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Background:  Teamwork and collaboration among nursing managers, nurses, doctors and peripheral hospitals treating mining patients is pivotal. A case study of specific mining primary healthcare clinics revealed a lack of teamwork among the doctors and nursing managers, even on decisions that show productivity., Objectives:  The aim of this study was to explore and describe nursing managers' perceptions of teamwork and collaboration in mining primary healthcare clinics in Gauteng., Method:  A qualitative, exploratory, descriptive and contextual research design was adopted to conduct this study. Data were collected by conducting semi-structured individual interviews with 10 participants and thematically analysed. Data saturation was reached by the seventh participant and confirmed with three more interviews. Trustworthiness measures and ethical considerations were preserved as protocols because of the nature of the study., Results:  Three themes emanated from the study: (1) team coordination and support improve teamwork and collaboration in primary healthcare clinics, (2) there is a lack of involvement from the nursing team, negatively influencing teamwork and collaboration and (3) collaboration can improve the quality of healthcare services rendered in mining primary healthcare clinics., Conclusion:  All mining primary healthcare clinic team members should be involved in operational activities to foster teamwork and collaboration.Contribution: This study revealed that teamwork and collaboration should be facilitated to improve the quality of healthcare service in mining primary healthcare clinics.

Succession planning in leadership is a strategic process used to identify and develop future leaders to fill key organizational positions. This process ensures continuity of leadership and helps maintain the organization's performance over time. Succession planning is essential for critical roles and can be part of a broader strategic plan for talent management. Organizations that are accredited by the American Nurses Credentialing Center (ANCC) in Nursing Continuing Professional Development (NCPD) can benefit from implementing succession planning to drive the stability of its work as an Accredited Provider and confirm that the organization maintains its commitment to quality in providing NCPD. This column describes how the Accredited Provider Program Director (AP-PD) role can benefit from implementing succession planning into the structure of the Accredited Provider processes. [ J Contin Educ Nurs. 2024;55(7):321-325.] .

Background:  Clinical supervision is pivotal in supporting nurses in rendering quality, safe patient care. Therefore, it is essential to understand clinical supervision from operational nursing managers' context to define existing challenges and propose suitable recommendations., Objectives:  This study aimed to explore and describe operational nursing managers' experiences of clinical supervision within the context of an academic hospital in Gauteng province and propose evidence-based practice recommendations to improve patient safety and the quality of clinical supervision., Method:  An exploratory, sequential, mixed-method design was used and implemented over two phases to take advantage of the strengths of both the qualitative and quantitative research designs. Unstructured individual interviews were conducted to collect data in phase one, and an adapted Manchester Clinical Supervision Scale (MCSS) questionnaire was used to collect data in phase two., Results:  Operational nursing managers work in stressful conditions and environments with a gross shortage of staff and tools of the trade while being expected to deliver high-quality and safe nursing care. Of the sampled respondents, 36% (n = 17) were dissatisfied with the supervision they received, while 64% (n = 30) were indifferent in the sense that they did not think it was adequate or inadequate., Conclusion:  Clinical supervisors should be trained and supported in clinical supervision, with regular workshops on interpersonal relations.Contribution: A clearer understanding of clinical supervision within the hospital context and evidence-based practice recommendations to improve patient safety and the quality of clinical supervision.

Objective: The purpose of this qualitative survey was to document executive nurse leaders' perception of their own leadership qualities in the context of the American Hospital Association (AHA) recommended membership requirements for executive hospital board appointment., Background: Hospital boards of trustees are increasingly responsible for the quality of care and its impact on financial performance. High-performing boards are focused on the accountability of chief executive officer for quality metrics. Nurse leaders have valuable insight into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight., Methods: Fifty senior-level nurse executive members polled from the American Organization of Nurse Leaders, the Texas Organization of Nurse Leaders, and the Texas Nurse Practitioners Association completed an online quantitative survey using The Center for Healthcare Governance (CHG) Assessment Tool© of the AHA, which details a list of skills, experience, and personal qualities for executive hospital board placement. Respondents ranked their individual knowledge and skills on a 4-point Likert scale., Results: Participant responses indicated that senior-level nurse executives have significant expertise in the key areas of quality, patient safety and performance, healthcare administration and policy, and business management. Areas ranking lower are those associated with organizational specialties: legal, construction project management, and finance., Conclusion: This information can be used to educate executive hospital boards regarding the qualifications of nurse leaders members. Nursing leaders, professional organizations, and academia can use this information to assess the skills of senior nursing leaders as it relates to potential board appointments., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: 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., Background: Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience., Methods: 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., Results: The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction., Conclusions: Interventions targeting frontline leaders positively impact CN performance., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: This study aims to report on the actions and incident management of the advanced practice nurses of a disaster operation team who were deployed in response to the COVID-19 outbreak, and to explore how it illustrated the Core Competencies in Disaster Nursing Version 2.0 delineated by the International Council of Nurses in 2019., Methods: This is a descriptive study. The participants (responders) communicated and reported their actions in the operation with headquarter on a popular social media platform in China (WeChat), established specifically for the three-rescue teams., Results: The response approach of advanced nurses to COVID-19 encompassed six of the eight domains of the competencies outlined in ICN CCDN V2.0, namely on preparation and planning, communication, incident management systems, safety and security, assessment and intervention., Conclusions: The response teams of advanced practice nurses in this study clearly demonstrated their competencies in disaster rescue, which fulfilled most of the core competencies set forth by the ICN., Implications for Nursing Management: The findings of this study contributed to understand the roles played by advanced practice nurses and nurse managers in disaster management and how these relate to the competencies set forth by the ICN., (© 2020 John Wiley & Sons Ltd.)

