The influence of nursing leadership on nurse performance: a systematic literature review

brady germain p. & cummings g.g. (2010) Journal of Nursing Management 18, 425–439
The influence of nursing leadership on nurse performance: a systematic literature review Aim The aim was to explore leadership factors that influence nurse performance and particularly, the role that nursing leadership behaviors play in nurses’ perceptions of performance motivation. Background Nurse performance is vital to quality patient care outcomes and nursing leadership behaviors have been linked to nurse performance. Evaluations A review of research articles that examined the factors that nurses perceived as influencing their motivation and performance was conducted. Eight studies were included in the final analysis. Key issues Nurses’ perceptions of factors that affect their motivation and ability to perform were grouped into five categories using content analysis: autonomy, work relationships, resource accessibility, nurse factors, and leadership practices. Nursing leadership behaviors were found to influence both nurses’ motivations directly and indirectly via other factors. Conclusion The review suggests that nurse performance may be improved by addressing nurse autonomy, relationships among nurses, their colleagues and leaders, and resource accessibility. Implications for nursing management Nursing managers and leaders may enhance their nurses’ performance by understanding and addressing the factors that affect their ability and motivation to perform.     

Doing the right thing: nursing students, relational practice, and moral agency

Registered nurses and nurse educators are often unaware of how nursing students experience the nursing profession. In the current practice climate of increased workloads, reduced funding, and higher patient acuity, nurse educators are likely to hear from colleagues how unprepared newly qualified nurses are for the needs of practice. It is difficult for many nursing students to see value in their practice because they become preoccupied with their perceived lack of knowledge and technical skills. Nurses and nurse educators should be aware of how this brands new graduates and informs their sense of developing professional identity. Despite their feelings of deficit in terms of skills and knowledge, it is clear that many nursing students are, in fact, effectively negotiating relational ethics. This article presents a collaborative account of the important relational work being undertaken by one group of nursing students in New Zealand.     

Lived Experiences of Male Nurse Educators: An Interpretive Phenomenological Inquiry

BackgroundMale nurses experience stereotypes and obstacles that affect their career progression in clinical and leadership roles. The experiences of male students and nurses in educational and clinical settings are documented, but no research explored the experiences of nurse educators.PurposeTo explore and develop a deeper understanding of the lived experiences of male nurse educators.MethodsAn interpretive phenomenological inquiry was used. Semi-structured interviews were conducted with 12 male educators in Khyber Pakhtunkhwa. Ricoeur's interpretation theory was used for data analysis.FindingsThe themes included “searching for respect and autonomy: from discrimination to recognition”, “keeping up the pace: proving worth as nurse educators”, “building relationship with the opposite gender: overcoming cultural constraints”, “withstanding unfair female nursing and non-nursing management”, “appreciating support from democratic management” and “envisioning a non-gendered nursing profession”.ConclusionMale educators surmounted various challenges while searching for respect and recognition and felt content with their professional growth. The greatest challenge was discriminative institutional and the government policies. The educators recognized that female dominance in nursing can be a hurdle, but they indicated that gender discrimination can be ended with collaborative efforts at personal, institutional, and governmental levels. Nursing regulatory bodies and institutions should develop policies that are conducive to recruitment of male and female educators. Separate sub-divisions could be established to provide support to and advocate for the rights of male nurses in clinical, educational, and leadership positions.     

Beyond transformational leadership in nursing: A qualitative study on rebel nurse leadership-as-practice

Most nurse leadership studies have concentrated on a classical, heroic, and hierarchical view of leadership. However, critical leadership studies have argued the need for more insight into leadership in daily nursing practices. Nurses must align their professional standards and opinions on quality of care with those of other professionals, management, and patients. They want to achieve better outcomes for their patients but also feel disciplined and controlled. To deal with this, nurses challenge the status quo by showing rebel nurse leadership. In this paper, we describe 47 nurses’ experiences with rebel nurse leadership from a leadership-as-practice perspective. In eight focus groups, nurses from two hospitals and one long-term care organization shared their experiences of rebel nurse leadership practices. They illustrated the differences between “bad” and “good” rebels. Knowledge, work experience, and patient-driven motivation were considered necessary for “good” rebel leadership. The participants also explained that continuous social influencing is important while exploring and challenging the boundaries set by colleagues and management. Credibility, trust, autonomy, freedom, and preserving relationships determined whether rebel nurses acted visibly or invisibly. Ultimately, this study refines the concept of rebel nurse leadership, gives a better understanding of how this occurs in nursing practice, and give insights into the challenges faced when studying nursing leadership practices.     

