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Merger and acquisition activities in health care are increasing in both the number and cumulative value of transactions in recent years, creating new and dynamic pressures on health care systems and current operating environments. These industry shifts, coupled with crises such as the COVID-19 global pandemic, create opportunities for innovation to increase capacity, improve productivity, achieve economies of scale, and positively impact health care quality, safety, access, and cost. However, neither consolidation nor innovation in and of themselves will yield sustainable clinical best practices nor achieve the desired quality, financial, efficiency, retention, or engagement outcomes. This article describes the approach used by one system-level Doctor of Nursing Practice prepared nurse executive to leverage evidence-based decision-making to guide, lead, and support the innovation needed to address first-year new graduate nurse turnover in a multistate not-for-profit health care system.

In 2019, the National Academy of Sciences, Engineering, and Medicine identified clinician burnout as a major problem that required immediate action because of its threat to both health care worker safety and patient safety. Unfortunately, the rise of COVID-19 in 2020 with no signs of a clear ending (as of the summer of 2022) has compounded this problem. Consequently, much focus has been placed by many to address clinician burnout and help alleviate this major threat to safety. Unfortunately, compared with clinician burnout, articles and resources to address frontline leader (FL) burnout are fewer. FLs are key to supporting teams and are integral to their success. They also execute and operationalize organizational strategic plans to ensure patient safety at the point of care. The burnout issue with bedside clinicians is a big issue, a fractured fault line in our health care system. However, without addressing the well-being of FLs, this fault line becomes a chasm. The column shares background from the American Organization for Nursling Leadership longitudinal studies and other pertinent research. It also provides examples of practices across the nation of how nurse executives are supporting their teams and promoting leader support and well-being.

Inequities between nursing workforce supply and demand continue to challenge nurse executives in creating the vision for a postpandemic nursing workforce. Health system's workforce redesign strategies must prioritize the changing needs of the multigenerational workforce to maximize the available supply of nurses willing to remain in the workforce. A test of a newly designed flexible workforce framework, aimed to meet the needs of the multigenerational workforce, resulted in increased fill rates and decreased costs of labor.

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.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.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.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.The results support the acceptability and feasibility of the psychoeducational group programme.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).

We aim to explore the perceptions of registered nurses undergoing the advanced practice nurse preparatory programme and of advanced practice nurses towards the recruitment of men into the advanced practice nursing workforce.Given the need to expand and diversify the advanced practice nursing workforce, it is important to recognize the potential implications of gender disparity. It is critical to understand why few males are recruited into the advanced practice nursing preparatory programme and to determine whether gender-related bias is present in the professional development of nurses.We use a descriptive qualitative design. Semi-structured interviews were conducted via Zoom (April to August 2021).Three themes were generated: 'The odds are eventually in the favour of men', 'The APN career-track is unpopular among men', and 'Balancing the gender gap in the APN workforce'. All themes are supported by three subthemes.Although males in nursing enjoy opportunistic advantages in entering the advanced practice nursing workforce, they are not interested in the role and not staying long enough in the nursing profession to become advanced practice nurses.Nurse managers should be more cognizant of the different social stereotypes faced by males and females in nursing. With such awareness, they can be more supportive and less biased in career counselling and job appraisals.

The purpose is to identify and synthesize the challenges of first-line nurse managers in home care concerning their managerial and leadership role, as described in current qualitative research literature.Increased responsibilities and shifting tasks in home care lead to challenges for first-line nurse managers. These challenges must be identified and evaluated to ensure quality care provision.A scoping review mapped current qualitative research on first-line nurse managers in home care, focusing on their managerial and leadership role. A systematic search was conducted in CINAHL, Medline, EMBASE, and SweMed+. A thematic analysis was conducted on the four included studies.First-line nurse managers' role in home care involves multiple responsibilities. Four themes emerged: "professional responsibilities," "relational responsibilities," "economic and organizational responsibilities," and "juggling responsibilities-a demanding balance."Findings provide new knowledge on how first-line nurse managers balance responsibilities in their role in the home care context-a complex context different from institutional settings like hospitals and long-term care. A focus on first-line nurse managers' support needs is necessary. Furthermore, an extensive research gap concerning first-line nurse managers' leadership and management role in home care indicates a need to increase knowledge from a range of perspectives.To develop sustainable and robust nursing leadership and management in home care, there is a need to (a) clarify first-line nurse managers' role and set boundaries around their responsibilities and (b) strengthen support from superiors, which will help empower first-line nurse managers in their daily work.

The study was conducted to understand the experiences of nurse managers with regard to the difficulties and opportunities they encountered during the pandemic.Although many studies have been carried out to understand how nurses were affected in the COVID-19 pandemic, there are few studies that treat the experiences of nurse managers.In this qualitative descriptive study with 19 nurse managers working in pandemic management at a university hospital in Turkey during the first three waves of the pandemic, data were collected between April and July 2021 using the semi-structured interview method. Content analysis was performed to analyse the data.Six themes were identified with respect to the experiences of nurse managers during the pandemic. These themes were initial reactions to the crisis, ineffective crisis management, excessive workload, the moral burden in decision-making, support of colleagues and other multidisciplinary team and nurse manager empowerment.The nurse managers had difficulties in their managerial roles during the pandemic. However, they also viewed the crisis as an opportunity because they were able to note the deficiencies in management at all levels of the hospital and their leadership and decision-making roles took on more importance.Nurse managers may use the results of this study to be prepared for the continuing COVID-19 pandemic and any other emergency circumstances that they may have to face in the future.

