Transformational nurse leadership attributes in German hospitals pursuing organization-wide change via Magnet® or Pathway® principles: results from a qualitative study.

BACKGROUND: Budget constraints, staff shortages and high workloads pose challenges for German hospitals. Magnet® and Pathway® are concepts for implementing organization-wide change and redesigning work environments. There is limited research on the key elements that characterize nurse leaders driving the implementation of Magnet®/Pathway® principles outside the U.S. We explored the key attributes of nurse leaders driving organization-wide change through Magnet®/Pathway® principles in German hospitals. METHODS: Using a qualitative study design, semi-structured interviews (n = 18) were conducted with nurse leaders, managers, and clinicians, in five German hospitals known as having started implementing Magnet® or Pathway® principles. The interviews were recorded and transcribed verbatim. Data were analyzed in Atlas.ti using content analysis. For the analysis, a category system was created using a deductive-inductive approach. RESULTS: Five leadership attributes and eleven sub-attributes were identified as main themes and sub-themes: Visionary leaders who possess and communicate a strong vision and serve as role models to inspire change. Strategic leaders who focus on strategic planning and securing top management support. Supportive leaders who empower, emphasizing employee motivation, individualized support, and team collaboration. Stamina highlights courage, assertiveness, and resilience in the face of challenges. Finally, agility which addresses a leader's presence, accessibility, and rapid responsiveness, fostering adaptability. CONCLUSIONS: The study demonstrates leadership attributes explicitly focusing on instigating and driving organization-wide change through Magnet®/Pathway® principles in five German hospitals. The findings suggest a need for comprehensive preparation and ongoing development of nurse leaders aimed at establishing and sustaining a positive hospital work environment.

Effects of nurse managers' inclusive leadership on nurses' psychological safety and innovative work behavior: The moderating role of collectivism.

INTRODUCTION: In the rapidly evolving healthcare landscape, the capacity to foster innovative work behavior among nurses is increasingly important. This study examined the dynamics between inclusive leadership, psychological safety, collectivism, and innovative work behavior among nurses. DESIGN: The study used a cross-sectional, correlational design. METHODS: This study utilized data from 730 medical-surgical nurses who provided direct care to patients. Standardized instruments were used to assess key study variables. Statistical analyses, including moderated mediation regressions, were employed to investigate the complex interplay among these variables. RESULTS: We found a positive association between inclusive leadership and innovative work behavior, and psychological safety mediated this relationship. Collectivism moderated inclusive leadership's direct relationship with psychological safety and its indirect relationship with innovative work behavior. The results revealed that nurses with lower levels of collectivism were more responsive to their managers' inclusive behaviors, strengthening the relation between inclusive leadership, psychological safety, and innovative work behavior. CONCLUSION: Our findings suggest that promoting inclusive leadership behaviors among nurse managers to create a psychologically safe environment can motivate nurses to engage in innovative work behavior. However, it is also important to understand that the effectiveness of leadership may differ depending on the collectivist values of individual nurses. CLINICAL RELEVANCE: Nurse managers should adopt inclusive leadership behaviors, such as valuing trust, open communication, and diversity, in order to foster psychological safety and innovative work behavior among nurses.

Examining the Perspectives of Nurse Managers on Missed Nursing Care in Surgical Units.

OBJECTIVE: To examine nurse managers' perspectives on missed nursing care (MNC) on surgical units. BACKGROUND: The phenomenon of MNC is an important concern for nurse researchers. However, the reality of how it is experienced by clinical nurse managers is largely unexplored. Understanding nurse managers' experiences with MNC could help develop useful approaches to reducing levels of MNC. METHODS: A descriptive qualitative study was conducted between December and June 2020, using face-to-face semistructured interviews with 10 nurse managers. RESULTS: Five themes were identified: 1) awareness of MNC; 2) rationale for MNC; 3) consequences of MNC; 4) questions of reporting; and 5) management of MNC. CONCLUSIONS: Nurse managers must use their positions and leadership skills to expect appropriate staffing approaches and material resources for surgical units, effective process for newly hired nurses, and the establishment of a reporting system for MNC to reduce the phenomenon in practice.

