The Role of Nurse Leaders in the Well-being of Clinicians.

This column reviews the concept of humanism in leadership. After surviving a year perceived by many healthcare professionals as the most challenging of a generation, the author reflects on leadership essentials for rebuilding our nursing workforce.

Developing Effective Senior Nurse Leaders: The Impact of an Advanced Leadership Initiative.

OBJECTIVE: The aim of this study was to measure structural empowerment (SE) and capture short-term changes in perception for senior nurse leaders before and after a formal development experience. BACKGROUND: The body of literature related to SE in senior nurse leaders is limited. Applying the SE concept to senior levels of nursing leadership provides a vehicle to impact nurse leader retention and ultimately the organization beyond singular units. METHODS: The Advanced Leadership Program (ALP) was designed in collaboration with the American Nurses Association to support personal and professional development for senior nurse leaders. The sample included 28 participants from the United States and the United Kingdom over a 6-month period. RESULTS: The effect of the intervention was seen in the postintervention survey rating SE higher in 5 of 7 domains as compared with the preintervention survey, reduction in overall turnover, and improvements in patient experience scores. Additionally, the participants evaluated the program in top categories, and comments were highly positive around peer support, improved working relationships, and expectations. CONCLUSION: The ALP has shown promise in strengthening SE for senior nurse leaders by supporting leadership skill development, follow-up training, and peer network development.

Using Structural Empowerment to Improve Outcomes.

In the changing healthcare climate, a robust continuous professional development program is critical to ensure excellent patient care and the best outcomes. It is essential for educators and leaders to understand the factors that enhance the impact of continuous professional development. Organizational leadership must support successful education programs and the ability to provide educational activities. In this month's Magnet® Perspectives, we will review how the Institute of Medicine and Quadruple Aim framework can support structural empowerment through continuous professional development to improve outcomes.

Reflecting on two distinct leadership roles during the pandemic.

ABSTRACT: For more than a year, the COVID-19 pandemic has caused unprecedented stress, anxiety, sadness, and fear, but it has also allowed people to reflect, learn, self-improve, and change. In this article, the author demonstrates how reflective practice enabled her to improve in two distinctly different leadership roles.

The Effectiveness of Charge Nurse Training on Leadership Style and Resiliency.

OBJECTIVE: The study objective was to investigate a charge nurse pilot training program as an effective, evidence-based training modality to improve leadership style and resiliency. BACKGROUND: Leadership is inherent and necessary in the charge nurse role. Little published research about charge nurse leadership training programs exists. METHODS: A pre-post design, with intervention and comparison groups, was conducted at an integrated healthcare system. A random sample of charge nurses was selected to pilot a standardized charge nurse leadership training program including in-person learning to foster leadership skills and nurture resiliency. RESULTS: The sample included 19 control participants and 22 intervention participants. Significant improvement was noted in transformational, transactional, leadership outcomes, and resiliency from preintervention to postintervention for the all subjects. Of the 22 intervention participants, the training elicited higher satisfaction with leadership behavior, followed by effectiveness and their ability to motivate. Charge nurses who attended training had higher resiliency scores pre-post intervention. CONCLUSION: The charge nurse pilot training was an effective program that led to improved leadership style and resiliency.

[Effective interventions enacted by Nurse Managers in daily practice to prevent and/or minimize the missed nursing care: ?ndings from an Italian qualitative study]. / Interventi attuati da infermieri con ruoli manageriali nella pratica quotidiana per prevenire e minimizzare le Missed Nursing Care: risultati di uno studio qualitativo italiano.

INTRODUCTION: Missed Nursing Care is widely recognized as affecting patient safety and healthcare outcomes. Theoretical frameworks, antecedents and consequences have been extensively studied while interventions aimed at preventing the Missed Nursing Care remain little investigated to date. Nurse Managers and Nurse Directors play a main role in promoting interventions at the unit, hospital and at the policy levels. However, few evidences are available to date, thus limiting an evidence-based approach. The aim of this study was to emerge interventions used on a daily basis by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. METHODS: A qualitative descriptive study design based upon a positive deviance approach was adopted. Twelve Nurse Managers and Nurse Directors were purposefully selected, working at Hospital, Healthcare Trust or Nursing Home levels, in Italy. Participants were interviewed in two focus group sessions. A thematic analysis of the audio-recorded interviews was performed by two researchers. RESULTS: The following interventions have been reported as effective in preventing and/or minimizing the Missed Nursing Care: (a) Expanding the nursing care capacity; (b) Ensuring the standard of care and an early detection of failures; (c) Monitoring the processes of care; (d) Promoting a shared decision-making; (e) Redesigning the layout of the hospital systems; (f) Promoting a culture towards the Missed Nursing Care prevention, and (g) Realigning the nurse management to the care of patients. DISCUSSION: Several interventions based mainly on process dimension and with preventive intents are daily enacted by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. Measuring the effect of these interventions through rigorous studies could help in expanding the evidence available to contrast a phenomenon that threatens patient safety.

