The influence of staff nurse perception of leadership style on satisfaction with leadership: A cross-sectional survey of pediatric nurses

BackgroundThere is evidence that transformational leadership style promotes nursing excellence. Differences in how supervisees and supervisors perceive the supervisor's leadership style may also be related to satisfaction with leadership. Research demonstrates that satisfaction with leadership is a critical element in the retention of nurses.ObjectiveTo evaluate staff nurse and nurse leader perceptions of leadership style.Methods16 supervisors and 179 supervisees completed the Multifactor Leadership Questionnaire and a demographic survey. Data were analyzed using parametric statistical techniques.ResultsAlthough staff perceived leaders as employing largely transformative leadership strategies, differences existed in leader-staff congruence in interpretation of leadership style and as related to the role of the leader.ConclusionsDifferences in interpretation of leadership style between supervisors and supervisees were associated with diminished satisfaction with leadership. In addition, those serving in a direct operational role (assistant nurse manager) were viewed as less transformative than leaders who maintained broader administrative responsibilities.     

Ineffective participation: reactions to absentee and incompetent nurse leadership in an intensive care unit

Aim  The aim of the present study was to analyse reactions to ineffective leader participation in an intensive care unit (ICU).
Background  Critical examination of leadership failures helps identify nurse manager behaviours to avoid.
Method  An online survey collected data from 51 interacting healthcare providers who work in an intensive care unit.
Results  Participants reported dissatisfaction with nurse leaders who were perceived as absent or ill prepared. Participants categorized intensive care unit productivity and morale as moderate to low. Multiple regression suggested the best predictor of perceived unit productivity was supervisor communication; the best predictor of employee morale was perceived leader mentoring.
Conclusions  Intensive care unit nurses reported wanting active participation from their leaders and expressed dissatisfaction when supervisors were perceived as absent or incompetent. Ineffective leader participation significantly correlated with lower employee perceptions of productivity and morale.
Implications for nursing management  Senior managers should recruit and develop supervisors with effective participation skills. Organizations primarily concerned about productivity should focus on developing the communication skills of nurse leaders. Units mainly concerned with employee morale should emphasize mentorship and role modelling. Formal assessment of nurse leaders by all intensive care unit team members should also be used to proactively identify opportunities for improvement.     

Facilitators and barriers to application of the Canadian C-spine rule by emergency department triage nurses

ObjectivesWe recently conducted a multicentre implementation study on the use of the Canadian C-Spine Rule (CCR) by emergency department (ED) nurses to clear the c-spine in alert and stable trauma patients (n = 4506). The objective of this study was to conduct a survey of nurses, physicians, and administrators to evaluate their views on the facilitators and barriers to the implementation of the CCR.MethodsWe conducted both a paper-based and an electronic survey of the three different ED hospital staff groups of nine large teaching hospitals in Ontario, including six regional trauma centres. The content of this survey was informed by a qualitative evaluation of the opinions of the study nurses who had participated in the validation study.Results57.5% (281/489) ED triage nurses, 50.2% ED physicians, and 82.8% of administrators responded. Nurse responses most often showed support from manager/educators and teamwork between physicians, nurses, and managers as being important facilitators to the use of the CCR. Physician responses most often identified the importance of a nurse leader/champion/educator, and presence of strong physician leaders. Administrator responses indicated the importance of nurse educators/champions, nurse engagement, and educational support. Barriers indicated by all three groups included busy department, lack of physician support, and lack of nursing support.ConclusionsBringing about change in clinical practice is complex. Strong leadership, effective communication, and senior physician buy-in appear to be very important. Identification of system-specific barriers and facilitators are important components of successful knowledge translation.     

