transformational leadership. The dimension of feedback and rewards received the lowest scores, while the nurse leaders reported moderate overall empowerment levels. A nurse leader's work-related well-being was positively correlated with structural empowerment and their superior's leadership style.

CONCLUSIONS

Despite the fact that nurse leaders reported relatively high levels of work-related well-being, more attention should be paid on the feedback and rewards and on the support of superiors as they positively influence the work-related well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

The transformational leadership should be supported in the organizations and by the education as it strengthens the work-related well-being and structural empowerment of nurse leaders.

Medical-surgical nurse leaders' experiences with safety culture: An inductive qualitative descriptive study

AIM

To describe safety culture as experienced by medical-surgical nurse leaders.

BACKGROUND

Safety culture remains a barrier in safer patient care. Nurse leaders play an important role in creating and supporting a safety culture.

METHODS

An inductive qualitative descriptive study using semi-structured interviews, document review, and observations in a Midwestern community hospital in the United States.

RESULTS

Making sure nurses are keeping patients safe, making sure nurses have nursing interventions in place, expecting nurses to stop unsafe acts or escalate when they feel uncomfortable, making sure nurses have what they need to provide safe care, organization prioritizes patient safety, and making sure nurses are learning and growing emerged as themes describing safety culture.

CONCLUSIONS

Nurse leaders made sure patients were safe by making sure everyone was doing their best to provide safe care. Insufficient time, too many priorities, insufficient resources, poor physician behaviors, and lack of respect for their role emerged as barriers to leading a safety culture.

IMPLICATIONS FOR NURSING MANAGEMENT

Organizations must remove barriers for nurse leaders to develop and lead a safety culture. Nurse leaders must learn to advocate successfully for safe nursing care and professional work environments.

Between a rock and a hard place: Nurse managers' experiences of large-scale organizational change in the public health service

Background

Nurse managers are often at the forefront of implementing organizational changes. Studies suggest that conflicting pressures and stress are high during such times, though little is known of how nurse managers experience the continuing run of change initiatives.

Aims

To explore nurse managers' experience of large‐scale organizational changes and its impact on their working lives and conditions.

Design

A qualitative phenomenological hermeneutical study utilizing a Ricœur‐inspired method of interpretation.

Methods

Semi‐structured interviews were conducted with 12 nurse managers at a public sector university hospital that had recently undergone large‐scale organizational changes. Interviews were conducted in 2021 during the covid‐19 pandemic. The analysis is based on the three‐stage Ricœur‐inspired analysis method by Pedersen and Dreyer.

Results

Three themes emerged outlining the nurse managers experiences of large‐scale organizational change: The need for support structures to be incorporated in the change process, The need for a guiding star, and The challenge of the values embedded in the Nurse Manager mindset. These themes were consistent across both predominantly positive as well as mainly negative experiences.

Conclusion

This study reveals the potential that receiving support from management, staff and peers has to positively influence the experiences of nurse managers during large‐scale organizational changes. However, lacking a clear vision for the process negatively influences their ability to support high‐level quality care within their wards, potentially increasing their feelings of stress and conflicting pressure.

Impact

Participants offered important insight into the sparsely explored subject of nurse managers' experiences of organizational change, the complexity they face and the potentially high personal costs. The study highlights the detrimental effects of not providing support to all managers in organizations undergoing change, and the parallels to the covid‐19 pandemic.

No Patient or Public Contribution was required for this study due to its aim.

"A Qualitative Evaluation Of The Hot Debrief/Follow-Up Initiative: Implications Of Readily Identifying Positive Outcomes In An Australian Emergency Department"

AIM

To gain insight into how emergency department nurses and doctors perceive the experience of being offered the opportunity to request a patient follow-up as part of a structured debrief initiative.

BACKGROUND

An increased prevalence of burnout and compassion fatigue amongst emergency clinicians is being recognised globally. A wellbeing initiative has been implemented within a large public hospital emergency department to combat these phenomena.

METHOD

A qualitative research approach using semi-structured interviews were carried out to explore the participants' views relating to the debrief/follow-up initiative.

