Crisis management competencies needed in a hospital setting during the COVID-19 pandemic: A qualitative study of nurse leaders.

AIM: To describe the crisis management competencies needed in a hospital setting during the COVID-19 pandemic from the perspective of nurse leaders. BACKGROUND: The COVID-19 pandemic generated many challenges for nurse leaders in hospitals, and management competencies are highlighted. However, there is little evidence available about nurse leaders' perceptions of the crisis management competencies needed in such situations. METHODS: A qualitative, descriptive, semi-structured interview study of nurse leaders (n = 20) was conducted between June and October 2021 in one Finnish central hospital. The data were analysed using inductive content analysis. RESULTS: The analysis yielded five main categories of crisis management competencies needed in a hospital setting during the pandemic: interactive communication competence, psychological resource management competence, systematic and proactive organising competence, active networking abilities and practices and change management approach in crisis management. CONCLUSIONS: Nurse leaders need new and different crisis management competencies in hospital organisations. The COVID-19 pandemic changed the working culture of nurse leaders, as they faced challenges that needed knowledge and skills beyond their previous management competence. IMPLICATIONS FOR NURSING MANAGEMENT: Additional training for nurse leaders in crisis management is needed. This training should reflect the competencies identified as necessary in crisis situations so that nurse leaders will be able to manage crisis situations effectively in future. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used in reporting the findings. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Nurse Managers' Professional Quality of Life During the COVID-19 Pandemic.

BACKGROUND: Health systems cannot effectively support nurse managers without understanding psychosocial effects of the COVID-19 pandemic. OBJECTIVE: The objective of this study was to describe the professional quality of life of frontline nursing management during the COVID-19 pandemic. METHODS: A cross-sectional online survey of 54 nurses in management positions at a large Midwest academic medical center during 2022 was conducted. Participants completed an electronic survey including demographics, Professional Quality of Life Measure Version 5, and items assessing past consideration of and future intent to leave their position, organization, or profession. RESULTS: Most participants had previously considered changing roles (80%) or leaving the organization during the pandemic (76%). Fewer respondents reported that changing role (24%) or organization (20%) was likely during the upcoming 6-12 months. Most participants scored in moderate ranges of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress scales (85%, 89%, and 74%, respectively). Higher Compassion Satisfaction was associated with extreme unlikelihood of leaving for an internal non-management role. Higher Burnout scores were associated with more time working and past consideration or future likelihood of leaving for an external non-nursing position. Secondary Traumatic Stress scores were higher for nurse managers and house operation managers than assistant nurse managers and associated with past consideration of moving to an internal non-management role or external non-nursing position and future likelihood of moving to an external non-nursing position. CONCLUSIONS: Nurse management occupies a demanding position between frontline staff needs and administrative requirements, profoundly impacted by COVID-19. Health care researchers, administration, and policymakers must learn how to support, retain, and sustain nursing management in a post-pandemic world.

Acute care nurse managers' definitions of and barriers to well-being: A thematic analysis of open-ended survey questions.

BACKGROUND: During the COVID-19 pandemic, acute care nurse managers functioned in a critical role by helping to advance the mission and goals of their organization while navigating a rapidly evolving healthcare landscape. This resulted in high levels of ongoing job-related stress which is linked to negative physical, psychological, and job-related outcomes. Little is known about the perceptions regarding their own professional well-being during this time. AIM: The aim of this study was to qualitatively describe acute care nurse managers' perceptions of and barriers to their professional well-being. METHODS: Using a qualitative descriptive approach, nurse managers from a hospital system in the southwestern United States responded to two short-answer, survey-based questions in 2022: (1) "Describe the definition of nurse-manager well-being in your own words" and (2) "What do you feel is your biggest barrier to professional well-being?" Reflexive thematic analysis was utilized to analyze participant responses (N = 80). RESULTS: Professional well-being is a complex concept influenced by the nurse manager's ability to navigate work-life balance; care for their own physical, emotional, and spiritual selves; give and receive support from stakeholders; and manage feelings of thriving vs. struggling in the role. Barriers most cited as influencing well-being included having too little time to get things done coupled with increasing workloads, feeling stuck in the middle among stakeholders, and coping with ongoing staffing challenges. LINKING EVIDENCE TO ACTION: The definition of and barriers to well-being are influenced by the specific needs and experiences of the nurse manager. While not all barriers can be immediately removed, the identification of individual and organization-specific barriers needs to be taken seriously, reviewed by those who can promote change, and evidence-based solutions for improvement piloted or implemented when feasible.