Competing Interests: The author declares no conflict of interest.

Background: Nursing managers have a critical role at the hospitals. The current study aims to investigate different experiences of nursing managers., Method: This is a qualitative study that investigates the experiences of 11 nursing managers in Shiraz, Iran. Semistructured interviews and thematic analysis were, respectively, applied for data collection and analysis., Results: It could be found from the current investigation that nursing managers have a critical role at the hospitals, and their creativities have more impacts on procedures compared to organizational orders. There are four major challenges faced by nursing managers including nursing shortage, structural deficiencies, lack of authorities, and burnout. Although shortage is considered as the most important challenge, there are more emphasizes on the improvement of their controlling power in order to prevent their fatigue and burnout., Conclusion: This study showed that creativity of nursing managers is the most important factor of system management; also, shortage and deficiencies are recognized as the most significant challenges faced by them. According to the current study, the shortage of nursing staff is the central issue that has to be considered., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Ahmad Kalateh Sadati et al.)

Background: The report of Saving Mothers indicated a decline of maternal mortality from 12.8% to 12.5% last triennium of 2017. This shows that regardless of availability of national maternal health guidelines, midwives and managers, 25% of maternal deaths were caused by preventable and avoidable factors. As such, support provided by managers is vital in promoting the utilisation of maternal guidelines., Objectives: The objective was to determine the support offered by managers to midwives during the implementation of maternal health guidelines., Method: The study design was cross-sectional descriptive in a quantitative domain. Simple random sampling was used to select 58 operational managers and two maternal managers. Data were collected using self-administered questionnaires and analysed using Statistical Package for Social Sciences version 23. Descriptive statistics provided by Microsoft Excel in the form of charts was used to describe data. Pearson's correlation test was used to describe relationships amongst variables., Results: The results revealed that 83.3% respondents indicated a shortage of staff to attend pregnant women. Fifty-six per cent of managers indicated that shortage of material resources contributed to substandard implementation of maternal guidelines. Supervision and monitoring of implementation of maternal guidelines was difficult as indicated by 53.3%, and 63.3% indicated lack of supervision., Conclusion: Limited support in terms of monitoring and supervision by managers was strongly indicated as having a negative effect on implementation of maternal guidelines. Capacity building was offered; however, shortage of resources led to poor implementation of maternal guidelines by midwives.

Introduction: the nurses´ perception of their supervisors´ leadership styles has a substantial impact on their well-being. Effective leadership in health care is crucial in improving and enhancing the effectiveness of health care systems. This study aims to assess the leadership styles of nurse leaders as perceived by employees, and to explore the relationship between perceived leadership styles and the quality of life of nurses in Lebanese hospital settings., Methods: it was a cross-sectional study conducted in 2017 and involved a sample of 250 nurses chosen randomly in eight hospitals. The survey included questions on socio-demographic and health-related characteristics, Multifactor Leadership Questionnaire 5X Short Form, and the Short Form Health Survey-12 V2 (SF-12v2)., Results: the managers used enough transformational leadership style, whereas they used fairly often transactional leadership. The Laissez-faire style was adopted from time to time by the managers. Male nurses perceive their managers as transformational significantly more than female nurses (2.94 vs. 2.73; p = 0.05). Transformational leadership style was statistically related to all scales scores of the SF-12v2 (p < 0.001) except the Social Functioning domain (p = 0.42). The transactional leadership style was associated with the Vitality scale scores (p < 0.001). The physical (p < 0.05) and Emotional Role (p < 0.001) and the mental health summary measure (p < 0.05) were lower in persons who perceived the leadership style of their manager as Laissez-faire., Conclusion: this study highlights the existence of a positive effect of leadership styles in the wellbeing of nurses, and confirms that nursing management has been identified as a challenge in the Lebanese hospitals., Competing Interests: The authors declare no competing interests., (Copyright: Ibtissam Mohamad Sabbah et al.)

