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A nurse-led standardized pre-authorization process was implemented to reduce decision turnaround times to subsequently reduce costs and improve access to care. Nurses should lead Quadruple Aim initiatives because of their expertise and unique positioning within health care systems. [ABSTRACT FROM AUTHOR]

Medical leave of absences occur due to physical, psychological, and work-related issues. It is imperative for nurse leaders to understand the impact of these situations on a nursing team from organizational and relational perspectives, and to address this issue by understanding the complexity of the transitional work process and improve this process. There may be opportunities to reintegrate nursing staff into areas with staffing challenges, increasing productivity and staff engagement, while ensuring cost avoidance. [ABSTRACT FROM AUTHOR]

Background: Design Thinking is gaining recognition as an innovative and creative approach to problem solving. Though nurse leaders need problem solving tools to address health care challenges, Design Thinking concepts are not commonly taught in nursing education. To introduce graduate level nursing students to Design Thinking, we held an educational activity focused on this content as part of required coursework. Purpose: The purpose was to describe and compare outcomes of a Design Thinking educational activity on students' perceived knowledge, confidence, and benefits to nursing practice. Methods: Graduate level nursing students participated in a 3-hour educational activity. After the session, students completed an anonymous 10-item survey of their perceptions of the educational activity. Results: Students reported increased knowledge and confidence of communication strategies and Design Thinking concepts that would benefit their practice. Conclusion: Nurse educators should include Design Thinking teaching and learning strategies in their programs. [ABSTRACT FROM AUTHOR]

Copyright of Environmental & Social Management Journal / Revista de Gestão Social e Ambiental is the property of Environmental & Social Management Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Discrimination against lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) individuals in healthcare settings remains a priority issue. Nurse leaders, who oversee the largest healthcare workforce, are critical in implementing inclusive practices to address LGBTQ+ discrimination, yet implementing LGBTQ+ inclusive practices and effective strategies is inconsistent. This qualitative descriptive study explored nurse leaders’ perceptions of LGBTQ+ inclusive practices across the United States to inform recommended strategies within health systems. Methods: Twenty-one nurse leaders (e.g., chief nurse executives) from diverse healthcare settings (e.g., children's hospitals and public health centers) in 12 states across the United States participated in semi-structured interviews from October to December 2023. Interview transcripts were analyzed using content analysis to (1) describe nurse leaders’ definitions of LGBTQ+ inclusive practices and (2) identify effective strategies for their implementation. Results: Nurse leaders defined LGBTQ+ inclusive practices to include delivering culturally responsive and competent care, fostering safe and affirming environments, integrating inclusivity into daily interactions and organizational culture, and supporting the needs of both LGBTQ+ staff and patients. Key implementation strategies included fostering a flexible organizational culture through open communication; a diverse workforce; and inclusive mission statements, policies, and strategic plans. Supportive infrastructure involved effective LGBTQ+ training and adapting electronic health record systems to include information on sexual orientation and gender identity. Active and interdisciplinary engagement from staff and leadership, as well as systematic data collection on patient and staff experiences, were essential for driving inclusivity. The advocacy highlighted included legislative support, discourse within the nursing profession, and the incorporation of LGBTQ+ inclusion into healthcare regulations and accreditation standards. Additionally, multisectoral partnerships with LGBTQ+ health experts and external organizations, along with multilevel evaluations, were recommended to develop tailored interventions and promote LGBTQ+ inclusive practices. Conclusion: Implementing LGBTQ+ inclusive practices in healthcare is a multifaceted effort influenced by strategies at various levels. Promoting a supportive organizational culture, establishing comprehensive support structures, encouraging active engagement, and fostering community partnerships can address the needs of LGBTQ+ individuals more effectively. Future implementation efforts should tailor strategies to accommodate variability across healthcare settings and regions, ensuring that practices are both adaptable and sustainable.

Aim: To describe the crisis management competencies needed in a hospital setting during the COVID‐19 pandemic from the perspective of nurse leaders. Background: The COVID‐19 pandemic generated many challenges for nurse leaders in hospitals, and management competencies are highlighted. However, there is little evidence available about nurse leaders' perceptions of the crisis management competencies needed in such situations. Methods: A qualitative, descriptive, semi‐structured interview study of nurse leaders (n = 20) was conducted between June and October 2021 in one Finnish central hospital. The data were analysed using inductive content analysis. Results: The analysis yielded five main categories of crisis management competencies needed in a hospital setting during the pandemic: interactive communication competence, psychological resource management competence, systematic and proactive organising competence, active networking abilities and practices and change management approach in crisis management. Conclusions: Nurse leaders need new and different crisis management competencies in hospital organisations. The COVID‐19 pandemic changed the working culture of nurse leaders, as they faced challenges that needed knowledge and skills beyond their previous management competence. Implications for nursing management: Additional training for nurse leaders in crisis management is needed. This training should reflect the competencies identified as necessary in crisis situations so that nurse leaders will be able to manage crisis situations effectively in future. Reporting method: The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used in reporting the findings. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Targeted interventions have been found effective for developing leadership practices in nurses. However, to date, no leadership training program based on the Strengths-Based Nursing and Healthcare Leadership approach exists. Objectives: Demonstrate the effectiveness of a Strengths-Based Nursing and Healthcare Leadership 6-month program designed for nurse and healthcare leaders on leadership capacity and psychological outcomes. Design: Concurrent mixed-methods with nurse and healthcare leaders from five healthcare organisations in Quebec and Ontario (Canada). Settings: Participants were recruited from five Canadian health care organizations: two in Toronto (Ontario) and three in Montreal (Quebec). Participants: A total of 50 nurse leaders and healthcare leaders were included in the quantitative component, and 22 (20 nurse leaders and two healthcare leaders) participated in the qualitative individual interviews. Methods: Quantitative and qualitative (interviews) methods were used. Quantitative data (pre-post surveys) were collected from the participants before their participation in the program (Time 0), as well as after the completion of the program (Time 1). Qualitative data (individual interviews) were collected from participants at the end of the program (Time 1). Analysis was conducted using descriptive statistics, paired-sample t-tests, and thematic analysis. Results: Quantitative results suggest a significant improvement in terms of leadership capabilities, work satisfaction, and reduction in perceived stress among participants. Three themes emerged from the qualitative data analysis: 1) focus on people's strengths, 2) structure and language based on Strengths-Based Nursing and Healthcare values, and 3) building support networks. Conclusions: The Strengths-Based Nursing and Healthcare Leadership program developed to build the leadership capabilities of nurse and healthcare leaders was found to be effective. The positive impact of the 6-month program was demonstrated. It was also shown that the leadership program can help improve the leadership competencies, well-being, and work satisfaction of participating nurses and healthcare leaders. Implication: This study reinforces the importance of working with educational, research, and healthcare organizations to establish leadership development programs and mentorship opportunities. Future leadership training should use a Strengths-Based Nursing and Healthcare Leadership lens when tackling leadership and stress in the workplace.