RESULTS

A total of 17 face-to-face semi-structured interviews were conducted. This research highlighted a number of common themes including the participants understanding and perception of the follow up initiative, the barriers and enablers of effective implementation, and the perceived benefits of following up on patient outcomes in the emergency setting. This research identified unanimous support for the initiative. No negative implications relating to the initiative were identified.

CONCLUSIONS

This study indicates the positive impacts of employing a deliberate and formalised approach to enabling staff to access follow-up information about the patients for whom they provide life-giving care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse Unit Managers should consider the findings of this research and understand the crucial role that nursing leadership can play in fostering the design and implementation of similar initiatives.

The integration of care ethics and nursing workload: A qualitative systematic review

AIM

The aim of this review was to explore literature from January 2017 to December 2021 for specific aspects of care ethics related to nursing workload in the acute care setting.

BACKGROUND

High nursing workload is associated with adverse outcomes for nurses as well as patients. Nursing workload goes beyond patient-to-nurse ratios and encompasses patient, nurse and organizational factors.

EVALUATION

This qualitative systematic review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The four features of care ethics related to nursing workload guided the review of qualitative studies in MEDLINE, CINAHL and PsycINFO, and synthesized findings were presented in the four phases of caring.

KEY ISSUES

Key issues include ethical dilemmas, time pressure, shared moral burden and managerial support.

CONCLUSION

To reduce nursing workload, a care ethics perspective can provide solutions through fortifying interprofessional relationships and enhancing empathetic actions.

IMPLICATIONS FOR NURSING MANAGEMENT

Situational, individual and team approaches to management allows for incorporation of personal values and ethics of care to support patient-centred care. Leadership initiating conversations and being proactive about workload can lead to an improved work environment for both the nurse and the nurse manager.

FINANCIAL COMPETENCIES AS INVESTIGATED IN THE NURSING FIELD: FINDINGS OF A SCOPING REVIEW

AIM

Mapping the extent of the research activity in the field of financial competencies and nursing, identifying main patterns, advances, gaps, and evidence produced to date.

BACKGROUND

Financial competencies are important indicators of professionalism and may influence the quality of care in nursing; moreover, these competencies are the basis of healthcare sustainability. Despite their relevance, studies available on financial competencies in the nursing field have not been mapped to date.

EVALUATION

A Scoping Review was guided according to (a) the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review, and (b) the Patterns, Advances, Gaps and Evidence for practice and Research recommendations framework.

KEY ISSUE

A total of 21 studies were included. Main research patterns have been developing/evaluating the effectiveness of education programmes; investigating the nurse's role in context of financial management; challenges and needs perceived by them; and tool validation to assess these competencies. The most frequently concept used across studies was "financial management competencies" (n=19).

CONCLUSION

The sparse production of studies across countries suggests that there is a need to invest in this research field.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurses with managerial roles should invest in their financial competencies by requiring formal training both at the academic and at the continuing education levels. They should also promote educational initiatives for clinical nurses, to increase their capacity to contribute, understand, and manage the emerging financial issues.

Turkish adaptation and psychometric testing of the caring assessment tool-administration

PURPOSE

The purpose of this study was to adapt the Caring Assessment Tool-Administration (CAT-Adm) to Turkish and to test the psychometric properties.

DESIGN AND METHODS

The study was carried out in a cross-sectional and methodological design. The sample consisted of 578 nurses.

FINDINGS

The total score correlation coefficients of the items in the scale ranged from 0.69 to 0.90, and the Cronbach alpha reliability coefficient was 0.98, indicating excellent reliability. The results of the factor analysis confirmed the single-factor structure of CAT-Adm and the scale fit was good.

CONCULATION

In this study, CAT-Adm was determined to be a reliable and valid tool.

PRACTICE IMPLICATIONS

With the use of CAT-Adm, nurses' perceptions of nurse managers' approach can be evaluated.

Effects of a learning programme for nurse managers to connect their experience: A quasi-experimental study

AIM

The present study aimed to examine the effects of a learning programme for nurse managers on connecting learning with their own experiences and fostering competence.

BACKGROUND

In Japan, second-level programmes for certified nurse administrators represent the main opportunity for formal training for nurse managers. However, it is difficult for nurse managers to transfer second-level programme learning to their workplace.