Knowing the perceptions of first-line nurse managers (FLNMs) regarding their managerial competence is an important step to resolve disparities between their perceived competence and the competencies required for them to effectively function in their roles. Yet, evidence examining managerial competence of FLNMs among public hospitals in Indonesia is sparse. To fill this gap, we conducted a cross-sectional study aimed to identify managerial competence of FLNMs according to hospital type and ownership. This study was conducted from January to May 2018 and included a convenience sample of 233 FLNMs selected from 13 public hospitals. We used the Indonesian-First-Line Nurse Managers Managerial Competence Scale (I-FLNMMCS) to measure managerial competence. Descriptive statistics, Kruskal-Wallis, and Dunn's Pairwise were used for data analysis. Findings showed a significant difference in managerial competence according to the hospital type ( p  < .05). The FLNMs with a Diploma III, those relatively older, in their position for 7 or more years, and with managerial training in Type A hospitals (larger hospitals) had the highest managerial competence. The FLNMs with a bachelor's degree, those relatively younger, with less training, and those in their position for 3 to 4 years in Type B and C hospitals (smaller hospitals) had less managerial competence. A significant difference was also found in managerial competence according to hospital ownership ( p <.05). Public hospitals owned by the Ministry of Health of Indonesia had the highest competence among the others. This study is useful for guiding future policy work for human resource development in public hospitals.

Background: In order to achieve the goals of the healthcare system, nursing managers are required to comply with ethical principles in decision-making. In complex and challenging healthcare settings, it is shown that the managers' mere awareness of ethics does not suffice and managers need to be sensitive toward making ethical decisions., Aim: To explore nursing managers and their sensitivity toward ethical decision-making by analyzing their related experiences., Method: The current study has been conducted in Iran in 2017 through a qualitative content analysis approach. Nineteen nurse managers were selected purposefully from different hospitals in Tehran. Data were collected using semi-structured, in-depth, face-to-face interviews, and after transcription, they were analyzed according to the Graneheim and Lundman method., Ethical Considerations: The research was approved by the ethics committee of Tarbiat Modares University, Tehran, Iran. Participants were informed about the purpose of the study and submitted written informed consents regarding their participation. The principle of autonomy, confidentiality, and anonymity was taken into account in data collection., Results: Fifteen subcategories, three categories (assertiveness, commitment, and insight), and one theme of excellent decision-making were the results of data analysis., Discussion: Findings showed that nursing managers' sensitivity to ethical decision-making allows them to make the best decision by insight, commitment, and assertiveness. Making a morally excellent decision ensures that ethical principles are followed in the healthcare system., Conclusion: Considering that most managers are committed to making ethical decisions, it is required to develop the scope of their insights even further using a professional management and ethical principles training program. Also, by addressing some of the ethical barriers at personal and organizational levels, the assertiveness in managers can be improved, which in turn can facilitate their ethical decision-making.

Background: Little is known about how nurses are prepared to participate or lead teams in conducting safe and effective care transitions, despite being a complex process in which the nurse has an integral role., Purpose: To conduct mapping review to identify and synthesize key recommendations regarding curriculum content needed to increase Clinical Nurse Leader and Nurse Educator student knowledge and skills regarding transitional care., Method: Guidelines for developing the transitional care nurse role published by national accrediting bodies and certification organizations were reviewed to identify the required competencies., Findings: Components identified included: communication; teamwork and collaboration; education and engagement of patient and family; promoting and support for self-management; and assessing/ managing risks/symptoms., Conclusion: Research evidence is needed to support academic preparation of nurses as leaders in care transition. The core transitional components identified can be used to develop competencies to assist training efforts of nurses in practice and educational settings., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Despite decades of intensive resource allocation to eliminate preventable harm and increase high reliability in the hospital, the prevalence of serious harm remains consistent., Local Problem: A hospital reduced targeted preventable harms using audit and feedback (A&F) but failed to globally reduce harm or increase proactive awareness. Nurse leaders lacked a defined process for identifying errors, mitigating risk, and teaching systems thinking to influence resiliency among teams., Methods: Nurse leaders underwent A&F of daily safety rounds. Adherence data on frequency, high-quality, and high-reliability organizational (HRO) leader practice standards and precursor incident reporting rates were trended., Results: Rounding practice adherence increased for the following defined standards: frequency (63%-79%); high quality (50%-90%); and HRO leadership (0%-67%). Precursor incident reporting rates increased 25%., Conclusions: A&F reinforced quality and accountability for daily safety rounds. HRO theory-guided feedback offered an innovative way to translate HRO influence into nurse leader practice.

Aim: This study examined the influence of toxic and transformational leadership practices on nurses' job satisfaction, psychological distress, absenteeism and intent to leave the organisation or the nursing profession., Background: Transformational leadership is attributed to favourable nurse consequences; however, the nursing literature is silent regarding the causal association between toxic leadership and nurses' job outcomes., Methods: This is a cross-sectional study involving 770 registered nurses from 15 hospitals in Central Philippines. Data were collected using seven self-report scales during the months of December 2019 to February 2020., Results: The composite scores for the transformational leadership scale and toxic leadership scale were 4.22 and 1.59, respectively. Toxic leadership predicted job satisfaction, absenteeism, psychological distress and intention to leave the profession. Transformational leadership predicted job satisfaction and intent to leave the profession., Conclusion: Results suggest that nurses working with a transformational leader report higher job contentment and lower intent to leave the nursing profession. Nurses who work for a manager exhibiting toxic leadership behaviours demonstrated lower job contentment, higher stress levels, frequent absenteeism and higher intent to leave the nursing profession., Implication for Nursing Management: Nurse retention strategies should include measures to foster transformational leadership and derail toxic leadership practices in nurse managers through evidence-based education, training and professional development., (© 2020 John Wiley & Sons Ltd.)