Supporting Time-Critical Decision Making: The Creation of a Nurse-Led Rapid Literature Review Service.

Due to shifting priorities and unforeseen challenges, nurse leaders often lack sufficient time and resources to systematically review and appraise the available literature in search of the best evidence to guide decisions. A nurse-led rapid review service can produce accelerated knowledge synthesis and contextualized translation of evidence in a resource-efficient manner. This article describes a nurse-led rapid review service implemented at a large academic medical center and provides a reproducible process to guide other healthcare organizations in developing similar programs.

Building Leaders for an Equitable and Inclusive Future.

ABSTRACT: The Association for Leadership Science in Nursing (ALSN) 2023 International Conference was held on October 28 to 30 in Birmingham, Alabama, and sponsored by the University of Alabama at Birmingham School of Nursing. ALSN is dedicated to uniting academic and practice leaders to shape leadership science, education in nursing, and the practice of nursing leadership. The theme for the conference was Building Leaders for an Equitable and Inclusive Future. Nurse leaders from the United States, Canada, and Brazil gathered to discuss leadership science.

Supporting the Role Transition of Interim Nurse Managers: Development of an Evidence-Based eManual.

Executive nurse leaders may rely on interim nurse managers (INMs) to fill vacated nurse manager positions open for an extended time. To optimize the INM role for future leadership succession planning, ongoing professional development for this role is critical. The authors describe the use of evidence in the creation of onboarding leadership resources to support the role transition of INMs within a healthcare environment over a 100-day period.

A Road Map for the Development of a Decisional Authority Framework for Professional Governance Using Accountability Grids.

Although resources are available to guide structures and processes for professional governance, limited information exists about defining and legitimizing the decisional authority needed to support direct care nurses' ownership of clinical practice as well as the role of nursing leaders. This article presents a road map for creating and implementing clinical nurse, nurse leader, and nurse executive accountability grids with clearly delineated authority to provide a decisional authority framework for professional governance in one organization.

Ethical Decision-Making Confidence and Professional Values Among Nurse Leaders.

OBJECTIVES: The aims of this study were to describe differences in nurse leaders' ethical decision-making confidence and their professional values based on identified characteristics and to explore the relationship between ethical decision making and professional values. BACKGROUND: Nurse leaders have multiple duties and obligations toward their patients, other staff, and the organizations where they work. However, ethical decisions can be complex, requiring the guidance of professional values and critical appraisal of the situation. METHODS: This study was conducted using a correlational design. Convenience sampling was used, resulting in a sample of 56 nurse leaders in various positions. RESULT: Ethical decision making and professional values were found to be strongly correlated. CONCLUSION: Ethical decision making and professional values are highly correlated in this sample. Understanding the importance of the effects of certain factors on ethical decision making can assist in forming an environment supportive of ethical practices for nurses.

Training Opportunities for Managers in Home Health, Hospice, and Community-Based Care Settings.

OBJECTIVE: The aim of this study was to identify areas for developing management skills-focused continuing education for managers working in home health, hospice, and community-based settings. BACKGROUND: Healthcare managers play a vital role in organizations, yet they have a range of management training. METHODS: Researchers conducted a cross-sectional survey of managers at a large Visiting Nurse Association. Descriptive and bivariate analyses were performed to examine confidence in management skills by respondent characteristic. Factor and cluster analyses were used to examine differences by role. RESULTS: For all 33 management tasks, managers with 6+ years of experience reported greater confidence than managers with 0 to 5 years of experience. Tasks with the lowest confidence were budgeting, interpreting annual reports, strategic planning, measuring organizational performance, and project planning. Managers were clustered into 5 "profiles." CONCLUSION: Management training is not 1-size-fits-all. Healthcare organizations should consider investing in training specific to the identified low-confidence areas and manager roles to better support and develop a robust management workforce.

Growing the Next Generation of Nurses and Nurse Leaders.

