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Healthcare delivery is increasingly complex, with frontline leader roles, especially the nurse manager (NM), pivotal for success. This role is highly stressful, often leading to burnout influencing job satisfaction and leadership effectiveness. A quality improvement project, including preintervention and postintervention assessment with a focused improvement event for NMs, in a large children's hospital was completed. Organization strategies to support professional well-being and enhance support for the NMs were identified and implemented.

This article discusses the development and psychometric testing of the Nursing Leadership Competency Assessment (LCA).Several leadership assessments are available for purchase, which are aligned with professional organizations. A competency-based leadership assessment is needed to identify the developmental needs of nurse leaders. Competent and confident nurse managers are critical to ensure positive relationships between nurse managers and clinical nurses.A multimethod approach was used to develop and test psychometric properties of the LCA. Items were drawn from 8 sources identifying nurse leader competencies.The 76-item assessment had a Cronbach's α of 0.99. Confirmatory factor analysis supported 6 hypothesized factors (domains): leading self, people, organizations, change, innovation, and globally. Subscale reliabilities ranged from α = 0.87 to α = 0.98.The LCA has demonstrated utility in assessing nurse leader competencies and guiding the development of educational opportunities in targeted content areas for specific leadership roles.

To examine the relationships between practice environment factors and nurse manager (NM) perceptions of workplace mistreatment (WPM).NMs have a unique perspective of business operations and care delivery and can offer insight into how WPM manifests in clinical settings at the leadership level.Researchers used a cross-sectional correlational design using a nonexperimental causal technique. A convenience sample of 139 NMs completed a survey regarding their perceptions of organizational change, the practice environment, and WPM.NMs reported experiencing incivility (98%) and bullying (90%). Approximately 20% variance explained mistreatment by relationships with supervisors and budgeted resources ( F4,134 = 9.16, P = 0.000).Modifiable factors can be identified to prevent or reduce WPM.

The purpose of this study was to determine the alignment between the American Nurses Credentialing Center's Magnet Recognition Program® standards and clinical nurse specialist (CNS) practice competencies.Despite documentation of CNS contributions to achieving and sustaining Magnet Recognition®, there is a lack of evidence clearly aligning Magnet® standards and CNS practice competencies.Using a crosswalk method, an expert panel of CNSs and chief nursing executives analyzed alignment of the 50 Magnet standards with the 44 National Association of Clinical Nurse Specialists core practice competencies.CNS practice competencies are aligned closely with Magnet standards: 86% of the 50 Magnet standards aligned with at least 1 CNS competency and 81.8% of CNS competencies aligned with at least 1 Magnet® standard.The alignment between Magnet standards and CNS competencies supports evidence of CNS contributions to organizational achievement of Magnet Recognition and will assist nurse executives in identifying a full scope of opportunities for CNSs to contribute to nursing excellence.

This study aimed to determine the weekly costs of contact precaution (CP) use with medically stable patients infected/colonized with methicillin-resistant Staphylococcus aureus (MRSA) and to estimate the annual financial and environmental costs of CP.The increasing use of disposables for infection control contributes to increasing hospital costs and amounts of solid waste at rates that are becoming unsustainable.A cost analysis was conducted using data from time/motion observations and previous waste audit study, along with hospital finance department values and US Department of Labor salary rates.Weekly and annual costs were $521.67 and $557 463 (5% hospital multidrug-resistant organism [MDRO] rate assumed). Personal protective equipment accounted for 43% of the waste produced (approximately 1600 pounds annually).Implications for nurse administrators include reevaluating activities that require personal protective equipment (PPE) and partnering with materials and human factor engineers to develop more financially and environmentally sustainable infection control practices.