This article describes innovative experiences of nurses during clinical work and identifies the factors promoting and hindering clinical innovation.The nursing staff is replete with innovations in providing medical and healthcare that can help nurses solve clinical problems. Nurses need to understand their experiences in the creation and identify the factors that facilitate or hinder clinical innovation.A semi-structured interview question framework was used to explore nurses' innovation patents, particularly the development of innovative ideas and the difficulties encountered in innovation. From 15 December 2021 to 17 February 2022, 14 nurses with innovation experiences were recruited in Shanghai, China, using a snowball sampling method. Interviews were conducted in the participants' native language, Chinese, and the interview records were analysed using Colaizzi phenomenological analysis.This study has formed three main themes which are facilitators (including seven sub-themes), barriers (including two sub-themes) and results of the innovation. Position characteristics, the ability to resolve obstacles in clinical work, peer motivation and pressure urge nurses to have innovative ideas. Self-support and external support helped nurses overcome difficulties in the process of innovation. Technical translation and seeking professional assistance help realize innovative ideas for nurses. However, busy clinical work and limited resources are important barriers to nurse innovation.Innovation in nursing comes from clinical problems, and nurses' creativity in healthcare organizations can promote positive changes in nursing practice. Nurses have carried out many innovative activities during their work, including quite a few aspects of promotion in this process. Some factors have hindered or promoted this innovation process, which is more extensive than in previous studies. Therefore, policymakers, nurse educators and hospital managers should establish an environment conducive to innovation and provide nurses with job flexibility and resources to foster innovation.This study suggests that nursing managers should take the initiative to care for nurses, pay attention to their contributions to hospitals and provide them with abundant resources. In addition, managers should try their best to allow every nurse to participate in exchanges and learn continuously. In doing so, the innovation level of nurses can be greatly improved.

The purpose of this scoping review is to map and synthesize research studies addressing the factors that impact leadership behaviours of front-line nurse managers.Leadership is a fundamental component of the role of front-line nurse managers. Ineffective leadership is associated with costly outcomes; thus, organizations seek effective strategies to facilitate consistent demonstration of leadership behaviours.Using a scoping review methodology, findings from 26 empirical studies were mapped to identify barriers and facilitators of leadership among front-line nurse managers. Major categories included personal and environmental factors with subthemes of personal characteristics, competencies and social support.Available evidence captures the influence of personal characteristics, education, competency and formal social support on leadership capacity. The role of informal social support was not captured.Multiple personal and environmental factors influence the capacity for leadership behaviours among front-line nurse managers. Strategies such as leadership development programmes, mentorship and peer support programmes, and work environments that support relational and structural support may increase leadership capacity for front-line nurse managers.Senior nurse leaders can use the results of this review to guide implementation of evidence-based strategies to recruit and retain front-line nurse managers.

The aim of this study is to explore the moral distress experiences of nurse officers during the COVID-19 pandemic.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.It is a descriptive phenomenological study that used content analysis.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.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.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 aim of this study is to describe primary care nurses' perceptions of their formal leaders' leadership behaviours and outcomes and explore differences based upon nurses' individual and work setting characteristics.Formal nursing leadership is positively associated with patient, nurse workforce and organizational outcomes, yet no studies have examined primary care nurses' perception of formal leadership behaviours and outcomes in the United States.Cross-sectional survey data from 335 primary care nurses were analysed to assess perceived leadership behaviours associated with transformational, transactional and passive-avoidant leadership styles, perceived leadership outcomes and individual and work setting characteristics.Positive leadership behaviours (transformational) were lower than those reported for other settings. There were significant differences in nurses' perceptions of their leaders' leadership behaviours and outcomes based upon individual and work setting characteristics.This study confirmed differences in perception of leadership and that individual and work setting characteristics influence nurses' perception of their leaders in primary care.Leaders must be versatile and consider the unique needs of each staff member and the influence of clinic characteristics.

The aim of this study is to explore the perceptions of Chinese registered nurses on toxic leadership behaviours of nurse managers and to determine its type, cause and response measures.The nurse manager is the front-line leader of the nurses who provide services directly to patients. Previous evidence suggests that toxic leadership behaviours of nurse managers do exist and it is necessary to understand the specifics of it.We used phenomenological research methods to conduct semi-structured in-depth interviews among 12 nurses at a tertiary hospital in Wuhan over the period from January to March 2022. And the data were analysed using Colaizzi seven-step analysis method.Four themes were discovered: (a) nurses' perceptions of toxic leadership behaviours; (b) toxic leadership behaviours of nurse managers; (c) reasons for toxic leadership behaviours of nurse managers and (d) measures for toxic leadership behaviours of nurse managers.Chinese nurses are exposed to the toxic leadership of nurse managers for multiple reasons and respond differently.This study helps nursing managers identify which behaviours are harmful to the nurse that require special attention in developing strategies to buffer against nurse managers' toxic leadership.

