Gold standard research and evidence applied: The Inspire Nursing Leadership Program.

Billions of dollars are invested annually in leadership development globally; however, few programs are evidence-based, risking adverse outcomes, and wasted time and money. This article describes the novel Inspire Nursing Leadership Program (INLP) and the outcomes-based process of incorporating gold standard evidence into its design, delivery, and evaluation. The INLP design was informed by a needs analysis, research evidence, and by nursing, Indigenous, and equity, diversity, and inclusion experts. The program's goals include enabling participants to develop leadership capabilities, cultivate strategic community partnerships, lead innovation projects, and connect with colleagues. Design features include an outcomes-based approach, the LEADS framework, and alignment with the principles of adult learning. Components include leadership impact projects, 360-assessments, blended interactive sessions, coaching, mentoring, and application and reflection exercises. The evaluation framework and subsequent proposed research design align to top-quality standards. Healthcare leadership programs must be evidence-based to support leaders in improving and transforming health systems.

ALSN 2021 Conference: Nursing Science for Leadership in the New Decade.

The Association for Leadership Science in Nursing's 2021 conference provided an opportunity to further enhance professional understanding of the difficulties facing nurse leaders as the COVID-19 pandemic continues to create unimaginable challenges. Presentations provided evidence in support of courageous caring leadership interventions.

Psychiatric Nurses' Lived Experiences of Workplace Violence in Acute Care Psychiatric Units in Western Canada.

Workplace violence directed at nurses in healthcare settings is a common occurrence across the globe resulting in negative nurse and organizational implications that may impact the quality of care provided. Psychiatric nurses working on acute care psychiatric units are at an increased risk and are frequently subjected to patients' violent and aggressive behaviors. These implications pose significant threats to the nurses' emotional, physical, and psychological health. Efforts to reduce workplace violence on acute care psychiatric units requires an examination of psychiatric nurses' lived experiences. A qualitative descriptive phenomenological inquiry was conducted using semi-structured interviews with 10 registered psychiatric nurses within a Western Canada health region to explore their lived experiences of patient-to-nurse workplace violence. The findings of this study highlight the implications of workplace violence and substantiates the urgent need to improve the safety on acute care psychiatric units.

Rethinking Resilience: Nurses and Nurse Leaders Emerging From the Post-COVID-19 Environment.

Nurses and nurse leaders are working in unprecedented intense and demanding environments, and the COVID-19 pandemic continues to place strain on their mental well-being. If stressful work conditions remain at extraordinary high levels, nurses and leaders may ultimately leave their positions, creating even more uncertainty in the workforce. Enhancing individual resilience has become a superficial response in retaining nurses during a global nursing shortage. We argue that resilience is not solely an individual responsibility. Rather, resilience it is a mutual responsibility between the individual and the organization. In this article, we discuss how nurse leaders can foster organizational resilience while also enhancing their own individual resilience within the current pandemic environment, and as we transition to a post-COVID environment.

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.

Surveys conducted pre- and post-implementation of a synergy tool: Giving voice to emergency teams.

AIM: To investigate the impact of a patients' needs assessment (synergy tool) on emergency department nurses' perceptions of quality, safe care delivery and morale. BACKGROUND: The synergy tool provides real-time data on types of patients, their arrival, management and discharge. This tool was introduced to two urban emergency departments in response to government priorities to reduce emergency department wait times and improve patient flow. METHOD: This survey, a component of participatory action research, measures perceptions of 158 nurses pre-introduction and 91 nurses post-introduction of the synergy tool. RESULT: Responses were consistent regarding intent to leave, workload/staffing, spirit at work and quality/safety. One question describing staff as working in 'crisis mode' indicated a significant improvement. CONCLUSION: Critical patient care may be missed during periods of overload, placing patients and staff at risk, leading to an increase in intent to leave. The synergy tool provides an objective means in real time for staff to identify their patients' care needs, assisting management with staffing decisions. Ongoing staff and management communication using tools such as the synergy tool may reduce perceptions of working in 'crisis mode'. IMPLICATIONS FOR NURSING MANAGEMENT: This research suggests that when managers employ a collaborative process and use evidence-based tools and approaches to addressing nurses' workload concerns, nurses' perceptions of working in 'crisis mode' diminish.

