The components of strategic leadership competencies of chief nurse executives in private hospitals in Thailand.

AIM: To determine the components of the strategic leadership competencies of chief nurse executives. BACKGROUND: The nursing executives are currently required to have strategic competencies including a strategic vision, a capability to inspire nursing staff to use their maximal potentials for the highest benefits of the organisation. METHODS: This research was mixed methods with phenomenology qualitative design and factor analysis. The samples consisted of 253 nurse executives from 65 private hospitals in Thailand. The content validity test was at 0.91, and the reliability was at 0.91. The data were analysed using content analysis and confirmatory factor analysis. RESULTS: There were 7 components of the strategic leadership with 75 competencies with factor loadings as follows: strategic-innovative thinking and planning (0.89), developing today's and tomorrow's leaders (0.89), relating the parts to the whole (0.82), building partnership (0.78), making it happen (0.78), corporate spirit (0.73) and giving direction (0.66). CONCLUSION: The new knowledge was 7 components with 75 competencies particularly the top 3 components for developing nurse executives in strategic thinking and innovation of nursing management to become strong leaders of today and tomorrow. IMPLICATIONS FOR NURSING MANAGEMENT: These findings contribute to leadership development for chief nurse executives in possessing the administrative capability and leadership attributes.

Reflections from a System Chief Nursing Executive: Intention to lead.

The integration and utilization of Chief Nurses (CNs) to lead and support complex health systems and health workforce optimization in governments, nongovernmental organizations, and across all health and social sectors is of paramount importance. At a time when the global nursing profession is challenged with a strained workforce and a growing leadership gap, it is essential that we examine and pay attention to the importance of the CN role. To attain universal health coverage, sustainable development goals, and global health, the need for the right number and a well-prepared nursing workforce is evident. While nursing recruitment and retention are key for system sustainability, it requires the right governance, leadership, infrastructure, and resources. A System CN can lead, advise, and impact the success of the nursing workforce in collaboration with senior leadership teams. At this time of major health challenges, too many health and social systems, both at government and nongovernmental levels, do not have a CN at all, or the role is delegated to a staff position with limited ability to impact the system on the local, regional, national, and global scale. Recruitment and investments targeting CNs are required to resuscitate, stabilize, and invigorate knowledgeable leaders who can transform, inspire, and maximize nursing contributions to assure access and quality healthcare. My personal and professional CN journey is highlighted here as an illustration for nurses who lead formally and informally, as they contemplate their own current and future ambitions and contributions.

Barriers and facilitators of care for diverse patients: Nurse leader perspectives and nurse manager implications.

OBJECTIVE: To examine chief nurse executives' perspectives on: (1) the provision of culturally and linguistically appropriate services in hospitals and (2) to identify barriers and facilitators associated with the implementation of culturally and linguistically appropriate services. BACKGROUND: Hospitals continue to face challenges providing care to diverse patients. The uptake of standards related to culturally and linguistically appropriate services into clinical practice is sluggish, despite potential benefits, including reducing health disparities, patient errors, readmissions and improving patient experiences. METHOD: A qualitative study with chief nurse executives from one eastern United States (US). Data were analysed using content analysis. RESULTS: Seven themes emerged: (1) lack of awareness of resources for health care organisations; (2) constrained cultural competency training; (3) suboptimal resources (cost and time); (4) mutual understanding; (5) limited workplace diversity; (6) community outreach programmes; and (7) the management of unvoiced patient expectations. CONCLUSIONS: As the American population diversifies, providing culturally and linguistically appropriate services remains a priority for nurse leaders. Being aware and utilizing the resources, policies and best practices available for the implementation of culturally and linguistically appropriate services can assist nursing managers in reaching their goals of providing high quality care to diverse populations. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are key in aligning the unit's resources with organisational goals related to the provision of culturally and linguistically appropriate services by providing the operational leadership to eliminate barriers and to enhance the uptake of best practices related to culturally and linguistically appropriate services.

Stress and resilience in a post-Francis world - a qualitative study of executive nurse directors.