Nurse leaders are increasingly called upon to provide their experience, expertise, and unique perspectives in nontraditional settings including in industry. Technology, software development, analytics, insurance, government, nurse entrepreneurs in business, consulting, and pharma are a few of the types of industries more frequently utilizing nurse leaders to inform, grow, govern, and operate their businesses. While the settings and skills may be different, the leadership competencies articulated through the American Nurses Association Nursing Administration Scope and Standards of Practice and the American Organization for Nursing Leadership Nurse Executive Competencies are still very much aligned and important to industry nurse leaders. This article articulates those commonalities and contrasts.

To describe nurse leaders' and digital service developers' perceptions of the future role of artificial intelligence (AI) in specialized medical care.Use of AI has rapidly increased in health care. However, nurse leaders' and developers' perceptions of AI and its future in specialized medical care remain under-researched.Descriptive qualitative methodology was applied. Data were collected through six focus groups, and interviews with nurse leaders (n = 20) and digital service developers (n = 10) conducted remotely in 2021 at a university hospital in Finland. The data were subjected to inductive content analysis.The data yielded 25 sub-categories, 10 categories and three main categories of participants' perceptions. The main categories were designated AI transforming: work, care and services and organizations.According to our respondents, AI will have a significant future role in specialized medical care, but it will likely reinforce, rather than replace, clinicians or traditional care. They also believe that it may have several positive consequences for clinicians' and leaders' work as well as for organizations and patients.Nurse leaders should be familiar with the potential of AI, but also aware of risks. Such leaders may provide betters support for development of AI-based health services that improve clinicians' workflows.

This study aimed at assessing the nature and effect of toxic leadership of nurse managers on the perceived job satisfaction and productivity of the nursing workforce.Nursing job outcomes such as job satisfaction and productivity are influenced by various factors in the nursing practice environment including leadership. Due to rising health care expenses and depleting material resources, the productivity of nurses that is expected to improve the efficiency of health care organizations is mostly low. Managers' toxic behaviour towards nurses affects their job satisfaction and subsequently low productivity.A multi-centre, cross-sectional descriptive design was used. Validated tools were used to collect data from participants, and data were analysed using descriptive, correlation, and hierarchical linear regressions.Registered nurses appraised the leadership behaviour of nurse managers to be toxic, with most managers exhibiting narcissistic leadership behaviour. Though all the components of toxic leadership behaviour of manager and job satisfaction were associated with the perceived productivity of the nurses; only intemperate leadership behaviour of the managers (β = -.301, p .005), and job satisfaction (β = .296, p .001) significantly predicted perceived productivity among nurses (RNurse managers' leadership behaviours were toxic. Nurses' job satisfaction and all components of managers' toxic leadership behaviour influenced productivity.There should be a policy developed to guide the creation and maintenance of efficient nursing leadership to enhance job satisfaction and productivity among nurses.

All nurses, particularly those working in critical care settings, are required to use medical devices when providing patient care. However, inconsistent practice and variations in documentation can make it challenging for nurses and nurse managers to identify what medical device training is required and when.To develop and evaluate the use of an electronic medical device training passport to identify the training needs of nurses in intensive care units (ICUs).A pilot study was conducted in a multi-unit critical care department in London, England, to determine if the passport could make it easier to identify ICU nurses' medical device training needs compared with existing practice. Nine participants were first asked to identify their needs using existing spreadsheets or paper records, then asked to identify them using the passport. The participants were also interviewed to identify their training requirements before and after using the passport. The data were analysed quantitatively and qualitatively.The electronic passport significantly improved identification of medical device training needs compared with paperwork or spreadsheets for all device groups, except for medical devices used on high dependency units ( P ≤0.005). However, there may be issues related to nurses' behaviours and expectations, particularly that staff do not always recognise their need for training.The findings of this pilot study suggest that the use of an electronic medical device training passport has many benefits and could make it easier to identify ICU nurses' training needs in clinical practice.

To evaluate nursing leaders' perception of communication and relationship management competencies while using digital platforms during the COVID-19 pandemic.Nursing leaders can achieve effective leadership by mastering these competencies leading to an overall improvement in the quality of nursing care. The COVID-19 pandemic has brought numerous challenges in communication, and digital platforms have been widely used in healthcare settings to mitigate contagion.Cross-sectional.The study was conducted between February and March 2021. A survey was adopted from the American Organization of Nurse Executives (AONE) and was sent to nursing leaders in Qatar through email.A total of 250 nurse leaders were invited to participate, but only 116 responded (RR 46.4%). The male participants represented a more significant proportion of 64.10%. Influencing behaviour, relationship management and effective communication had the lowest scores, which indicates low competency.Despite obtaining satisfying scores, nursing leaders in Qatar should strive for professional development and knowledge acquisition to improve their communications and relationship management competencies.Healthcare organizations must understand that nursing leaders should strive for professional development and knowledge acquisition to improve their communication and management.