Leading in a time of crisis.

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.

Aim: This paper describes the development and testing of the psychometric property of the Toxic Leadership Behaviors of Nurse Managers (ToxBH-NM) Scale., Background: Toxic leadership is growing increasingly pervasive in the field of nursing. However, the current literature lacks comprehensive attempts to explain how toxic leadership disrupts work processes in the field of nursing, a reality confounded in part by the absence of a reliable and a valid scale on which to examine toxic leadership behaviours in nurse managers., Methods: An exploratory sequential research design was used to formulate and evaluate the psychometric property of ToxBH-NM Scale. The content validity was examined by experts in nursing administration. A sample of 313 nurses from selected hospitals was recruited to assess the scale's reliability and validity. The factor structure of the newly developed scale was determined by exploratory factor analysis (EFA)., Results: Exploratory factor analysis for ToxBH-NM Scale revealed 30 items loading on four factors. The overall Cronbach's α coefficient of the scale was 0.975, and Cronbach's α coefficient ranged from 0.895 to 0.965 for the four factors. Corrected item-to-total (0.310-0.69) and item-to-item correlations (0.47-0.66) were acceptable. The Scale-content Validity Index was 0.957, and the Item-content Validity Index ranged from 0.833 to 1.000. The test-retest reliability coefficient of ToxBH-NM Scale was 0.801, with a reliability coefficient that ranged from 0.745 to 0.911 for the four factors. The four factors explained 71.84% of the observed variance., Conclusions: ToxBH-NM Scale shows good psychometric properties and can be used to evaluate toxic leadership behaviours among nurse managers., Implications for Nursing Management: The use of ToxBH-NM Scale can aid nurse managers in better understanding and managing their own leadership behaviours within their organisations and in fostering desirable work outcomes among employees, a positive work climate and overall organisational success., (© 2020 John Wiley & Sons Ltd.)

Aim: To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change., Background: While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity., Method: The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n = 15) in a large Canadian paediatric hospital., Results: Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions., Conclusion: Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes., Implications for Nursing Management: The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated; 2) the physical environment needs to be considered when determining staffing requirements; and 3) identity transitions need to be managed., (© 2020 John Wiley & Sons Ltd.)

The shortage of experienced nurses is a concern in health organizations. This study investigated the leadership styles of nurse managers' impact on turnover intention among nurses in hospitals. A descriptive correlational research design was used. Samples of 250 nurses working in five hospitals were selected to complete self-administered questionnaire. Findings show that participatory and transformational leadership styles are predominantly practiced. Correlation analysis revealed that participative and transformational leadership styles decreases turnover intention while autocratic and laissez-faire leadership styles increases turnover intention. Therefore, leadership styles of nurse managers are determinants of nurses' turnover intentions.

Given the implications of value-based reimbursement, nurse leaders must thoughtfully assimilate an extraordinary amount of quality, safety, and patient experience data to effectively drive behavioral change. This article proposes Swanson Caring Theory (SCT) as context for Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) improvement strategies. The diagnostic model described herein is not intended to encompass the full scope of nursing care, but rather to help nurse leaders interpret HCAHPS results in terms of the SCT attributes of compassion, competence, and patient well-being.

Aim: To explore nurses' perceptions of nurse managers' (NMs') communicative relationships that encourage nurses' decisions to buy-in to organisational initiatives to enhance patients' experiences with care (PEC)., Background: The role of the nurse to patient experience is well established, yet little is known about how the communicative relationship between manager and nurse relates to nurse buy-in to PEC initiatives., Method: An exploratory qualitative descriptive study was conducted with 15 nurses from two inpatient medical-surgical units in a large acute care hospital using semi-structured interviews., Results: Three themes were identified. The communicative relationship was developed and strengthened through the manager's: (a) multimodal approach to communicating and influencing, (b) engaging and supporting staff and (c) promoting staff-led decision-making., Conclusions: Nurses in our study who reported having a strong communicative relationship with their NM perceived that this relationship encouraged their buy-in and engagement in PEC initiatives., Implications for Nursing Management: An assessment of the communication between the frontline NM and his or her team is important for understanding why initiatives to support PEC are or are not yielding desired results., (© 2020 John Wiley & Sons Ltd.)