Background: Many healthcare professionals have left their professions recently because of increased moral distress, and the COVID‐19 pandemic has had a further major impact on the ever‐changing healthcare environment. Aim: The purpose of the study was to examine care leaders' experiences of moral distress in their daily work in older adult care. Methodology: A qualitative design was used. The data consisted of texts from interviews with care leaders (N = 8) in an older adult care context. Content analysis was used to analyse the data. Findings: Five themes emerged: (1) moral distress arises from a lack of time, (2) moral distress contributes to a sense of inadequacy but also a sense of responsibility, (3) moral distress arises from an imbalance in values, (4) increased knowledge and open discussion help reduce moral distress and (5) reflection, increased support and increased resources can reduce moral distress. Conclusion: Moral distress is something that care leaders, according to this study, experience daily in an older adult care context and it is considered to have increased. Care leaders can experience moral distress from a lack of time; patient‐related, relative‐related or other ethically difficult situations or an imbalance between own values and an organisation's, other caregivers', patients' and/or patients' relatives values. Increased staffing resources, more knowledge (training and lectures) and time for reflection individually, in groups or with an outside expert could increase care leaders' insights into and ability to reduce moral distress. Although situations that are characterised by moral distress are burdensome, care leaders have the opportunity to learn from such situations through reflection and discussion and can develop strategies for future ethical challenges. Future research could focus on exploring caregivers' experiences of moral distress. [ABSTRACT FROM AUTHOR]

Abstract Aim To describe the crisis management competencies needed in a hospital setting during the COVID‐19 pandemic from the perspective of nurse leaders. Background The COVID‐19 pandemic generated many challenges for nurse leaders in hospitals, and management competencies are highlighted. However, there is little evidence available about nurse leaders' perceptions of the crisis management competencies needed in such situations. Methods A qualitative, descriptive, semi‐structured interview study of nurse leaders (n = 20) was conducted between June and October 2021 in one Finnish central hospital. The data were analysed using inductive content analysis. Results The analysis yielded five main categories of crisis management competencies needed in a hospital setting during the pandemic: interactive communication competence, psychological resource management competence, systematic and proactive organising competence, active networking abilities and practices and change management approach in crisis management. Conclusions Nurse leaders need new and different crisis management competencies in hospital organisations. The COVID‐19 pandemic changed the working culture of nurse leaders, as they faced challenges that needed knowledge and skills beyond their previous management competence. Implications for nursing management Additional training for nurse leaders in crisis management is needed. This training should reflect the competencies identified as necessary in crisis situations so that nurse leaders will be able to manage crisis situations effectively in future. Reporting method The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used in reporting the findings. Patient or public contribution No patient or public contribution.

Nurses are needed in formal and informal leadership positions to address known challenges in medical-surgical settings. To be successful, medical-surgical nurses must be supported to engage purposefully in leadership development over their careers. [ABSTRACT FROM AUTHOR]

Background: Nurses with inadequate clinical experience assume leadership positions as first-line managers in hospitals in Malawi due to shortage of Registered Nurses. It is presumed with support from senior nurse leaders, inexperienced nurses can lead successfully. Research suggests Supportive Leadership (SL) can positively influence performance. The study examined the effect of SL (mentoring, relationship building, team working, and positive work environment) on performance of Inexperienced Nurse Leaders (INLs) in the Central West Quality Satellite Zone Hospitals of Malawi. Methods: A convergent mixed methods design was used, with qualitative findings being presented. The sample was selected using purposive sampling. Data was collected through in-depth interviews with 10 Senior Nursing Officers (SNOs) and 10 INLs and was analysed using Collaizi's thematic method. Ethical approval was granted by the National Commission for Science and Technology in Malawi. Results: SL promoted the performance of INLs. Mentoring empowered the INLs to lead though it was done inconsistently. The INLs acknowledged the presence of work relationships and collaborative healthcare teams in the wards/units. The work relationships and teams eased work and the INLs felt supported. The work environment was positive in some wards and non-conducive in others. The main challenges were a shortage of nurses, financial and material resources. Conclusion: The research results have shown the importance of SL of SNOs in the CWQSZ hospitals of Malawi despite the existing shortage of nurses, material, and financial resources. The leadership style promoted the performance of INLs. The results contribute to the existing limited body of knowledge of SL in nursing. [ABSTRACT FROM AUTHOR]

Background: Unreasonable workload and work‐related stress can reduce nurse leaders' job satisfaction and productivity and can increase absence and burnout. Nurse leaders' workload in public healthcare settings is relatively unresearched. The Aim: The aim of this study was to investigate nurse leaders' perceptions of workload and task distribution with relation to leading work tasks in public healthcare. Research Design, Participants and Research Context: A qualitative explorative design was used. The data material consisted of texts from interviews with nurse leaders in public healthcare (N = 8). The method was inspired by content analysis. The COREQ checklist was used. Ethical considerations: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Findings: Six main themes were found: Increased and unreasonable workload, Length of work experience as nurse leader affects perception of workload, Number of staff and staff characteristics affect perception of workload, Versatile and flexible task distribution, Working overtime as a way of managing high workload and Insufficient time for leadership mission. Conclusion: The workload for nurse leaders in a public healthcare setting was perceived to be unreasonable. Common measures for managing high workload included working overtime, delegating work tasks and organising more staff resources in the form of additional staff. How nurse leaders perceive their workload was linked to both the number of staff and staff characteristics. These should both be considered equally important when determining staff levels and measuring nurse leaders' workload. Future research should focus on investigating workload and task distribution from nurses' perspectives. Relevance to Clinical Practice: Through this study, greater understanding of workload and the diverse work of nurse leaders in a public healthcare setting has been revealed, which can be used to further develop the framework for nurse leaders' work. [ABSTRACT FROM AUTHOR]