Nurse perspectives in the emergency department: The synergy tool in workload management and work engagement.

AIM: To explore emergency nurses' perceptions of how a nurse-driven patient needs assessment tool, the synergy tool, influenced their workload management. BACKGROUND: Quadruple Aim, particularly the fourth aim of improved staff work experiences, served as the conceptual framework to engage nurses in a participatory action research project. This project took place between 2017 and 2020 in two tertiary care emergency departments in one large Canadian city. METHOD: This study employed a qualitative descriptive component, focus group interviews and nurse comments on two open-ended survey questions. RESULTS: Use of the synergy tool heightened nurses' awareness of patients' holistic care needs. Nurses also stated how patient needs assessment data helped them identify unsafe workloads. CONCLUSIONS: The synergy tool, adapted for emergency department use by nurses, was a means to engage and empower nurses. Patient needs assessment data from the tool identified staffing gaps, resulting in additional nursing staff for both emergency departments. IMPLICATIONS FOR NURSING MANAGEMENT: A focus on patient needs assessment can be an effective way to address nurses' workload concerns.

Nurse managers implementing the lean management system: A qualitative study in Western Canada.

AIM: This study explores the perceptions and experiences of nurse managers involved in implementing the Lean management system in a Western Canadian province. BACKGROUND: The provincial government of Saskatchewan, Canada, implemented a multimillion-dollar investment in the Lean management system to transform health care delivery by reducing waste and increasing efficiency of processes and outcomes. METHODS: This qualitative exploratory study employed semi-structured interviews with 14 nurse managers in urban and rural health regions in one Canadian province. RESULTS: Six themes outline the difficulties nurse managers experienced in juggling role responsibilities alongside a poorly implemented change system with scarce resources. CONCLUSION: The results showed tensions in the implementation of a Lean model adapted in the context of health care organisations. The expectations for nurse managers to be pivotal players in the implementation of transformative health care practices that promote and sustain strategies to reduce waste, improve coordination and increase patient safety require investment in leadership development. IMPLICATIONS FOR NURSING MANAGEMENT: Lean management systems significantly impact the roles of nurse managers who require adequate resources and training to successfully adapt. The results of this study may be used for more effective support mechanisms for nurse managers.

Assessing the implementation processes of a large-scale, multi-year quality improvement initiative: survey of health care providers.

BACKGROUND: Beginning in 2012, Lean was introduced to improve health care quality and promote patient-centredness throughout the province of Saskatchewan, Canada with the aim of producing coordinated, system-wide change. Significant investments have been made in training and implementation, although limited evaluation of the outcomes have been reported. In order to better understand the complex influences that make innovations such as Lean "workable" in practice, Normalization Process Theory guided this study. The objectives of the study were to: a) evaluate the implementation processes associated with Lean implementation in the Saskatchewan health care system from the perspectives of health care professionals; and b) identify demographic, training and role variables associated with normalization of Lean. METHODS: Licensed health care professionals were invited through their professional associations to complete a cross-sectional, modified, online version of the NoMAD questionnaire in March, 2016. Analysis was based on 1032 completed surveys. Descriptive and univariate analyses were conducted. Multivariate multinomial regressions were used to quantify the associations between five NoMAD items representing the four Normalization Process Theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). RESULTS: More than 75% of respondents indicated that neither sufficient training nor resources (collective action) had been made available to them for the implementation of Lean. Compared to other providers, nurses were more likely to report that Lean increased their workload. Significant differences in responses were evident between: leaders vs. direct care providers; nurses vs. other health professionals; and providers who reported increased workload as a result of Lean vs. those who did not. There were no associations between responses to normalization construct proxy items and: completion of introductory Lean training; participation in Lean activities; age group; years of professional experience; or employment status (full-time or part-time). Lean leader training was positively associated with proxy items reflecting coherence, cognitive participation and reflexive monitoring. CONCLUSIONS: From the perspectives of the cross-section of health care professionals responding to this survey, major gaps remain in embedding Lean into healthcare. Strategies that address the challenges faced by nurses and direct care providers, in particular, are needed if intended goals are to be achieved.