This article explores the concept of leadership in health and social care. All nurses have an important leadership role, which is reflected in the principles of the NHS Leadership Academy and in the new curriculum for nursing students. By critically applying the 'novice to expert' model of clinical competence to leadership, nurses are encouraged to consider the skills involved in moving from novice to expert alongside identifying the strengths and skills they wish to develop. Nurses are encouraged to reflect on leadership approaches operating in health and social care and to consider the type of leader they want to be. This article examines what expert or exemplary leadership might involve and some of the characteristics that are required. An expert leader can recognise their own values and beliefs, and the values and beliefs of those they lead and serve., Competing Interests: None declared, (© 2020 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Aim: The aim of this study was to explore the perceived challenges of nurse managers when caring for patients with dementia in acute hospitals and identify possible solutions to address these challenges., Background: Although dementia care in acute hospitals is suboptimal, few solutions have been identified. Multi-level factors need to be considered to promote changes in practice., Method: Two focus groups were held with sixteen nurse managers responsible for eleven acute medical wards in Malta. Deductive qualitative analysis using an adapted version of McKinsey 7-S model was used as an a priori framework to categorize the perceived challenges and solutions., Results: The nursing managers identified a number of organizational challenges that have a direct impact on the quality of care of patients with dementia. They also suggested a number of solutions such as realigning the hospital strategy, improving training and care coordination, redesigning the ward environment and changing leadership styles., Conclusion: This study highlight the complexity of improving dementia care in hospitals and continues to show that a system-wide approach is needed., Implications for Nursing Management: Understanding the challenges and identifying possible solutions can help hospital staff provide better person-centred dementia care., (© 2019 John Wiley & Sons Ltd.)

In healthcare, teamwork is promoted as a means of delivering high-quality care. Although the literature emphasizes the personal responsibility of healthcare workers to work effectively within teams, it is equally vital to understand the role of leaders in supporting teamwork. In a focused ethnography that examined teamwork and its impact on care delivery and job satisfaction for healthcare workers, our participants shared how their leaders impacted team functioning. In this study, we examined these data related to leadership and found a strong daily relational component to team management, in contrast to high-level, strategic recommendations in the literature; this has significant implications for leaders., (Copyright © 2020 Longwoods Publishing.)

Background: Frontline nurse managers influence the implementation of evidence-based practices (EBP); however, there is a need for valid and reliable instruments to measure their leadership behaviors for EBP implementation in acute care settings., Aim: The aim of this study was to evaluate the validity and reliability of the Implementation Leadership Scale (ILS) in acute care settings using two unique nurse samples., Methods: This study is a secondary analysis of ILS data obtained through two distinct multisite cross-sectional studies. Sample 1 included 200 registered nurses from one large Californian health system. Sample 2 was 284 registered nurses from seven Midwest and Northeast U.S. hospitals. Two separate studies by different research teams collected responses using written and electronic questionnaires. We analyzed each sample independently. Descriptive statistics described individual item, total, and subscale scores. We analyzed validity using confirmatory factor analysis and within-unit agreement (awg). We evaluated factorial invariance using multigroup confirmatory factor analyses and evaluating change in chi-square and comparative fit index values. We evaluated reliability using Cronbach's alpha., Results: Confirmatory factor analyses in both samples provided strong support for first- and second-order factor structure of the ILS. The factor structure did not differ between the two samples. Across both samples, internal consistency reliability was strong (Cronbach's alpha: 0.91-0.98), as was within-unit agreement (awg: 0.70-0.80)., Linking Evidence to Action: Frontline manager implementation leadership is a critical contextual factor influencing EBP implementation. This study provides strong evidence supporting the validity and reliability of the ILS to measure implementation leadership behaviors of nursing frontline managers in acute care. The ILS can help clinicians, researchers, and leaders in nursing contexts assess frontline manager implementation leadership, deliver interventions to target areas needing improvement, and improve implementation of EBP., (© 2019 Sigma Theta Tau International.)

Introduction: In-training assessment reports (ITARs) summarize assessment during a clinical placement to inform decision-making and provide formal feedback to learners. Faculty development is an effective but resource-intensive means of improving the quality of completed ITARs. We examined whether the quality of completed ITARs could be improved by 'nudges' from the format of ITAR forms., Methods: Our first intervention consisted of placing the section for narrative comments at the beginning of the form, and using prompts for recommendations (Do more, Keep doing, Do less, Stop doing). In a second intervention, we provided a hyperlink to a detailed assessment rubric and shortened the checklist section. We analyzed a sample of 360 de-identified completed ITARs from six disciplines across the three academic years where the different versions of the ITAR were used. Two raters independently scored the ITARs using the Completed Clinical Evaluation Report Rating (CCERR) scale. We tested for differences between versions of the ITAR forms using a one-way ANOVA for the total CCERR score, and MANOVA for the nine CCERR item scores., Results: Changes to the form structure (nudges) improved the quality of information generated as measured by the CCERR instrument, from a total score of 18.0/45 (SD 2.6) to 18.9/45 (SD 3.1) and 18.8/45 (SD 2.6), p = 0.04. Specifically, comments were more balanced, more detailed, and more actionable compared with the original ITAR., Discussion: Nudge interventions, which are inexpensive and feasible, should be included in multipronged approaches to improve the quality of assessment reports.