Copyright of Hoitotiede is the property of Hoitotieteiden Tutkimusseura HTTS r.y. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Perioperative nursing units are described as one of the most challenging practice environments, characterized by a distinct hierarchal culture and rapid pace. These dynamics create challenges for creating a culture of safety, where meso-level nurse leaders (MLNLs) must operate in the space between the micro level of direct patient care and the macro-level administrative priorities. Purpose: Guided by complexity leadership theory, we sought to understand the strategies MLNLs used to facilitate a culture of safety in perioperative settings. Methodology: A qualitative descriptive study with semistructured interviews was conducted. Inductive thematic analysis was used to analyze content from the interviews, and several techniques (audit trail, reflexivity, peer debriefing) were used to ensure rigor. Results: Seventeen MLNLs completed an interview, and analysis identified four strategies that MLNLs reported to foster safety as meso-leaders in perioperative environments: (a) recognizing the unique perioperative management environment, (b) learning not to take interactions personally, (c) developing "super meso-level nurse leader" skills, and (d) appealing to policies and patient safety. Conclusion: Perioperative environments require MLNLs to use multifaceted strategies to keep the peace among many stakeholders and foster patient safety. Practice Implications: Our study shows how clear organizational policies and procedures can serve as a vital tool—moving attention away from a feeling of individual "policing" and toward joint discussion about shared patient safety goals—and ultimately support MLNLs in challenging perioperative work environments. Perioperative environments create unique challenges, and organizations should consider perioperative-specific leadership training to prepare MLNLs for these roles. [ABSTRACT FROM AUTHOR]

This study explores the perceived congruence of effective values of nursing leadership between the nurse leaders and the staff nurses in a multicultural tertiary hospital. Methods: This is a descriptive sequential mixed-methods study conducted in a multicultural medical city in Saudi Arabia. Purposive sampling was used in the qualitative phase, while stratified sampling was used for the quantitative part. There were 70 participants in the qualitative phase, including 33 nurse leaders and 37 staff nurses. The quantitative phase had 571 participants, including 105 nurse leaders and 466 staff nurses. Results: Congruent values were categorised into six emerging themes: (1) cascading deference; (2) paragon of probity; (3) professional competence; (4) compassionate presence; (5) team diversity and inclusion; (6) calibrated communication. The quantitative survey confirmed that the values identified from the interviews were considered to be vital by both nurse leaders and staff nurses, and there were no statistically significant differences between staff nurses' and nurse leaders' perceptions, regardless of their nationality, as demonstrated by one-way ANOVA, with p-values less than 0.05 deemed to be statistically significant. Conclusion: Both nurse leaders and staff nurses in the multicultural institution have congruent leadership values that are perceived as essential to achieve institutional goals and, ultimately, safe and high-quality patient care. [ABSTRACT FROM AUTHOR]

Background: Mental healthcare can be considered a unique practice due to its ethical characteristics, and an awareness of ethics is crucial when working in a mental health setting. Several ethical challenges exist, and professionals may not always recognize the ethical aspects of psychiatric care. Research on psychiatric care from nurse leaders’ perspective is scarce but important, because nurse leaders can impact and cultivate workplace culture. Aim: To explore the phenomenon of unethical conduct in a psychiatric inpatient context from nurse leaders’ perspectives. Research design: Qualitative exploratory design. In-depth semi-structured interviews. Participants and research context: Eight nurse leaders from two different healthcare organizations in Finland. Leadership experience ranged between 2 and 30 years. Ethical considerations: Research ethics permission was received from a Research Ethics Board where the researchers are domiciled. Guidelines on good scientific practice as delineated by the Finnish Advisory Board on Research Integrity TENK were followed. Findings: Six main categories were generated: Unethical conduct and violations against patients, Unethical conduct and violations against staff, Unethical conduct and violations by staff against other staff, Unethical conduct and violations against leaders, Reasons underlying unethical conduct, and Consequences of unethical conduct and the positive development of psychiatric care. Conclusions: Unethical conduct was seen to be a multifaceted phenomenon, and patients and staff alike can experience and engage in unethical conduct. Unethical conduct against patients was linked to power imbalance (nature of involuntary care, staff attitudes) and a focus on rules based in historical precedent (paternalistic, routine-focused, not patient-centered). Unethical conduct against staff was linked to the nature of involuntary care and patient ill-health. Unethical conduct by staff against other staff was linked to a lack of understanding for others’ work, interpersonal chemistry, (length of) work experience, and staff character. Unethical conduct against leaders was linked to leaders being perceived as the organization. [ABSTRACT FROM AUTHOR]

Nursing leaders have recognized the need for consistent mechanisms to promote and sustain nursing professionalism. Peer-to-peer feedback and peer review are widely effective for nurse professionalism and self-regulation, patient care outcomes, and retention. Unprofessional behavior has been noted as widespread in health care and the effects on patients, clinicians, and organizations have been well-documented. Approximately 10% of the registered nurses in the United States belong to a collective bargaining unit (CBU) or union. This article will describe how a peer feedback program to address unprofessional behavior was implemented in a Magnet nursing practice with CBU representation. • Collaboration with collective bargaining units can result in shared goals. • Collaboration and discussion can produce an effective peer feedback program. • Peer feedback is important to create a culture of safety and respect. [ABSTRACT FROM AUTHOR]

• Effective communication in healthcare means approaching every interaction with the intention of all involved to understand concerns, experiences, and opinions. • Utilizing a systematic approach to teach communication skills achieves positive learning outcomes. • Refining nursing students' communication skills prepares them to be leaders in the healthcare system. Effective communication is essential to nurses at all levels. Most educational activities related to communication focus on therapeutic techniques between nurse and patient. Opportunities for students to participate in activities that promote persuasive communication skills are vital. Students participated in a learning activity, which challenged them to master main influence channels utilizing identified persuasion techniques. Several students were successful in selling ideas. The education innovation refined students' communication skills and met competencies related to leadership. [ABSTRACT FROM AUTHOR]