Toxic leadership and its relationship with outcomes on the nursing workforce and patient safety: a systematic review.

PURPOSE: This study aims to appraise and synthesize evidence examining the effects of toxic leadership on the nursing workforce and patient safety outcomes. DESIGN/METHODOLOGY/APPROACH: This is a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases (SCOPUS, PubMed, Web of Science, CINAHL and Psych INFO) were searched to identify relevant articles. Two independent researchers conducted the data extraction and appraisal. A content analysis was used to identify toxic leadership outcomes. FINDINGS: The initial literature search identified 376 articles, 16 of which were deemed relevant to the final review. Results of the content analysis identified 31 outcomes, which were clustered into five themes: satisfaction with work; relationship with organization; psychological state and well-being; productivity and performance; and patient safety outcomes. Seven mediators between toxic leadership and five outcomes were identified in the included studies. PRACTICAL IMPLICATIONS: Organizational strategies to improve outcomes in the nursing workforce should involve measures to build and develop positive leadership and prevent toxic behaviors among nurse managers through theory-driven strategies, human resource management efforts and relevant policy. ORIGINALITY/VALUE: The review findings have provided modest evidence suggesting that working under a leader who exhibits toxic behaviors may have adverse consequences in the nursing workforce; however, more research examining if this leadership style influences patient safety and care outcomes is warranted.

Structural and Psychological Empowerment of Learners Enrolled in Continuing Nursing Leadership Education in Finland: A Quasi-Experimental Longitudinal Study.

BACKGROUND: This study was conducted to assess structural and psychological empowerment among learners enrolled in a continuing leadership education program. Although the number of nurse leadership development interventions has increased, there is little evidence on how they influence leaders' empowerment. METHOD: A longitudinal study was employed, with learners (N = 85) enrolled in a continuing leadership education program as the participants. Data were collected in the beginning, at the end, and 8 months after the completion of the program using internationally validated instruments. Data were analyzed statistically. RESULTS: A total of 25 learners (29%) responded to the questionnaire at all three data collection points. The education significantly increased psychological and structural empowerment across all dimensions except formal power. These increased levels of empowerment were partially sustained at the 8-month follow-up time point. CONCLUSION: Continuing education seems to benefit nurse leaders, and the continuing nursing leadership education program was positively associated with learners' perceived empowerment. [J Contin Educ Nurs. 2023;54(10):462-471.].

Nurse managers' experience during the COVID-19 pandemic in China: A qualitative study.

AIMS: The aim of the study was to explore the experiences of female new nurse managers during the COVID-19 pandemic. DESIGN: This was a phenomenological study, and qualitative descriptive analysis was used. METHODS: New nurse managers were defined as new nurse managers with less than 3 years of management experience in this study. During November and December of 2021, 18 female new nurse managers were interviewed face-to-face with a semi-structured interview guide in three municipal hospitals. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for evaluating qualitative research reports. Data analysis was performed using Colaizzi's seven-step method. RESULTS: Four main themes and 10 sub-themes were extracted from the collected data. The four major themes were as follows: (1) a shift in stress; (2) work-related physical and psychological discomfort; (3) reflection on the cause; (4) coping and struggles. CONCLUSIONS: New nurse managers were experiencing great stress and exhaustion in their roles. It is important that they are helped to handle situations. Providing them with readily accessible support, addressing their psychosocial needs and addressing exhaustion is necessary. Considering their short management time, the hospital should provide adequate support in human, financial and material areas and provide training to help new nurse managers better adapt to their new roles. In addition, nurse directors should create a culture of mutual respect, identify workplace bullying and create a harmonious and cooperation-oriented work environment for new nurse managers. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Exploring the role of the nurse unit manager in forensic mental health inpatient units: A qualitative study.

Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting.

Well-being in acute care nurse managers: A risk analysis of physical and mental health factors.

BACKGROUND: Nurse managers have experienced tremendous stress during the COVID-19 pandemic, contributing to negative psychological outcomes. Positive professional well-being is a construct that can be promoted to mitigate poor psychological outcomes and burnout in nurses. Little is known about the health, healthy behaviors, effects of stress on homelife, and well-being of nurse managers in the United States (U.S.). AIMS: The aims of the study were to explore nurse managers' well-being related to self-reported stress and health perceptions and habits. METHODS: A sample of 80 (41% response rate) nurse managers responded to a cross-sectional web-based survey sent via email in a southwestern U.S. 13-hospital system. Nurses answered 39 quantitative questions about demographics, well-being (9-item Well-Being Index [WBI]), perceptions of stress affecting homelife, and perceptions of health and health-related behaviors. RESULTS: Mean WBI (2.9 [2.7]) indicated risk for poor psychological outcomes. Managers (75%) reported stress from work affected their personal lives and a decline in overall health during the pandemic. Most (80%) reported burnout and emotional problems. Nurse managers had 8.1 times increased risk of poor WBI scores if stress from work affected their personal life than if they reported no spillover stress into their personal life (OR = 8.1, 95% CI [2.6, 25.0]). LINKING EVIDENCE TO ACTION: Findings from this study add a nuanced understanding of nurse managers' well-being. The strongest risk factor for poor WBI scores was stress levels affecting personal life. Interventions to improve well-being in nurse managers are needed. Limitations are the convenience sampling, limited geographic location, and response rate of <50%. Further research is needed to support nurse managers in stress reduction and development of boundaries that prohibit the spillover effect of workplace stress. Organizations may consider a combination of administrative support and changes as well as provision of on-the-job training of interventions that support individual well-being.

How do work-life balance programmes influence nurses' psychological well-being? The role of servant leadership and learning goal orientation.

AIMS: Our study aims to investigate the effect of work-life balance programmes on Chinese nurses' psychological well-being, directly and indirectly, via learning goal orientation. Our research also aims to investigate the moderating role of servant leadership, a holistic leadership style that prioritizes serving employees, in the association between work-life balance programmes and psychological well-being. DESIGN: A questionnaire-based, time-lagged study (1-week interval). METHODS: From September 2022 to October 2022, we collected a total of 211 matched and valid responses from nurses working for hospitals in Jiangsu Province, China. Data regarding work-life balance programmes, servant leadership, learning goal orientation and psychological well-being were gathered using a survey administered in two waves, 1 week apart. We utilized the PROCESS Model 5 to test the moderated mediation model. RESULTS: Work-life balance programmes significantly improved nurses' psychological well-being. Moreover, learning goal orientation mediated the relationship between work-life balance programmes and psychological well-being. However, servant leadership did not moderate the association between work-life balance programmes and psychological well-being. CONCLUSION: Our study contributes to extant nursing literature by attending to the organizational strategies that promote psychological well-being. This study is novel because it evaluates the mediating and moderating process through which work-life balance programmes improve nurses' psychological well-being. IMPACT: The provision of work-life balance programmes could enhance learning goal orientation, resulting in possible improvement in nurses' psychological well-being. Moreover, servant leadership styles may contribute to psychological well-being. Our study can help nurse managers enhance their organizational strategies (e.g. work-life balance programmes) and leadership resources (e.g. servant leadership styles) to address nurses' well-being issues. PATIENT OR PUBLIC CONTRIBUTION: This paper addresses the United Nations' Sustainable Development Goal 3 regarding 'Good Health and Well-being'.