Research utilization and clinical nurse educators: A systematic review

Background Clinical nurse educators and other linking agents such as clinical nurse specialists, advanced nurse practitioners, and nurses working in research leadership positions are an important link in the facilitation of evidence‐based practice in health care organizations. Aim The purpose of this paper is to report the findings of a systematic review of the literature regarding clinical nurse educators and research utilization, using the Promoting Action on Research Implementation in Health Services framework as a backdrop for the analysis. Findings There is a positive relationship between research utilization and attitude toward research, higher levels of education, and reading professional nursing journals among clinical nurse educators. The authors suggest that not all clinical nurse educators have the necessary critical appraisal skills and research knowledge to use research effectively in practice. Conclusions Few studies have examined clinical nurse educators and the determinants of their research utilization behaviour in clinical practice. Future research on clinical nurse educators needs to focus on the outcomes of research utilization, including the effectiveness of their role as facilitators and the contexts in which they practice.     

Articulating nursing in an interprofessional world

It is essential that nurses in practice clearly articulate their role in interprofessional clinical settings. Assumptions, stereotypes, power differentials and miscommunication can complicate the interaction of healthcare professionals when clarity does not exist about nurses' knowledge, skills and roles. Conflicting views among nurse scholars as to the nature of nursing knowledge and its relationship to practice complicate the task of nurses in explaining their performance and role to others in interprofessional environments. Interprofessionality is potentially misunderstood by nurse leaders, practitioners and educators, isolating nurses in an increasingly inter-disciplinary healthcare system. The theorization of contemporary nursing is explored through the views and perspectives of current nurse scholars. The ability to explain nursing knowledge, skills and roles to others in interprofessional interactions is a nursing competency, as well as an interprofessional one. Nurses, nurse leaders and nurse educators are challenged to engage in interprofessionalism so as to have an influence in the evolution of healthcare education and practice environments.     

Nursing workforce utilization: an examination of facilitators and barriers on scope of practice

Several reports have highlighted the need to address underutilization of health human resources, but barriers to and facilitators of role optimization for nurses are poorly understood. The purpose in this study was to understand the perceptions of nurses - Licensed Practical Nurses (LPNs), Registered Nurses (RNs) and Registered Psychiatric Nurses (RPNs) - of the extent to which they can work to full scope of practice and identify barriers and facilitators in optimizing their roles. As part of a mixed-methods study, semi-structured interviews were conducted with 167 acute care nurses (RNs, LPNs, RPNs and nurse managers) in three western Canadian health regions. Approximately 48% of all nurses interviewed felt they were working to full scope, at least some of the time. Barriers to working to full scope included heavy workload, high patient acuity, lack of time, poor communication and ineffective teamwork. Identified facilitators were working as a team, management and leadership support and support for continuing education. Barriers need to be addressed in light of nursing shortages, as these are closely related to job satisfaction and directly affect the retention and recruitment of all groups of nurses. Policies and strategies based on these findings must be developed to ensure that nurses can work to their full scope of practice.     

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.     

Developing Tomorrow’s Leaders Through Unit-Based Councils

Unit-based councils (UBCs) are a helpful tool in creating future nurse leaders. By engaging in UBCs, nurses have the ability develop professionally, not only in the nursing, but also into strong leadership roles. Nurses are provided with the skills and tools needed to create positive change in their nursing unit, promote interprofessional collaboration between colleagues, and develop skills that are necessary when stepping into a leadership role. UBCs develop an environment of collaboration and trust between nurses, and empower them to become stakeholders in their practice.     