AIMS: The aim of this study was to explore the role stressors experienced by executive nurse directors and strategies employed to maintain resilience. BACKGROUND: Recent financial pressures on and care quality scandals in the UK NHS impact on the work of executive nurse directors. The short length of tenure and the high number of vacancies for these posts point to the exacting demands of the role and raise questions about the support mechanisms available for the most senior nurses in NHS organizations. DESIGN: A grounded constructivist study. METHODS: Semi-structured telephone interviews conducted between February-July, 2014. RESULTS: Stressors were both chronic (workload, lack of corporate responsibility for quality, reductions in quality team staffing, tensions between financial solvency and care quality and personal vulnerability) and acute (dealing with complaints and major incidents). Resilience required the support of fellow executives, peers, family and mentors and could be enhanced by self-discipline, good preparation for the post and ongoing coaching. CONCLUSION: Recent fiscal austerity and scandals relating to quality of care have increased pressure on executive nurse directors. Increasing size of organizations, limited resources devoted to quality combined with poorly defined limits of responsibility are all major stressors and executive nurse directors, both in the United Kingdom and internationally, need clear strategies to maintain resilience. Repetitive demands for data by oversight organizations may detract from more important quality assurance strategies.

Searching for ethical leadership in nursing.

BACKGROUND: Attention to ethical leadership in nursing has diminished over the past several decades. OBJECTIVES: The aim of our study was to investigate how frontline nurses and formal nurse leaders envision ethical nursing leadership. RESEARCH DESIGN: Meta-ethnography was used to guide our analysis and synthesis of four studies that explored the notion of ethical nursing leadership. PARTICIPANTS AND RESEARCH CONTEXT: These four original studies were conducted from 1999-2008 in Canada with 601 participants. ETHICAL CONSIDERATIONS: Ethical approval from the original studies covered future analysis. FINDINGS: Using the analytic strategy of lines-of-argument, we found that 1) ethical nursing leadership must be responsive to practitioners and to the contextual system in which they and formal nurse leaders work, and 2) ethical nursing leadership requires receiving and providing support to increase the capacity to practice and discuss ethics in the day-to-day. DISCUSSION AND CONCLUSION: Formal nurse leaders play a critical, yet often neglected role, in providing ethical leadership and supporting ethical nursing practice at the point of patient care.

Predictors of Leadership Competencies Among Nurse Executives in the Kingdom of Saudi Arabia.

Background: Awareness and development of nurse executives' leadership competencies has been considered a key strategy for the success of healthcare organizations. However, only a few studies about nurse executives' leadership competencies are available in the literature, and no study has been conducted about the topic within Saudi Arabian context. The aim of this study was to assess the leadership competencies of nurse executives and the predictors of these competencies. Methods: This quantitative study used a descriptive, cross-sectional, and correlational design. The study recruited a total convenience sample of 136 nurse executives who voluntarily consented to participate. The respondents self-rated the online survey, "Leadership Competency Assessment Tool: Self-Assessment." Data collection was conducted between September 2022 and November 2022. Test of correlation and multiple regression analyses were conducted. Results: The overall mean score of nurse executives' leadership competencies was 3.38 out of 5.0, which was below the level of having excellent leadership competencies. Four dimensions had mean scores below the level of having excellent leadership competencies, namely, communication and relationship building (3.48), knowledge of the healthcare environment (3.29), leadership (3.45), and business skills (3.15), while nurse executives had excellent leadership competencies only in the professionalism dimension (3.51). Age (p=0.04), highest educational attainment (p=0.01), current role (p<0.01) and length of experience (p=0.02) as nurse executive, monthly salary (p=0.03), nationality (p=0.04), and having seminars/trainings in leadership and management (p=0.01) were considered predictors of the leadership competencies of nurse executives. Conclusion: Nurse executives reported a low level of leadership competencies, thus implying necessary actions for improvement. There were personal factors that influenced the level of nurse executives' leadership competencies. To achieve quality outcomes and maintain a high level of nursing care in hospital organizations, these findings must be considered in planning strategies related to the improvement of the leadership competencies of nurse executives.

Chief Nurse Executives involuntary turnover in times of health care reforms: Findings from an interpretative phenomenology study.