It is imperative to support the next generation of nurses and nurse leaders facing the challenges of our complex health systems. A formal mentoring program provides a structure that allows nurses to have a relationship that promotes ongoing counsel, career development, and a myriad of other benefits with another nurse or other healthcare professionals. The 2023 Magnet® Application Manual requires organizations to implement and use mentoring and succession planning programs under the transformational leadership standard. Adopting and sustaining effective and meaningful mentoring and succession planning activities and programs promote an environment of inclusion and professional development. In addition to formal mentoring programs, the importance of informal mentoring relationships can have a lasting impact on nurses along their nursing journey.

Advancing Professional Governance to Improve Health Outcomes.

Developing the skills and behaviors needed for nurses to lead in professional governance has long been a priority at the American Organization for Nursing Leadership (AONL). The annual AONL Professional Governance Leadership Conference is an important part of advancing nursing professional governance, convening nurses in all roles to discuss professional governance concepts and leadership practices. AONL has produced publications and podcasts exploring the professional governance foundations, roles, and behaviors, available on its website. This article discusses AONL's partnership in the development of a new book, Professional Governance for Nursing: The Framework for Accountability, Engagement, and Excellence, edited by AONL faculty and former staff.

Racism and Nursing Leadership in Massachusetts: A Mixed-Methods Study.

BACKGROUND: Nursing in the United States has evolved within the same historical context that has reproduced and spread racism worldwide. Nurse administrators are integral to the quality of nurses' practice and play a key role in eliminating racial injustice in places of work. PURPOSE: Using a feminist and critical race feminist framework, this study examined Massachusetts nurses' experiences of racism in their places of work, focusing on nurse administrators' influence on the nonadministrator (staff nurse) experience of racism experiences before and after George Floyd's death. METHODS: An investigator-developed, electronic survey was sent to Massachusetts professional nursing organizations for distribution to their members in 2021. Two hundred nineteen nurse respondents completed Likert-scale and open-ended branching logic survey questions to yield the quantitative and qualitative data analyzed for this mixed-methods study. FINDINGS: Nurse administrators were: 1) more likely than staff nurses to state that policies and meetings to address racism and diversity, equity, and inclusion had taken place before and after George Floyd's murder; and 2) less likely than staff nurses to directly experience racism at the hands of a colleague or a superior. Nurse administrators influence staff nurses' experiences of racism.

Leadership Behaviors of Frontline Nurse Managers: A Mixed-Methods Research Study Identifying Essential Areas for Social Support.

OBJECTIVE: This study examined how frontline nurse managers (FLNMs) perceive and experience formal and informal social support and how personal factors and social support relate to their transformational leadership (TL) behaviors. BACKGROUND: Ineffective leadership by FLNMs is associated with costly outcomes. Evidence suggests that leadership development is a function of personal and social factors; however, a better understanding of this process is needed. METHODS: A convergent mixed-methods design was used. The quantitative strand included a cross-sectional survey in a sample of FLNMs. The qualitative strand used a semistructured interview and a descriptive qualitative approach with a subset of this sample. RESULTS: Formal and informal social support is positively related to the TL behaviors of FLNMs as evidenced by the convergent data. The influence of family members in the work-related decisions of FLNMs has been underreported in the literature and is an area for consideration in supporting retention and desired leadership behaviors. CONCLUSION: The findings of this study imply a need for organizations to establish systems that endorse the growth of FLNMS, create opportunities for career advancement, and integrate members of the FLNMs' personal support systems into recognition initiatives.

Enhancing Organizational Review and Promoting Sustainability of DNP Student Projects: Implications for Nurse Leaders.

This project aimed to evaluate the DNP projects at an academic medical center, assess the sustainability of DNP final projects, and explore potential opportunities to enhance the organizational review processes. The organization's graduate student review committee reviewed DNP projects implemented at the organization over the last 8 years. The sustainability of projects was less than anticipated. Recommendations are provided to enhance the DNP project approval process and improve strategies for sustainability.

Determinants of Nurse Managers' Transformational Leadership: The Role of Individual Unit and Organizational Characteristics.

