Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review.

AIM: To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies. DESIGN: Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). DATA SOURCES: PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022. REVIEW METHODS: Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group. RESULTS: Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only. CONCLUSIONS: A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies. IMPACT: Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated. NO PATIENT OR PUBLIC CONTRIBUTION: Prospero ID CRD42021292290.

Nursing peer feedback: Optimizing our relationships with human resources and collective bargaining organizations.

Nursing leaders have recognized the need for consistent mechanisms to promote and sustain nursing professionalism. Peer-to-peer feedback and peer review are widely effective for nurse professionalism and self-regulation, patient care outcomes, and retention. Unprofessional behavior has been noted as widespread in health care and the effects on patients, clinicians, and organizations have been well-documented. Approximately 10% of the registered nurses in the United States belong to a collective bargaining unit (CBU) or union. This article will describe how a peer feedback program to address unprofessional behavior was implemented in a Magnet nursing practice with CBU representation.

Fostering belonging and social connectedness in nursing: Evidence-based strategies: A discussion paper for nurse students, faculty, leaders, and clinical nurses.

BACKGROUND: The phenomenon of loneliness among healthcare providers, particularly nurses, has garnered increasing attention due to its detrimental effects on individual well-being and professional retention. The isolation experienced by nurses has been linked to heightened turnover rates and intentions to leave the profession, posing significant challenges to healthcare systems globally. Recognizing loneliness as an epidemic in 2023, the U.S. Surgeon General highlighted the urgency of addressing this issue within the healthcare workforce. PURPOSE: This paper explores evidence-based strategies to mitigate loneliness and promote social connectedness among nurses, drawing insights from various stakeholders. It aims to offer actionable recommendations to enhance the nursing experience and retain professionals in the field. DISCUSSION: Strategies include peer support programs, mentorship initiatives, wellness activities, and fostering open communication. Leveraging technology for virtual connections is also highlighted, especially in remote work scenarios. CONCLUSION: A holistic approach is vital, combining individual, interpersonal, and systemic interventions to combat nurse loneliness. Prioritizing social connectedness fosters a supportive work environment, benefiting both nurses and patient care quality.

In Search of Evidence: A Scoping Review of School Nurse Leadership Training Programs.

This scoping review explores leadership training opportunities for school nurses. The review was conducted to inform the development of a new leadership training program for school nurses in Massachusetts. A search conducted across four databases (PubMed, CINAHL, ERIC, and Web of Science) yielded four articles meeting the search criteria published between 1993 and 2007, and no articles meeting the criteria after 2007. The four articles that were found discussed the approaches and evaluation methods of school nurse leadership training programs. They revealed varying training structures and evaluation approaches and covered a wide range of leadership competencies. Importantly, all of the programs reported enhancements in participants' leadership knowledge and practice upon completion of the training program. This review highlights the necessity of documenting and disseminating program outcomes in peer-reviewed literature to guide the development of new initiatives and recommends adopting standardized evaluation frameworks.

Nurse leaders' perceptions of workload and task distribution in public healthcare: A qualitative explorative study.

BACKGROUND: Unreasonable workload and work-related stress can reduce nurse leaders' job satisfaction and productivity and can increase absence and burnout. Nurse leaders' workload in public healthcare settings is relatively unresearched. THE AIM: The aim of this study was to investigate nurse leaders' perceptions of workload and task distribution with relation to leading work tasks in public healthcare. RESEARCH DESIGN, PARTICIPANTS AND RESEARCH CONTEXT: A qualitative explorative design was used. The data material consisted of texts from interviews with nurse leaders in public healthcare (N = 8). The method was inspired by content analysis. The COREQ checklist was used. ETHICAL CONSIDERATIONS: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. FINDINGS: Six main themes were found: Increased and unreasonable workload, Length of work experience as nurse leader affects perception of workload, Number of staff and staff characteristics affect perception of workload, Versatile and flexible task distribution, Working overtime as a way of managing high workload and Insufficient time for leadership mission. CONCLUSION: The workload for nurse leaders in a public healthcare setting was perceived to be unreasonable. Common measures for managing high workload included working overtime, delegating work tasks and organising more staff resources in the form of additional staff. How nurse leaders perceive their workload was linked to both the number of staff and staff characteristics. These should both be considered equally important when determining staff levels and measuring nurse leaders' workload. Future research should focus on investigating workload and task distribution from nurses' perspectives. RELEVANCE TO CLINICAL PRACTICE: Through this study, greater understanding of workload and the diverse work of nurse leaders in a public healthcare setting has been revealed, which can be used to further develop the framework for nurse leaders' work.