METHODS

This quasi-experimental study used a two-group pretest-posttest design with purposive sampling and non-random assignment of 29 consenting Japanese nurse managers who were participating in a second-level programme through a prefectural nursing association. The programme provided reflection papers and feedback from a researcher, as well as reflective group sessions. The outcome measure was the Japanese First-Line Nurse Managers Competence Inventory (JNMCI) score.

RESULTS

The intervention group showed significant improvement in JNMCI scores after participating in the programme. A significant difference in JNMCI scores was also observed between the intervention and comparison groups.

CONCLUSION

This learning programme led to improved competency among nurse managers.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse manager development programmes should include reflection papers and feedback, as well as reflective group sessions, to improve competency among nurse managers.

Nurse managers leadership styles and intention to stay among nurses at the unit in Ghana

INTRODUCTION

Enabling effective leadership is significant in contemporary healthcare delivery. Nurse Managers' (NMs) leadership styles are a major predictor of nurses' retention. Using the 'Full Range Leadership' model as the organising framework, this study explored NMs leadership styles and their influence on intention to stay among nurses in Ghana.

METHODS

A quantitative cross-sectional design using the Multifactor Leadership Questionnaire (MLQ-5x), was used to explore nurses' intention to stay at their current workplace. Data were collected from 348 nurses in 38 selected hospitals and analysed using Pearson correlation and multiple linear regression.

RESULTS

NMs exhibited different leadership styles based on the circumstance, but mostly used a participative leadership style, followed by transformational and transactional leadership styles. Nurses showed a high level of intention to stay. The intention to stay at the current workplace was high (3.26 out of 4) among nurses. The findings show that 85.6% of the nurses had intended to stay. The leadership styles of NMs jointly predicted 20.9% of the variance in intention to stay among nurses.

CONCLUSION

Regular in-service training programs in leadership is critical for NMs to strengthen their leadership skills. NMs should be encouraged to widely use participative leadership styles to foster inclusiveness of staff in the unit.

Quality of care plans in long-term care facilities for the older persons-How well is information from RAI assessments utilised in care planning?

BACKGROUND

In Finland, care plans at long-term care facilities (LTCF) for the older persons should be based on information from Resident Assessment Instrument (RAI) assessments and the principles of structured data. Hence, managers are responsible for ensuring that the RAI system is used to a satisfactory extent, the provided information is used in care planning, and that staff members are competent at composing high-quality care plans.

AIM

To explore the congruence between first-line managers' assessments of the extent to which care plans include RAI information and separately observed RAI-related contents of care plans.

METHODS

The study was based on a descriptive, cross-sectional survey of first-line managers (n = 15) from three LTCF organisations and a randomly selected sample of care plans (n = 45) from two LTCF organisations in Finland. Manager responses and analysis of care plans were reviewed at a general level. The data were gathered in 2019 and analysed using statistical methods and content analysis.

RESULTS

First-line managers' assessments of the extent to which their units' care plans included RAI information did not match the observed care plan contents. The care plan analysis revealed that managers significantly overestimated the extent to which care plans included RAI-related content.

CONCLUSION

Managers at LTCF organisations need more training to be able to sufficiently support their staff in using RAI information to draft high-quality care plans.

IMPLICATION FOR PRACTICE

Care plans must include a higher level of information related to RAI assessments. To develop competencies in drafting high-quality care plans, training related to RAI information utilisation on all aspects of the care plan should be emphasised and training should be provided to first-line managers and more broadly across the nursing staff.

'Stolen Time'-Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia

The research has reported a high prevalence of low-quality and missed care for patients with community-acquired pneumonia (CAP). Optimised nursing treatment and care will benefit CAP patients. The aim of this study was to describe the barriers and facilitators influencing registered nurses’ (RNs’) adherence to evidence-based guideline (EBG) recommendations for nursing care (NC) for older patients admitted with CAP. Semi-structured focus group interviews (n = 2), field observations (n = 14), and individual follow-up interviews (n = 10) were conducted in three medical units and analysed by a qualitative content analysis. We found a main theme: ‘‘stolen time’—delivering nursing at the bottom of a hierarchy’, and three themes: (1) ‘under the dominance of stronger paradigms’, (2) ‘the loss of professional identity’, and (3) ‘the power of leadership’. These themes, each comprising two to three subthemes, illustrated that RNs’ adherence to EBG recommendations was strongly influenced by the individual RN’s professionalism and professional identity; contextual barriers, including the interdisciplinary team, organisational structure, culture, and evaluation of the NC; and the nurse manager’s leadership skills. This study identified central factors that may help RNs to understand the underlying dynamics in a healthcare setting hindering and facilitating the performance of NC and make them better equipped for changing practices.