Workplace social capital mediates the relationship between authentic leadership and three dimensions of organizational commitment of hospital nurses: A cross-sectional study.

AIM: This study aimed to examine the mediating effect of workplace social capital on the relationship between authentic leadership and the three dimensions of organizational commitment: affective, normative, and continuance. METHODS: In January 2019, anonymous self-reported questionnaires were distributed to 1220 nurses working in the general wards of two university hospitals in Japan. Structural equation modeling was used to examine the mediating effects of workplace social capital on the relationship between nurse managers' authentic leadership and the three dimensions of organizational commitment. RESULTS: Six hundred and fifty-nine data points were analyzed (valid response rate = 54.0%). Participants' average age was 28.6 years (standard deviation: 6.6), and 93.3% were female. The mediation indirect effect of workplace social capital between authentic leadership and organizational commitment was statistically significant in the models of affective organizational commitment and normative organizational commitment, but not in the model of continuance organizational commitment. CONCLUSIONS: The effects of authentic leadership and workplace social capital had different impacts on each of the three dimensions of organizational commitment. Nurse managers' authentic leadership and workplace social capital can enhance nurses' positive commitment to the organization.

The effect of talent management on the job satisfaction and organizational commitment of nurses.

AIM: To determine the effect of talent management on job satisfaction and organizational commitment of nurses and the mediating role of job satisfaction. BACKGROUND: Talent management plays a critical role in attracting, developing, and retaining nurses and is effective in the formation of job satisfaction and organizational commitment. METHODS: This correlational study sample consisted of 482 volunteering nurses who were selected through a convenience sampling method. Data were collected using an information form, the Talent Management Scale, the Minnesota Satisfaction Questionnaire, and the Organizational Commitment Scale. The data were analyzed using descriptive statistics, Pearson correlation analysis, single linear regression, and hierarchical regression analysis. The Baron and Kenny model was used to determine the mediation effect. FINDINGS: Talent management affected the intrinsic, extrinsic subdimensions of job satisfaction and the total score and the affective commitment, normative commitment, and continuance commitment significantly and positively. Job satisfaction had a full mediating role in the effect of talent management on affective commitment and continuance commitment and a partial mediating role in affecting normative commitment. CONCLUSION: Talent management in organizations can increase nurses' job satisfaction and organizational commitment and nurses' job satisfaction can play a mediating role in the effect of talent management on organizational commitment. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study demonstrates that nurse managers and decision-makers should adopt talent management practices in nursing. Desired results such as nurses' job satisfaction and organizational commitment can be achieved by focusing on the development of nurses' talents.

Perceptions of public health nursing Team Leaders (TLs) and Team Supervisors (TSs) on nurse's development in Fiji.

BACKGROUND: Nurse team leaders are responsible for contributing to managing the quality of service delivery and facility output of their nurses to ensure there is a high quality of care delivered by the health system. This study aimed to explore the perceptions of public health nursing Team Leaders (TLs) and public health nursing Team Supervisors (TSs) on nurses' development in Fiji. METHODS: A qualitative study was used to gather information using in-depth phone interviews among TLs and TSs comprising Chief Midwifery Nursing Officer (CMNO), Director of Nursing (DON), Sub-divisional Nursing Managers (SDNMs), acting SDNMs and Nursing Manager (NM) at Central health division in Fiji. The data was collected through semi-structured open-ended questionnaires and were audio recorded. The data was analyzed using manual thematic analysis process. RESULTS: The study comprised of 26 participants, which included 10 TSs and 16 TLs. Four themes were identified for the results amongst TSs and TLs: ethical development; professional development; psychological development; and recommendations. However, nine sub- themes were identified for TSs and eight sub-themes were identified for the result amongst TLs. CONCLUSION: This study highlighted that TLs and TSs elaborated on the need for the ethical, professional, psychological development, nursing development and also on the importance of policies and guidelines. Professional ethics should be integrated into the Continuous Profession Development (CPD) points that are used to renew yearly nursing licenses as well as exposing the need for having competencies on professional ethics in nurses' logbooks. Further research is needed to determine the in-depth barriers.