Aim: The purpose of this study was to gain a general overview of the time management disposition of clinical nursing managers in China and its related factors., Background: Effective time management is important for managers to achieve organizational goals. However, there is a lack of big-sample research exploring the impact of psychological and socio-demographic characteristics on time management disposition., Method: The study adopted a cross-sectional and descriptive design; 531 nursing managers from seven regions of China were recruited., Results: The nursing managers performed best on sense of time's value, followed by time monitoring ability and sense of time efficacy. Time management disposition was predicted by self-efficacy, SDS scores, managerial experience, the character strength of self-control and number of children., Conclusion: The "norm" level of the Chinese clinical nursing managers' time management disposition was at a favourable level, but these managers performed poorly in the aspect of time monitoring. It is recommended that actions be taken to improve nursing managers' time management disposition in order to maximize their time-use efficiency and enhance the quality of nursing management., Implications for Nursing Management: A greater understanding of nursing managers' time management disposition will provide a reference for subsequent actions to improve nursing managers' time management behaviour, which in turn will improve the quality and efficiency of nursing management., (© 2019 John Wiley & Sons Ltd.)

Objective: To examine the scientific evidence about the nursing practice environment in Primary Health Care., Methods: Three-step scoping review. 1) An initial research on CINAHL and MEDLINE. 2) A broader search using the same keywords and search terms in the remaining EBSCOHost platform databases. 3) Search the bibliographical references of the selected articles. The studies selected were from 2007 to 2018., Results: 19 articles were included, most reported findings of the nursing practice environment and results for clients, nurses, nurse managers and the efficiency of organizations, in Primary Health Care., Conclusion: Improving the environment of nursing practice has consequences on the quality of nursing care, with increased results for clients, nursing and Primary Health Care.

Objectives: To evaluate the reliability and validity of the Financial Management Competency Self-assessment (FMCA) in executive nurse leaders (ENLs) and to determine how ENLs develop and apply financial knowledge., Background: Financial literacy (FL) helps in planning, implementing, and evaluating fiscal decisions, but many ENLs report weaknesses in this core competency., Methods: An explanatory-sequential mixed-methods study was conducted to psychometrically test the FMCA and explore how ENLs with different levels of FL develop and apply financial knowledge. Eligible participants (n = 178) were recruited from a population of ENLs across the United States., Results: The test-retest reliability of the FMCA was good (mean difference, 6.80; 95% confidence interval). Correlations between domain scores (P < .01) and the overall score (Cronbach's α = .99) demonstrated the reliability and validity of the instrument. The cutoff scores were fair indicators of different levels of FL in ENLs (P < .001). Self-awareness, gaps in hospital and graduate nursing education, application of financial knowledge, and a micro versus macro view emerged as important themes in the qualitative analysis., Conclusion: FMCA reliability and validity were established. FMCA cutoff scores were established to determine FL level, and the ENL lived experience described in financial knowledge development and application.

Aims: To examine the associations between unit managers' authentic leadership with job satisfaction and organizational commitment and to investigate whether nurse tenure has a moderating effect on these associations., Background: Authentic leaders create trusting relationships with their staff and help nurses become more satisfied with their jobs and committed to their organizations. Because nurses have different perceptions of their working environments based on their tenure, the effectiveness of managerial leadership differ accordingly., Methods: This study is a cross-sectional secondary analysis using survey data from 1,118 staff nurses. To determine the significant tenure range for the associations between authentic leadership, job satisfaction and organizational commitment, the Johnson-Neyman method was used., Results: Authentic managerial leadership perceived by staff nurses had positive associations with job satisfaction and organizational commitment. The strengths of these associations were attenuated with nurse tenure and were no longer significant for nurses with more than 20 years of tenure., Conclusions: Although authentic leadership in managers was effective, the strengths of its effectiveness varied based on nurse tenure., Implications for Nursing Management: According to nurse tenure, differentiated approaches are needed to increase the job satisfaction and organizational commitment of staff nurses., (© 2019 John Wiley & Sons Ltd.)

Charge nurses often act as the eyes and ears of the unit. They are leaders, clinical experts, educators, policy enforcers, and patient advocates. They ensure patients and caregivers receive high-quality, safe, and evidence-based care. With the shift in health care from the in-patient to outpatient setting, patients are becoming more acute and complex for staff nurses. Charge nurses are pivotal in the successful care and management of these patients. Unfortunately, charge nurses often receive minimal training and are placed in this role with inadequate preparation and support. This can lead to feelings of anxiety, stress, and dissatisfaction with their job. Providing nurses with structured education about this role can create a safer and more positive work environment. This article discusses the development, implementation, and evaluation of a charge nurse orientation program in the outpatient infusion setting. [J Contin Educ Nurs. 2019;50(11):517-521.]., (Copyright 2019, SLACK Incorporated.)

Leaders must distinguish between diffusion as a change strategy, education as a stimulus for change, and implementation strategies associated with implementation science. This article provides an operational definition for implementation science, the distinguishing characteristics in leading transformational change, and the degrees of implementation. [J Contin Educ Nurs. 2019;50(11):491-492.]., (Copyright 2019, SLACK Incorporated.)