Aim: This scoping review aimed to identify the existing evidence on how nurse leaders promote and maintain civility amongst nurses in health care settings. Background: Research on managing workplace incivility in nursing, a prevalent and concerning issue worldwide, recommends nurse leaders to command cultural change through strong leadership and civility interventions. However, there is very little empirical evidence summarizing and analysing how nurse leaders pragmatically achieve civility, and combat workplace incivility, in the health care setting. Evaluation: A scoping review was undertaken using the electronic databases CINAHL, Emerald Insight, MEDLINE, PsychINFO, PubMed and Scopus. Google Scholar was used to search for grey literature. Key issues: The eight studies included in this review describe how nurse leaders promote and maintain civility under four key themes: (1) creating a shared vision, (2) educating self and others, (3) fostering accountability and (4) providing support. Conclusion: The review provides an overview of commonly used strategies and actions that pragmatically promote and maintain civility in the health care setting by nurse leaders, while also highlighting areas of future research needed to strengthen the evidence base. Implications for Nursing Management: It is important for nurse leaders to gain an understanding of evidence‐based practices when addressing workplace incivility in order to address this prevailing problem for the future and safety of nurses moving forward. [ABSTRACT FROM AUTHOR]

Aim: This study aims to establish postgraduate students' perceptions of the organizational culture and readiness for evidence‐based practice of their workplaces in the Kingdom of Saudi Arabia. Background: Nurse shortages and a reliance on a transient nurse workforce have long been a challenge in the Kingdom of Saudi Arabia. Developing a home‐grown nurse workforce, a key objective of the Government of Saudi Arabia, can help to address this. Evidence‐based practice offers a mechanism to address this. Evidence‐based practice implementation is heavily reliant on the prevailing organizational culture. Establishing the organizational culture and readiness for evidence‐based practice is crucial for sustainable evidence‐based practice implementation. Methods: A pre‐experimental pilot study collected data from the same participants at three different points. As part of this, a questionnaire measuring organizational culture and readiness for evidence‐based practice was administered twice. Descriptive, inferential and correlational statistics were employed to analyse the data. Results: Results demonstrated improved participant perceptions of the organizational culture and readiness for evidence‐based practice of their workplaces between the first (M = 76.58, SD = 19.2) and second (M = 92.10, SD = 23.68) data collection points, indicating moderate movement towards a culture of evidence‐based practice. Strengths, challenges and opportunities for improvement were identified. Conclusion: This study established participants' perceptions of the organizational culture and readiness for evidence‐based practice of their workplaces, affording insight into context‐specific strategies to embed evidence‐based practice in health care organizations. Implications for Nursing Management: Assessing an organization's culture and readiness for evidence‐based practice (EBP) can afford insight on the strengths, challenges and opportunities that exist to equip nurse managers to advance evidence‐based practice at individual, professional and organizational levels. This study demonstrated the importance of promoting an environment conducive to EBP and putting in place the necessary resources to support evidence‐based practice implementation. Nurse managers can play a central role in this. [ABSTRACT FROM AUTHOR]

Aim: To explore nurse leaders' experiences of professional responsibility to facilitate nursing competence in general wards. Background: Nurse leaders are responsible for maintaining high levels of competence among nurses to improve patient safety. Methods: Qualitative analysis was conducted between February and April 2019 using semi‐structured interview data from 12 nurse leaders in surgical and medical wards at three Norwegian hospitals. Results: Four main themes were identified: struggle to achieve nursing staff competence; focus on operational and budgetary requirements rather than professional development; demands to organize sick leaves and holiday periods; and challenges in facilitating professional development. Conclusion: Nurse leaders felt that their responsibilities were overwhelming and challenging. They witnessed more support for current administrative tasks than for the implementation of professional development. Additionally, unclear work instructions from the employer provided few opportunities to facilitate professional development. Hospital management failed to ensure quality of care and patient safety in general wards by not supporting the strengthening of nurses' professional competence and preventing turnover. Implications for Nursing Management: Management may integrate formal work instructions that clarify nurse leaders' responsibilities as professional developers, allowing nurse leaders to meet their obligation of maintaining adequate professional competence among nursing staff in general wards. [ABSTRACT FROM AUTHOR]

Nursing is in a challenging place, and we are facing many incredibly complex issues that are steeped in culture and tradition. These "wicked problems" often arise when organizations face constant change or unprecedented challenges. In this article, we discuss current issues that hinder all nurse leaders from elevating nursing as a profession, with a particular focus on the role and contributions of the academic nurse leader in creating and sustaining positive change. By prioritizing meaningful collaboration, reimagining education for nursing outside the hospital walls, investing in evidence for practice, and advocating by amplifying new voices, we can identify shared goals and develop coordinated plans of action. The goal of academic nursing is to work to understand wicked disciplinary problems while also analyzing and critiquing what is not working, articulating possible solutions, and collaborating with other nurse leaders to address these complex issues. This also means that academic nursing should be held equally accountable for delivering results. [ABSTRACT FROM AUTHOR]