To explore the practices and self-confidence of nurse manager (NM) decision-making related to evaluating RN hiring needs.Evidence-based hiring strategies to sustain workforce stability were identified as a gap in the literature. Locally, inconsistencies in the method that NMs use to determine how many RNs to hire and at what frequency to hire them were observed, posing a threat to strategic workforce planning.Using a mixed-methods, qualitative descriptive design, researchers used in-depth interviews and surveys to assess current practices and NM confidence related to evaluating hiring needs.The overarching theme among the 10 participants was false confidence. Subthemes reflected the dissonance in confidence and high variability in the hiring process. NM stress, time spent, and confidence were not correlated with years' experience.NMs experience stress, spend excessive time, and use varying approaches to evaluate hiring needs. Years of managerial experience are unrelated to practical skills or level of confidence in hiring decision-making.

The main aim of this study was to determine the perceptions of clinical nurses and nurse leaders about authentic nurse leadership, work environment, pandemic impact, well-being and intent to leave their position and profession during the second year of the pandemic.This research team studied the variables pre-pandemic and in year one of the pandemic. As the pandemic continued, subsequent reports of workforce instability, deteriorating work environment and vulnerable well-being called for an understanding of the current state to inform needed actions by leadership.This study is a cross-sectional, descriptive, correlational analysis using national survey data from 1795 US clinical nurses and nurse leaders in the fall of 2021.Pandemic impact was high, authentic nurse leadership was present, healthy work environment was not present and nurse well-being was at-risk and negatively correlated to both healthy work environment and authentic nurse leadership. Within our sample, 61.8% of nurses had no intention to leave their positions, and 82.5% had no intention to leave the profession. Compared with clinical nurses, nurse managers had significantly higher scores on all instruments.The findings of this study support leadership as positively related to a healthy work environment. Authentic nurse leadership, a healthy work environment and nurse well-being are all critical components of efforts to stabilize the nursing workforce as we recover and rebuild post-pandemic.This is a call to action for leadership that will serve the goals of retaining nurses, rebuilding work environments and improving well-being.

The aim of this study is to describe nurse perceptions of nurse leaders' internal crisis communication during the COVID-19 pandemic.Internal communication is a vital part of nurse leaders' work, even more so during crises such as the COVID-19 pandemic.This is a cross-sectional study design. The data were collected from 204 Finnish nurses in February 2021. A questionnaire developed in this study consisted of 29 items measuring internal crisis communication and seven demographic variables. The relationships between the variables were examined with cross-tabulation, a chi-squared test and non-parametric tests. Factor structure was evaluated with exploratory factor analysis and reliability with Cronbach's alpha.Nurses perceived the timeliness of communication highest and interaction the lowest. Nurses from intensive care, acute care and operative rooms gave highest evaluations for the content of communication and timeliness. Nurses working with COVID-19 patients daily or weekly evaluated the highest level of false communication.Nurse leaders' internal crisis communication was timely, especially in the most critical units dealing with the pandemic. The study highlighted the importance of considering a unit's special needs for internal crisis communication. Interaction between nurse leaders and nursing staff during periods of crisis needs improvement.Nurse leaders' successful and emphatic communication is important in supporting nurses in managing a crisis.

This study aims to explore the disciplinary processes for nurses, from organizational supervision to final decisions by the Finnish regulatory authority.Regulatory authorities are responsible for protecting the public, by ensuring that they receive safe, competent and ethical nursing care, but little is known about the disciplinary processes for nurses.This is a retrospective document analysis of 296 disciplinary decisions by the Finnish regulatory authority from 2007 to 2016. The data were analysed using a quantitative design with descriptive statistics.We studied 204 disciplined nurses (81.4% female) with a mean age of 43.5 years. The disciplinary process comprised organizational supervision, complaints, investigations and decisions. Nurses with substance abuse issues were more likely to face criminal investigations and receive temporary decisions. The process lasted from under 1 month to years and could have profound effects on nurses, colleagues and nurse managers and compromise patient safety.This study identified key factors that could inform the disciplinary processes for nurses. More knowledge is needed about how organisations ensure patient safety when unprofessional conduct is suspected.Retaining nursing professionals is vital due to global shortages, and more attention should be paid to organizational supervision and support for nurses during disciplinary processes.

This commentary suggests that within the context of dementia care, the revision of nursing codes of ethics to accommodate the acceptability of therapeutic lies under limited circumstances may be appropriate.Therapeutic lies (a prosocial lie) are told in the best interests of a person with dementia, to avoid distress or harm that may be derived from an act of truth-telling. However, their acceptability remains a contentious issue and is not reflected in nursing codes.Nursing codes are reviewed in conjunction with empirical research on prosocial and therapeutic lies and how nurses interpret and implement codes.Prosocial lies are perceived to be ethically preferable when truth-telling causes unnecessary harm. However, nurses may feel conflicted using therapeutic lies believing honesty to be obligatory.Codes may benefit from revision, by acknowledging the permissibility of therapeutic lies under limited circumstances. This may assist nurses with ethical decision-making and potentially reduce distress in this challenging area of practice.It may be beneficial for nurse mangers to initiate discussions with staff regarding unnecessary harm and therapeutic lies. Nurse managers may also wish to advocate for the revision of codes as suggested in the commentary.

