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Objectives: This study aimed to investigate clinical leadership behaviors among critical care nurses and compare the differences between nurses in private and public hospitals. Methods: A cross-sectional survey including 365 critical care nurses with a bachelor's degree in nursing science were recruited in two Egyptian hospitals (a government teaching hospital and one private hospital from January to March 2019. A socio-demographic characteristics form and the Clinical Leadership Behaviors Questionnaire (CLB-Q) were used to collect data. For comparison and analysis, the mean score was calculated and converted to a percentage value. Results: Results showed that the overall mean score of nurses' clinical leadership behaviors was 77.11 ± 11.87, the level was higher, and the highest score of the communication dimension was 91.84 ± 7.38. The mean score of nurses at a private hospital (90.48 ± 5.53) was higher than that at a government teaching hospital (68.29 ± 4.21) (P < 0.001). On nursing experience, nurses with 5-10 years had higher mean score in self-awareness, advocacy and empowerment, decision making, quality and safety, teamwork, and clinical excellence dimension of clinical leadership behavior than those who worked less than 5 years or more than 10 years (P < 0.01). Single nurses had higher mean score in advocacy and empowerment, decision making, quality and safety, and clinical excellence dimension of clinical leadership behavior than those who married (P < 0.01). Conclusions: Nurse managers should foster clinical leadership by enabling critical care nurses to practice clinical excellence and encouraging their attendance in training programs on quality and safety. Nurses in government hospitals need improvement in clinical leadership behaviors regarding all dimensions.
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BACKGROUND: The global COVID-19 pandemic has challenged nurse leaders in ways that one could not imagine. Along with ongoing priorities of providing high quality, cost-effective and safe care, nurse leaders are also committed to promote an ethical climate that support nurses' moral courage for sustaining excellence in patient and family care. AIM: This study is directed to develop a structure equation model of crisis, ethical leadership and nurses' moral courage: mediating effect of ethical climate during COVID-19. ETHICAL CONSIDERATION: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University, Egypt. METHODS: A cross-sectional design was used to conduct this study using validated scales to measure the study variables. It was conducted in all units of two isolated hospitals in Damanhur, Egypt. A convenient sample of 235 nurses was recruited to be involved in this study. RESULTS: This study revealed that nurses perceived a moderate mean percent (55.49 ± 3.46) of overall crisis leadership, high mean percent (74.69 ± 6.15) of overall ethical leadership, high mean percent (72.09 ± 7.73) of their moral courage, and moderate mean percent of overall ethical climate (65.67 ± 12.04). Additionally, this study declared a strong positive statistical significant correlation between all study variables and indicated that the independent variable (crisis and ethical leadership) can predict a 0.96, 0.6, respectively, increasing in the dependent variable (nurses' moral courage) through the mediating impact of ethical climate. CONCLUSION: Nursing administrators should be conscious of the importance of crisis, ethical leadership competencies and the role of ethical climate to enhance nurses' moral courage especially during pandemic. Therefore, these findings have significant contributions that support healthcare organizations to develop strategies that provide a supportive ethical climate. Develop ethical and crisis leadership competencies in order to improve nurses' moral courage by holding meetings, workshops, and allowing open dialogue with nurses to assess their moral courage.