Background: Recent articles have described the challenges in developing nurse leaders to advance nursing science, improve health, healthcare, and health equity, and build the next generation of nurses. Over the past 25 years, the Robert Wood Johnson Foundation (RWJF) has implemented many programs to develop nurse leaders to address these challenges., Purpose: This article shares lessons learned from four RWJF programs and how the authors recommend those lessons can be applied today., Methods: The Robert Wood Johnson Foundation (RWJF) has supported nursing leadership development for over fifty years. Discussion of four RWJF nursing programs including the Executive Nurse Fellows (1998-2017); the New Jersey Nursing Initiative (2009-2016); the Nurse Faculty Scholars (2007-2017) and the Future of Nursing Scholars (2013-2023) is used to highlight strategies and lessons learned., Findings: Key lessons for developing the next generation of nurse leaders and strengthening the nurse leader pipeline include the importance of continuing leadership development over the course of one's career; accelerating the nursing PhD to faculty pipeline; strong intentional mentoring; and building supportive communities to ensure long term impact., Discussion: While these program examples had purposeful philanthropic funding, the lessons can also be implemented by building partnerships with federal agencies, philanthropy, and universities., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Mental healthcare can be considered a unique practice due to its ethical characteristics, and an awareness of ethics is crucial when working in a mental health setting. Several ethical challenges exist, and professionals may not always recognize the ethical aspects of psychiatric care. Research on psychiatric care from nurse leaders' perspective is scarce but important, because nurse leaders can impact and cultivate workplace culture. Aim: To explore the phenomenon of unethical conduct in a psychiatric inpatient context from nurse leaders' perspectives. Research design: Qualitative exploratory design. In-depth semi-structured interviews. Participants and research context: Eight nurse leaders from two different healthcare organizations in Finland. Leadership experience ranged between 2 and 30 years. Ethical considerations: Research ethics permission was received from a Research Ethics Board where the researchers are domiciled. Guidelines on good scientific practice as delineated by the Finnish Advisory Board on Research Integrity TENK were followed. Findings: Six main categories were generated: Unethical conduct and violations against patients, Unethical conduct and violations against staff, Unethical conduct and violations by staff against other staff, Unethical conduct and violations against leaders, Reasons underlying unethical conduct, and Consequences of unethical conduct and the positive development of psychiatric care. Conclusions: Unethical conduct was seen to be a multifaceted phenomenon, and patients and staff alike can experience and engage in unethical conduct. Unethical conduct against patients was linked to power imbalance (nature of involuntary care, staff attitudes) and a focus on rules based in historical precedent (paternalistic, routine-focused, not patient-centered). Unethical conduct against staff was linked to the nature of involuntary care and patient ill-health. Unethical conduct by staff against other staff was linked to a lack of understanding for others' work, interpersonal chemistry, (length of) work experience, and staff character. Unethical conduct against leaders was linked to leaders being perceived as the organization., Competing Interests: Declaration of conflicting interestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Discrimination against lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) individuals in healthcare settings remains a priority issue. Nurse leaders, who oversee the largest healthcare workforce, are critical in implementing inclusive practices to address LGBTQ+ discrimination, yet implementing LGBTQ+ inclusive practices and effective strategies is inconsistent. This qualitative descriptive study explored nurse leaders' perceptions of LGBTQ+ inclusive practices across the United States to inform recommended strategies within health systems., Methods: Twenty-one nurse leaders (e.g., chief nurse executives) from diverse healthcare settings (e.g., children's hospitals and public health centers) in 12 states across the United States participated in semi-structured interviews from October to December 2023. Interview transcripts were analyzed using content analysis to (1) describe nurse leaders' definitions of LGBTQ+ inclusive practices and (2) identify effective strategies for their implementation., Results: Nurse leaders defined LGBTQ+ inclusive practices to include delivering culturally responsive and competent care, fostering safe and affirming environments, integrating inclusivity into daily interactions and organizational culture, and supporting the needs of both LGBTQ+ staff and patients. Key implementation strategies included fostering a flexible organizational culture through open communication; a diverse workforce; and inclusive mission statements, policies, and strategic plans. Supportive infrastructure involved effective LGBTQ+ training and adapting electronic health record systems to include information on sexual orientation and gender identity. Active and interdisciplinary engagement from staff and leadership, as well as systematic data collection on patient and staff experiences, were essential for driving inclusivity. The advocacy highlighted included legislative support, discourse within the nursing profession, and the incorporation of LGBTQ+ inclusion into healthcare regulations and accreditation standards. Additionally, multisectoral partnerships with LGBTQ+ health experts and external organizations, along with multilevel evaluations, were recommended to develop tailored interventions and promote LGBTQ+ inclusive practices., Conclusion: Implementing LGBTQ+ inclusive practices in healthcare is a multifaceted effort influenced by strategies at various levels. Promoting a supportive organizational culture, establishing comprehensive support structures, encouraging active engagement, and fostering community partnerships can address the needs of LGBTQ+ individuals more effectively. Future implementation efforts should tailor strategies to accommodate variability across healthcare settings and regions, ensuring that practices are both adaptable and sustainable., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Nursing burnout remains a public health crisis. However, few stakeholders have considered the disproportionate toll of burnout among nurses of color, including nurses identifying as Black, Hispanic/Latino, or Native American. We convened a one-day conference, titled Solutions to Health Inequities and Nurses' Emotional Exhaustion (SHINE), to begin identifying contributing factors and solutions to burnout amongst nurses of color. SHINE included plenaries, small group discussions, and breakout sessions with nearly 40 expert stakeholders from around the country. We employed a deliberative dialogue (DD) methodology to identify key takeaways and implications for research, practice, and policy. High-priority solutions included: improving the work environment and nurse staffing, reducing stigma against nurses seeking mental healthcare, addressing workplace racism as a root cause of nurse burnout, and increasing support for nurses experiencing racism at work. Key priorities identified through SHINE offer a roadmap for nurse leaders to address burnout through an equity-centered lens., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Palliative care nurses experience huge pressures, which only increased with coronavirus disease 2019 (COVID-19). A reflection on the new demands for nursing care should include an evaluation of which evidence-based practices should be implemented in clinical settings. This paper discusses the impacts and challenges of incorporating coaching strategies into palliative care nursing. Evidence suggests that coaching strategies can foster emotional self-management and self-adjustment to daily life among nurses. The current challenge is incorporating this expanded knowledge into nurses' coping strategies. Coaching strategies can contribute to nurses' well-being, empower them, and consequently bring clinical benefits to patients, through humanized care focused on the particularities of end-of-life patients and their families. [ABSTRACT FROM AUTHOR]