Impact of Role Stressors on the Health of Nurse Managers: A Western Canadian Context.

OBJECTIVE: A qualitative exploratory inquiry was used to understand nurse managers' (NMs') perceptions of their role stressors, coping strategies, and self-health related outcomes as a result of frequent exposure to stressful situations in their role. BACKGROUND: Strong nursing leadership is required for desirable staff, patient, and organizational outcomes. A stressed NM will negatively influence staff nurse satisfaction and retention, patient outcomes, and organizational performance. Stress can affect NMs' mental and physical heath, leading to job dissatisfaction and turnover. METHODS: A qualitative exploratory inquiry was conducted using semistructured interviews with 23 NMs and 1 focus group interview. RESULTS: Findings suggest that coping strategies may be inadequate, given the intensity and demands of the manager role, and could negatively impact NMs' long-term health. CONCLUSIONS: Senior nurse leaders can significantly impact the health and productivity of NMs by minimizing the adverse effects of role stress and foster a positive work environment.

Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses' practice.

AIMS AND OBJECTIVE: To draw on the findings of a grounded theory study aimed at exploring how power is exercised in nurse-manager relationships in the hospital setting, this paper examines the empirical and pragmatic adequacy of grounded theory as a methodology to advance the concept of empowerment in the area of nursing leadership and management. BACKGROUND: The evidence on staff nurse empowerment has highlighted the magnitude of individual and organisational outcomes, but has not fully explicated the micro-level processes underlying how power is exercised, shared or created within the nurse-manager relationship. Although grounded theory is a widely adopted nursing research methodology, it remains less used in nursing leadership because of the dominance of quantitative approaches to research. Grounded theory methodology provides the empirical and pragmatic relevance to inform nursing practice and policy. Grounded theory is a relevant qualitative approach to use in leadership research as it provides a fine and detailed analysis of the process underlying complexity and bureaucracy. DESIGN: Discursive paper. METHOD: A critical examination of the empirical and pragmatic relevance of grounded theory by (Corbin & Strauss, , ) as a method for analysing and solving problems in nurses' practice is provided. CONCLUSIONS: This paper provides evidence to support the empirical and pragmatic adequacy of grounded theory methodology. Although the application of the ontological, epistemological and methodological assumptions of grounded theory is challenging, this methodology is useful to address real-life problems in nursing practice by developing theoretical explanations of nurse empowerment, or lack thereof, in the workplace. RELEVANCE TO CLINICAL PRACTICE: Grounded theory represents a relevant methodology to inform nursing leadership research. Grounded theory is anchored in the reality of practice. The strength of grounded theory is to provide results that can be readily applied to clinical practice and policy as they arise from problems that affect practice and that are meaningful to nurses.

Seeking Connectivity in Nurses' Work Environments: Advancing Nurse Empowerment Theory.

The purpose of this study was to investigate how staff nurses and their managers exercise power in a hospital setting in order to better understand what fosters or constrains staff nurses' empowerment and to extend nurse empowerment theory. Power is integral to empowerment, and attention to the challenges in nurses' work environment and nurse outcomes by administrators, researchers, and policy-makers has created an imperative to advance a theoretical understanding of power in the nurse-manager relationship. A sample of 26 staff nurses on 3 units of a tertiary hospital in western Canada were observed and interviewed about how the manager affected their ability to do their work. Grounded theory methodology was used. The process of seeking connectivity was the basic social process, indicating that the manager plays a critical role in the work environment and nurses need the manager to share power with them in the provision of safe, quality patient care.

