The Power of Resilience While Working to Change the Structures that Determine Health and Well-Being.

This article explores the power of resilience in helping nurse executive leaders who are working to effect change in structural determinants of health at direct care, interprofessional, organizational, and policy levels. It leverages research, literature, and personal experiences to outline techniques that can help leaders in health care overcome challenges. Specifically, it considers self-care, building relationships, seeking support, maintaining a positive attitude, and practicing mindfulness as critical to driving meaningful change.

I became a leader by coincidence: specialised nurses as leaders in the field of mental health and substance abuse.

PURPOSE: This study aims to examine nurses' motivation for leadership and explore important challenges nurses face in leadership positions. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews were conducted with 20 nurses in leading positions. Thematic analysis was used to analyse the data. FINDINGS: Nurse leaders are recruited from clinical settings, and the transition process from clinical nurse to leader is demanding. Their motivation for leadership seems to be in human values and caring for others. Lack of strategic focus might be a challenge. Nurses in leadership positions emphasize the importance of good relationships with the staff and require an increased focus on strategic leadership. RESEARCH LIMITATIONS/IMPLICATIONS: Studies have revealed the frustration associated with the role of a nursing leader. According to an evaluation of a clinical leadership development programme, nurses were found to be inadequately prepared for their roles. They had not experienced positive role models, they felt overwhelmed and they regarded colleagues and nursing management structures as unsupportive. There is a need for further research into effective measures to strengthen nurse managers. PRACTICAL IMPLICATIONS: The role of leaders has changed over time. There are now increasing requirements and objectives with regard to laws, action plans, improvement projects and cost-effectiveness. A nurse leader has both many tasks and great responsibility. Good leadership relies on skilled nurse leaders meeting statutory requirements in patient care and delivering good quality and patient-safe services. Engaging in process-oriented guidance, such as mentoring, is one way to become more aware of oneself as a professional leader (Mathena, 2002). ORIGINALITY/VALUE: By identifying and understanding the specific challenges that nurse leaders face, this study can contribute to the development of interventions and strategies to improve leadership practices, thereby enhancing organizational effectiveness.

Nurse Managers' Perceived Self-leadership Levels: A Cross-sectional Study.

OBJECTIVE: The aim of this study was to determine the perceived levels of self-leadership among nurse managers in the United States. BACKGROUND: Self-leadership is the ability to influence and engage oneself to be self-aware and responsible, and leverage strengths to perform. Despite benefits identified from extant literature, there are no studies on self-leadership among nurse managers in the United States. METHODS: A cross-sectional descriptive design was used. Eighty-eight nurse managers completed a survey using the Revised Self-Leadership Questionnaire. RESULTS: Nurse managers identified moderate levels of self-leadership; the strategies with the lowest scores were constructive thought strategies, self-reward behaviors, and visualizing performance. There was a relationship between age and the identified self-leadership levels. CONCLUSIONS: Further studies are needed to understand self-leadership among nurse leaders in the United States and beyond. There is an opportunity to increase nurse managers' self-leadership level by focusing on interventions to increase constructive thought pattern strategies, self-reward behaviors, and visualizing successful performance.

Toxic leadership, mental well-being and work engagement among nurses: a scale adaptation study and structural equation model approach.

PURPOSE: Although the background on positive and supportive leadership styles and their positive effects is constantly increasing, it is known that negative and destructive leadership styles are less researched. Thus, examining the toxic leadership behaviors of nurse managers and the effects of these on nurses has a critical significance. When the measurement tools evaluating toxic leadership are examined, it is seen that there is a need for measurement tools that evaluate the toxic leadership behaviors of nurse managers. This study's purpose is to psychometrically examine the Turkish version of the Toxic Leadership Behaviors of Nurse Managers (ToxBH-NM-TR) Scale and test the hypothesized conceptual model that includes the relationships between toxic leadership, mental well-being and work engagement. DESIGN/METHODOLOGY/APPROACH: This quantitative research was carried out in psychometric, correlational and cross-sectional design. A total of 559 nurses were included in the study by using the convenience sample method. The ToxBH-NM-TR Scale, Warwick-Edinburg Mental Well-Being Scale and Utrecht Work Engagement Scale (UWES) were used to measure the latent variables of the study. The data were collected between June and October 2020 with the online survey method. IBM SPSS Statistics 24 and Amos 21 statistical programs were used to analyze the data. FINDINGS: The scale-content validity index of the ToxBH-NM-TR was 0.88. Confirmatory factor analysis results showed that the fit indices were acceptable. The ToxBH-NM-TR had high internal consistency and temporal stability. In addition, the relationships between the latent variables of the study were in the expected direction and statistically significant (p < 0.001). The hypothesized conceptual model showed an acceptable or good fit to the data. Mental well-being partially mediated the relationship between toxic leadership and work engagement. The study showed that the ToxBH-NM-TR is a valid and reliable instrument and provided evidence that confirmed the hypothesized conceptual model. RESEARCH LIMITATIONS/IMPLICATIONS: The first of these is the fact that managers' toxic leadership behaviors were determined based on nurses' self-report. For this reason, participants' potential prejudices may have affected the results of the study. The second limitation concerns the data collection technique. Using face-to-face data collection techniques during the COVID-19 pandemic could create a danger/risk for the health of nurses, researchers and patients. Therefore, the nurses in this research were reached through an online survey on social media platforms. The participants of the study were limited to those who had access to social media. Finally, some socio-demographic and professional characteristics of the participants may be a confounding variable for the model. For this reason, this conceptual model needs to be validated on other samples in different countries to increase the generalizability of the research results. PRACTICAL IMPLICATIONS: The characteristics of this leadership style should be understood, and its effects on employees and organizations should be evaluated by screening regularly to prevent the development of toxic leaders and to eliminate the harmful effects of their behavior. The nurses should respond decisively to the forces that cause them to submit in order not to encourage a toxic leadership style. Healthcare institutions should develop procedures and take a proactive approach to destructive and negative leadership behaviors and practices. In addition, nurse managers should get feedback by using informal networks and 360-degree assessment tools and evaluate whether their leadership has a toxic function by regularly screening the effects of their leadership. ORIGINALITY/VALUE: The results of this study offer important implications for nurses, managers and healthcare institutions and can be useful in gaining awareness about the negative effects of a toxic leadership style. In addition, the study provides a valid and reliable scale that will enable the identification of managers with this leadership style to prevent the development of toxic leaders and eliminate the harmful effects of their behavior.