The phenomenon of loneliness among healthcare providers, particularly nurses, has garnered increasing attention due to its detrimental effects on individual well-being and professional retention. The isolation experienced by nurses has been linked to heightened turnover rates and intentions to leave the profession, posing significant challenges to healthcare systems globally. Recognizing loneliness as an epidemic in 2023, the U.S. Surgeon General highlighted the urgency of addressing this issue within the healthcare workforce. This paper explores evidence-based strategies to mitigate loneliness and promote social connectedness among nurses, drawing insights from various stakeholders. It aims to offer actionable recommendations to enhance the nursing experience and retain professionals in the field. Strategies include peer support programs, mentorship initiatives, wellness activities, and fostering open communication. Leveraging technology for virtual connections is also highlighted, especially in remote work scenarios. A holistic approach is vital, combining individual, interpersonal, and systemic interventions to combat nurse loneliness. Prioritizing social connectedness fosters a supportive work environment, benefiting both nurses and patient care quality. • Policies promoting social connection and belonging improve nursing work environments. • Supportive work relationships enhance belongingness and nurse well-being. • Nurse leaders foster belonging with positive communication and supportive teamwork. • Faculty mentorship and social support systems improve nursing student experiences. • Social connectedness and belonging reduce the risk of burnout in nursing professionals. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to gain insight on how nurse leaders manage a culture of safety for graduate nurses. Background: Current theoretical approaches to safety culture tend towards a checklist approach that focuses on institutional characteristics, failing to examine the quality of interpersonal relationships. These interpersonal interactions are often seen as separate from the institutional realities of resource allocation, nurse–patient ratios, patient acuity or throughput. A theoretical approach is required to illuminate the dialectic between the structure of an organisation and the agency created by nurse leaders to promote patient safety. Design Qualitative exploratory descriptive study. Methods: Semi‐structured interviews were undertaken with 24 nurse leaders from hospital and aged care settings. Thematic analysis and Giddens structuration theory was used to describe the findings. Results: Nurse leaders identified a range of reciprocal communicative and cultural norms and values, decision‐making processes, personal nursing philosophies, strategies and operational procedures to foster patient safety and mentor graduate nurses. The mentoring of graduate nurses included fostering critical thinking, building and affirming formal structural practices such as handover, teamwork, medication protocols and care plans. Conclusions: The study provides insight into how nurse leaders foster a culture of safety. Emphasis is placed on how agency in nurse leaders creates an environment conducive to learning and support for graduate nurses. Implications for Nursing Management: Nurse leadership functions and decision‐making capacity hinges on multiple factors including practicing agency and aspects of the social structure such as the rules for safe communication, and the various institutional protocols. Nurse leaders enforce these forms of engagement and practice through their legitimation as leaders. They have both allocative and authoritative resources; they can command resources, direct staff to attend to patients and/or clinical tasks, mentor, guide, assign, correct and encourage with the authority vested in them by the formal structure of the organisation. In doing so, they sustain the structure and reinforce it. [ABSTRACT FROM AUTHOR]

Advanced practice registered nurses (APRNs) significantly contribute to health promotion, disease prevention, and disease management. Yet, barriers to APRN practice exist, including regulatory, state, and institutional barriers, that hinder their ability to practice to the full extent of their education, licensure, and certification. Nurse leaders can play an important role in helping reduce unnecessary institutional barriers to APRN practice. [ABSTRACT FROM AUTHOR]

The purpose of this study was to understand nurse leadership development within the Irish context. Limited literature is published related to nursing leadership development within small island countries. Explorative semi structured interviews, underpinned by a phenomenology philosophy, were conducted to understand the ascribed meaning of nurse leadership development experiences within the Irish context. The major themes from this study included: leadership strategies, political acumen, cultural influence, and gender norms. The Republic of Ireland nurse leaders used participatory leadership styles, assertive communication, and political acumen to influence the advancement of national policies, nursing education and advanced practice opportunities.

Background: Time management is of particular importance in nursing. One of the most effective variables associated with time management is emotional intelligence (EI). This study assessed the relationship between time management and EI and the level of EI and time management skills in head nurses in emergency and intensive care units. Methods: A cross-sectional study was conducted on all head nurses in the emergency and intensive care units of nine educational hospitals at Isfahan University of Medical Sciences in Iran in 2015 using Bradberry-Greaves' EI and Macan's Time Management Questionnaires. Results: Participants' total time management score was (104.15 ± 6.98); total EI score was (128 ± 15.80). There was no significant relationship between overall EI and time management skills. There was a significant relationship between age and the emotional self-awareness dimension of EI (p =.027) and the mechanics dimension of time management (p =.037), and between work experience and overall time management skills (p =.049) and the mechanics dimension of time management (p =.038). Conclusions: Specific EI and time management skills may help head nurses to cope with the challenges they face, which may improve the quality of nursing care. Nursing leaders should consider the importance of time management and EI in increasing motivation and satisfaction of nursing staff and improving quality of care. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of involving nurses in health policy, nurse's involvement faces many challenges. Literature showed that there is a low level of nurses' and nurse leaders' involvement in health policy development. Aim: The aims of this study were to examine (a) the level of Jordanian head nurses' involvement in health policy development and their perceived benefits and barriers; (b) the relationships between level of knowledge, competence, and interest in health policy and the level of involvement in health policy development; and (c) the relationship between the level of self-efficacy (efficacy expectation and outcome expectation) and the level of involvement in health policy development. Methods: A cross-sectional descriptive correlational study design was adopted in this study. A convenience sampling of 250 participants from hospitals affiliated to three health sectors in Jordan (private, governmental, and university) were recruited to complete a self-administered questionnaire. Descriptive statistics and Pearson correlation coefficient were used to answer the study questions. Results: The results revealed a moderate level of involvement of head nurses in the policy development. The most frequent cited political activity was "providing written reports, consultations, research." "Lack of time" was the most perceived barrier, while "improving the health of the public" was the most perceived benefit. Workshops or sessions at conferences is the most indicated source of knowledge. Participants had an excellent level of skills with positive relationships between the competence and both of the levels of professional and personal involvement in health policy. Participants reported a low level of confidence in performing political activities as well as the impact of such activities on health outcomes. Positive relationship was indicated between self-efficacy and the levels of professional and personal involvement in political activities. Implications: Health policies affect nurses and their practice. Overcoming the barriers and enhancing the levels of head nurses' knowledge and competence regarding health policies can help activating their roles in health policy development process. This will help in activating nurses' role in health policy development, which in turn will have a positive impact on health outcomes. [ABSTRACT FROM AUTHOR]