L'objectif de cette étude était d'examiner comment s'effectue l'exercice du pouvoir par les gestionnaires et le personnel infirmier en milieu hospitalier afin d'une part de mieux comprendre ce qui favorise ou contraint l'autonomisation des infirmières et infirmiers et d'autre part de contribuer au développement de la théorie de l'autonomisation du personnel infirmier. Le pouvoir d'action faisant partie intégrante de la notion d'autonomisation, l'attention portée par les administrateurs, les chercheurs et les décideurs aux résultats du personnel infirmier ainsi qu'aux difficultés avec lesquelles celui-ci doit composer dans son milieu de travail a rendu nécessaire le développement d'une compréhension théorique plus approfondie de l'exercice du pouvoir au sein de la relation qui lie les gestionnaires aux infirmières et infirmiers. Un échantillon composé de 26 membres du personnel infirmier de 3 unités d'un hôpital de soins tertiaires de l'ouest du Canada a été observé et soumis à des entretiens portant sur la façon dont les gestionnaires influencent la capacité des infirmières et infirmiers à effectuer leur travail. Une méthodologie favorisant le développement d'une théorie enracinée dans les données empiriques a été employée. L'étude a permis de constater que la quête de liens est le processus social fondamental à l'œuvre, ce qui indique que les gestionnaires jouent un rôle essentiel dans le milieu de travail et que le personnel infirmier a besoin que ceux-ci partagent avec lui l'exercice du pouvoir pour assurer la prestation aux patients de soins sécuritaires et de qualité.

A Critical Perspective on Relations between Staff Nurses and their Nurse Manager: Advancing Nurse Empowerment Theory.

This study considers empowerment in nurse-manager relations by examining how conflict is handled on both sides and how the critical social perspective has influenced these relations. The authors use inductive analysis of empirical data to explain how (1) nursing work is organized, structured, and circumscribed by centrally determined policies and practices that downplay nurses' professional judgement about patient care; (2) power is held over nurses in their relationship with their manager; and (3) nurses' response to power is to engage in strategies of resistance. The authors illustrate how power influences relations between staff nurses and managers and provide a critical analysis of the strategies of resistance that result in personal, relational, and critical empowerment among staff nurses. Through resistance, staff nurses engage in alternative discourses to counteract the prevailing neoliberal organizational and managerial discourses of efficiency and cost-effectiveness.

Cette étude se penche sur la question de l'autonomisation dans les relations entre infirmières et gestionnaires. Elle examine notamment la façon dont les conflits sont gérés par les deux camps et l'influence qu'exerce la perspective sociale critique sur ces relations. Les auteures ont recours à l'analyse inductive de données empiriques afin d'expliquer (1) la façon dont le travail infirmier est organisé, structuré et encadré par des politiques et des pratiques déterminées par des instances centrales et qui minimisent le jugement professionnel des infirmières en matière de soins aux patients; (2) le pouvoir des gestionnaires dans le cadre de leurs relations avec les infirmières; et (3) la réaction des infirmières face au pouvoir et les stratégies de résistance. Les auteures mettent en lumière l'influence qu'exerce le pouvoir sur les relations entre le personnel infirmier et les gestionnaires et présentent une analyse critique des stratégies de résistance qui mène à une autonomisation personnelle, relationnelle et critique au sein des effectifs infirmiers. Par la voie de la résistance, le personnel infirmier amorce un discours alternatif qui neutralise les discours organisationnels et gestionnaires néolibéraux dominants axés sur l'efficience et le rapport coût-efficacité.

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.

A Call for Urgent Action: Innovations for Nurse Retention in Addressing the Nursing Shortage.

The COVID-19 pandemic has become a defining moment for healthcare delivery and the health workforce despite "being prepared" for it [...].

Embracing relational competencies in applying the LEADS framework for health-care leaders in transformational change and the COVID-19 pandemic.

PURPOSE: The purpose of this paper is to assess the extent to which the LEADS Framework guided health-care leaders through organizational change and the COVID-19 pandemic in a western Canadian province. DESIGN/METHODOLOGY/APPROACH: A qualitative exploratory inquiry assessed the extent to which health leaders applied competencies that aligned with the LEADS Framework. A purposeful sample of 22 health-care leaders participated in the study representing senior, mid-level and front-line health-care leaders in various health-care organizations to ensure diverse representation of leader competencies. The authors conducted semi-structured interviews to collect the data and used Braun and Clarke's (2006) six-phase approach to guide data analysis. FINDINGS: The analysis suggests that health-care leaders found Engaging with Others and Developing Coalitions were the most critical themes of the LEADS Framework for change management and for navigating the COVID-19 pandemic. Findings reveal that during transformational change and a crisis context, leaders embrace relational approaches to adapt and improve performance in dynamic organizations. PRACTICAL IMPLICATIONS: These findings have implications for a relational approach to improve teamwork and decrease emotional strain; a focus on mobilizing and sharing power with nurses; and educational programs to advance relational and self-management skills, shared leadership, communication, change management, human resource and talent development as critical learning components for current and future health-care leaders. ORIGINALITY/VALUE: The LEADS Framework is used to examine how health-care leaders responded to transformational change in the organization while situated in a pandemic context.