The objective of this multisite study was to explore the professional and personal experiences of US nurse managers (NMs) during the COVID-19 pandemic.NMs are the most accessible and visible nurse leaders to the frontline staff during this pandemic.Thirty-nine NMs from 5 health systems across the US participated in focus groups in this qualitative study. Data were analyzed using a constant comparative method.Three major themes were identified: challenges, feelings and emotions, and coping. Subthemes emerged within each major theme.NMs across the country accepted considerable responsibility at great professional and personal consequence during the pandemic. NMs experienced challenges, ethical dilemmas, and expressed negative emotions. As the usual coping strategies failed, NMs reported that they are considering alternative career choices. This work provided evidence to help senior leaders strategize about mechanisms for reducing managerial dissonance during times of stress.

The aim of this study was to assess the influence of 3 variables on unit-based nurse managers' self-perception of business and financial competence in patient care: 1) educational degree; 2) participation in leadership development continuing education; and 3) prior nursing management experience.Nurse managers must develop business acumen to support patient care and the nurses who provide care. Successful managers must become fluent in the language of finance and must understand how to use it. Their ability to promote continuous quality improvement (QI) in a cost-effective, resource-conscious manner is the foundation of economic viability.A feasibility study was conducted using Facebook to recruit nurse managers nationally and to distribute an electronic survey designed to assess the unit-based managers' self-perceptions of business and financial competence in patient care.The strongest predictors of self-perceived business and financial competence were continuing education and MSN degree. Years of experience in a leadership role did not predict self-reported levels of business or financial competence in patient care.Findings suggest that nursing leadership competency in the area of finance is developed through continuing education. Healthcare organizations should implement comprehensive nursing leadership mentoring and orientation programs for nurse managers to improve their self-perceptions of business and financial competencies.

The National Academies of Medicine consensus study committee reported that US healthcare workers experience high levels of burnout resulting from external pressures on the healthcare system and the organization of work. Nurse managers are especially susceptible to burnout. This column provides evidence-based strategies to improve the work environment, reduce the burden of job demands, and promote well-being among nurse managers.

A virtual mental well-being initiative was developed for nurse leaders to provide education about mental health and to teach self-care skills.Because of substantial demand placed on nurse leaders during the COVID-19 pandemic, organizations must address stress and burnout by providing a continuum of care to include education, support, and intervention.All levels of nurse leaders at a multicampus healthcare system were invited to attend. Data were collected on coping, empowerment, burnout, and quality of life. Participant responses to discussion prompts were compiled and reviewed.Although the independent parallel comparison did not show significant improvements, scores on the coping, empowerment, burnout, and quality-of-life measures were maintained. Discussion prompts yielded valuable insights into nurse leader experiences and session effectiveness.This type of education, as well as psychological support, will continue to be needed after the pandemic due to burnout, moral injury, and primary or secondary trauma. Findings are applicable to future crisis situations.

This article explores crisis leadership, with the purpose of offering a series of leadership behaviors and strategies for nurse administrators to limit and reduce the harm of crises, specifically the COVID-19 pandemic, to healthcare professionals. Based on the assumption that generic or universal crisis management approaches are generally ineffective and efficacious crisis management must be tailored to a specific crisis, a study was conducted to identify the most serious COVID-based stressors. The results revealed 5 categories of COVID stressors which are, in ascending order: miscellaneous, administration, patients/patient family issues, inherent aspect of the job (nursing), and personal issues. Personal issues comprised more than half of the greatest COVID-specific stressors. Building on relevant crisis management literature and the identification of COVID-specific stressors, this article provides suggestions and proven tactics for nurse administrators to guide their crisis leadership efforts for the COVID-19 pandemic. The lessons of this article are applicable to other crises.

The sobering facts are clear: hospitals and health systems are facing a severe nursing shortage, with safe inpatient staffing approaching near-crisis levels. Safely staffing inpatient care is challenging. Stopping the exodus of nurses from acute care must be prioritized by the entire C-suite, with the chief nurse executive at the center of all decisions. Beyond aggressive retention strategies, different in-kind solutions to address the practice environment are nonnegotiable and help address nursing concerns about continued hospital employment.