Whether natural or human-induced, disasters are a global issue that impact health care systems' operations, especially in the acute care setting. The current COVID-19 pandemic is a recent illustration of how health care systems and providers, especially nurses, respond to a rapidly evolving crisis. Nurse leaders in the acute care setting are pivotal in responding to the multifactorial challenges caused by a disaster. A quality improvement project was developed to increase nurse leaders' knowledge and confidence in disaster management during the COVID-19 pandemic at 2 Magnet-designated acute care hospitals within the John Muir Health system in Northern California. A total of 50 nurse leaders initially participated in this project, with 33 participants completing the postintervention survey. Results indicated significant improvement in perceived knowledge and confidence in disaster management after the intervention. Qualitative responses from project participants highlighted the need to annualize educational opportunities to sustain knowledge and consistently review emergency management operations plans. This quality improvement project provided an approach to educating nurse leaders in disaster management to promote resilience, support of employees, and optimal patient outcomes during disasters. [ABSTRACT FROM AUTHOR]

This scoping review explores leadership training opportunities for school nurses. The review was conducted to inform the development of a new leadership training program for school nurses in Massachusetts. A search conducted across four databases (PubMed, CINAHL, ERIC, and Web of Science) yielded four articles meeting the search criteria published between 1993 and 2007, and no articles meeting the criteria after 2007. The four articles that were found discussed the approaches and evaluation methods of school nurse leadership training programs. They revealed varying training structures and evaluation approaches and covered a wide range of leadership competencies. Importantly, all of the programs reported enhancements in participants' leadership knowledge and practice upon completion of the training program. This review highlights the necessity of documenting and disseminating program outcomes in peer-reviewed literature to guide the development of new initiatives and recommends adopting standardized evaluation frameworks., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This article discusses the impact of staffing shortage on nurses' mental health, and outlines ways, including a successful rounder initiative, for nurse leaders and facilities to address nurses' stress and burnout. This article discusses the impact of staffing shortages on nurses' mental health, and outlines ways, including a successful rounder initiative, for nurse leaders and facilities to address nurses' stress and burnout. [ABSTRACT FROM AUTHOR]

The purpose of this concept analysis is to explore the concept of resistance and provide an operational definition for nurse leaders. While resistance has been deemed a major barrier to the implementation of successful practice change in popular literature, specific evidence as to how it is a barrier within health care organizations is lacking. The Walker and Avant model of concept analysis was used to analyze the concept of resistance. Literature searches utilized the Cumulative Index for Nursing and Allied Health Literature (CINAHL), PsychARTICLES, and Google scholar. Resistance is defined as an individual's behavior in response to perceived or actual threat in an attempt to maintain baseline status. It may be preceded by and amplified through mistrust, fear, and communication barriers, ultimately influencing the implementation, quality, and sustainability of the change. Historically resistance has been viewed with negative conations due to its potential impact on organizational success. However, resistance is a normal response to a threat to baseline status. Nurse leaders prepared with knowledge of resistance, including the antecedents and attributes, can minimize the potential negative consequences of resistance and capitalize on a powerful impact of change adaptation. [ABSTRACT FROM AUTHOR]

Aim: To explore the association between work–family conflict and overall well‐being among Chinese nurse leaders. Background: Nurse leaders are constantly busy at the clinical frontline, mostly experience high stress levels at work and have little time to spend with the family. There is little evidence to know about the association between work‐family conflict and overall well‐being, which is essential for high‐quality medical care. Methods: A cluster sampling method was used to recruit 42 nurse leaders. Data were collected using the Chinese versions of the Multidimensional Work–Family Conflict Scale and the General Well‐Being Schedule. Descriptive analyses, independent t tests, ANOVAs and Pearson's correlation were used for the statistical analysis. Results: The mean scores (SD) of work–family conflict and well‐being were 2.17 (0.57) and 4.51 (0.61), respectively. Negative correlations were observed with strain‐based and behaviour‐based work–family conflict and overall well‐being. Conclusion: Stress from work–family conflict is positively correlated with the overall well‐being of Chinese nurse leaders. Implications for Nursing Management: Hospital administrators should be aware of specific risk factors and implement accordingly the interventional strategies to decrease the stress levels and improve the overall well‐being of nurse leaders. [ABSTRACT FROM AUTHOR]

Purpose: To determine nurses' challenges, extent of involvement, and the impact of involvement in politics and policy making. Organizing Construct: Nurses in politics and health policy making. Methods: Literature was searched in PubMed, Scopus, Google Scholar, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID, and Open Grey using phrases comprising the following key words: "nurses", "policy making", "politics", "health policy", "nurses involvement in policy making/politics/health policy", "nurses challenges in policy making/politics/policy", and "impact of nursing policy making/politics/health policy"; 22 articles published from January 2000 to May 2019 were included. Findings: The major challenges included intra‐ and interprofessional power dynamics, marginalization of nurses in policy making, and nursing profession–specific challenges. The extent of involvement was inadequate, and nurses mainly worked as policy implementers rather than as policy developers. Those nurses who participated in policy development focused on health promotion to build healthy communities and to empower nurses and the nursing profession. Conclusions: Nurses' involvement in policy making has not improved over time. Nursing institutions and regulatory bodies should prepare and encourage nurses to work as policymakers rather than implementers and advocate for the rightful place of nurses at policy‐making forums. Clinical Relevance: Preparation for health system policy making starts in the clinical settings. Educational institutions and nurse leaders should adequately prepare nurses for policy making, and nurses should participate in policy making at the organization, system, and national levels. [ABSTRACT FROM AUTHOR]

The global crime of human trafficking, has nursing leaders urgently assessing, developing, and implementing various strategies to ensure the safety and well-being of human trafficked victims and their teams. The complex elements of human trafficking and the impact of associated consequences on victims and teams, coupled with needed resources to serve trafficked victims, could overwhelm any health care organization and community agencies. As the call for action surrounding this victimization grows, nurses are well-positioned to lead through the complexity. This article describes an improvement project led by clinical nurses and a nurse leader that involved interdisciplinary groups, the local nonprofit community, and state agencies. The ensuing partnership created a system-wide trauma-informed human trafficking program that identified and holistically addressed the health care needs of trafficked victims throughout the risk continuum. [ABSTRACT FROM AUTHOR]