A mixed-methods pilot study of a psychoeducational group programme for nurse managers during the COVID-19 pandemic.

AIM: This mixed-methods pilot study aimed to measure the feasibility and acceptability of a psychoeducational group programme and determine its impact on mental well-being. BACKGROUND: The programme was developed to promote self-care, growth and adaptive coping for nurse managers. The programme themes were resilience, insight, self-compassion and empowerment. METHODS: The sample included 19 hospital-based nurse managers. Outcomes included post-traumatic growth, resilience, insight, self-compassion, empowerment, perceived stress, burnout and job satisfaction. Paired samples t tests were conducted to compare outcomes at baseline to follow-up. Qualitative interviews were conducted. Thematic analysis was used to code the qualitative responses by keyword, which were then aggregated into themes. RESULTS: Participants reported higher post-traumatic growth and psychological empowerment after the intervention. The following six themes emerged most consistently from the qualitative interviews: feasibility of the programme, benefits of peer support, sources of stress, barriers to self-care, sources of strength and sustainability of effects. CONCLUSIONS: The results support the acceptability and feasibility of the psychoeducational group programme. IMPLICATIONS FOR NURSING MANAGEMENT: Health care organizations can support and promote the implementation of programmes to alleviate burnout and improve mental well-being amid the complex demands of nursing management (ClinicalTrials.gov: NCT04987697).

Exploring the working environment of Hospital Managers: a mixed methods study investigating stress, stereotypes, psychological safety and individual resilience.

BACKGROUND: Hospital managers are responsible for the delivery of organisational strategy, development of clinical services and maintaining quality standards. There is limited research on hospital managers, in particular how stress manifests and impacts managers and the presence of individual resilience. Managers must work closely with clinical colleagues, however these relationships can be hindered by the perception of stereotyping and differing priorities. This study aimed to explore the working environment of hospital managers, focusing upon the unique stresses faced, psychological safety and the presence of resilience. METHODS: This study utilised mixed methodology using an embedded approach. Participants were purposively recruited from all levels of hospital management within one National Health Service Trust in London, United Kingdom. An exploration of managers experiences was undertaken using semi-structured qualitative interviews. Psychological safety and individual resilience were additionally assessed using validated surveys. Qualitative data were analysed iteratively using inductive thematic analysis, and triangulated with quantitative data. Kruskal-Wallis statistical analysis was performed to evaluate differences in resilience and psychological safety according to seniority and background experience. RESULTS: Twenty-two managers were recruited and interviewed, with 20 returning completed surveys. Key findings from the thematic analysis included the importance of good working relationships with clinical colleagues, the persistence of some stereotyping, and feeling unsupported in times of challenge. Stresses described included the bureaucracy involved when delivering change, conflict with colleagues and target driven expectations. Participants described their own psychological safety as lower than desired, supported by quantitative data; but recognised its importance and strived to create it within their own teams. Sixteen participants had 'normal' scores for resilience, with senior managers more likely to have higher scores than those more junior (p=0.011). CONCLUSION: Positive working relationships, high psychological safety and individual resilience are important for organisational safety and individual wellbeing. Our data illustrate unique stressors faced by hospital managers, provide detail on sometimes challenging working relationships, and demonstrate scope to improve both the psychological safety and resilience of those in managerial positions. A map for senior healthcare leaders was constructed, facilitating the identification of modifiable areas within their organisation to promote good working relationships and improve the working environment of hospital managers.

Does transformational leadership and psychological empowerment improve nurses' innovative behaviour during COVID-19 outbreak? A cross-sectional study.