The aim of this study was to describe the current state of the interim manager (IM) role and the impact of the role on job performance.Interim managers provide leadership during organizational change, yet little is known about the role and its impact on outcomes.An electronic survey was completed by 179 IMs working in acute care hospitals. Instruments included the Nurse Manager Practice Environment Scale, Decision Involvement Scale, Subjective Stress Scale, Maslach Burnout Inventory, and Brief Resilience Scale.The average tenure for IMs was 10 months. Despite moderately high levels of stress and exhaustion, IMs were resilient, positively viewed their work environment, and perceived their job performance as positively impacting nurse and patient outcomes. Interim managers were generally satisfied in their roles and likely to pursue nursing leadership as a career.Interim managers desire permanent leadership opportunities providing a pool for replacing exiting nurse managers. Support is needed to be successful.

Nurse leaders have a responsibility to nurture a work environment that prioritizes meaningful recognition. This quality improvement project explored the perceptions of meaningful recognition of inpatient pediatric surgical nurses. Meaningful recognition provides a chance to honor all voices, particularly those that have not been previously heard. To be heard is to be honored and to be recognized is to be valued.

Although many clinical leaders use the cultural competency model to help clinicians deliver equitable care, evidence on the model's effectiveness is mixed. In this article, the authors propose that nursing leaders adopt cultural humility as a framework that better positions nurses to build trust, engage patients in their care, and improve health outcomes. This article outlines 4 strategies that leaders can use to actively engage staff in cultural humility and support the cultural transformation required to mitigate the impact of clinician bias in care delivery.

This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics.Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience.University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program.The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction.Interventions targeting frontline leaders positively impact CN performance.

Nurses and nurse leaders are working in unprecedented intense and demanding environments, and the COVID-19 pandemic continues to place strain on their mental well-being. If stressful work conditions remain at extraordinary high levels, nurses and leaders may ultimately leave their positions, creating even more uncertainty in the workforce. Enhancing individual resilience has become a superficial response in retaining nurses during a global nursing shortage. We argue that resilience is not solely an individual responsibility. Rather, resilience it is a mutual responsibility between the individual and the organization. In this article, we discuss how nurse leaders can foster organizational resilience while also enhancing their own individual resilience within the current pandemic environment, and as we transition to a post-COVID environment.

The ability to respond effectively and efficiently during times of crisis, including a pandemic, has emerged as a competency for nurse leaders. This article describes one institution's experience using the American Organization of Nurse Leaders Competencies for Nurse Executives in operationalizing the concept of surge capacity.

The AONL Nurse Executive Fellowship supports nurses who are new to an executive role in developing critical executive competencies. Participants engage in an in-depth specialized assessment process to help them understand themselves and the impact on their leadership. Learnings from the 1st 2 cohorts of fellowship participants provide insight into challenges faced by new executives and how self-awareness can improve performance to address those challenges.

OBJECTIVE The purpose of this study was to determine chief nursing officer (CNO) perspectives on how to sustain the infrastructure required for successful American Nurses Credentialing Center (ANCC) Magnet® redesignation. BACKGROUND American Nurses Credentialing Center Magnet designation is a prestigious achievement reflective of years of dedication, innovation, mentoring, and leadership support. As challenging as the initial attainment of Magnet status can be, sustaining the success and becoming redesignated is considered even more difficult by many CNOs. However, there have been no published reports indicating how to be successful in Magnet redesignation. METHOD A grounded theory qualitative approach was used, and data were collected through telephone interviews with CNOs who had successfully attained at least 1 redesignation. RESULTS Fourteen CNOs participated; data were organized into 6 themes and 15 subthemes describing the critical elements for Magnet redesignation. CONCLUSION Relationships among the 6 themes and subthemes are theorized in the form of a wheel with 6 spokes. When "set in motion," the wheel gathers momentum and all of the model elements become coalesced into the organizational ethos.