This study aims to present the theory of resigning in supporting nurse managers in dealing with nurses' ethical challenge of caring.In a COVID-19 era, nurses continue to be ethically challenged in maintaining safe patient care. Nurse managers play a critical role supporting staff in responding to the complexities of working in, under resourced environments.Literature suggests care delivery is compromised in times of staff shortages, lack of resources and increased demands on nurses. Examining caring behaviours through the theoretical lens of the theory of resigning enables nurse managers to understand nurses' behaviours, cultivating supportive working environments.Nurses strive to provide quality, safe care but are sometimes unable to give the level or type of care they wish, due to the presence of constraints.This paper provides suggestions for nurse managers in dealing with nurses' daily moral distress arising from working within constraints while still trying to provide safe care.Nurse managers need to develop greater insights into the ethical dilemmas nurses experience and support them to temporarily realign beliefs and values, while continuing to work within constraints. Understanding ethical dilemmas of prioritizing care is required to address and manage this concern.

To examine relationships between psychological capital, work engagement and organisational citizenship behaviour among nurses.Psychological capital, work engagement and organisational citizenship behaviour are all positive variables associated with work. Clarifying the relationship between the variables can help nursing managers implement tailored and effective intervention strategies to improve individual and organisational performance and quality of care.A quantitative cross-sectional study was designed.The study was carried out from June 2021 to September 2021 in Sichuan Province, China. A total of 606 nurses working at six tertiary hospitals were selected with convenience sampling. Participants were investigated using demographic, work-related information questionnaire, Psychological Capital Questionnaire, Utrecht Work Engagement Scale and Organizational Citizenship Behavior Questionnaire.The scores of psychological capital, work engagement and organisational citizenship behaviour were 102.56 ± 15.47, 67.96 ± 21.71 and 101.57 ± 11.57, respectively. The multiple linear regression model explained 7.3% of the total variance in organisational citizenship behaviour related to demographic and work-related factors. There was a significant positive correlation between psychological capital, work engagement and nurses' organisational citizenship behaviour. Additionally, structural equation modeling showed that work engagement mediated the relationship between psychological capital and organisational citizenship behaviour with the partial mediating effect of 0.093. The final model explained 28% of organisational citizenship behaviour.Our results suggest that both psychological capital and work engagement are facilitators for organisational citizenship behaviour in nurses. Managers can increase nurses' organisational citizenship behaviour through developing psychological capital and improving the work engagement.This study indicates that both psychological capital and work engagement are protective factors of organisational citizenship behaviour, which provide proof for optimizing human resources management from a positive psychology perspective. Our finding can help managers correctly understand the mechanism of the relationship among work engagement, psychological capital and organisational citizenship behaviour and adopt effective intervention strategies to promote nurses' organisational citizenship behaviour.

To explore the relationships between inclusive leadership, empowering leadership, nurses' perceived psychological empowerment and nurses' innovation capacity.Innovation capacity is essential for nurses to adapt to the changing health care environment. However, the current knowledge of nurses' innovation capacity and its' relationships between inclusive leadership, empowering leadership and psychological empowerment, is limited.A cross-sectional survey using a convenience sample was conducted among 1355 nurses in 10 hospitals in Tianjin, China. The data were analysed by correlation analysis, univariate analysis and PROCESS macro.High inclusive leadership, empowering leadership and high psychological empowerment were associated with high innovation capacity. The total effect of inclusive leadership and empowering leadership on innovation capacity through psychological empowerment was significant, with their indirect effects accounting for 69.19% and 61.29% of the total effect, respectively.To cultivate nurses' innovation capacity, the development of inclusive leadership, empowering leadership and psychological empowerment is important.This research highlights the importance of inclusive leadership and empowering leadership to foster nurses' innovation capacity. Understanding the mediating role of psychological empowerment is expected to help nurse managers develop relevant intervention strategies to cultivate nurses' innovation capacity.

To explore nurse leaders' resilience and their role in supporting nurses' resilience during the COVID-19 pandemic.The COVID-19 pandemic has challenged health care systems on a global level. Nurse leaders are tasked with ensuring high-quality care, even during crises, which requires active problem-solving and confidence in the future-resilience from leaders.A scoping review was conducted using inductive thematic analysis and the PCC (Participants, Concept, Context) framework. The PubMed, Scopus, CINAHL, and PsycINFO databases, as well additional studies and grey literature, were searched from December 2019 to June 2021.The review included 12 studies. Nurse leaders' self-awareness, self-reflection, and coping strategies described their resilience during the pandemic. A relational leadership style, supportive and safe work environment, and adequate communication were found to support nurses' resilience.There is scarce research concerning nurse leaders' resilience during the COVID-19 pandemic. Future research needs to address nurse leaders' personal resilience due to the link with nurses' resilience.A healthy work environment is essential for nurses' resilience. During crises, nurse leaders should adopt relational leadership styles and actively interact with nursing staff.

This study examines the effect of servant leadership on the performance of the hospital through the mediating effect of trust in the leader. It further analyses the moderating role of psychological empowerment.Hospitals in Pakistan experience a severe shortage of nurses. Nurses are overworked and need support to provide quality patient care. Servant leadership, which focuses on the growth and development of followers, is of relevance in such context.A sample of 339 registered nurses from four public hospitals in Pakistan provided survey data. Instruments with established psychometric properties and structural equation modelling were used to test the model.Servant leadership has a significant direct effect on trust in the leader and an indirect effect on the performance of the hospital through trust in the leader. A moderated mediation test reveals that the relationship between trust in the leader and the performance of the hospital is stronger when nurses report high psychological empowerment.Servant leadership instils trust among nurses and elevates the organisational performance of the hospital.Hospitals should select and train nurse managers who can embody the principles of servant leadership and provide resources to increase psychological empowerment among nurses.