AIMS: To investigate the relationships between transformational leadership, psychological empowerment and innovative behaviour among nurses in China. BACKGROUND: The innovative behaviour of nurses is important to adapt to the changing medical environment. However, there is currently a limited understanding of the relationship between nurses' innovative behaviour and transformational leadership and psychological empowerment during the pandemic. METHODS: Convenience sampling was used to conduct an investigation involving 1317 nurses from 10 hospitals in China from January 2022 to April 2022. Data analysis was performed using correlation analysis, univariate analysis and multiple regression analysis. The STROBE checklist was followed when writing this manuscript. RESULTS: High transformational leadership and high psychological empowerment were associated with high innovative behaviour. The results of the multiple linear regression analysis showed that physical condition, whether or not you have attended academic conferences or whether or not you have participated in fund research projects, transformational leadership and psychological empowerment were the main factors on nurses' innovative behaviour, together explaining 64.5% of the total variance. CONCLUSION: Promotion of transformational leadership and psychological empowerment is vital for nurses to promote innovation, thereby meeting the urgent demand for innovative nurses and the rapid development of nursing disciplines. IMPLICATIONS FOR NURSING MANAGEMENT: This study highlights the importance of transformational leadership in developing nurses' innovative behaviours. Understanding the role of psychological empowerment can help nurse managers formulate relevant intervention strategies and cultivate nurses' innovative behaviour.

Nurse managers' burnout and organizational support: The serial mediating role of leadership and resilience.

AIMS: To investigate the relationship between organizational support and nurse managers' burnout and the serial multiple mediating effects of leadership and resilience. BACKGROUND: Nurse managers are at a high risk of burnout, especially during the COVID-19 pandemic. However, no research has been done to examine the associations between nurse managers' organizational support, leadership, resilience and burnout. METHODS: This cross-sectional study recruited 458 nurse managers from 13 tertiary public hospitals in Jiangsu, China. They completed the Survey of Perceived Organizational Support, the Clinical Leadership Survey, the Resilience Scale and the Maslach Burnout Inventor-Human Service Survey. The serial mediating effect of individual leadership and resilience was estimated using the structural equation modelling method via Mplus 7.0. RESULTS: There were direct and indirect effects of organizational support on burnout, controlling for work variables. Leadership and resilience serially mediate the association between organizational support and burnout (ß = -.051, 95% confidence interval: -0.093 to -0.020). CONCLUSIONS: Among nurse managers, organizational support may be sequentially associated with improved leadership first and then resilience, which in turn is related to decreased burnout. IMPLICATIONS FOR NURSING MANAGEMENT: We recommend that hospital administrators incorporate leadership, resilience and burnout assessment in the routine psychological screening of nurse managers and creatively apply the organizational interventions to decrease nurse managers' burnout.

Nurse leaders' work-related well-being-Relationships to a superior's transformational leadership style and structural empowerment.

AIMS: To describe how nurse leaders' work-related well-being is related to a superior's transformational leadership style and structural empowerment. BACKGROUND: The demanding role of nurse leader means that these professionals experience emotional exhaustion and challenges with work-life balance. They can also be influenced by the leadership style of their own superiors. METHODS: A cross-sectional questionnaire using two internationally validated scales, namely, the Transformational Leadership Scale and Conditions For Work Effectiveness Questionnaire-II, was used. Statistical methods were applied during data analysis. RESULTS: A total of 155 nurse leaders participated completed the questionnaire. The participants' work-related well-being scores ranged from 8 to 10. The participants felt that their superiors employ transformational leadership. The dimension of feedback and rewards received the lowest scores, whereas the nurse leaders reported moderate overall empowerment levels. A nurse leader's work-related well-being was positively correlated with structural empowerment and their superior's leadership style. CONCLUSIONS: Despite the fact that nurse leaders reported relatively high levels of work-related well-being, more attention should be paid on the feedback and rewards and on the support of superiors as they positively influence the work-related well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Transformational leadership should be supported in organisations and through education as it strengthens work-related well-being and structural empowerment of nurse leaders.