Objective The objective of this study was to explore the relationship between staff nurses' perceptions of nurse manager caring behaviors and patient experience. Background Despite numerous interventions aimed at changing the provision of patient care to improve care quality, patient experience scores have remained moderate. Little research has been conducted exploring how caring relationships in the professional practice environment might play a role in the patient experience of care. Methods A cross-sectional, correlational design was used to examine the relationship between staff nurses' perceptions of nurse manager caring behaviors as measured by the Caring Assessment Tool-Administration (CAT-Adm) and acute-care patient experience using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Results There was a positive relationship between the staff nurses' perceptions of nurse manager caring behaviors and patients' HCAHPS overall hospital rating. There also was a positive relationship between the CAT-Adm scores and nurse manager visibility. Conclusion Departments had higher HCAHPS overall hospital rating when the staff nurses perceived their unit manager as caring. In addition, the more staff nurses actually visualized their nurse manager during a shift, the more they perceived their nurse manager as caring.

Organizations across the country are redesigning care delivery to improve quality and outcomes, enhance the patient experience, reduce costs, and, ultimately, produce better population health. Leaders from the American Organization for Nursing Leadership engaged key stakeholders to discuss the role nursing can play and the toolkit that will be introduced this year to guide nurse leaders in striving for value.

This column reviews the concept of humanism in leadership. After surviving a year perceived by many healthcare professionals as the most challenging of a generation, the author reflects on leadership essentials for rebuilding our nursing workforce.

With the evolution from single healthcare entities to health systems, the role of the system chief nurse executive (SCNE) has evolved. The SCNE leads at the highest executive level in the system and has continuum of care accountability. To effectively support the scope and breadth of the SCNE role, the organizational structure must contain key elements to ensure success. This article outlines the key elements of a system nursing organization and serves to aid in the development, improvement, and sustainability of successful system nursing structures.

The purpose of this study was to describe the moral distress experiences of nurse managers. Moral distress has been studied among direct patient care providers including nurses and physicians. The moral distress experience among nurse managers is less understood. We conducted a qualitative descriptive study with 19 nurse managers from 5 healthcare institutions in Virginia. Interview data were analyzed using a directed content analysis, as the structural components of the moral distress phenomenon are already known. Participants suffered moral distress when they were unable to achieve or maintain effective unit function and felt caught in the middle between their units' and employees' needs and organizational directives. System-level causes of moral distress are common among nurse managers. Future research should involve measurement of moral distress among nurse managers and exploration of effective interventions.

OBJECTIVE Researchers examined associations between Index for Professional Nursing Governance (IPNG) scores and outcomes, by US and international hospitals. BACKGROUND Nursing governance and effects on nurse-related outcomes are not well studied. METHODS Associations were evaluated using average IPNG scores from 2170 RNs and nurse-sensitive indicators (NSIs) and patient and RN satisfaction outcomes (n = 205 study units, 20 hospitals, 4 countries). RESULTS International units had better IPNG shared governance scores (113.5; US = 100.6; P < 0.001), and outcomes outperforming unit benchmarks (6 of 15, 40.0%; US = 2 of 15, 13.3%). Shared governance significantly outperformed traditional governance for 5 of 20 (25.0%) US outcomes (patient satisfaction = 1, RN satisfaction = 4) and for 3 of 11 (27.3%) international (patient satisfaction = 1, RN satisfaction = 2). Internationally, self-governance significantly outperformed traditional governance and shared governance for 5 of 12 (41.7%) outcomes (NSI = 2, patient satisfaction = 3). CONCLUSIONS Shared governance is a strategy that can be considered by nurse leaders for improving select outcomes.

The aim of this study was to measure structural empowerment (SE) and capture short-term changes in perception for senior nurse leaders before and after a formal development experience.The body of literature related to SE in senior nurse leaders is limited. Applying the SE concept to senior levels of nursing leadership provides a vehicle to impact nurse leader retention and ultimately the organization beyond singular units.The Advanced Leadership Program (ALP) was designed in collaboration with the American Nurses Association to support personal and professional development for senior nurse leaders. The sample included 28 participants from the United States and the United Kingdom over a 6-month period.The effect of the intervention was seen in the postintervention survey rating SE higher in 5 of 7 domains as compared with the preintervention survey, reduction in overall turnover, and improvements in patient experience scores. Additionally, the participants evaluated the program in top categories, and comments were highly positive around peer support, improved working relationships, and expectations.The ALP has shown promise in strengthening SE for senior nurse leaders by supporting leadership skill development, follow-up training, and peer network development.