Moral distress experienced by care leaders' in older adult care: A qualitative study.

BACKGROUND: Many healthcare professionals have left their professions recently because of increased moral distress, and the COVID-19 pandemic has had a further major impact on the ever-changing healthcare environment. AIM: The purpose of the study was to examine care leaders' experiences of moral distress in their daily work in older adult care. METHODOLOGY: A qualitative design was used. The data consisted of texts from interviews with care leaders (N = 8) in an older adult care context. Content analysis was used to analyse the data. FINDINGS: Five themes emerged: (1) moral distress arises from a lack of time, (2) moral distress contributes to a sense of inadequacy but also a sense of responsibility, (3) moral distress arises from an imbalance in values, (4) increased knowledge and open discussion help reduce moral distress and (5) reflection, increased support and increased resources can reduce moral distress. CONCLUSION: Moral distress is something that care leaders, according to this study, experience daily in an older adult care context and it is considered to have increased. Care leaders can experience moral distress from a lack of time; patient-related, relative-related or other ethically difficult situations or an imbalance between own values and an organisation's, other caregivers', patients' and/or patients' relatives values. Increased staffing resources, more knowledge (training and lectures) and time for reflection individually, in groups or with an outside expert could increase care leaders' insights into and ability to reduce moral distress. Although situations that are characterised by moral distress are burdensome, care leaders have the opportunity to learn from such situations through reflection and discussion and can develop strategies for future ethical challenges. Future research could focus on exploring caregivers' experiences of moral distress.

Effect of ethical nurse leaders on subordinates during pandemics.

BACKGROUND: As caring in times of pandemics becomes extremely stressful, the volume and intensity of nursing work witness significant increase. Ethical practices are therefore even more important for nurses and nurse leaders during this special period. RESEARCH AIM: The aim was to explore the relationship between ethical nurse leaders and nurses' task mastery and ostracism, and to examine the mediating role of relational identification in this relationship during pandemics. RESEARCH DESIGN: Based on social exchange theory, this study tests a theoretical model proposing that ethical nurse leaders can increase nurses' task mastery and reduce their ostracism by improving their relational identification with leaders during pandemics. PARTICIPANTS AND RESEARCH CONTEXT: A multilevel and multi-wave field study using data from 172 nurses from 45 departments of two comprehensive hospitals was performed from April to August 2020 to test proposed hypotheses. ETHICAL CONSIDERATIONS: We received formal approvals from the ethical committee of the hospital where we conducted this study before the data collection. RESULTS: Ethical nurse leaders can indeed increase nurses' task mastery and reduce their ostracism during the pandemic period; furthermore, nurses' identification with their leaders mediates these relationships. We find that ethical leadership plays an even more important role in improving nurses' task mastery and reducing their ostracism that may be facilitated by pandemics this special time. Nurses will become more identified with their leaders when they are treated by ethical ways. DISCUSSION: The study tries to advance our understanding of the important role of ethical leadership in nurse management literature and provide useful suggestions for healthcare institutions, nurse leaders, and nurses during pandemics. CONCLUSION: Theoretical contributions and practical implications of our findings are discussed. Specifically, we suggest that healthcare institutions cultivate ethical nurse leaders to facilitate nurses' relational identification, which in turn will positively influence work outcomes.

Nurse leaders' experiences of professional responsibility towards developing nursing competence in general wards: A qualitative study.