With increased demand for registered nurses (RN), due to increasing shortage and turnover rate, the role of meaningful recognition becomes of paramount importance. We hypothesized that RNs and leaders value forms of recognition differently, due to generational gap and changing health care environment. This study included 46 RN/support staff (RN/SS group) and 10 nurse leaders (leaders group) from a Level 1 trauma center. Mean values from 5-point Likert scale survey on 31 forms of recognition (grouped into 6 categories) and demographics (age, nursing experience, and gender) were compared. All participants were separated into groups: 35 years of age and younger (millennials; n = 29) and older than 35 years (Gen X/boomers; n = 27). Majority of RN/SS were 26–35 years of age (43.5%) and 50.0% had less than 3 years of nursing experience. Half of the leaders were 36–45 years of age (p =.01 vs. RN/SS), and 70.0% had 16 years of experience or greater (p =.001). There was 9:1 female-to-male ratio in both groups (p =.8). The RN/SS rated "salary increase" highest and leaders rated "celebration for years of service" highest (both means: 4.4). When categorized, "monetary rewards" ranked highest both by RN/SS and leaders (means: 4.4 and 4.1). Overall, there was no statistically significant difference between mean values. The Gen X/boomers rated statistically significantly higher 9 forms and 3 categories (written/public acknowledgment and private verbal feedback) than millennials. Mean values for forms/categories of recognition were lower for RN/SS than for leaders, but differences were not statistical. Age drove the most difference in most meaningful forms, as preference for monetary rewards stems from the younger generations' focus on work-life balance. [ABSTRACT FROM AUTHOR]

• Work–family conflict (WFC) has been studied among staff nurses but not nurse leaders. • This survey finds that nurse managers/executives have more WFC than staff nurses. • IOM calls upon the nursing profession to step into leadership roles. • WFC could make nurses reluctant to fill and remain in manager/executive roles. • Leaders need to assess and meet the work–family needs among nurses in all roles. Nurses frequently are caught between the demands of work and family. While studies have explored this issue among staff nurses, none have compared nurse leaders to staff nurses. This study compares work–family conflict (WFC) and family–work conflict (FWC) among staff, managerial, and executive nurses. In this survey design, 20% of registered nurses were randomly sampled across Florida with a 9% response rate. Survey questions included personal, professional, and work environment characteristics and perceptions of WFC/FWC. Analyses of variance tested the differences between- and within-group scores for WFC/FWC for staff, managerial, and executive nurses. Ordinary Least Squares regressions tested the relationships between personal, professional and work environment measures, focusing on the three different nursing roles, and WFC/FWC scores. Nurses experienced more WFC than FWC. Staff nurses experienced significantly less WFC than nurse managers and nurse executives (analysis of variance mean difference −0.881 and −2.693, respectively). Nonwhite nurses experienced more WFC and FWC than white nurses. Longer shift length predicted greater WFC. FWC was lower with paid leave for childbirth. Higher WFC among nurse managers and executives may discourage nurses from taking on or staying in leadership roles. Efforts must be taken to decrease WFC/FWC among nurses in these roles. [ABSTRACT FROM AUTHOR]

Background: Organizations and nurse leaders do not always effectively support nurses' ethical competence. More information is needed about nurses' perceptions of this support and relevant factors to improve it. Purpose: The aim of the study was to examine relationships between nurses' perceived organizational and individual support, ethical competence, ethical safety, and work satisfaction. Methodology: A cross-sectional questionnaire survey was conducted. Questionnaires were distributed to nurses (n = 298) working in specialized, primary, or private health care in Finland. Descriptive statistics, multifactor analysis of variance, and linear regression analysis were used to test the relationships. Results: The nurses reported low organizational and individual support for their ethical competence, whereas perceptions of their ethical competence, ethical safety, and work satisfaction were moderate. There were statistically significant positive correlations between both perceived individual and organizational support, and ethical competence, nurses' work satisfaction, and nurses' ethical safety. Conclusions: Organizational and individual support for nurses' ethical competence should be strengthened, at least in Finland, by providing more ethics education and addressing ethical problems in multiprofessional discussions. Findings confirm that organizational level support for ethical competence improves nurses' work satisfaction. They also show that individual level support improves nurses' sense of ethical safety, and both organizational and individual support strengthen nurses' ethical competence. Practice Implications: These findings should assist nurse leaders to implement effective support practices to strengthen nurses' ethical competence, ethical safety, and work satisfaction. [ABSTRACT FROM AUTHOR]

Azita Emami,1 Darcy Jaffe,2 Paula Minton-Foltz,3 Grace Parker,4 Susan Manfredi,5 Theresa Braungardt,6 Kelly W Marley,1 Laura Cooley,1 Staishy Bostick Siem7 1University of Washington School of Nursing, Seattle, WA, USA; 2Harborview Medical Center, University of Washington Medicine, Seattle, WA, USA; 3Patient Care Services, Harborview Medical Center, University of Washington Medicine, Seattle, WA, USA; 4University of Washington Medical Center, Seattle, WA, USA; 5Patient Care Services, Northwest Hospital and Medical Center, Seattle, WA, USA; 6Valley Medical Center, Seattle, WA, USA; 7Marketing and Communications, University of Washington School of Nursing, Seattle, WA, USA Abstract: This paper presents the findings from a national survey which the University of Washington conducted among leaders of 32 US academic nursing institutions that are part of academic health centers (AHCs) and complements these findings with results from a separate report by the American Association of Colleges of Nursing. While expressing overall satisfaction with their AHC relationships, these leaders find that nursing is often given greater parity in matters of education and research than in mission setting, financial, and governance matters. AHCs are being asked to meet new health care challenges in new ways, starting with the education of health care professionals. AHCs need to be restructured to give nursing full parity if the nation’s and world’s needs for preventive and clinical care are to be best met.Keywords: nursing parity, academic nursing institutions, nurse leaders, institutional alignment