Nursing leadership can play an essential role in the development of nursing informatics solutions by virtue of their broad understanding and oversight of nursing care. We describe a systems-level method for creating nursing informatics solutions with clearly defined structure and leadership from nursing executives. Based on the guiding principles of clear lines of responsibility, respect for expertise, and commitment to project aims, this allows nursing executive leadership to organize, set up, and own the development of nursing informatics solutions.

Innovation keeps an organization competitive and adaptive to change. Nurse leaders are looking for new ways to innovate and transform, being challenged to influence quality, design new care delivery models, and create workplaces that empower nurses to advance new ideas that lead to innovation. Innovation involves risk as well as new ways of thinking. The workforce must feel confident that a creative approach to problem-solving is valued and supported. The nurse leader must role model use of creative approaches to problem-solving and promote a spirit of innovation among today's workforce. The nurse leader can learn to be more creative and can use education to empower staff to use creative thinking techniques to solve problems in practice. The transformational nurse leader can use any one or more of the tools and techniques offered in this article to inspire and educate the workforce on creative approaches to problem-solving and ultimately to generate innovative solutions to real practice problems.

Aim: To explore how nurse managers perceive and experience their role in supporting the well-being of intensive care nurses., Background: While it is known that nurse manager behaviours affect nurse well-being, literature indicates that intensive care nurses may not receive the support they require. Understanding how nurse managers see their role in supporting nurse well-being is crucial to offer recommendations for improvement., Methods: Qualitative multiple case study design. Twelve semi-structured, in-depth interviews were conducted with nurse managers from Australian intensive care unit settings. Data were analysed using thematic analysis., Results: Nurse manages felt unsure about what their supportive role involved, lacked training on how to support nurse well-being and called for organisational backup to carry out their role effectively. The study also provided insight into the strategies that enabled nurse managers to support nurse well-being., Conclusion: There is currently no consensus on the role of the nurse manager in supporting nurse well-being resulting in inconsistencies and wide practice variations. Furthermore, nurse managers need support and training if they are required to support nurse well-being., Implications for Nursing Management: A clear definition of the nurse manager supportive role describing the purpose and core functions involved in this role must be developed to support nurse well-being., (© 2019 John Wiley & Sons Ltd.)

Aim: To explore the extent of Australian nurse managers' engagement in clinical care activities., Background: Hybrid nurse manager roles lack clarity in the optimal balance between the clinical and other activities, resulting in stress and challenges in recruiting and retaining nurse managers., Methods: In a national survey using the Advanced Practice Role Delineation tool, Australian nurses self-assessed their level of engagement in activities across five domains of nursing practice. The subset sample analysed comprised 2,758 registered nurses, 390 clinical (front-line) nurse managers and 43 organisational (middle) nurse managers. Median domain scores were compared with non-parametric tests of difference., Results: Clinical nurse managers were in a hybrid role, reporting high levels of engagement across the domains. Lower scores observed for organisational nurse managers highlight the shift to strategy-focussed activities that occurs as nurses up the management hierarchy., Conclusions: By indicating their engagement in the clinical care domain, respondents demonstrated that clinically focused activities were not entirely lost from either front-line or middle-management roles., Implications for Nursing Management: Nurse managers equipped with clinical and management skills, and allowed time to remain engage in clinical care activities are critical for patient-centred and cost-effective care in today's complex health care environments., (© 2019 John Wiley & Sons Ltd.)

In this month's Magnet Perspectives column, the director of the Magnet Recognition Program highlights the program staff and leadership at ANCC responsible for the Magnet Program.

Introduction: Hospitals are known to be the most complex entities to manage. In fact, the main problem in healthcare are the expensive needs with limited resources. During the last years the complexity of the nurse manager role has gradually changed from assistance to management. However, nowadays the methods for quantifying the nurse managers' skills and performance are not available. The aim of this study is to implement a method to assess and measure the skills of the nurse managers. An innovative indicator to globally evaluate the features, the professional skills and their performance is described., Methods: The authors started with an interview with the directors of all the nurses as the top experts of the nurse managers' technical skills. The purpose of this step was to understand what were the features of a valuable nurse manager. The methods identified three different aspects (qualitative, quantitative and relational) that were transformed in a single indicator. These parameters also enable to identify the strengths and weaknesses of each professional. An important implication of this score is the possible improvement of loss-making skills., Results: A total of 18 centres, with their nurse managers, were evaluated in this study. All the results confirmed the judgment of the Healthcare Professions Structure Manager., Conclusions: This assessment method, validated with these tests, evaluated the nurse manager's ability to deal with personnel, resources and patients and to quantify his/her organizational and welfare performances. It is useful for planning actions that allow nurse managers to improve their skills., (©2019 Pacini Editore SRL, Pisa, Italy.)