AIM: To explore nurse leaders' experiences of professional responsibility to facilitate nursing competence in general wards. BACKGROUND: Nurse leaders are responsible for maintaining high levels of competence among nurses to improve patient safety. METHODS: Qualitative analysis was conducted between February and April 2019 using semi-structured interview data from 12 nurse leaders in surgical and medical wards at three Norwegian hospitals. RESULTS: Four main themes were identified: struggle to achieve nursing staff competence; focus on operational and budgetary requirements rather than professional development; demands to organize sick leaves and holiday periods; and challenges in facilitating professional development. CONCLUSION: Nurse leaders felt that their responsibilities were overwhelming and challenging. They witnessed more support for current administrative tasks than for the implementation of professional development. Additionally, unclear work instructions from the employer provided few opportunities to facilitate professional development. Hospital management failed to ensure quality of care and patient safety in general wards by not supporting the strengthening of nurses' professional competence and preventing turnover. IMPLICATIONS FOR NURSING MANAGEMENT: Management may integrate formal work instructions that clarify nurse leaders' responsibilities as professional developers, allowing nurse leaders to meet their obligation of maintaining adequate professional competence among nursing staff in general wards.

Nurse leadership in promoting and supporting civility in health care settings: A scoping review.

AIM: This scoping review aimed to identify the existing evidence on how nurse leaders promote and maintain civility amongst nurses in health care settings. BACKGROUND: Research on managing workplace incivility in nursing, a prevalent and concerning issue worldwide, recommends nurse leaders to command cultural change through strong leadership and civility interventions. However, there is very little empirical evidence summarizing and analysing how nurse leaders pragmatically achieve civility, and combat workplace incivility, in the health care setting. EVALUATION: A scoping review was undertaken using the electronic databases CINAHL, Emerald Insight, MEDLINE, PsychINFO, PubMed and Scopus. Google Scholar was used to search for grey literature. KEY ISSUES: The eight studies included in this review describe how nurse leaders promote and maintain civility under four key themes: (1) creating a shared vision, (2) educating self and others, (3) fostering accountability and (4) providing support. CONCLUSION: The review provides an overview of commonly used strategies and actions that pragmatically promote and maintain civility in the health care setting by nurse leaders, while also highlighting areas of future research needed to strengthen the evidence base. IMPLICATIONS FOR NURSING MANAGEMENT: It is important for nurse leaders to gain an understanding of evidence-based practices when addressing workplace incivility in order to address this prevailing problem for the future and safety of nurses moving forward.

Nurse leader agency: Creating an environment conducive to support for graduate nurses.

AIM: The aim of the study was to gain insight on how nurse leaders manage a culture of safety for graduate nurses. BACKGROUND: Current theoretical approaches to safety culture tend towards a checklist approach that focuses on institutional characteristics, failing to examine the quality of interpersonal relationships. These interpersonal interactions are often seen as separate from the institutional realities of resource allocation, nurse-patient ratios, patient acuity or throughput. A theoretical approach is required to illuminate the dialectic between the structure of an organisation and the agency created by nurse leaders to promote patient safety. DESIGN: Qualitative exploratory descriptive study. METHODS: Semi-structured interviews were undertaken with 24 nurse leaders from hospital and aged care settings. Thematic analysis and Giddens structuration theory was used to describe the findings. RESULTS: Nurse leaders identified a range of reciprocal communicative and cultural norms and values, decision-making processes, personal nursing philosophies, strategies and operational procedures to foster patient safety and mentor graduate nurses. The mentoring of graduate nurses included fostering critical thinking, building and affirming formal structural practices such as handover, teamwork, medication protocols and care plans. CONCLUSIONS: The study provides insight into how nurse leaders foster a culture of safety. Emphasis is placed on how agency in nurse leaders creates an environment conducive to learning and support for graduate nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leadership functions and decision-making capacity hinges on multiple factors including practicing agency and aspects of the social structure such as the rules for safe communication, and the various institutional protocols. Nurse leaders enforce these forms of engagement and practice through their legitimation as leaders. They have both allocative and authoritative resources; they can command resources, direct staff to attend to patients and/or clinical tasks, mentor, guide, assign, correct and encourage with the authority vested in them by the formal structure of the organisation. In doing so, they sustain the structure and reinforce it.

Organizational culture and readiness for evidence-based practice in the Kingdom of Saudi Arabia: A pre-experimental study.