The purpose of this study was to describe the experience of chief nursing officers (CNOs), including leadership strategies that they developed as they encountered the administrative challenges posed by COVID-19.The COVID-19 pandemic required CNOs to make difficult decisions and to support nursing staff as they cared for critically ill and dying patients, and therefore, they experienced intense stress during a pandemic of a highly infectious disease. Understanding the challenges that CNOs faced in this crisis will help hospitals and CNOs to better prepare for the future.Using a descriptive qualitative approach, we conducted interviews with 9 CNOs from hospitals across the United States. The goal of the interviews was to develop an understanding of the difficulties that these CNOs encountered during the COVID-19 pandemic and their emotional response to the challenging situations.Themes of frustration, heartbreak, and feeling overwhelmed, exhausted, and helpless were revealed. In addition, pride in being a nurse was expressed.Themes revealed in this study suggested intentional leadership strategies that would be useful in future healthcare crises.

To investigate the associations between perceived overqualification, organisational commitment and work passion of nurses.Few studies have considered the effects of perceived overqualification and organisational commitment on work passion of nurses, especially in developing countries.This is a multicentre cross-sectional study. A total of 4511 nurses from eight tertiary hospitals were recruited. The Scale of Perceived OverQalification (SPOQ), the Organizational Commitment Scale (OCS) and the Work Passion Scale (WPS) were used to collect the data. Hierarchical multiple regression were employed.Perceived overqualification and organisational commitment were the main predictors for both harmonious and obsessive passions (each p .001). The unique effect of organisational commitment (βOur findings indicate that high perceived overqualification clearly reduces nurses' harmonious passion and increases their obsessive passion, whereas high organisational commitment significantly promotes nurses' harmonious and obsessive passions.Nurse managers should distinguish the different effects of perceived overqualification and organisational commitment on work passion. Effective intervention should be developed to release nurses' potential abilities and improve their organisational commitment and work passion. Chinese Clinical Trial Registry: ChiCTR2100047974.

Responding to and navigating the COVID-19 pandemic were demanding and all-consuming for executive nurse leaders. Long-term pandemic challenges will continue and therefore it is important for nurse leaders to develop their reflective practice to increase role competency, gain wisdom, and advance the profession. The complex postpandemic world requires nurse leaders to show up differently, stop ineffective practices, continue best practices, and implement new ideas to improve performance and outcomes. This article offers a framework for leadership reflection, through role negotiation technique, to identify lessons from the lived nurse executive experience of the COVID-19 pandemic. Specific focus is placed on communication, teamwork, professional governance, posttraumatic growth, gratitude, diversity/equity/inclusion, and social determinants of health. These concepts, along with specific tactics, will help leaders set priorities, aid nursing leadership practice, identify meaningful goals and desired outcomes, and effectively lead to advance the nursing profession postpandemic.

To appraise the current instruments available for measuring the nursing work environment and re-examine the definition and construct of the nursing work environment.A psychometrically sound instrument is fundamental to understanding and improving the nursing work environment. The nursing work environment is a complex construct, and its definition remains inconclusive. None of the instruments available is considered as the gold standard.A comprehensive searching was undertaken in August 2021 in six databases according to PRISMA. The COSMIN and modified GRADE were applied to assess the methodological quality and measurement properties of the instruments. Instruments were categorized into three levels. The definition and construct of nursing work environment were revisited.Forty-one studies (19 instruments) were included. One, fourteen, and four instruments are respectively appraised as A-, B- and C-level recommendation. Definition and eight labels of nursing work environment are identified.This paper provides recommendations for selecting a proper instrument for the nursing work environment.This study helps nurse managers to select instruments and understand the construct of the nursing work environment. The eight labels can be used as a reference for tailoring policy aimed at creating a favourable nursing work environment.

To explore nurse managers' perceived importance of competencies for their current job at different levels and the associated factors.Little work to date has explored the perceived importance of competencies in nursing leadership and management or considered the related factors in the Taiwan healthcare context.Data collected from a previous large study comprising a cross-sectional web-based survey were analysed. Kruskal-Wallis test, two-sided Fisher exact test and multiple linear regression models were used for statistics analysis.The mix of three skills in Katz's model indicated that human skills were equally important in all three managerial levels. Of the 23 competencies, effective communication and political astuteness were rated by nurse managers at all levels as the highest-scored (M = 4.88, SD = 0.34) and lowest-scored competency (M = 3.92, SD = 0.78), respectively. Managerial level was a significant predictor of the perceived importance of competency.Relationship-based competencies were prominent in the perceived importance of competencies among nurse managers at different levels. Managerial hierarchy influences the relative importance of the different managerial competencies.This study's results provide the talent strategy framework required for improving the competencies of nurse managers at all levels.