Background: Effective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections. Infections with multi-resistant bacteria's, associated with healthcare, is a known problem. The nursing home setting differs from other healthcare environments in individual and organisational factors such as knowledge, behaviour, and attitude to improve hand hygiene and it is therefore difficult to research the influential factors to improve hand hygiene. Studies have shown that increasing knowledge, behaviour and attitudes could enhance hand hygiene compliance in nursing homes. Therefore, it may be important to examine individual and organisational factors that foster improvement of these factors in hand hygiene. We aim to explore these influences of individual and organisational factors of hand hygiene in nursing home staff, with a particular focus on the function of role modelling by nursing managers., Methods: We conducted a mixed-methods study surveying 165 nurses and interviewing 27 nursing managers from nursing homes in Germany., Results: Most nurses and nursing managers held the knowledge of effective hand hygiene procedures. Hygiene standards and equipment were all generally available but compliance to standards also depended upon availability in the immediate work area and role modelling. Despite a general awareness of the impact of leadership on staff behaviour, not all nursing managers fully appreciated the impact of their own consistent role modelling regarding hand hygiene behaviours., Conclusion: These results suggest that improving hand hygiene should focus on strategies that facilitate the provision of hand disinfectant materials in the immediate work area of nurses. In addition, nursing managers should be made aware of the impact of their role model function and they should implement this in daily practice.

Aim: To characterize registered nurses' (RNs') perceptions of nurse leaders' transformational leadership (TL) qualities in Finnish university hospitals and identify predictors of positive and negative evaluations., Background: Transformational leadership can improve health care but requires development. Information on TL is typically derived from survey results, which are vulnerable to confounders., Method: Cross-sectional survey. Registered nurses' perceptions of nurse leaders were measured with the TL scale. Kohonen's self-organizing map was used to cluster the data based on RNs' opinions and questionnaire items. Logistic regression explained background characteristics' effects on cluster formation., Results: A total of 1,970 RNs participated and evaluated their nurse leaders' TL qualities as moderate. Giving feedback and rewarding clustered separately from other TL qualities. Females and permanent workers evaluated nurse managers more negatively but nurse directors positively. Positive perceptions of nurse managers' TL predicted better TL among nurse directors. Vice nurse managers gave the most positive evaluations. A total of 197 RNs had no opinions about nurse directors' TL., Conclusions: Registered nurses evaluated nurse managers' TL qualities as moderate and were unfamiliar with nurse directors. Background characteristics affecting evaluations differed between leader types., Implications for Nursing Management: Giving feedback and rewarding should be more closely associated with other TL qualities. Transformational leadership requires transformational approaches from both nurse managers and directors., (© 2019 John Wiley & Sons Ltd.)

Aim: Explore the recent literature to examine the factors that affect safety culture within health care teams., Background: Health care organisations must understand and improve their safety culture. However, safety culture is a complex phenomenon which interacts with a myriad of factors, making it difficult to define, measure and improve., Evaluation: A comprehensive search strategy was used to search four major databases. Peer-reviewed which were published in English between 2006 and 2017 and presented research studies related to safety culture in health care teams were included. A narrative analysis was undertaken., Key Issues: Issues relevant to the definition, measurement and improvement of safety culture, the impact of teamwork and communication on safety culture, the role of leaders and accountability are explored., Conclusion: The above themes inform our understanding of developing, measuring and sustaining safety culture in health care teams. However, further research is warranted to accurately understand how to measure and improve safety culture., Implications for Nursing Management: To support a safety culture, initiatives to facilitate effective communication between nurse practitioners and other health care professionals must be introduced. Nurse managers should adopt leadership strategies that will support nurses' psychological safety and create a just culture., (© 2018 John Wiley & Sons Ltd.)

Most health care organizations are designed using industrial model performance standards based on conformity and conventionality. In the new economy, marked with exponential change, convergent competition, and empowered consumers, leaders are faced with building a model that can accommodate personalized medicine, managing patient-centered expectations, and value-creating hubs to remain viable. [J Contin Educ Nurs. 2019;50(5):196-198.]., (Copyright 2019, SLACK Incorporated.)

Aim: To examine personal, ward and organisational factors related to the functioning of general hospital staff under missile attack., Background: The summer of 2014 is remembered in Israel for missile attacks from the Gaza Strip targeting the civilian population of southern Israel., Methods: The study was carried out in two steps: (1) Qualitative-a focus group to identify the issues faced by the staff of a hospital under fire, (2) Quantitative-a cross-sectional study among 409 hospital workers to explore: (a) personal involvement in decision-making, (b) clarity of directives, (c) coping with emergency on the ward and on (d) the management level, (e) personal professional functioning., Results: A statistically significant positive correlation was found between personal involvement in decision- and policy-making, the clarity of directives and hospital ward functioning. A regression analysis demonstrated that executive management and leadership, clarity of directives and workers' personal functioning statistically significantly explained 46.1% (R 2  = 0.461) of the variance in ward functioning during emergency., Conclusion: Clarity of directives and executive management and leadership in emergency were positively associated with ward functioning and coping with emergency., Implications for Nursing Management: To ensure proper hospital functioning during emergency, managers must demonstrate personal involvement and leadership, providing clear directives., (© 2018 John Wiley & Sons Ltd.)