AIM: This study aims to establish postgraduate students' perceptions of the organizational culture and readiness for evidence-based practice of their workplaces in the Kingdom of Saudi Arabia. BACKGROUND: Nurse shortages and a reliance on a transient nurse workforce have long been a challenge in the Kingdom of Saudi Arabia. Developing a home-grown nurse workforce, a key objective of the Government of Saudi Arabia, can help to address this. Evidence-based practice offers a mechanism to address this. Evidence-based practice implementation is heavily reliant on the prevailing organizational culture. Establishing the organizational culture and readiness for evidence-based practice is crucial for sustainable evidence-based practice implementation. METHODS: A pre-experimental pilot study collected data from the same participants at three different points. As part of this, a questionnaire measuring organizational culture and readiness for evidence-based practice was administered twice. Descriptive, inferential and correlational statistics were employed to analyse the data. RESULTS: Results demonstrated improved participant perceptions of the organizational culture and readiness for evidence-based practice of their workplaces between the first (M = 76.58, SD = 19.2) and second (M = 92.10, SD = 23.68) data collection points, indicating moderate movement towards a culture of evidence-based practice. Strengths, challenges and opportunities for improvement were identified. CONCLUSION: This study established participants' perceptions of the organizational culture and readiness for evidence-based practice of their workplaces, affording insight into context-specific strategies to embed evidence-based practice in health care organizations. IMPLICATIONS FOR NURSING MANAGEMENT: Assessing an organization's culture and readiness for evidence-based practice (EBP) can afford insight on the strengths, challenges and opportunities that exist to equip nurse managers to advance evidence-based practice at individual, professional and organizational levels. This study demonstrated the importance of promoting an environment conducive to EBP and putting in place the necessary resources to support evidence-based practice implementation. Nurse managers can play a central role in this.

Involvement of Jordanian Head Nurses' in Health Policy Development: A Cross-Sectional Study.

BACKGROUND: Despite the importance of involving nurses in health policy, nurse's involvement faces many challenges. Literature showed that there is a low level of nurses' and nurse leaders' involvement in health policy development. AIM: The aims of this study were to examine (a) the level of Jordanian head nurses' involvement in health policy development and their perceived benefits and barriers; (b) the relationships between level of knowledge, competence, and interest in health policy and the level of involvement in health policy development; and (c) the relationship between the level of self-efficacy (efficacy expectation and outcome expectation) and the level of involvement in health policy development. METHODS: A cross-sectional descriptive correlational study design was adopted in this study. A convenience sampling of 250 participants from hospitals affiliated to three health sectors in Jordan (private, governmental, and university) were recruited to complete a self-administered questionnaire. Descriptive statistics and Pearson correlation coefficient were used to answer the study questions. RESULTS: The results revealed a moderate level of involvement of head nurses in the policy development. The most frequent cited political activity was "providing written reports, consultations, research." "Lack of time" was the most perceived barrier, while "improving the health of the public" was the most perceived benefit. Workshops or sessions at conferences is the most indicated source of knowledge. Participants had an excellent level of skills with positive relationships between the competence and both of the levels of professional and personal involvement in health policy. Participants reported a low level of confidence in performing political activities as well as the impact of such activities on health outcomes. Positive relationship was indicated between self-efficacy and the levels of professional and personal involvement in political activities.Implications: Health policies affect nurses and their practice. Overcoming the barriers and enhancing the levels of head nurses' knowledge and competence regarding health policies can help activating their roles in health policy development process. This will help in activating nurses' role in health policy development, which in turn will have a positive impact on health outcomes.

Challenges, Extent of Involvement, and the Impact of Nurses' Involvement in Politics and Policy Making in in Last Two Decades: An Integrative Review.

PURPOSE: To determine nurses' challenges, extent of involvement, and the impact of involvement in politics and policy making. ORGANIZING CONSTRUCT: Nurses in politics and health policy making. METHODS: Literature was searched in PubMed, Scopus, Google Scholar, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID, and Open Grey using phrases comprising the following key words: "nurses", "policy making", "politics", "health policy", "nurses involvement in policy making/politics/health policy", "nurses challenges in policy making/politics/policy", and "impact of nursing policy making/politics/health policy"; 22 articles published from January 2000 to May 2019 were included. FINDINGS: The major challenges included intra- and interprofessional power dynamics, marginalization of nurses in policy making, and nursing profession-specific challenges. The extent of involvement was inadequate, and nurses mainly worked as policy implementers rather than as policy developers. Those nurses who participated in policy development focused on health promotion to build healthy communities and to empower nurses and the nursing profession. CONCLUSIONS: Nurses' involvement in policy making has not improved over time. Nursing institutions and regulatory bodies should prepare and encourage nurses to work as policymakers rather than implementers and advocate for the rightful place of nurses at policy-making forums. CLINICAL RELEVANCE: Preparation for health system policy making starts in the clinical settings. Educational institutions and nurse leaders should adequately prepare nurses for policy making, and nurses should participate in policy making at the organization, system, and national levels.