OBJECTIVE: The aim of this study was to examine the relationship between various factors and self-perceived transformational leadership among a sample of Filipino nurse managers (NMs). BACKGROUND: Transformational leadership plays a crucial role in promoting positive outcomes in healthcare settings, particularly for NMs. Understanding the factors that influence NMs' self-perceived transformational leadership is essential for improving leadership practices and enhancing organizational effectiveness. METHODS: A cross-sectional research design was used to collect data from 260 NMs using standardized measures. RESULTS: Employment status, the number of units managed, the type of hospital employment, psychological distress, and job satisfaction were factors that significantly influenced their leadership perceptions. CONCLUSION: By addressing the identified factors, nursing organizations can create an environment that promotes effective leadership practices, ultimately enhancing patient outcomes, staff satisfaction, and overall organizational performance.

Newly graduated nurses' commitment to the nursing profession and their workplace during their first year of employment: A focused ethnography.

BACKGROUND: The commitment of nurses to their profession and workplace is closely linked to the delivery of high-quality patient care. Existing literature highlights the positive impact of commitment on care quality and patient outcomes. Conversely, a lack of commitment can lead to nurse burnout and disengagement. However, it remains unclear whether and how cultural beliefs and practices influence newly graduated nurses' commitment to the nursing profession and their workplace. AIM: To explore the cultural beliefs and practices influencing newly graduated nurses' commitment to the profession and commitment to their workplace during their first year of employment. DESIGN: A focused ethnographic study. METHODS: Data consisted of field notes from 94 h of participant observations and 10 semi-structured interviews with newly graduated nurses working in acute care settings in Denmark. Data were analysed using ethnographic content analysis. Data were collected between March and June 2022. RESULTS: The findings reveal a major theme, termed 'A State of Transience among Newly Graduated Nurses', consisting of two themes: 'Newly Graduated Nurses' Pursuit of Professional Development and Supportive Work Environments' and 'A Lack of Formal Agreements or Conditions to Meet Expectations for Professional Development.' CONCLUSION: Hospitals and nurse managers need to support newly graduated nurses in their first employment after registration by providing a range of clinical experiences through job rotation opportunities within the same organization, deliver on promises for onboarding support and foster a culture of trust. These strategies will help maintain the motivation, commitment and ability of newly graduated nurses to deliver high-quality patient care, thereby reducing the likelihood of turnover. RELEVANCE FOR CLINICAL PRACTICE: A trusting and supportive work environment is fostered by providing diverse clinical experiences and consistent support for newly graduated nurses. To address potential high turnover associated with job rotation, hospitals need to rethink how retention is defined and measured, moving beyond hospital unit-level models and measures. REPORTING METHOD: This study reports to the SRQR guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Effect of caring leadership intervention program for first-line nurse managers on their managerial actions and nurse outcomes.

AIM: The aim of the study was to examine the effect of a caring leadership intervention program for first-line nurse managers (FLNM) on their caring knowledge and managerial actions as well as nurses' perceived FLNM caring behaviours and nurse outcomes. DESIGN: A quasi-experimental study design was implemented on two groups; study and control, including 30 FLNM and 150 nurses for each. METHODS: Self-report questionnaires about FLNMs' knowledge of caring behaviours and their managerial actions, nurses perceived line nurse managers' caring behaviours and nurses' outcomes (job satisfaction and work engagement) were utilized to collect study data from 1 July 2022 to 30 December 2022. RESULTS: A statistically significant difference and changes were revealed between the study and control groups in FLNMs' caring knowledge and their managerial actions, and nurses' perceived FLNMs' caring behaviours, nurses' job satisfaction and nurses' work engagement during post-test in comparison to pre-test. Higher total mean scores of post-test in the study group were recorded compared to those of control group regarding FLNMs' caring knowledge and their managerial actions as well as nurses 'perceived FLNMs' caring behaviour, job satisfaction and work engagement. CONCLUSION: The caring leadership intervention program for FLNMs was highly effective in enhancing their caring knowledge and managerial actions as well as nurses' perceived FLNM caring behaviours and nurse outcomes. IMPLICATIONS FOR THE PROFESSION: Caring leadership can help FLNMs to create a healthy environment, resulting in a positive outcome for nurse staff, patients and healthcare organizations. PATIENT AND PUBLIC CONTRIBUTION: No patient and public contribution.