The experience of moral distress by chief nurse officers during the COVID-19 pandemic: A descriptive phenomenological study.

AIM: The aim of this study is to explore the moral distress experiences of nurse officers during the COVID-19 pandemic. BACKGROUND: Moral distress has emerged as a challenge for nurses ad nurse leaders, revealing the need for health professionals and health care managers to examine, understand and deal with moral distress un Nurse leaders. METHODS: It is a descriptive phenomenological study that used content analysis. RESULTS: Thirteen chief/assistant nurse officers were interviewed, and four themes were identified: being a manager in the pandemic, situations that cause moral distress, effects of moral distress and factors that reduce moral distress. CONCLUSION: Faced with various expectations, such as the management of unusual and uncertain processes, and the management of the psychological responses of both employees and themselves, chief nurse officers struggled significantly to maintain their moral integrity and experienced moral distress during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Extraordinary situations such as pandemics have factors that led to moral distress for a Chief Nursing Officer (CNO). Health care systems in which nurse managers are excluded from decision-making processes have a traditional hierarchical structure that ignores CNOs professional autonomy, contributing to the development of moral distress. Therefore, CNOs should engage in self-reflection to recognize their own moral distress experiences, examine the existing health system to identify the factors that cause moral distress and take actions to implement changes to eliminate these factors. To cope with moral distress, CNOs should also improve their communication skills, team collaboration skills and the use of scientific knowledge and take responsibility in their managerial role.

The relationship between the political skills and negotiation behaviors of front-line nursing managers.

BACKGROUND: Frontline nursing managers must possess sufficient political skills to successfully navigate organizational structures and relationships and produce positive results in complex healthcare systems. AIM: This study explores the relationship between the political skills and negotiation behaviors of frontline nursing managers. METHOD: The researchers adopted a quantitative correlational methodology to conduct the study in two selected hospitals with 100 frontline nursing managers determined through convenience sampling. Political Skill Inventory and Negotiation Self-Assessment Inventory were used to assess the political skills of nurse managers and measure the behaviors that they rely on most readily during negotiations, respectively. RESULTS: The study sample had an average level of political skill and relied moderately on compromise during negotiations. There was a strong positive correlation between political skills, accommodation, and collaboration behaviors. Moreover, there was a strong negative correlation between political skills, avoidance, and competition. Further, there was a negative correlation between political skills and compromise behavior of negotiation. CONCLUSION: Although nursing managers used different negotiation behaviors at different degrees in different situations, they mostly relied on compromise during negotiation. Therefore, hospital administrators should work on improving frontline nursing managers' political skills to improve their negotiation behaviors.

Perceived impact of nurse turnover on the organization: A Delphi study on managers of nursing.

AIMS: The study aimed to identify the aspects and items of nurse turnover impact on organizations as perceived by nursing management. BACKGROUND: Turnover rate does not capture the extent to which an organization is affected by turnover. Another indicator is required to assess the control status of turnover impact. METHODS: A Delphi study was conducted in 2021, where 2670 managers of nursing at 712 hospitals were asked to complete the survey three times. Factor analysis was conducted on these items for which a consensus was reached. RESULTS: Overall, 232 managers who responded multiple times, including the third survey, were included in the analysis. Consensus was reached for 36 items affected by turnover and considered important for nursing management. Using exploratory factor analysis, the following six factors were extracted: quality of nursing care, physical and mental health of nursing staff, workload and working conditions of nursing staff, relationships among nursing staff members, sense of responsibility among nursing staff, and cost and benefit of hiring replacement personnel. CONCLUSIONS: Six factors consisting of 36 items were extracted that can be used to assess the impact of nurse turnover. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can assess the status of the organization more appropriately by understanding the factors that impact nurse turnover in vaious facilitites and look at strategies to overcome the impact on nurse staffing.