Identifying the predictors of turnover intention based on nurse managers' toxic leadership behaviors among nurses in Iran: a cross-sectional correlational study.

BACKGROUND: Unfavorable leadership practices are a growing concern in the field of healthcare and nursing that have adverse consequences on nurses' career outcomes. One of the undesirable leadership styles is the toxic leadership style. Considering the importance of nursing managers' leadership style and its impact on nurses' performance and the scarcity of studies in this field, the present study was conducted to determine toxic leadership behaviors in nursing managers and their relationship with the turnover intention among nurses. METHODS: A multicenter cross-sectional correlational study. This study involved 551 nurses from 5 educational-medical centers in Ardabil province, north-western Iran. Three self-report scales, including The demographic and occupational information form, the Toxic Leadership Behaviors of Nurse Managers Scale (ToxBH-NM), and the turnover intention questionnaire were adopted for assessment purposes in this study. Data were analyzed using SPSS (Version 22) software using descriptive statistics, Pearson correlation coefficient test, t-test, ANOVA test, and multiple linear regression analysis. RESULTS: Overall, 551 nurses participated in this research. There was a significantly positive relationship between Turnover intention and Toxic leadership behavior Subscales (r = 0.475, p < 0.001). Furthermore, multiple linear regression analysis showed Toxic leadership behavior Subscales (Intemperate behavior, Narcissistic behavior, Self-promoting behavior, and Humiliating behavior), Hospital, unit, Age, and Marital status predict Turnover intention when other variables are controlled. CONCLUSION: A leader who directly and indirectly adopts toxic behavior toward their employees destructively affects both individuals and organizations. Nurses who work for a manager exhibiting toxic leadership behaviors demonstrated higher turnover intention.

Organizational Supports for Nurse Managers in a North American Context: A Scoping Review.

Organizational support for nurse managers (NMs) is not a new phenomenon. However, generally speaking, NMs are not well supported in their roles. This lack of support is burdensome to NMs' role functioning and has impacts on NM recruitment and retention; NM job satisfaction; and outcomes for front-line nurses and patients. There is a gap in the nursing literature as to what supports are currently in place to effectively support NMs. A scoping review (n = 24) focusing on North American healthcare organizations was conducted to examine what organizational supports are currently in place to support NMs and highlight gaps. Arksey and O'Malley's (2005) scoping review framework was used for this review. NM supports are currently lacking; however, they do include orientation to the NM role; competency and professional development; ancillary and clinical support; and support from upper management. The implications for nursing leadership related to organizational supports and gaps in supports for NMs are presented. Healthcare organizations have work to do in order to better support NMs and ensure quality work environments that facilitate the successful functioning of NMs at all stages of their career.

Developing Leaders and Fighting Burnout: An Interview With Sharon Pappas.

This year, Sharon Pappas, PhD, RN, NEA-BC, FAAN, Chief Nurse Executive (CNE) at Emory Healthcare (EHC), Atlanta, Georgia, received the American Organization for Nursing Leadership (AONL) prestigious Lifetime Achievement Award, which honors an AONL member recognized by the nursing community as a significant leader in the nursing profession and who has served AONL in an important leadership capacity. As CNE of Georgia's largest healthcare system, she leads and supports a Magnet® nursing culture across EHC, with the goal of achieving Magnet designation for the entire EHC system. Dr Pappas was commended for her leadership in leading the EHC incident command during COVID-19 where she focused on providing exceptional patient care and supporting clinical nurses caring for critically ill patients.

Recommendations From a Systematic Review of Leadership Development to Support a New Nursing Practice Model.