Leadership: the key to quality outcomes

Nurse executives are charged with creating a workforce that provides quality care in a creative and cost-effective manner. Style of leadership determines how nurse executives relate to their professional nurses and ultimately how successful their health care institutions will be. The practice-based theory of nursing leadership called the Integrated Leadership Practice Model can be practiced by nurse executives to promote employee satisfaction, assure that quality care is provided based on standards and competencies, and promote an organizational culture committed to quality. This article proposes the application of integrated leadership to the practice of nurse executives and demonstrates how they can foster and support this model for nursing leadership within their nurse managers.     

Changing the image of nursing in Jordan through effective role negotiation.

As with other nurses worldwide, image, status and role definition are prominent issues in Jordan. Here nursing is considered menial work and the roles and responsibilities of the nurse have not yet been formally defined by royal decree, Jordanian courts or the nursing profession. Moreover, while nursing curricula ordinarily influence scope of practice, nurse educators have long noted an incongruity between nurses training and their roles in practice. Although Jordanian nurses are educated to be change agents, patient advocates, health educators and critical thinkers they function more like medical assistants and housekeepers.     

Assessing emergency nursing competence

Assessing emergency nursing competence is an ongoing issue for emergency clinical nurse specialists (CNS), educators, and other members of the leadership team. Validation of emergency nurses' competency is not only required by regulatory agencies, but common sense tells people that they need to know that nurses can safely care for patients. Strategies for evaluating and improving emergency nursing competence based on the author's experience are discussed in this article.     

Smoking practices among nursing students: a comparison of two studies

Findings of numerous studies that have explored the smoking practices of nurses reveal a high incidence of smoking that is incongruent with the health beliefs of the profession. Nurses who smoke are less likely to teach or positively influence patients who smoke. They may even undermine health teaching efforts of other health professionals. Studies of smoking practices of nursing students also reveal high incidences of smoking. Included among the determinants of this practice are lack of knowledge of the health effects of smoking, the academic setting, and the role that nursing education may play. In this comparison of two independent studies similar in design, smoking rates were similar to that of the female population and to registered nurses. Students who smoke either started smoking or increased their smoking in nursing school. They knew the health hazards of smoking and most had tried to quit in the past. Challenging opportunities exist for nurse educators to study and implement strategies to prevent smoking initiation and encourage cessation among future nurses.     

Meaningful and engaging teaching techniques for student nurses: A literature review

Helping undergraduate nursing students to contextualise theory learnt in the classroom to their professional practice can be challenging for nurse educators. This article provides a critical review of contemporary literature that explores strategies and techniques that nurse educators within university settings have adopted to address this challenge. This review was conducted as part of a broader research project that involved interviewing nurse educators to explore how they attempt to make their teaching meaningful and engaging for student nurses. The data was analysed using thematic analysis and the intention is to share the wealth of ideas gleaned with other nurse educators, including in the form of an evidence-based inventory of teaching approaches found to be effective in enhancing the meaningfulness and engagement of content to nursing learners.     

The challenge of caring for patients in pain: from the nurse’s perspective

Aim. To increase understanding of what it is like for nurses to care for patients in pain. Background. Hospitalised patients are still suffering from pain despite increased knowledge, new technology and a wealth of research. Since nurses are key figures in successful pain management and research findings indicate that caring for suffering patients is a stressful and demanding experience where conflict often arises in nurses’ relations with patients and doctors, it may be fruitful to study nurses’ experience of caring for patients in pain to increase understanding of the above problem. Design. A phenomenological study involved 20 dialogues with 10 experienced nurses. Results. The findings indicate that caring for a patient in pain is a ‘challenging journey’ for the nurse. The nurse seems to have a ‘strong motivation to ease the pain’ through moral obligation, knowledge, personal experience and conviction. The main challenges that face the nurse are ‘reading the patient’, ‘dealing with inner conflict of moral dilemmas’, ‘dealing with gatekeepers’ (physicians) and ‘organisational hindrances’. Depending upon the outcome, pain management can have positive or negative effects on the patient and the nurse. Conclusions. Nurses need various coexisting patterns of knowledge, as well as a favourable organisational environment, if they are to be capable of performing in accord with their moral and professional obligations regarding pain relief. Nurses’ knowledge in this respect may hitherto have been too narrowly defined. Relevance to clinical practice. The findings can stimulate nurses to reflect critically on their current pain management practice. By identifying their strengths as well as their limitations, they can improve their knowledge and performance on their own, or else request more education, training and support. Since nurses’ clinical decisions are constantly moulded and stimulated by multiple patterns of knowledge, educators in pain management should focus not only on theoretical but also on personal and ethical knowledge.     