Experiences of frontline nurse managers during the COVID-19: A qualitative study

Aim

To explore experiences of frontline nurse managers during COVID‐19.

Background

The COVID‐19 pandemic has complicated care provision and healthcare management around the world. Nurse managers have had to face the challenge of managing a crisis with precarious resources. Little research has been published about the experiences of nurse managers during the COVID‐19 pandemic.

Methods

A qualitative descriptive study of 10 frontline nurse managers at a highly specialized university hospital in Spain was carried out. Semi‐structured interviews were conducted between June and September 2020. The Consolidated Criteria for Reporting Qualitative Research checklist was used for reporting.

Results

Six themes emerged: constant adaptation to change, participation in decision‐making, management of uncertainty, prioritization of the biopsychosocial well‐being of the staff, preservation of humanized care and ‘one for all’.

Conclusions

This study provides evidence for the experiences of nurse managers during the COVID‐19 pandemic. In addition, analysing these experiences has helped identify some of the key competencies that these nurses must have to respond to a crisis and in their dual role as patient and nurse mediators.

Implications for Nursing Management

Knowing about the experiences of frontline nurse managers during the pandemic can facilitate planning and preparing nurse managers for future health disasters, including subsequent waves of COVID‐19.

Towards remote leadership in health care: Lessons learned from an integrative review

AIM

To gather and synthesize current empirical evidence on remote leadership and to provide knowledge that can be used to develop successful remote leadership in health care.

DESIGN

A integrative literature review with an integrated mixed methods design.

DATA SOURCES

The literature search was carried out between February and March 2019 in the CINAHL, Medline (Ovid), PsycInfo, Scopus, SocIndex, Web of Science and Business Source Elite (EBSCO) databases.

REVIEW METHODS

An integrative review was conducted to identify relevant studies published from 2010 to 2019. Of the 88 eligible studies, 21 studies met the inclusion criteria and were selected for the final review. The included studies were analysed using mixed methods synthesis, more specifically, data-based convergent synthesis.

RESULTS

The performed analysis identified three main themes: characteristics of successful remote leadership; enhancing the leader-member relationship; and challenges in remote leadership. The first theme included the following sub-themes: remote leader characteristics; trust; communication; and leading the team culture. The second theme covered the importance of organizing regular face-to-face meetings, clear communication policies and the connection between positive team spirit and good remote leader-member relationship, while the third theme emphasized leader- and member-related challenges for remote work.

CONCLUSIONS

As none of the identified studies had been conducted in a health care setting, future remote leadership research must also specifically consider the health care context. This will be pivotal to exploring how remote work can foster a safe workplace culture, empower health care workers, increase job satisfaction and improve patient outcomes.

IMPACT

Remote leadership has rarely been studied in the health care context. Trust, communication, team spirit and a leader's characteristics are central to remote leadership, a finding which is useful for re-evaluating and improving the current culture at health care organizations.

Managing maternal and child health nurses undertaking family violence work in Australia: A qualitative study

AIM

To explore the experience of nurse managers managing maternal and child health nurses undertaking family violence work in Victoria, Australia.

BACKGROUND

Health care practitioners' ability to address violence against women is strengthened by health service systems that include effective staff management and leadership. Maternal and child health nurses work with women experiencing abuse; however, their support by the health system and their managers has not been examined.

METHOD

Semi-structured interviews with 12 nurse managers in 2019-2020 explored how they supervised and managed nurses. The data were analysed using reflexive thematic analysis.

RESULTS

We identified three themes-(a) managing the service: being resourceful; (b) supporting nurses' emotional safety; and (c) hitting the ground running: the demands on the manager.

