Leadership and management in mental health nursing

blegen n.e. & severinsson e. (2011) Journal of Nursing Management 19 , 487–497
Leadership and management in mental health nursing Background Mental health nurses are agents of change, and their leadership, management role and characteristics exist at many levels in health care. Previous research presents a picture of mental health nurses as subordinate and passive recipients of the leader’s influence and regard leadership and management as distinct from the nurses’ practical work. Aim The aim was to provide a synthesis of the studies conducted and to discuss the relationship between nursing leadership and nursing management in the context of mental health nursing. Method A literature search was conducted using EBSCO-host, Academic Search Premier, Science Direct, CINAHL and PubMed for the period January 1995–July 2010. Results Leadership and management in the context of mental health nursing are human activities that imply entering into mutual relationships. Conclusion Mental health nurses’ leadership, management and transformational leadership are positively related in terms of effectiveness and nurses’ skills. Implication for nursing management It is important to consider mental health nurses’ management as a form of leadership similar to or as a natural consequence of transformational leadership (TL) and that ethical concerns must be constantly prioritized throughout every level of the organization.     

The moral leadership of the nursing profession.

As the largest group of professional workers in the health care field, nurses possess the numbers to command a key role among health professionals. It is, however, apparent that nurses must assume a more visible and vital leadership role in the delivery of health care if nursing is to remain a viable profession. Nursing's immediate goal must be to unite forces in an effort to bring about greater involvement of nurses in planning, delivering and assuming accountability for the nursing component of health services at all levels. The ease with which the profession is able to accomplish this goal is dependent upon the ability of nursing's leadership to evoke a sense of harmony and balance within the profession, while creating a dynamic image of nursing among other health professionals and the public. Today, there is a need for strong moral leadership in the nursing profession. In ‘moral leadership’ the power of the leader is used to work with the group as a whole, while guiding individual members towards satisfaction and self-fulfilment. A critical evaluation of the profession's leadership capabilities should begin with definitions of the role and responsibility of nurses for leadership in the professional association. By its very nature, the professional association stands as the leadership mechanism of the profession and, by working through the association, nursing leadership can unify nursing forces, implement plans aimed at involving more nurses in health planning activities, and facilitate the involvement of individual nurses in determining the conditions of employment under which they practise.     

Beyond profession: nursing leadership in contemporary healthcare

Aim(s)  To examine nursing leadership in contemporary health care and its potential contribution to health service organization and management.
Background  As the nursing profession repositions itself as an equal partner in health care beside medicine and management, its enhanced nursing standards and clinical knowledge are not leading to a commensurate extension of nursing's power and authority in the organization.
Method(s)  An ethnographic study of an ICU in Sydney, Australia, comprising: interviews with unit nursing managers (4); focus groups (3) with less experienced, intermediate and experienced nurses (29 in total); and interviews with senior nurse manager (1).
Results  Inter- and intra-professional barriers in the workplace, fragmentation of multidisciplinary clinical systems that collectively deliver care, and clinical and administrative disconnection in resolving organizational problems, prevented nurses articulating a model of intensive and end-of-life care.
Conclusion(s)  Professional advocacy skills are needed to overcome barriers and to articulate and operationalize new nursing knowledge and standards if nurses are to enact and embed a leadership role.
Implications for nursing management  The profession will need to move beyond a reliance on professional clinical models to become skilled multidisciplinary team members and professional advocates for nurses to take their place as equal partners in health care.     

Integrating health promotion into nursing curricula in Hong Kong

The health care system in Hong Kong has historically been steeped in the biomedical paradigm. Health care reform, however, is finally putting health promotion on the agenda of governments and health care providers. As the largest group of providers in Hong Kong, nurses must assume a leadership role in the transition of the current illness-focused system to one that emphasizes health and promotes wellness. For nurses to take up the challenge of health promotion, they need to acquire the requisite knowledge and skills. Nursing curricula must emphasize this new paradigm and provide opportunities for students to develop expertise in health promotion and disease prevention. This article describes a health-promotion initiative carried out by 1st-year students in an undergraduate nursing program in Hong Kong. The health-promotion project aims to prepare graduates who will be able to meet health care needs and function effectively in the future health care system. Not only will these nurses be capable of becoming future leaders of the health-promotion movement in Hong Kong, they are also contributing to the health and wellness of Hong Kong citizens.     

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.     