Using a Delphi Survey to Develop Clinical Nursing Research Priorities Among Nursing Management.

OBJECTIVE: The aim of this study was to identify clinical nursing research priorities among nurse managers (NMs). BACKGROUND: Determining research priorities is the 1st step toward building a solid evidence base for clinical practice. NMs are well poised to identify research priorities, and yet, a literature review revealed a dearth of research priorities as determined by clinical NMs. METHODS: Using a Delphi survey, 38 NMs were queried at a large, urban hospital regarding critical priorities for nursing research. RESULTS: Critical priorities for clinical nursing research included nursing workforce/nursing workflow and communication (categorized as critical by 68% and 53% of NMs, respectively). Other important priorities focused on falls/patient safety/hospital-acquired infections, patient/family satisfaction, emergency preparedness, patient outcomes, and collaboration/interdisciplinary research. CONCLUSIONS: Because NMs are positioned to direct clinical research agendas, the results provide a critical guide for policy development surrounding nursing research. Directing research toward these identified topics will help build a solid evidence base for nurses and ultimately improve patient outcomes.

The Perceptions of Professional Leadership Coaches Regarding the Roles and Challenges of Nurse Managers.

OBJECTIVE: The purpose of this study was to explore professional coaches' perceptions of nurse managers (NMs) and the NM role. BACKGROUND: Nurse Managers are often inadequately prepared, developed, and supported in their roles. Professional coaching is a strategy that may prove beneficial to help prepare NMs for their roles. METHODS: A qualitative design using researcher-participant interviews of 11 professional coaches provided data regarding coaches' perceptions of NMs and the role development needs. RESULTS: Coaches reported why they made the decision to coach NMs, why NMs sought coaching services, how the NM experience differed from that of higher level leaders, and what the coaches believed was their most valuable contribution when working with NMs. CONCLUSION: Findings suggest that coaches can provide needed support to NMs to maximize their role effectiveness and preparedness.

Delineation of the Nursing Supervisor Role: A Pilot Study.

OBJECTIVE: The purpose of this study was to describe a sample of nursing supervisors and their work. BACKGROUND: The role of the nursing supervisor is not well understood. The supervisor population is poorly defined, as are their ideal academic preparation and work activities. METHODS: This study followed the American Nurses Credentialing Center® framework for role delineation studies. A convenience sample of 50 nursing supervisors from New Jersey was recruited to complete an online survey including demographic data and prioritization of work activities. RESULTS: Participants represented a homogeneous and aging workforce with diverse professional preparation. Exploratory factor analysis revealed 6 categories of nurse supervisor work including administrative presence, leadership liaison, patient safety and experience, patient care advocacy, throughput, and external response. Work activities were prioritized. CONCLUSIONS: Nurse supervisors prioritized responding to emergencies above all other responsibilities. This study should be replicated in a nationwide sample of nurse supervisors.

Grassroots to Global: The Future of Nursing Leadership.

The 2018 International Nursing Administration Research Conference, Grassroots to Global, was held in Atlanta, Georgia, with attendees from 38 US states, Canada, and China. Presenters discussed the need for nurse leaders to be prepared to partner with those inside and outside of healthcare to create innovative, interprofessional care delivery models; advocate for advancements in technology to address healthcare access shortages; and lead new areas of research that can drive policy change to support nurse leaders in long-term care and the essential role of the nurse manager in creating optimal practice environments for quality outcomes. This article will report on these important insights.

The Relationship Between Experiential Learning and Nursing Management Competency.

OBJECTIVE: This study aimed to examine the relationship between experiential learning and nursing management competency among nurse managers (NMs) in the early years of a supervisory role. BACKGROUND: The relevance of experiential learning to the development of NMs has been explored in an effort to harvest the knowledge embedded in shared NM practice narratives. However, the relationship between experiential learning and nursing management competency has not been empirically measured. METHODS: The author developed an experiential learning-based program for NMs in the initial 3 years of a supervisory role. Sixty-three NMs were enrolled. The relationship between experiential learning and nursing management competency was evaluated using multiple regression analysis after completing this program. RESULTS: The results of multiple regression analysis revealed a significant relationship between experiential learning and nursing management competency (P < .001). CONCLUSIONS: A significant relationship was identified between experiential learning and nursing management competence.