OBJECTIVE: To develop a new nursing practice model for use within the US military, researchers aimed to create evidence-based recommendations for nursing leadership development based on current literature. BACKGROUND: The role of nursing leadership has many implications, including better nurse and patient outcomes. Therefore, an actionable compilation of recommendations informing how to develop effective nurse leaders could be helpful for current and aspiring nurse leaders. METHODS: Researchers conducted a systematic literature review of 5 databases searching for relevant articles published from 2001 to 2020. RESULTS: Seventy-eight articles were synthesized to develop a list of 5 broad yet actionable recommendations for leadership development. CONCLUSIONS: Leadership development is essential for current and future nurse leaders. The recommendations identified from this review can assist in developing leaders. Leaders can use these recommendations to guide leadership training initiatives, engage in self-development, or begin succession planning.

Examining the Nurse Manager Practice Environment Effects on Burnout: Results of a Cross-sectional Multisite Study.

OBJECTIVE: This study examined the relationships between the dimensions of the nurse manager (NM) practice environment (PE) and burnout. BACKGROUND: NMs are critical to the success of their unit(s). Understanding the degree to which their PE characteristics impact their level of burnout is important to NM retention. METHOD: A cross-sectional research design using a 71-item questionnaire was used to measure NM characteristics, hospital characteristics, NM PE, and burnout. There were 110 completed respondents across 22 hospitals in the United States. RESULTS: Moderate inverse relationships exist between the NM PE and 2 of the 3 (work and personal) dimensions of burnout. NM age and tenure also showed an inverse relationship with burnout. CONCLUSIONS: This study added evidence showing a statistically significant relationship between NM PE and the work and personal dimensions of burnout. These results also suggest the relationships NMs have with the patients on their unit(s) do not add to their level of burnout.

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.

Educational intervention in social skills for Primary Care nurses.

OBJECTIVE: to assess an educational intervention on social skills for nurses who work in Primary Health Care. METHOD: a qualitative research-intervention study, carried out in the municipalities covered by the 17th Health Regional of Paraná. It was developed in three interrelated stages: exploratory, where meetings were held with the managers to define the groups and logistics for running the course; intermediate, developed in meetings with different groups of nurses, addressing selected topics; assessment, in which the nurses developed a personal plan to improve their social skills. RESULTS: participants were 57 nurses who acted as coordinators of Primary Care. They considered the educational intervention in social skills fundamental for positive changes in their professional performance. FINAL CONSIDERATIONS: the educational intervention in social skills was assessed as an important strategy to strengthen the development of nurses' managerial and care skills.

Nursing and midwifery research priorities for Kenya: Results from a national Delphi survey.

BACKGROUND: The International Council of Nurses and the World Health Organization have prioritized evidence-based nursing and midwifery practice derived from nurse-led research. However, in a low-resource country like Kenya, there is a need to identify research priorities to optimize utilization of limited existing research infrastructure and funding. Kenya lacks a nursing and midwifery research strategy to guide research prioritization. INTRODUCTION: The goal of this study was to identify and describe nursing and midwifery research priorities for Kenya. METHODS: A cross-sectional Delphi survey using two iterative rounds of electronic data collection was used to reach a consensus about priorities for nursing and midwifery research in Kenya. NVivo-12 was used to analyze the qualitative data to identify categories, sub-themes, and themes; descriptive statistics were used to analyze quantitative data. RESULTS: Participants included 159 nurse managers, administrators, and educators representing regional, county, and national referral, private, and faith-based hospitals, nurse training schools, research institutions, and nursing organizations in Kenya. Staffing challenges, motivation, remuneration, and funding for higher education were ranked as the top critically important issues using a cutoff point of ≥ 70% agreement. CONCLUSION: There is a need for the development of a National Framework for Nursing and Midwifery Research Priorities in Kenya to guide research that builds excellence in meeting nursing and midwifery human resource concerns and ultimately improves patient care practices and outcomes. IMPLICATIONS FOR NURSING AND NURSING POLICY: The objective of Kenya's health goals delineated within three key national health documents cannot be attained without adequate numbers of nursing and midwifery professionals and policies that address nursing and midwifery staffing challenges, remuneration for employment, and improved funding for higher education.

Embracing Possibilities and Change With a Relational Approach to Leadership: An Interview With Kay Kennedy.

In this column, Kay Kennedy, DNP, RN, NEA-BC, CPHQ, chief executive officer for Leadership, LLC, shares how her career journey and the relationships that she built along the way led to a contemporary nursing leadership theory called Human-Centered Leadership.

A Visionary Think Tank to Address the Nursing Workforce Crisis.

The COVID-19 pandemic exacerbated an existing problem plaguing hospital systems across the United States: a nursing workforce shortage. This article describes how one institution applied the American Organization for Nursing Leadership Nurse Executive Competencies to convene an immersive think tank to reimagine the nursing workforce.

An Innovative Assistant Nurse Manager Residency Program Focused on Participation, Satisfaction, Promotion, and Retention.

Assistant nurse managers (ANMs) were asked what they needed to be successful, fully engaged, and equipped to perform in their roles. The ANM Residency Program was created to support development of new ANMs through resources, education, and mentoring. Evaluations were used to guide curriculum enhancements and improve course facilitation. Participation, satisfaction, promotion, and retention were measured. Similar programs may be used to support development for all levels of nurse leaders.