Paths to nursing leadership

AIM: The aim was to explore why nurses enter nursing leadership and apply for a management position in health care. The study is part of a research programme in nursing leadership and evidence-based care. BACKGROUND: Nursing has not invested enough in the development of nursing leadership for the development of patient care. There is scarce research on nurses' motives and reasons for committing themselves to a career in nursing leadership. METHOD: A strategic sample of 68 Finnish nurse leaders completed a semistructured questionnaire. Analytic induction was applied in an attempt to generate a theory. FINDINGS: A theory, Paths to Nursing Leadership, is proposed for further research. Four different paths were found according to variations between the nurse leaders' education, primary commitment and situational factors. They are called the Path of Ideals, the Path of Chance, the Career Path and the Temporary Path. CONCLUSION: Situational factors and role models of good but also bad nursing leadership besides motivational and educational factors have played a significant role when Finnish nurses have entered nursing leadership. The educational requirements for nurse leaders and recruitment to nursing management positions need serious attention in order to develop a competent nursing leadership.     

Developing the leadership skills of new graduates to influence practice environments: a novice nurse leadership program

The authors of the recently published Institute of Medicine on the Future of Nursing report emphasized the importance of preparing nurses to lead change to advance health care in the United States. Other scholars linked practice environments to safe quality care. In order for nurses to fully actualize this role in practice environments, they need to possess leadership skills sets that identify and respond to challenges faced. New nurses are no exception. This article presents a program with a 5-year track record that is designed to support transition and enhance the skill sets of leadership for new nurses in their first year of practice. Qualitative and quantitative evaluation measurements at baseline and postprogram provided data for evaluation of the first 4 cohorts in the program. Evaluative outcomes presented indicate that new nurses gained leadership and translational research skills that contributed to their ability to influence practice environments. Nonetheless, practice environments continue to need improvement and ongoing leadership from all levels of nursing must be upheld.     

Dare to be different: transformational leadership may hold the key to reducing the nursing shortage

Health care leadership continues to run under a transactional style that may be causing nurses to leave the system. Nurses no longer wish to stay in the profession perhaps because they struggle ideologically with the system in which they work. However, nurses may hold the key to transforming health care and dragging it into the 21st century in terms of work practices and reform. This is because nurses are visionary, creative, involved in decision making at patient level and have gender based qualities, and communication strategies that the health care sector needs. In contrast to transaction leadership, transformational leadership and team development has a positive affect on communication and team building. The later style is ideologically suited to nurses and may ensure the future of nurses and nursing in the health care sector. The case study described in this paper was an actual working environment and one that I came across all too often as a registered nurse and clinical educator.     

Nurses and 'difficult' patients: negotiating non-compliance

BACKGROUND: There is a large body of nursing literature on patient non-compliance. While some articles address non-compliance as a patient problem to be resolved by nursing interventions, there is also a growing number that critique this approach. This reflects the discomfort many nurses feel about the practice of labelling patients as non-compliant. AIM: The aim of this discussion paper is to build on the critical nursing literature to offer an alternative to the interventions commonly directed at patients who do not follow health care advice. This alternative approach locates patients within their social context and focuses on those who adapt health care advice to fit with their beliefs, life situation and circumstances. The aim is to encourage nurses to learn about how health care treatments affect patients'lives, and not merely their health. METHOD: Specific nursing articles were reviewed to demonstrate the ways in which the concept of compliance is used within the nursing literature. These articles were then used to support an argument that promotes a patient-centred approach to health care. CONCLUSION: A patient-centred approach involves transferring power and authority away from health care professionals and towards patients. We encourage nurses to take a leadership role by changing the way in which health care is delivered towards a focus on patients'lives. Learning about patients' lives may assist nurses to offer health information to patients that is more relevant and, therefore, useful.     

Promoting leadership and management in Australian general practice nursing: what will it take?

Aim This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. Background Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. Conclusions The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. Implications for nursing management There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.     

Examining family and community nurses’ core competencies in continuing education programs offered in primary health care settings: An integrative literature review

AimTo identify gaps in existing family and community nurse (FCN) continuing education programs and to investigate whether FCN core competencies are covered in continuing education programs offered in primary health care settings.BackgroundIn global pandemics such as COVID-19, there is an urgent need for staff development using transformative learning and help registered nurses build up their competencies and form a new professional identity as family and community nurses (FCNs). Therefore, FCN education programs become of high importance to enhance nurses’ core competencies through continuing education.MethodsAn integrative review of the literature was conducted applying the Whittemore and Knafl methodological strategy for studies published between 2015– June 2021.ResultsFCN core competencies, including the “decision-making process, navigation as care coordinator and patient advocate and promoting individual and family health to support the quality of nursing care,” were poorly covered in the FCN programs. Specifically, e-health played a very limited role in FCN continuing education, while ethics, managing change, managing disparity and diversity and leadership skills, did not emerge at all.ConclusionThe identified gaps can be incorporated into future FCN continuing education programs and may help improve nurses’ competence and health care delivery and support new integrated models of care, namely, person-centered and community-based models.     