A comparative analysis of work-family conflict among staff, managerial, and executive nurses.

BACKGROUND: Nurses frequently are caught between the demands of work and family. While studies have explored this issue among staff nurses, none have compared nurse leaders to staff nurses. This study compares work-family conflict (WFC) and family-work conflict (FWC) among staff, managerial, and executive nurses. METHODS: In this survey design, 20% of registered nurses were randomly sampled across Florida with a 9% response rate. Survey questions included personal, professional, and work environment characteristics and perceptions of WFC/FWC. Analyses of variance tested the differences between- and within-group scores for WFC/FWC for staff, managerial, and executive nurses. Ordinary Least Squares regressions tested the relationships between personal, professional and work environment measures, focusing on the three different nursing roles, and WFC/FWC scores. FINDINGS: Nurses experienced more WFC than FWC. Staff nurses experienced significantly less WFC than nurse managers and nurse executives (analysis of variance mean difference -0.881 and -2.693, respectively). Nonwhite nurses experienced more WFC and FWC than white nurses. Longer shift length predicted greater WFC. FWC was lower with paid leave for childbirth. DISCUSSION: Higher WFC among nurse managers and executives may discourage nurses from taking on or staying in leadership roles. Efforts must be taken to decrease WFC/FWC among nurses in these roles.

Visionaries in geriatric nursing: A legacy for the future.

There are many nurses who had a significant impact on the development and growth of gerontological nursing. There are those that provided the foundation and were the building blocks of gerontological nursing. Those following served as the cornerstones to fortify the foundation of gerontological nursing. Today there are rising scholars serving as the stepping-stones for the future of gerontological nursing. This article highlights the exemplary gerontological nurses that contributed and are contributing to the research, practice, and education of the mature specialization of gerontological nursing.

Association between work-family conflict and overall well-being among Chinese nurse leaders.

AIM: To explore the association between work-family conflict and overall well-being among Chinese nurse leaders. BACKGROUND: Nurse leaders are constantly busy at the clinical frontline, mostly experience high stress levels at work and have little time to spend with the family. There is little evidence to know about the association between work-family conflict and overall well-being, which is essential for high-quality medical care. METHODS: A cluster sampling method was used to recruit 42 nurse leaders. Data were collected using the Chinese versions of the Multidimensional Work-Family Conflict Scale and the General Well-Being Schedule. Descriptive analyses, independent t tests, ANOVAs and Pearson's correlation were used for the statistical analysis. RESULTS: The mean scores (SD) of work-family conflict and well-being were 2.17 (0.57) and 4.51 (0.61), respectively. Negative correlations were observed with strain-based and behaviour-based work-family conflict and overall well-being. CONCLUSION: Stress from work-family conflict is positively correlated with the overall well-being of Chinese nurse leaders. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital administrators should be aware of specific risk factors and implement accordingly the interventional strategies to decrease the stress levels and improve the overall well-being of nurse leaders.

Use of Evidence-based Practice Models and Research Findings in Magnet-Designated Hospitals Across the United States: National Survey Results.