In recent years, due to several health care system reforms in different countries, an increased involuntary turnover rate of Chief Nurse Executives has been reported around the World. However, no data on their perceived experience of their dismissal have been documented up to now in the European context. Describing the experience of involuntarily dismissed Chief Nurse Executives was the main aim of this interpretative phenomenological study. Data were collected through face-to-face audiotaped interviews performed by involving a purposeful sample of 13 Chief Nurse Executives; data analysis was performed by using the QSR NVIVO 11 software. The Chief Nurse Executives' experience of Being fired is characterized by three main themes: (1) "Health Care Institutions are places influenced by political turbulences"; (2) "My competence and presence in the arena is despised by a range of strategies"; and (3) "Transiting from darkness to light". According to their experience, the reason for dismissal was due to changes in the political climate and the introduction of a new chief executive officer; moreover, Being fired caused a deep pain similar to that experienced during bereavement. In some socio-political contexts, the political climate can influence the role of a Chief Nurse Executive: political membership, whether implicit or explicit, is considered of great value. In other contexts, the Chief Nurse Executives' value is based on professional competences and achieved outcomes. At times of changes in the political climate, the peculiarities of the specific socio-political context should be evaluated as to whether one should anticipate his/her resignation or not.

Turnover Intention Among Nurses in Nurse Managers, Directors, and Executives: Developing a Tool for Measuring Environmental Factors.

BACKGROUND AND PURPOSE: Turnover among nurse managers, directors, and executives is associated with staff nurse retention and patient outcomes. The purpose of this article is to describe the development of an instrument to evaluate factors associated with intent to leave among these leaders within acute care facilities. METHODS: The Nurse Leader Environment Support Survey (NLESS) was developed and evaluated using exploratory factor analysis and reliability testing (Cronbach's α). Data was obtained as part of a large nationwide electronic survey (N = 1,903). RESULTS: Factors converged into three major themes (organizational culture, professional vulnerability, and workplace relationships) which were consistent across all three leadership groups. Factor subscales exhibited Cronbach's α > .7. CONCLUSIONS: The NLESS is a useful tool in comparing reasons for turnover among nursing leadership groups. Future refinement may prove useful in identifying and clarifying foundational causes of turnover.

Giving voice to quality and safety matters at board level: A qualitative study of the experiences of executive nurses working in England and Wales.

BACKGROUND: Recent reports into egregious failing in the quality and safety of healthcare in the UK have focussed on the ability of executive boards to discharge their duties effectively. Inevitably the role of executive nurses, whose remit frequently includes responsibility for quality and safety, has become the object of increased scrutiny. However, limited evidence exists about the experiences of the UK's most senior nurses of working at board level. OBJECTIVE: We aimed to generate empirical evidence on the experiences of executive nurses working at board level in England and Wales. We posed two research questions: What are the experiences of nurse executives working at board level? What strategies and/or processes do nurse executives deploy to ensure their views and concerns about quality and safety are taken into account at board level? DESIGN: Qualitative interviews using semi-structured interviews. SETTING: NHS England and Wales. PARTICIPANTS: Purposive sample of 40 executive board nurses. METHODS: Semi-structured interviews followed by a process of thematic data analysis using NVivo10 and feedback on early findings from participants. RESULTS: Our findings are presented under three headings: the experiences of executive nurses working with supportive, engaged boards; their experiences of being involved with unsupportive, avoidant boards with a poor understanding of safety, quality and the executive nursing role and the strategies deployed by executive nurses to ensure that the nursing voice was heard at board. Two prominent and interrelated discursive strategies were used by executive nurses - briefing and building relationships and preparing and delivering a credible case. Considerable time and effort were invested in these strategies which were described as having significant impact on individual board members and collective board decision making. These strategies, when viewed through the lens of the concept of "groupthink", can be seen to protect executive nurses from accusations by board colleagues of disloyalty whislt also actively restricting the development of "groupthink" within the board. Another finding of note was that executive boards may not be permanently fixed as either unsupportive or supportive as participants described how certain boards that were initially unsupportive adopted a more supportive attitude towards matters of safety and quality. CONCLUSIONS: These highly positioned nurses can provide invaluable advice and support to boards around matters of quality and safety. However, the work of nurse executives remains an under-research area and more work is needed to better understand the ebb and flow of power and influence at play within hospital boards.