CONCLUSION

Inadequate support for nurse managers undermines workplace well-being and role satisfaction, impacting the safety and supervision of nurses doing family violence work.

IMPLICATIONS FOR NURSING MANAGEMENT

An integrated family violence systems approach must include improved training and support for nurse managers to enable reflective practice and ensure effective support for nurses working with women experiencing abuse.

Determining the effect of neuro-linguistic programming techniques on the conflict management and interpersonal problem-solving skills of nurse managers: A mixed methods study

AIM

This study, which used quantitative and qualitative design, was conducted to explore the effect of neuro-linguistic programming techniques on the conflict management and interpersonal problem-solving skills of nurse managers.

BACKGROUND

Neuro-linguistic programming is among the methods that can enable managers to achieve the desired results in managing interpersonal problems and conflicts in an organisation.

METHODS

The research was carried out with a mixed methods approach. The Personal and Professional Characteristics Information Form, Interpersonal Problem-Solving Inventory and Rahim Organizational Conflict Inventory-II were applied to 41 nurse managers and nurses to collect quantitative data for the study. Semi-structured questionnaires were used to collect qualitative data in focus-group interviews held both before and 6 months after the training.

RESULTS

As a result of the content analysis of the qualitative data, the nurse managers in the training group were found to have improved abilities to plan and increased flexibility, positiveness, happiness and motivation when compared to the nurse managers in the control group. Findings supporting these data were obtained in the analyses of interviews with nurses.

CONCLUSION

Neuro-linguistic programming training can make a difference in terms of helping nurse managers to develop interpersonal problem- and conflict-solving skills.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can use neuro-linguistic programming techniques for conflict management and interpersonal problem-solving occurring in their organizations. For this purpose, it is recommended that pregraduate and postgraduate neuro-linguistic programming training is provided to nurse managers.

Workplace violence from the perspective of hospital ward managers in Sweden: A qualitative study

AIM

The aims of the study are to explore workplace violence perpetrated by patients or visitors from the perspective of hospital ward managers and to describe how ward managers perceive their leadership role and manage related incidents.

BACKGROUND

Few studies focus on workplace violence from the perspective of ward managers even though they are the closest managers to the operational staff.

METHOD

Fifteen semistructured interviews were analysed using qualitative content analysis.

RESULTS

Four categories emerged: the face of workplace violence, a two-fold assignment, strive towards readiness to act, and managing incidents.

CONCLUSION

While the most common acts of workplace violence are considered less serious and related to patients' medical conditions or dissatisfied visitors, hospital organizations focus on serious but rarely occurring incidents. Consequently, ward managers have limited opportunities to ensure a safe work environment on an everyday basis.

IMPLICATIONS FOR NURSING MANAGEMENT

To support ward managers' occupational safety and health management, workplace violence prevention and management should be acknowledged as an important responsibility for senior management in hospitals. It is important to identify incidents that most likely will occur at the wards and to create strategies related to those incidents. Strategies could include risk assessments, prevention, evaluation, education and reflection combined with, for example, scenario training.

Nurse managers' competencies: A scoping review

AIM

To describe and synthesize scientific literature on nurse managers' competencies.

BACKGROUND

The key strategy for the success of health organisations currently resides in the capacity of the nurse manager to develop advanced competencies in management. However, there is a lack of systematic reviews that synthesize knowledge about nurse managers' competencies.

EVALUATION

A scoping review was conducted using electronic databases including Web of Science, Scopus, PubMed and Cumulative Index to Nursing and Allied Health Literature.

KEY ISSUES

After the first analysis, 392 competencies were observed from 76 studies. Finally, 53 competencies were grouped according to their characteristics. The two most-cited competencies were communication and finance.

CONCLUSIONS

Knowing the competencies required by nurse managers can help organisations create strategies to develop competent managers. In addition, from the results we can infer what might be the core competencies, since 22 main competencies from the total number were identified.

IMPLICATIONS FOR NURSING MANAGEMENT

The competencies identified constitute the body of knowledge necessary for nurse managers. In addition, it is possible to generate a pathway for learning and professional development for nurses before they work at the microlevel of management. The starting point for this pathway could be the 22 core competencies.