The aim of this study is to explore the experiences of Jordanian first-line nurse managers during COVID-19.Nurses are exposed to life-threatening occupational risks during COVID-19. Exploring the first-line nurse managers' experiences will help in designing health policies to better deal with such emerging crises.A descriptive phenomenological study was conducted. A purposive sample was used to recruit 16 first-line nurse managers from Jordanian hospitals. Semistructured interviews were conducted. Phenomenological data analysis method was used to analyse the data.Four major themes emerged: (a) unprecedented pressure (first-line nurse managers revealed their suffering with the unprecedented demanding situations during COVID-19 pandemic); (b) strengthening system and resilience (nurse managers employed several strategies to strengthen the health system and enhance resilience); (c) building a supportive team (the presence of a robust supportive system is vital to deal with the pandemic); and (d) maturity during the crisis (exposure to a new experience developed nurse managers management skills and self-awareness).The unprecedented pressure associated with COVID-19 drained first-line nurse managers physically and psychosocially. Providing adequately trained staff and medical equipment is important to better deal with crises.Strengthening emergency training and improving emergency response plans of hospitals are essential.

This 2-part study was conducted to validate nurse manager (NM) leadership competencies that support clinicians in using evidence-based practice (EBP).Numerous studies validate the critical need for NM support among clinicians seeking to engage in EBP.In phase 1, a Delphi study was conducted to establish the validity of a set of NM leadership competencies that support EBP. In phase 2, descriptive analyses, tests of significance, and reliability coefficients were used to assess reliability.An expert panel achieved consensus on a set of 22 NM leadership competencies that constitute effective support for EBP. Further quantitative analyses demonstrated excellent levels of internal consistency and overall consistent outcomes across time.A valid set of 22 NM leadership competencies with evidence of reliability that successfully support clinicians to engage in EBP in clinical settings was established.

Achieving fellow designation is commonly a career goal for nurse leaders. The path to achievement can be confusing, and once a goal is set, choosing the right designation is important. This column outlines the background of fellow designation, clarifies differences between fellow designation and other career advancement options, and presents ideas for consideration by nurse leaders as they pursue career advancement through fellow designation.

Frontline nurse leaders direct staff and unit systems while ensuring that quality, safe patient care is provided. It is unknown if frontline nurse leaders oriented with only on-the-job-training are competent and if a professional development program will improve their competencies. This project's purpose was to measure self-assessed competencies, using the Nurse Manager Inventory Tool, of 38 frontline nurse leaders. This project used a quasi-experimental design and utilized pre- and postsurvey for evaluation purposes of a leadership development curriculum.

To explore the lived experience of utilizing peer group supervision in practice for community health nurses.Community health nursing is an autonomous and challenging role where quality clinical supervision has benefits for the registered nurse. The structured New Zealand Coaching and Mentoring model of peer group supervision provides the foundation for this research.An interpretative hermeneutic study explored the experience of peer group supervision in a regional health service in Australia. Qualitative in-depth interviews were conducted with all levels of nursing staff to gain an understanding of their experience of peer group supervision.Data interpretation through hermeneutic analysis revealed the value and professional sustenance gained by participants. Identified game changers include adherence to rules and the influence of group dynamics. These areas were found to impact the quality of supervision.This research provides different perspectives of peer group supervision that shares the experience of staff immersed in the process. Peer group supervision yields benefits for community health nurses; however, the research has implications for practice.Nurse managers require information when making key decisions regarding workplace implementation. Effective supervision is only possible when balance between benefits and game changers are achieved.

Aim To explore the experiences of nurses' work stress related to COVID-19 regular epidemic prevention and control in China. Background The global COVID-19 epidemic is still severe, and China's ongoing regular epidemic prevention and control still cannot be relaxed, which places demands on nurses. Methods Thirty nurses and 8 nurse managers were interviewed using semistructured in-depth interviews, and the data were analysed by the Colaizzi seven-step analysis method. Results Four themes were extracted as follows: environmental factors, organizational factors, personal factors and positive factors in coping with stress. Conclusions Nursing managers should pay attention to construction of the first-line departments of regular epidemic prevention and control. The shortage of nurses' human resources and the increase of nurse-patient conflicts are problems that need to be solved urgently. In addition, this research also emphasizes the importance of promoting nurses' stress-related growth and thinking about the possibility of reform. Implications for nursing management The construction of the hospital environment and increasing the resilience of nursing teams require attention. We should attach importance to the training of nurses' communication skills and provide sufficient organizational support and economic guarantees for nurses. Finally, perhaps we should also consider whether it is necessary to reform the relevant hospital systems and how to reform them.

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.

AIMS This study aimed to analyse the prevalence of nurse-to-nurse horizontal violence in Chinese hospitals and examine the effects of head nurse's caring and nurse's group behaviour on horizontal violence. BACKGROUND Horizontal violence is a serious global problem affecting the nursing profession, but little is known of the issue in Chinese hospitals. Increasing evidence has showed that leadership and group factors are important in facilitating horizontal violence. Whether the head nurse's caring and group behaviour perceived by nurses has protective effects against horizontal violence remains unclear. METHODS A cross-sectional online-based questionnaire study was performed in seven general hospitals in Hubei Province, China. Data related to the demographic information, horizontal violence, head nurse's caring and group behaviour were collected. Descriptive analyses, chi-squared tests and logistic regression were used for data analysis. RESULTS In total, 1942 valid questionnaires were collected, with a 92.70% effective response rate (1942/2095). Of those, 59.1% (1148/1942) of respondents had experienced horizontal violence at least once in the previous 6 months. Covert negative behaviours were more frequently reported. Compared with the low level, moderate and high levels of the head nurse's caring showed a lower risk of horizontal violence (odds ratio [OR] = 0.400, p