Using the Donabedian framework to examine transitional care for cardiac patients and family caregivers.

PURPOSE: This study aims to examine how health-care managers in acute care and post-acute care facilities support and plan to improve transitional care for cardiac patients and their family caregivers, to better manage care in the home. DESIGN/METHODOLOGY/APPROACH: A qualitative descriptive approach, guided by appreciative inquiry was used in this study. A purposive sample of 16 participants were engaged in the study. Participants completed a demographic questionnaire, the caregiver policy lens questionnaire and participated in one of four focus group interviews. The semi-structured focus group interviews were audio-recorded and analyzed using thematic analysis. FINDINGS: Using Donabedian's framework, six major themes contributed to how health-care managers can improve transitional care: structure included supporting personnel and continuing education; process included enacting approaches of care, coordinating care among the health-care team and calling to work upstream; and outcomes included needing to clarify expectations of home care services and witnessing the impact of the caregiver role. ORIGINALITY/VALUE: These findings demonstrate the importance of Donabedian's core dimensions of structure and processes in influencing caregiver outcomes. These results emphasize the central role of the manager in influencing system change to improve transitional care.

Implementing the Synergy Model: A Qualitative Descriptive Study.

Hospitals across our nation are seeking to implement models of care that meet the primary goals of Quadruple Aim: Improved population health, cost-effective care delivery, and patient and provider satisfaction. In an effort to address the Quadruple Aim and our patients' care needs, Hamilton Health Sciences (HHS) embarked on a model of care delivery redesign, beginning with nursing care delivery. From 2013 to 2018, 12 clinical programs at HHS implemented the Synergy Model with its accompanying synergy patient needs assessment tool for nurses to objectively assess patients' acuity and dependency needs. Data on patients' priority care needs were used to inform a nursing model of care redesign at HHS, including skill mix and staffing levels. This five-year project was an organization-wide quality improvement initiative. As part of the evaluation, HHS leaders partnered with health services nurse researchers to conduct a mixed methods study. This paper describes the evaluation outcomes from the qualitative component of the study, which included interviews with clinical nurse leaders and direct care nurses. Data were analyzed using descriptive thematic analysis. Some key findings were increased nurse awareness of patients' holistic care needs and leaders' capacity to plan staffing assignments based on patients' priority care needs. Themes helped inform recommendations for key stakeholders, including nurse leaders and direct care nurses.

Oncology nurses' perceptions of their relations with family members in an ambulatory cancer care setting: a mixed methods study.

Trends signal an increasing prevalence of people living through and beyond a cancer diagnosis with an enhanced reliance on ambulatory cancer care services and family caregiving. Despite this trend, there has been limited focus on nurses' experiences with providing support to families who care for patients in the community. For oncology nurses in ambulatory care settings, job satisfaction has decreased significantly as they are concerned with their ability to consistently provide safe and quality care to patients and their family. Although other studies indicated that the lack of time and limited resources are regrettably accepted aspects of nurses' work environments, our mixed methods small-scale study addressed how work environments still can meet the growing need for enhanced support and relations among nurses, patients, and families in ambulatory cancer care.

Using the Synergy Tool to Determine Regina Emergency Department Staffing Needs.

This article describes a three-year project between nurse researchers, the Saskatchewan Health Authority, the provincial nurses' union and nurses and leadership from two Regina tertiary care emergency departments. The purpose of the project was to create staffing guidelines based on patients' priority care needs. A patient needs assessment tool - the synergy tool - was used to categorize patients' acuity and dependency needs. Staffing guidelines were developed to match patients' needs to nurses' years of experience and classification. Staffing guidelines based on patient needs were compared to guidelines determined by operational budgets. The identified staffing gaps resulted in nurse hires for both emergency departments.