Clinical leadership in contemporary clinical practice: implications for nursing in Australia

BACKGROUND: Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians. AIM: The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making. KEY ISSUES: Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians. CONCLUSIONS: Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.     

Public health nurses perception of clinical leadership in Ireland: narrative descriptions

Aim  The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses' in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery.
Background  Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles.
Method  Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery.
Results  Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective.
Conclusions  Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor.
Relevance to nurse managers  Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.     

Nurses in the C-suite: leadership beyond chief nurse

The US health care system is reaching a critical point. Consistent cost increases coupled with a struggling economy has illuminated the burden of more than $650 billion annually in health care expenditures. The ability to afford health care is a growing concern for individuals, businesses, and state and federal governments. In addition to costs, variability in quality, and utilization belie any claims of a rational and consistent system of care. Transformational change will require leaders to shape our future health care institutions. Nursing has historically not been considered as a leadership source for change of this magnitude. However, due to the sheer size of nursing, core skills, and competencies, nurses could be a viable resource. Competencies needed for nurse, health care, and physician executives were compared using the HealthCare Leadership Alliance data, which created a body of knowledge that identifies competencies in 5 domains. Findings demonstrate that nurses, health care executives, and physicians possess more than 80% of the competencies reviewed. To successfully take on the role of leading institutional response to the dramatically changing health care environment, nurses must not only have the requisite leadership skills and experience, they must also have an expectation of themselves to lead at this level.     

The hidden treasure in nursing leadership: informal leaders

downey m., parslow s. & smart m. (2011) Journal of Nursing Management 19 , 517–521
The hidden treasure in nursing leadership: informal leaders Aim The goal of the present article was to generate awareness of characteristics of informal leaders in healthcare with the emphasis on nurses in acute care settings. There is limited research or literature regarding informal leaders in nursing and how they positively impact nursing management, the organization and, ultimately, patient care. Identification of nurses with leadership characteristics is important so that leadership development and mentoring can occur within the nursing profession. Background More than ever, nursing needs energetic, committed and dedicated leaders to meet the challenges of the healthcare climate and the nursing shortage. This requires nurse leaders to consider all avenues to ensure the ongoing profitability and viability of their healthcare facility. Key issues This paper discusses clinical nurses as informal leaders; characteristics of the informal nurse leader, the role they play, how they impact their unit and how they shape the organization. Implication for nursing management Informal nurse leaders are an underutilized asset in health care. If identified early, these nurses can be developed and empowered to impact unit performance, efficiency and environmental culture in a positive manner.     

The impact of a three-tiered model of nursing redeployment during the COVID-19 pandemic: A cross-sectional study

ObjectiveThe COVID-19 pandemic resulted in extreme system pressures, requiring redeployment of nurses to intensive care units. We aimed to assess the impacts of a 3-tiered pandemic surge model on nurses working in intensive care units during the COVID-19 pandemic.MethodologyIn this cross-sectional study, 931 nurses (464 intensive care and 467 redeployed nurses) who worked within four adult units in Western Canada during pandemic surge(s) were invited via email to participate in a survey. The survey explored the impact of redeployment, rapid unit orientations, just-in-time training, and the 3-tiered model of nursing during pandemic surge. Burnout was measured utilizing the Copenhagen Burnout Inventory questionnaire.ResultsA total of 191 survey responses were retained (59 intensive care nurses and 132 redeployed). Survey results are reported by tier, with outcomes varying based on team leadership, intensive care unit, and redeployment nursing roles. Burnout in personal and workplace domains was present amongst all nursing tiers, while only team leadership roles experienced burnout in the patient domain. Overall, team leadership roles and permanent intensive care nurses experienced the highest rates of burnout. Redeployed nurses reported numerous aids to success including support from colleagues, prior experience, and educational supports. Skill-based orientation, ongoing education, optimized scheduling, role clarity, and mitigators of psychological impacts were identified by respondents as potential facilitators of redeployment and surge models.ConclusionNurses working within this tiered model experienced high degrees of burnout, with highest prevalence amongst team leads and intensive care nurses. Optimization of support for and interventions aimed at improving well-being are important considerations going forward.Implications for clinical practiceTargeted strategies are required to support education, role transition, and optimize competency and role clarity during nursing redeployment for overcapacity surge. Essential strategies to support redeployed nurses include individualized competency assessments pre-redeployment and prior to role transitions, pairing redeployed nurses with the same intensive care nurse consistently, and availability of a nurse educator or resource for additional just-in-time training supports. Contingency disaster strategies should also include interventions targeting staff wellness and prevention of burnout, as well as identify scenarios in which redeployment may increase risks of psychological harm. Debriefing and peer-to-peer support models may increase the efficiency of psychological support for nurses, though additional research is required. Lastly, given enaction of tiered models of nursing care is largely a novel occurrence in the intensive care unit, leadership training is required to support frontline nurses taking on supervisory roles within these team models.     