The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care

Mcsherry R., pearce P., Grimwood K. & Mcsherry W. (2012) Journal of Nursing Management 20, 7–19
The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care Aim The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. Background The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. Key issues Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. Conclusions Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. Implications for nursing management The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing.     

Becoming a nurse faculty leader: practices of leading illuminated through advancing reform in nursing education

PURPOSE. The purpose of this study was to explore the lived experience of becoming a nurse faculty leader. BACKGROUND. In a recent study of 24 nurse faculty leaders across the United States about their experience of becoming a leader, many of the participants hesitated to call themselves leaders. METHODS. This interpretive phenomenological study explored the meaning and significance of nurse faculty leadership. Exemplars of participant leadership development experiences are provided to assist readers in determining how the findings relate to their own practice. FINDINGS. The data revealed that leadership emerges as an embodied practice when nurse educators become involved in advancing reform. Practical leadership strategies for advancing reform in nursing education are presented. CONCLUSION. Leadership is learned through three everyday practices of advancing reform in nursing education: being involved with others; struggling to serve as a symbol and preserve authenticity; and creating an environment for change. This study offers new insight on leadership development, with practical implications for how leadership is taught in nursing curriculum and how nurses can more effectively own leadership roles.     

The leadership concept in Iranian nursing

Background:  Although greater emphasis has been placed on leadership skills in nursing management in the last decade, the concepts are often confused or used erroneously by Iranian nurses. At the same time we have observed that wide variations in nurses' clinical practice appeared to be related to the presence or absence of leadership skills among senior nurses.
Aim:  To begin to identify the concepts used for expressing leadership in nursing within the Iranian cultural context.
Methods:  A qualitative approach was adopted using content analysis of semi-structured interviews carried out with 10 nurse managers from hospitals in Teheran. The data were analysed using the constant comparative method.
Findings:  Fifty-five primary codes were identified from the respondents' experiences and from these three main themes were abstracted for describing the leadership concept. These were 'personality traits', 'being a model', and 'being a spiritual guide for the nursing profession'.
Conclusion:  Implementing the culture of patient safety and dignity needs leadership. From Iranian nurse managers' perspectives a leader as a spiritual guide should empower nurses spiritually; it means he/she has a vision for nursing; has clear and explicit objectives; and has a commitment to nursing. Nurses who are confident about the underlying concepts of leadership in their culture can help to adapt nursing to an ever-changing healthcare environment.     

Nurse Faculty Provide Essential Support to Graduate Nursing Students During COVID-19 Pandemic

Nurses in formal and informal leadership roles have been stretched to fulfill duties in their own role and be pulled into staffing. These emerging leaders have little energy to pursue an advanced academic degree when they are already considering leaving the profession. In a health care industry filled with ambiguity and volatility, continued efforts to support, retain, and recruit nurses in graduate leadership programs are essential. This article describes how graduate nursing faculty provided support to graduate students in unprecedented times.     

Wanted-nurses. Ethical issues and the nursing shortage

The persistent nursing shortage is challenging the values and beliefs of the nursing profession and causing nurses to ask how they can fulfill their ethical responsibilities to patients when there are an insufficient number and a maldistribution of nurses. Nurses are expressing job dissatisfaction, experiencing moral distress, and wondering about their inability to provide quality patient care. In this article, the author addresses the commitment to care for patients and the ethical dilemma with which nurses are grappling: caring for self versus caring for others. Recommendations for possible action include reenvisioning the profession of nursing, empowering nurses, providing support, and restructuring the work environment. Taken together, these actions have the potential to reduce the moral distress that nurses are experiencing and to enable them to honor their commitment to patient care.