From coping to building nurse manager resilience in rural workplaces in western Canada

AIM

To investigate the role stressors, and how coping strategies cultivated nurse managers' resilience in rural workplaces.

BACKGROUND

A stressful workplace can impair the mental and physical health of nurse managers leading to poor performance. Building and sustaining manager resilience in complex and stressful practice environments is necessary to attract and maintain competent and skilled managers.

METHOD

In this qualitative exploratory inquiry, a purposive sampling method was used to recruit 16 nurse managers in rural western Canada.

RESULTS

Coping strategies fostered manager's resilience that made their work meaningful, and included putting out fires, psychologically reframing a situation, serving others and receiving support.

CONCLUSIONS

Managers brought expertise, knowledge and skill to make their work meaningful and central to ongoing health service delivery in these rural communities. Nurse manager resilience can be strengthened by using evidence-based strategies in an increasingly complex health care environment.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers need to be supported and encouraged to develop awareness of their own protective factors as they cope with challenging situations. Building resilience through formal education, social support and meaningful recognition is an important focus for nurse leaders in establishing a healthy work environment and maintaining a stable nursing workforce.

Competency Model for the Middle Nurse Manager (MCGE-Logistic Level)

Healthcare systems are immersed in transformative processes, influenced by economic changes, together with social and health instability. The middle nurse manager plays a fundamental role, since he or she is responsible for translating the strategic vision, values and objectives of the organization. The objective of this study was to propose the model of competencies to be developed by the middle nurse manager in the Spanish healthcare system. Our methodology consisted in the application of the Delphi method in order to reach an agreement on the necessary competencies, and principal component analysis (PCA) was used to determine the construct validity, reducing the dimensionality of the set of data. Fifty-one competencies were identified for the definition of the model, highlighting decision-making, leadership and communication. The PCA pointed out the structural validity of the proposed model through the saturation of the main components (α Cronbach > 0.631). The results show the model of competencies which the middle nurse manager in the Spanish healthcare system must develop. Middle nurse managers may use these as criteria to plan their professional strategies in the context of management. This model of competencies can be applied to establishing selection processes or training programs for the role of middle nurse manager.

Nurse manager communication and outcomes for nursing: An integrative review

AIM

To evaluate literature on the importance of good communication between managers and nurses, and its influence on nurses and patient care.

BACKGROUND

In the nursing scenario, concepts such as engagement and job satisfaction are tied to manager communication and influence the care provided (Kunie et al., 2017). It is crucial to recognize the importance of manager communication on the nurses and patient care. The evaluation was guided by this question: in the review of post-2014 quantitative studies, is there evidence that nurse managers with high communication competence have better patient/staff outcomes than those with lower competencies?

EVALUATION

We evaluated current research through an evidence review on the day-to-day influence of nurse manager communication. We conducted our search using common health databases. Since the American Organization for Nurse Leadership developed nurse manager competencies in 2014, we only included articles published after that year. Further inclusion criteria included primary, quantitative and peer-reviewed research.

KEY ISSUES

Thirty articles remained after the application of inclusion/exclusion criteria with five themes emerging: patient safety and quality, job satisfaction, leadership styles, innovative practice and general management skills.

CONCLUSION

Research associates positive patient and staff outcomes with a leader who exhibits communication competences.

IMPLICATIONS FOR NURSING MANAGEMENT

Assessment of current competence levels in communication in nurse managers is needed. Education for improving communication skills is also needed.

The relationship between nurse managers' personality traits and their conflict management strategy preferences

AIM

To investigate the relationship between nurse managers' personality traits and conflict management strategies.

BACKGROUND

Despite the important role of personality traits in conflict management strategy preferences, no study to date has addressed the relationship between personality traits and conflict management in nurse managers.

METHODS

A descriptive and cross-sectional design was applied. The study sample consisted of 114 nurse managers from six hospitals, and 111 participants completed forms for a total response rate of 97.36%.

RESULTS

The main findings revealed that the conflict management strategies used by nurse managers participating were as follows: integrating (39.21, range = 29-45), avoiding (38.39, range = 23-65), compromising (31.51, range = 24-40), dominating (20.05, range = 12-28 ) and obliging (19.42, range = 14-25). It was seen that managers whose personality traits were extraverted, agreeable or conscientious chose the integration strategy to manage conflict, whereas managers with emotional inconsistency in personality traits preferred the avoiding strategy.