For more than 40 years, shared governance has supported structural empowerment and engaged nurses in their practice. Although progress has been made in advancing nursing ownership of practice through shared governance, mature nursing autonomy has yet to be achieved. It is time to evolve to professional governance, emphasizing accountability, professional obligation, collateral relationships, and decision making. Nurse leaders are provided with historical context and recommendations for effectively leading professional governance in an empowering work culture.

A strong shared governance framework gives nurses control over their practice. Whether unit based or system wide, shared governance provides the infrastructure to deliver high-quality patient care, especially in a crisis. This month's Magnet® Perspectives column takes a closer look at the concept of shared governance, how it has evolved, why it is important, and how it helped nurses in Magnet hospitals navigate the early months of the COVID-19 pandemic. We explore the critical nature of ensuring that everyone's voice is heard to not only survive but also ultimately thrive during times of change.

Dynamic nursing leadership and engagement of nursing at all levels are critical to effective care delivery. During the COVID-19 crisis, many organizations suspended non-COVID-related meetings, including professional governance councils where practice decisions are made. This article highlights how shared or professional governance was leveraged during this global pandemic at a large academic medical center and community hospital effectively sustaining autonomous nursing practice while responding to a rapidly changing environment and impacting quality patient care.

Healthcare organizations must be intentional and purposeful in creating diversity programs. A nursing leader mentorship program for racial and ethnic minority nurse managers was introduced at a large academic medical center to meet this need. The program design was based on the successful Leadership Institute for Black Nurses, first conducted at a university school of nursing. The participants in the 4-month program were 16 nurse managers from 2 city hospitals and their mentors.

This article explores the experiences and learnings of 2 ambulatory care nurse leaders on the front lines of the Covid-19 pandemic using the theory "navigating through chaos" as a framework.

Objective The study examined relationships between nurses' perceptions of implicit rationing of nursing care and leadership style in the nursing work environment. Background Nurses' perceptions of higher amounts of implicit rationing of nursing care relate to perceptions of lower quality of care and poorer patient outcomes. This study was the 1st to examine leadership style and implicit rationing of nursing care. Methods Using a cross-sectional survey study design, 35 039 RNs were randomly sampled during September 2017 to March 2018. Results Findings support an association between nurses' perceptions of an emotionally intelligent leadership style and lower amounts of implicit rationing of nursing care. Conclusion Implicit rationing of nursing care in the nursing work environment is significantly associated with emotionally intelligent leadership style. Nurse executives, and nursing faculty in administrative-focused graduate programs, can provide development and education in emotionally intelligent leadership skills.

The nurse manager role is increasingly complex, and oftentimes, leadership competencies are learned through experience rather than an effective role transition. The need for a transition-to-practice program for new nurse managers is frequently cited in the literature. This evidence-based practice project resulted in significant improvement in leadership competencies and was used in the development of an American Organization for Nursing Leadership nurse manager transition-to-practice program to be offered in 2021.

This case study reveals how 1 organization moved beyond traditional professional boundaries to achieve Magnet recognition.

Nursing leaders have voiced concern about the health and well-being of nurses and other healthcare providers during the recovery phase of disaster response after the coronavirus pandemic. There is much that can be learned from the experiences of our military colleagues. Behavioral health military nurses serving on readiness teams have educated leaders on how to apply psychological first aid (PFA) within their units during the recovery phase of disasters. This article will describe how nursing leaders can use PFA to enhance psychological support and resilience in their staff.

When the coronavirus hit the United States earlier this year, hospitals across the country were forced to quickly convert to crisis mode. Overnight, health systems transformed clinical and administrative operations to care for rising numbers of COVID-19 patients. Now, as the country slowly reopens and we move back to "normal," hospitals again face a major reboot to regroup and recover. Those that meet this challenge successfully will survive. Many others will not. This month's Magnet Perspectives column examines how Magnet hospitals are uniquely positioned to ride the waves and manage the chaos. What are the components that helped them adapt and adjust when COVID-19 struck, and how are those elements facilitating response and recovery? The column also looks at how the Magnet Recognition Program itself responded to challenges posed by the coronavirus and altered some of its long-standing processes to meet customer needs.