Nursing leadership and health policy: everybody's business.

We all know great leadership when we see it. Outstanding nurse leaders, guided by a moral compass, simultaneously see the big picture and the consequences at micro level. While policy and politics determine health and nursing practice, most nurses just want to get on with their day job. They carry out decisions made by others but have little say in them, and weak influence or status, although they are increasingly knowledgeable and skilled. In settings where policy decisions are made - parliaments, governments, and boardrooms - nurse leaders are often neither heard nor heeded. This is starting to change. The global Nursing Now campaign is working with the International Council of Nurses, and the World Health Organization, to create and strengthen strategic nursing leadership, as modelled by the International Council of Nurses' Global Nursing Leadership Institute. A new window of opportunity is opening, with the bicentennial of Florence Nightingale's birth in 2020. Now is the moment!

'It's the relationship you develop with them': emotional intelligence in nurse leadership. A qualitative study.

AIM: to investigate emotional intelligence (EI) and its relationship to nursing leadership. BACKGROUND: strong, effective leadership is core to organisational competency and significantly influences care quality. EI is the ability to understand one's own feelings and to assess and respond to the feelings of others. It is linked to self-awareness, self-management, social awareness and social skills, all of which are vital in leadership roles. However, insufficient research explores EI in nursing leadership from the perspective of nurse leaders. DESIGN: a qualitative study employed interpretive phenomenological analysis methods, using a purposive sample of band 7 sisters/charge nurses/team managers (n=5) from one Welsh health board. Semistructured interviews were recorded and analysed in four stages. FINDINGS: four clusters of themes were identified, each with two to three subthemes. These were: sensing others-the empathetic leader; experiencing the affected sense of self; strategies employed to build the team; and reading the flux of the organisation. CONCLUSION: although the nurse leaders were unfamiliar with the concept of EI, their narratives reflected some core values of EI. However, significant barriers around time, pressure and staffing levels impeded their potential to use EI to become more effective leaders. Nurse leaders should harness the power of emotions to influence others to achieve excellent care.

Exploring Nurse Manager Support of Evidence-Based Practice: Clinical Nurse Perceptions.

OBJECTIVE: The study identifies what constitutes nurse manager (NM) support and other resources that enable clinical nurses (CNs) to engage in evidence-based practice (EBP). BACKGROUND: Clinical nurses report that NM support enables them to use EBP but what constitutes NM support is still unclear. METHODS: Nurse managers, CNs, and EBP mentors received specialized education and use a team approach for EBP. Data were collected preintervention, mid-intervention, and postintervention from observations, interviews, journaling, and surveys. RESULTS: Results demonstrate how NMs can perform their role responsibilities and still engage CNs to develop a spirit of inquiry, seek answers to their clinical questions using EBP, and advance their clinical performance to improve patient outcomes. Four NM supportive behaviors emerged: cultivating a shared EBP vision, ensuring use of EBP, communicating the value of EBP, and providing resources for EBP. CONCLUSION: Through education and support, NMs describe supportive behaviors necessary for the successful conduction of EBP by CNs.

Leadership Practices and Engagement Among Magnet® Hospital Chief Nursing Officers.

OBJECTIVE: Describe the relationship between leadership practices and engagement of chief nursing officers (CNOs) in Magnet® organizations. BACKGROUND: Transformational leadership practices and CNO engagement are vital in influencing nursing practice. METHODS: Magnet hospital CNOs were invited to participate in a quantitative descriptive study via an online survey published in 2 newsletters. RESULTS: The CNOs rated their leadership practices high across all dimensions; the top leadership practice of Magnet CNOs was enabling others to act. There was a strong positive correlation between the vigor of engagement and the challenge the process leadership practice. CONCLUSION: This is the 1st study of Magnet CNOs transformational leadership practices and their work engagement and therefore adds to our understanding of the important characteristics to build future leadership development programs for nurse leaders at the executive level. Particularly noteworthy for the development of future nurse executives is the strong link between vigor and challenging the process.

The Implementation of a Structured Nursing Leadership Development Program for Succession Planning in a Health System.

Preparing future nursing leaders to be successful is important because many current leaders will retire in large numbers in the future. A structured nursing leadership development program utilizing the Essentials of Nurse Manager Orientation online program provided future nursing leaders with content aligned with nursing leadership competencies. Paired with assigned mentors and monthly leadership sessions, the participants increased their perception of leadership competence.

The nexus of nursing leadership and a culture of safer patient care.