Many nurse managers transition from proficient bedside nurses to leadership roles without formal leadership training. Their new role moves beyond the bedside of affecting an individual patient outcome to a position where their leadership behaviors, decisions, and actions impact the staff, patients, and families on a unit and organizational level. While new nurse managers are coached and mentored by their director, there is still an opportunity to provide a more standardized and structured approach to ensure optimal development and outcomes. A Nurse Manager Residency program supports the new leader by providing a forum for education, leadership development, and mentorship to demonstrate the critical components of a successful leader that promote staff engagement, patient experience, and excellence in nursing.

The health care settings of today are rapidly evolving in form and function, challenging nurse executives to adopt, adapt, and develop new ways to lead and find professional fulfillment in their roles. The organizational design of many health care settings has changed from a functional to a matrix structure to facilitate more effective and efficient operations. While the structures and reporting relationship of contemporary nurse executives may have changed significantly, the primary responsibility of championing the advancement of the profession of nursing remains essential. The mastery of change management methods is critical for the nurse executive to successfully lead in today's dynamic health care settings. A well-developed and actualized nursing professional practice model is a foundational tool for the nurse executive to employ to advance the profession of nursing in any health care setting or structure. This article describes how a nurse executive used change management methods and principles to lead the development of a new network-wide unifying nursing professional practice model in a highly matrixed health care setting.

Nurse scientist (NS) roles in clinical practice settings are key components of The Future of Nursing and ANCC Magnet® recognition. Despite increased opportunities for NS roles, leveraging these roles to advance nursing science remains at an early stage. We describe opportunities and challenges for NSs in clinical practice settings, highlighting the value of a strong partnership with chief nurse officers as critical for the success of NSs and outcomes associated with these roles.

If you work in healthcare, regardless of your role, experience or background, you are part of a team, united by a desire to provide the very best care and support not just to those using your services, but to each other. This sense of common purpose is so obvious it is often overlooked but should never be assumed. This article will explore the conditions that affect team effectiveness in contemporary healthcare systems. Twenty-first century healthcare systems are required to deliver safe, high-quality care which aims to tackle the social determinants of health through prevention, promotion, restoration and maintenance of health. Working in silos and providing episodic care is an approach no longer fit for the growing demands of ageing and complex populations. A population health approach is now required to meet the demands our health systems face. This requires an integrated, person-centred approach based on strong system leadership and professional commitment which supports interteamworking where cross-boundary and systems-working is the norm. Leading teams to work across whole systems has real benefits. Diverse, cross-functional teams have been shown to make better quality decisions, be more innovative, undertake change successfully and be better at problem-solving.1 Edmondson coined the term ‘extreme teaming’ for situations where team members 1. Work across multiple teams at once, 2. Come together for short periods such as in emergency departments where teams convene and disband constantly (teamworking on the fly) or 3. Come together from diverse backgrounds to address complex and often novel problems. This extreme teaming is as challenging as it is necessary, and leadership is vital in doing it well.2 A team can be defined as ‘two or more people interacting dynamically, interdependently and adaptively towards a common and valued goal, who have been assigned specific roles or functions to perform’.1 How team …

AimTo explore the experience of nurse managers managing Maternal and Child Health nurses undertaking family violence work in Victoria, Australia.BackgroundHealth care practitioners' ability to address violence against women is strengthened by health service systems that include effective staff management and leadership (García-Moreno et al., 2015). Maternal and Child Health nurses work with women experiencing abuse; however, their support by the health system and their managers has not been examined.MethodSemi-structured interviews with 12 nurse managers in 2019-2020 explored how they supervised and managed nurses. The data were analysed using Reflexive Thematic Analysis.ResultsWe identified three themes - a) managing the service: being resourceful; b) supporting nurses' emotional safety; c) hitting the ground running: the demands on the manager.ConclusionInadequate support for nurse managers undermines workplace well-being and role satisfaction, impacting the safety and supervision of nurses doing family violence work.Implications for nursing managementAn integrated family violence systems approach must include improved training and support for nurse managers to enable reflective practice and ensure effective support for nurses working with women experiencing abuse.

Objective The aim of this study was to compare self-perception of leadership practices among nurse managers (NMs), day shift nurses, and night shift nurses (NSNs). Background Nurse managers have complex roles in healthcare, with clinical, administrative, and 24-hour accountability for unit activities. Transformational leadership inspires performance beyond expectations, while transcending self-interest for the good of the organization. Methods A comparative, secondary data analysis study of the Leadership Practices Inventory (LPI) 2018. Results Day shift nurses' and NSNs' mean scores had lower perceptions of leadership practices than NMs' self-assessment. Day shift nurses, NSNs, and NMs identified the highest mean scores in "enable others to act" (8.57, 8.62, and 8.82, respectively). Conclusions The LPI assessment, the defined observer groups, and unique data visualization informed development of a comprehensive follow-up plan supporting individual and group leadership development. Research examining differences in perceptions of LPI practices across observer groups, particularly direct report staff nurses, is warranted.