CONCLUSIONS

Nurse managers are important to effectively managing conflicts in the clinical environment. Personality trait may be linked to the successful management of conflict.

IMPLICATIONS FOR NURSING MANAGEMENT

Revealing the relationship between nurse managers' personality traits and associated conflict management strategies can help senior management organise useful training programmes to improve the conflict management capabilities.

Burnout and patient safety: A discriminant analysis of paediatric nurses by low to high managerial support

AIM

To explore how levels of managerial support discriminate paediatric nurses' burnout, quality of life, intent to leave and adverse patient events.

DESIGN

A quantitative correlational study.

METHODS

A total of 225 paediatric nurses were selected from nine major hospitals across Jordan. The main measures used were the Copenhagen Burnout Inventory and the brief version of World Health Organization-Quality of Life Instrument. The study methods were compliant with the STROBE checklist.

RESULTS

Nurse manager support was negatively associated with adverse patient events, work-related burnout, client-related burnout, and intent to leave; and positively with physical and psychological quality of life. Frequency of nosocomial infections characterized low manager support, whereas medication errors described high support. Greater nurse manager support decreased the likelihood of adverse patient outcomes.

Nursing workload assessment in an intensive care unit: A 5-year retrospective analysis

AIMS

To study the correlation between the workload of intensive care nursing teams and the sociodemographic, anthropometric and clinical characteristics of patients in critical condition in a Portuguese Intensive Care Unit (ICU) during a 5-year period.

BACKGROUND

Currently, indices of nursing workload quantification are one of the resources used for planning and evaluating ICUs. Evidence shows that there are several factors related to critical patients and their hospitalisation which potentially influence the nursing workload.

DESIGN

Retrospective cohort analysis of a health record database from adult patients admitted to a Portuguese ICU between 1 January 2015-31 December 2019.

METHODS

Simplified Therapeutic Intervention Scoring System (TISS-28) scores of 730 adult patients. Three TISS-28 assessments were considered: first assessment, last assessment and average. The STROBE guidelines were used in reporting this study.

RESULTS

The TISS-28 has an average of 34.2 ± 6.9 points at admission, which is considered a high nursing workload. A somewhat lower result was found for the discharge and average assessments. It shows that basic activities accounted for the highest percentage of time spent (38.0%), followed by the cardiovascular support category (26.5%). The TISS-28 shows consistent results throughout the study period, despite a small trend reduction in the last 2 years.

CONCLUSIONS

Lower workloads were found for age ≤44 years and with a shorter length of stay. Higher workload was more probable in patients classified in Cullen Class IV (OR = 2.5) and with a normal to higher weight percentile (OR = 1.9 and 1.5, respectively).

RELEVANCE TO CLINICAL PRACTICE

Knowledge of the factors influencing the nursing workload facilitates the implementation of rules to improve performance in nursing interventions, based on the redefinition of care priorities, increased productivity, human resources management and reduction of additional costs to the organisation, related to possible adverse events, among others.

Reaching a tipping point: Perioperative nurse managers' narratives about reasons for leaving their employment-A qualitative study

Aim

To describe reasons why nurse managers in perioperative settings decide to leave their employment.

Background

Current literature has shown that perioperative nurse managers’ reasons to leave their positions are formed through an interaction of factors.

Methods

Individual in‐depth interviews were performed with seven nurse managers, all women, in perioperative settings in Sweden. Data were analysed using systematic text condensation.

Results

Five key themes were identified: (a) to end where I started, as a frontline nurse; (b) I wanted to develop further to the next level in my career; (c) I ran out of ideas; (d) I lost trust in my head manager and did not believe in the new organisation and (e) I had had enough of being offended by my superior manager and my employees.

Conclusion

Nurse managers experienced feeling forced into a decision to leave because of being offended by their superiors or their employees. Furthermore, the findings indicate that nurse managers should be offered support from superior managers and the organisation together with time for discussions.

Implications in Nursing Management

The most essential element should be the influence of caritative leadership and the obvious expectation of being treated with dignity, respect and appreciation.