Investigation of the relationship between nurses' perception of toxic leadership and their organizational trust levels and turnover intentions.

AIM: This study aimed to investigate the relationship between nurses' perception of toxic leadership and their organizational trust levels and turnover intentions. DESIGN: This cross-sectional study was conducted using an online survey of 168 nurses working in public and university hospitals. METHODS: Data were collected between April and November 2022 with the Toxic Leadership Scale, Organizational Trust Scale and Turnover Intention Scale. Descriptive statistics, correlations, and regression analyses were used to analyse these data. RESULTS: It was determined that almost half of the nurses (46.4%) were exposed to negative behaviours from their managers within the last year. Nurses' perception of toxic leadership, organizational trust level and turnover intention were moderate. It was found that nurses' perceptions of toxic leadership had a negative effect on organizational trust level (R2 = .691; ß = -0.832; p < .05) and a positive significant effect on turnover intention (R2 = .267; ß = 0.521; p < .05). CONCLUSIONS: This study revealed that toxic leadership behaviours in health organizations should be struggled with to increase nurses' organizational trust and reduce their turnover. In this context, an organizational culture in which toxic behaviours are not tolerated should be established in health organizations. IMPACT: What problem did the study address? In the literature, mostly positive leadership behaviours of nurse managers are emphasized and little is known about their negative behaviours such as toxic leadership. What were the main findings? It was determined that nurses who perceived more toxic behaviour from their managers had less trust in their organizations and higher turnover intention. On whom will the research have an impact? To provide a positive working environment and reduce turnover, it is necessary to create an organizational culture in which the toxic behaviours of nurse managers are not tolerated. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Accountability focus and nurses' performance: A moderated-mediation model by using experiment design simulations.

AIM: The aim of this study was to test a moderated-mediation model, explaining how and under which circumstances a process- or an outcome-accountability focus affects performance. DESIGN: Randomized controlled design, using screen-based simulations. METHODS: Data were collected during 2021. Two screen-based simulations of medication administration (for low- and high-complexity tasks) were used. Each participant was randomly assigned to one of the six experimental conditions. Nurses completed validated questionnaires on strain levels and their perceptions of the simulated task complexity and accountability focus. Performance was assessed via validated checklists assessing nurses' performance of the simulation. RESULTS: Task complexity significantly moderated the relationship between accountability-focus conditions and strain. For the process-accountability-focus condition, strain levels were lower during high-complexity tasks compared with low-complexity tasks, while for the outcome-accountability-focus condition, strain levels were lower during low-complexity tasks compared with high-complexity tasks. The highest strain levels were observed under the no accountability-focus condition. Additionally, this interaction had an impact on performance, with nurses' strain playing a mediating role. CONCLUSIONS: Any accountability focus reduces strain levels and enhances performance compared with having no accountability focus. The choice of accountability focus should be based on task-complexity considerations. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Managers can effectively reduce nurses' strain and improve performance by prioritizing outcome accountability focus for simpler tasks and process accountability focus for complex tasks. IMPACT: The study addressed previous ambiguous findings regarding the type of accountability focus that better motivates nurses' performance. By considering accountability focus, nurse managers can balance nurses' strain levels with improved performance. REPORTING METHOD: We have adhered to the relevant EQUATOR guidelines: CONSORT. PATIENT OR PUBLIC CONTRIBUTION: There is no patient or public contribution, as the study only concerns the providers of the service, that is the nurses themselves.

The DAISY Award: Meaningful Recognition's Impact on Patients, Nurses, and Organizations.

This review demonstrates the impact of The DAISY Award and how meaningful recognition (MR) through gratitude affects nurse engagement, healthy work environments (HWEs), and patient/families' (PFs) experiences. MR has mutual benefits for nurses and PFs, promoting therapeutic healing and resiliency. MR in HWEs can impact organizations' care quality, fiscal health and influence public perceptions. Nurse leaders should create an environment where MR is a core strategic imperative that impacts nurse, patient, and organizational outcomes.