Objective The purpose of this study was to describe generation Y nurses' perceptions of their nurse managers' servant leadership characteristics as well as the relationship between these characteristics and intent to stay on the job. Background To attract and retain generation Y nurses, organizational leaders need to develop an understanding of this generation's perspectives around workplace loyalty and commitment. Method This study had a quantitative correlational research design. The Servant Leadership Survey (SLS) measured 116 generation Y nurses' perception of their manager's use of servant leadership. Results Generation Y nurses' most positively rated servant leadership characteristic of their managers was accountability; the lowest was forgiveness. Significant positive relationships were found between the overall SLS score and intent to stay and between the SLS dimensions of standing back, empowerment, authenticity, humility, and stewardship, and intent to stay on the job. Conclusions Generation Y nurses are seeking characteristics in their nurse managers that will attract them to stay on the job; if these characteristics are lacking, they may leave.

A pediatric teaching hospital developed a comprehensive leadership training program for midlevel nurse leaders with varying levels of management knowledge and experience. Content was based on American Organization for Nursing Leadership nurse manager competencies and data from a comprehensive needs assessment. Learners identified differentiating between leadership and management, influencing behavior, managing change, and communication as areas of increased confidence. This program is applicable to any hospital with multiple midlevel nurse leaders new to the role.

In today's dynamic healthcare environment, it is more important than ever that the chief nursing officer (CNO) possesses transformational leadership skills. This includes the cultivation of leaders whom the CNO can partner with to advance strategic priorities that benefit patients, families, clinical nurses, and others within a strong, supportive practice environment. A collaborative partnership not only ensures the advancement of an agenda for change but also enhances communication and visibility and provides an opportunity for development of key individuals on the executive team. By supporting partnerships, the CNO has the opportunity to keep talented leaders in the pipeline and to identify those who should be a part of the succession planning process. This is a critically important concept that can lead to a smooth leadership transition.

Objective This quality improvement initiative sought to develop a proactive integrated system approach to advance care planning (ACP) through leadership and colleague engagement. Background Nurse leaders have the capacity to influence the professional competencies of care teams in ACP. Nurse leaders were educated on the importance of ACP, national quality metrics, resources for staff education, and ways to integrate ACP into workflows based on a population management model. Methods The project design is a prospective, mixed method design. Results Nurse leader participants demonstrated a significant increase in knowledge of the importance of ACP and evidence-based models to increase staff engagement and competency. Conclusions Study supports nurse leader interventions, promoted engagement of proactive ACP to honor patient choice, and aligns with the mission and vision of one of the largest national Catholic healthcare organizations of being a trusted partner for life.

Absence of nurse manager succession planning in an academic medical center necessitated a quality improvement project to identify, select, and enroll emerging leaders into a development program. The authors used organizational competencies and an evidence-based approach to effectively identify barriers, select future nurse leaders, and discover opportunities for process improvement.

The significant role of the chief nurse executive in leading healthcare innovation has been widely discussed in the literature, including the importance of monitoring market disruptors and determining how to best respond. Critical to implementing and sustaining innovation is attention to leadership competencies, organizational enablers, and cultural transformation throughout the entire nursing enterprise. Chief nurse executives are challenged to examine personal and organizational readiness.

We are midway through a milestone year for nursing, and we have just finished a month-long celebration of Florence Nightingale's 200th birthday. The party may be over, but the work continues. How do we keep the momentum going, not just for 2020, but well beyond? In this month's Magnet Perspectives column, we explore ways to continue to promote the Year of the Nurse through its 3 anchors: nursing excellence, leadership, and innovation. We also take a look at how Magnet organizations stay relevant in these areas, by infusing lifelong learning, evidence-based practice, and clinical inquiry into the culture and making every day an opportunity to celebrate and elevate nursing.