Authentic leadership of preceptors: predictor of new graduate nurses' work engagement and job satisfaction

giallonardo l.m ., wong c.a . & iwasiw c.l . (2010) Journal of Nursing Management 18, 993–1003
Authentic leadership of preceptors: predictor of new graduate nurses' work engagement and job satisfaction Aim To examine the relationships between new graduate nurses’ perceptions of preceptor authentic leadership, work engagement and job satisfaction. Background During a time when the retention of new graduate nurses is of the upmost importance, the reliance on preceptors to facilitate the transition of new graduate nurses is paramount. Methods A predictive non-experimental survey design was used to examine the relationships between study variables. The final sample consisted of 170 randomly selected Registered Nurses (RNs) with <3 years experience and who worked in an acute care setting. Results Hierarchical multiple regression demonstrated that 20% of the variance in job satisfaction was explained by authentic leadership and work engagement. Furthermore, work engagement was found to partially mediate the relationship between authentic leadership of preceptors and engagement of new graduate nurses. Conclusions New graduate nurses paired with preceptors who demonstrate high levels of authentic leadership feel more engaged and are more satisfied. Engagement is an important mechanism by which authentic leadership affects job satisfaction. Implications for nursing management Managers must be aware of the role preceptors’ authentic leadership plays in promoting work engagement and job satisfaction of new nurses.     

Nursing leadership–myth or reality?

The recent profound changes in health care policy and the management and organization of the National Health Service have had a major impact upon nursing. Indeed, the development of the new management culture has challenged the organizational and management structure of nursing. This paper explores the role of nursing leadership in relation to the management of care delivery. The need for nursing leadership, its struggle for emergence and its effectiveness are discussed. The author concludes that for nursing to survive in the reformed health services strong leadership is essential. To achieve this the profession must move away from its traditional power base and refocus on clinical practice and the management of nursing rather than the management of nurses.     

Changes in community nursing in Australia: 1995-2000

AIM: This paper reports a study whose aim was to examine the congruence between community nurses' perceptions and the realities of changes in their work. BACKGROUND: There have been increasing challenges to the delivery of community nursing services in Australia over the past decade. Acute care sector changes and the recent focus on health promotion, prevention, early identification and intervention adds pressure and creates tensions for community nurses, which are well-documented in the literature. There is, however, a lack of empirical evidence of actual changes in community nurses' workloads and the focus of their work. Validation of nurses' perceptions would enable them to have a stronger voice in the future development of community health care. METHODS: Four sources of data were used: community health client administrative data 1995-2000; occasions of service data 1995-2000; staffing numbers 1998-2001; and interviews with 14 community nurses in late 2001. RESULTS: Documentary evidence shows that there has been a large increase in the number of adult clients, and all clients are increasingly receiving a shorter, more intensive, clinically focussed service and are then discharged from care, rather than receiving a lower intensity service over a longer period of time. Staffing numbers have not increased to match this higher acuity and intensity. These changes were echoed by the nurses, who reported that expanded acute care roles were impacting on their workload and resulting in a loss of holistic primary health care focus. There has been a lack of leadership and proactive planning by community nurses in response to these changes. CONCLUSION: Community health care in Australia is shifting from primary to short-term clinical care. Greater opportunities for community nurses to engage proactively in defining and promoting their role in the health care system are needed in order to ensure an appropriate balance of acute clinical and holistic primary health care in the community.     

Vision, permission and action: a bottom up perspective on the management of public health nursing

AIM: To explore the opportunities and obstacles that impinge on attempts to advance public health nursing, paying particular attention to the role of, and implications for, nursing management. BACKGROUND: Nurses are to have a central role in the government's drive to re-invigorate the United Kingdom public health agenda. This paper explores the perceptions and support needs of the primary and community nurses, health visitors and midwives charged with meeting that goal. METHOD: Focus group interviews were conducted separately with health visitors, school nurses, district nurses, community midwives and practice nurses from the a single health authority area in Yorkshire. Eight group interviews were conducted involving 31 practitioners in total. All interviews were audio recorded and transcribed in full. Data were analysed using the framework approach. FINDINGS: Workload, resource and time pressures limit the ability of community and primary care nurses to deliver public health work. Furthermore, nurses feel that the leadership required to guide service delivery and optimize deployment of under utilized public health skills at local level is missing, and that public health activity lacks legitimacy. CONCLUSION: If the new public health agenda is to be delivered, nursing managers will have to be clear about what is meant by public health work and decide whether it is to remain a peripheral concern or core activity. Having made that decision they must communicate it to practitioners on the ground through word and deed--that is, by identifying capacity, restructuring workloads and re-prioritizing activity.