AIMS AND OBJECTIVES: To explore the connection between +6 nursing leadership and enhanced patient safety. BACKGROUND: Critical reports from the Institute of Medicine in 1999 and Francis QC report of 2013 indicate that healthcare organisations, inclusive of nursing leadership, were remiss or inconsistent in fostering a culture of safety. The factors required to foster organisational safety culture include supportive leadership, effective communication, an orientation programme and ongoing training, appropriate staffing, open communication regarding errors, compliance to policy and procedure, and environmental safety and security. As nurses have the highest patient interaction, and leadership is discernible at all levels of nursing, nurse leaders are the nexus to influencing organisational culture towards safer practices. DESIGN: The position of this article was to explore the need to form a nexus between safety culture and leadership for the provision of safe care. CONCLUSIONS: Safety is crucial in health care for patient safety and patient outcomes. A culture of safety has been exposed as a major influence on patient safety practices, heavily influenced by leadership behaviours. The relationship between leadership and safety plays a pivotal role in creating positive safety outcomes for patient care. A safe culture is one nurtured by effective leadership. RELEVANCE TO PRACTICE: Patient safety is the responsibility of all healthcare workers, from the highest executive to the bedside nurse, thus effective leadership throughout all levels is essential in engaging staff to provide high quality care for the best possible patient outcomes.

[The advantages of a third party in the "work organization" of head nurses.] / Le bénéfice du tiers dans le « travail d'organisation ¼ des cadres de santé.

The organisation of production of care is a task that requires three different levels of competence: operational, structural and learning skills. The organisational requirements (OR) of the Head Nurse (HN) are often centered on the operational level, to the detriment of the other two levels. This difficulty is due to the organisation which presents limited political, cognitive and pragmatic levels of rationality.The aim of this study was to identify the impact of a third party in relation to the organisation and its effect on the HN's OR. An educational device places HN students in the position of a third party to allow them to work on an organisational problem delegated by a HN. The research-intervention followed 17 projects over a period of one year.Intervention by a third party legitimised the problem by recognizing the difficulties in nursing and reconfiguring relations between healthcare professionals in a political dimension. The methods employed by the third party reassured the HN and completed their knowledge, placing particular focus on the importance of methodology and managerial posture. In practice, the third party supported the HN's power to act and coordinate the various members of the team. The third party contributes to the development of the HN's OR and completes certain limits of the HN's rationality. Nevertheless, difficulties still remain in the development of practices outside the medical team, limiting the extension to other services.A unit managerial support, a collective schedule and open spaces of discussion are recommended to bring structure and support to the OR.

Bringing the OhioHealth Nursing Strategic Plan to Life With the AONE Care Innovation and Transformation Program.

Contemporary CNOs are committed to developing the next generation of nurse leaders. At OhioHealth, the nursing strategic vision includes the belief that every nurse will be a leader in improving health across the care continuum. In 2016, the OhioHealth System partnered with AONE to participate in the Care Innovation and Transformation program resulting in bedside nurses living this strategic vision and creating positive changes in quality, safety, and satisfaction for patients and families.

Effects of RN Age and Experience on Transformational Leadership Practices.

OBJECTIVE: This study reported the evolution of transformational leadership (TL) practices and behaviors across years of age, management experience, and professional nursing practice within a professional nursing leadership organization. BACKGROUND: Recent studies of CNO TL found valuations peak near age 60 years. This study reported on a wider range of management positions, correlating years of RN practice and management experience and age to TL metrics. METHOD: This study used Kouzes and Posner's Leadership Practices Inventory-Self-Assessment (LPI-S) to survey a nursing leadership organization, the Association of California Nurse Leaders (ACNL). Anonymous responses were analyzed to identify leadership trends in age and years of professional service. RESULTS: On average, LPI-S metrics of leadership skills advance through years of management, RN experience, and age. The TL scores are statistically higher in most LPI-S categories for those with more than 30 years of RN or management experience. Decade-averaged LPI-S TL metrics in the ACNL survey evolve linearly throughout age before peaking in the decade from age 60 to 69 years. A similar evolution of TL metrics is seen in decades of either years of management experience or years of RN experience. Transformational leadership increased with nursing maturity particularly for LPI-S categories of "inspire a shared vision," "challenge the process," and "enable others to act." CONCLUSION: In the ACNL population studied, decade-averaged leadership metrics advanced. Leadership evolution with age in the broader RN population peaked in age bracket 60 to 69 years. The LPI-S averages declined when older than 70 years, coinciding with a shift from full-time work toward retirement and part-time employment.