BACKGROUND: All nurses have responsibilities to enculturate evidence-based practice (EBP) and translate and implement research findings into nursing care, practices, and procedures. AIMS: To report EBP-related findings from the national Hospital-Based Nursing Research Characteristics, Care Delivery Outcomes, and Economic Impact Survey questionnaire. METHODS: In this cross-sectional survey research study of 181 nursing research leaders, 127 responded to these questions: "Has your hospital adopted or does it use a model of evidence-based practice?" "If yes, what is the name of the model and how is it used?" "Does your hospital implement (translate) findings from nursing research into clinical practice?" "Describe how your hospital implements these findings and whose responsibility it is." "What factors do you believe facilitate the implementation of findings from nursing research into clinical practice at your hospital?" Qualitative content analyses were used. RESULTS: Over 90% of nursing research leaders specified that their hospital used an EBP model and implements findings into practice. The most frequently reported models were the Iowa Model of Evidence-Based Practice, Johns Hopkins Nursing Evidence-Based Practice Model, and Advancing Research and Clinical Practice Through Close Collaboration Model. EBP models were used most frequently for education and training, nurse residency programs, and EBP and research fellowships. Findings were implemented through policy and procedure committee processes, shared governance structures, and EBP processes. Those responsible for implementing findings were project leads, nursing professional practice councils, and clinical nurse specialists and advanced practice nurses. Implementation facilitators were nursing leadership, dissemination of findings, and engaged and educated nurses. LINKING EVIDENCE TO ACTION: These new findings report >90% EBP model use and implementation. All nurses, especially our leaders, have responsibilities to evaluate EBP and how nursing research findings are implemented (translated) into practice. Ideally, engaged and educated nurses who enculturate, support, and sustain EBP will facilitate advancing nursing practice to improve patient and work environment-related outcomes.

An integrative review of leadership competencies and attributes in advanced nursing practice.

AIM: To establish what leadership competencies are expected of master level-educated nurses like the Advanced Practice Nurses and the Clinical Nurse Leaders as described in the international literature. BACKGROUND: Developments in health care ask for well-trained nurse leaders. Advanced Practice Nurses and Clinical Nurse Leaders are ideally positioned to lead healthcare reform in nursing. Nurses should be adequately equipped for this role based on internationally defined leadership competencies. Therefore, identifying leadership competencies and related attributes internationally is needed. DESIGN: Integrative review. METHODS: Embase, Medline and CINAHL databases were searched (January 2005-December 2018). Also, websites of international professional nursing organizations were searched for frameworks on leadership competencies. Study and framework selection, identification of competencies, quality appraisal of included studies and analysis of data were independently conducted by two researchers. RESULTS: Fifteen studies and seven competency frameworks were included. Synthesis of 150 identified competencies led to a set of 30 core competencies in the clinical, professional, health systems. and health policy leadership domains. Most competencies fitted in one single domain the health policy domain contained the least competencies. CONCLUSIONS: This synthesis of 30 core competencies within four leadership domains can be used for further development of evidence-based curricula on leadership. Next steps include further refining of competencies, addressing gaps, and the linking of knowledge, skills, and attributes. IMPACT: These findings contribute to leadership development for Advanced Practice Nurses and Clinical Nurse Leaders while aiming at improved health service delivery and guiding of health policies and reforms.

Nurse leaders' role in medical assistance in dying: A relational ethics approach.

Recent changes to the Criminal Code of Canada have resulted in the right of competent adult Canadians to request medical assistance in dying (MAID). Healthcare professionals now can participate if the individual meets specific outlined criteria. There remains confusion and lack of knowledge about the specific role of nurses in MAID. MAID is a controversial topic and nurses may be faced with the challenge of balancing the duty to provide routine care, with moral reservations about MAID. The role of a nursing leader is to support nurses by ensuring they have the knowledge they require to care for patients requesting the service, whether or not the nurse is directly involved in the MAID process. The moral dilemmas raised by MAID provide an opportunity to look at a relational ethics approach to nursing leadership both for MAID and other difficult situations that arise in nursing practice. Relational ethics is a framework that proposes that the ethical moments in healthcare are based on relationships and fostering growth, healing, and health through the foundational concepts of mutual respect, engagement, embodiment, and environment. This article will use a relational ethics framework to examine how nursing leadership can support nurses who care for patients requesting MAID.

A Case for Leadership Development in Nursing Practice.

The Institute of Medicine (IOM) (2011) report, 'The Future of Nursing: Leading Change, Advancing Health,' was inspired by a vision to strengthen nursing leadership to help transform health care. Paralleling the IOM report, a core belief of the American Nephrology Nurses Association is to provide nurses with leadership opportunities, and encourage nurses to seize opportunities to develop and polish their leadership skills. This article discusses 'The Leadership Challenge' as one model for leadership development that can propel individuals, including nurses, toward exemplary leadership. The article presents the Five Practices of Exemplary Leadership within 'The Leadership Challenge' as an effective evidence-based path to achieving the extraordinary.