Theoretical Frameworks of Leadership in Nursing: Critical Reflections

ObjectivesThe objective of this article is to present a comprehensive view on the topic of nursing leadership discussing the theoretical frameworks that underpin its manifestation, the leadership styles in nursing, the overall landscape in nursing leadership including the context where leadership is being practiced, and finally looking at the educational pathways for building leadership capacity and sustainabilityData SourcesRelevant studies on the topic as well professional associations, national and international organizations’ evidence have formed the basis for this article.ConclusionThe role of the nurse leaders is complex and demanding within the context of health care. Its value has been increasingly drawing the attention of national and international organizations. The nurse leader is performing tasks within rapidly shifting environments that require constant changes to best address the organizational goals but remain true to the values and perspectives envisioned by the nursing profession. Through the implementation of corresponding competency frameworks, the capacity and preparedness of nurse leaders can be cultivated ideally in a multidisciplinary context.Implications for Nursing PracticeNurse leaders are increasingly assuming positions of authority across the structures of health care organizations. There is need to timely and appropriately increase the preparedness of nurse leaders to assume and sustain these challenging and dynamic roles.     

The impact of debriefing modalities on nurse practitioner students’ knowledge and leadership skills in managing fatal dysrhythmias: A pilot study

Acute care nurse practitioners (ACNPs) require special training and educational preparation to meet their role expectations. Using high fidelity simulation with debriefing modalities is considered one of the innovative learning strategies in graduate nursing. No studies have investigated debriefing modalities in nurse practitioner programs specially ACNPs leadership skills. The purpose of this study was to examine the difference in students' knowledge, code team leader skills and self-efficacy using two debriefing modalities. A two group, pretest-posttest quasi-experimental design was used. Students were divided into video-assisted debriefing group vs. verbal debriefing following a simulation scenario of managing emergency codes. There were no significant differences between the two groups in knowledge acquisition/retention, leadership skills, and self-efficacy, but there was a significant difference in self-efficacy in both groups between two-time points. There was a general improvement in teams' performance. Students preferred verbal debriefing over video-assisted debriefing. The debriefing session plays an important role in graduate nursing education. Acute care nurse practitioners are lacking a formal leadership training to meet their advanced role. Nurse Educators, and simulation/debriefing leaders may benefit from our study results to develop a structured, formal curriculum and educational instruction focusing on acute care nurse practitioners’ role change especially leading a resuscitation team.     

Becoming a nursing faculty leader

Academic leaders are one component of a well-prepared faculty that is required to achieve and sustain excellent educational programs. But what is it like to become an academic leader? How does one become a leader? These questions were addressed in an interpretive study in which nurse faculty leaders were interviewed about the experience of becoming a leader. Interview texts were analyzed hermeneutically by a research team to uncover three themes (common, shared experiences): Being Thrust into Leadership, Taking Risks, and Facing Challenges, which are explicated in this article. This study develops the evidence base for leadership preparation at a time when there is a strong need for nursing education leaders in academia.     

Distilling the Antecedents and Enabling Dynamics of Leader Moral Courage: A Framework to Guide Action

Intelligent, robust and courageous nursing leadership is essential in all areas of nursing, including mental health. However, in the nursing leadership literature, the theoretical discourse regarding how leaders recognise the need for action and make the choice to act with moral purpose is currently limited. Little has been written about the cognitions, capabilities and contextual factors that enable leader courage. In particular, the interplay between leader values and actions that are characterised as good or moral remains underexplored in the nursing leadership literature. In this article, through a discursive literature synthesis we seek to distill a more detailed understanding of leader moral courage; specifically, what factors contribute to leaders’ ability to act with moral courage, what factors impede such action, and what factors do leaders need to foster within themselves and others to enable action that is driven by moral courage. From the analysis, we distilled a multi-level framework that identifies a range of individual characteristics and capabilities, and enabling contextual factors that underpin leader moral courage. The framework suggests leader moral courage is more complex than often posited in theories of leadership, as it comprises elements that shape moral thought and conduct. Given the complexity and challenges of nursing work, the framework for moral action derived from our analysis provides insight and suggestions for strengthening individual and group capacity to assist nurse leaders and mental health nurses to act with integrity and courage.     

What constitutes effective leadership? Perceptions of magnet and nonmagnet nurse leaders

Magnet hospitals, so named because of their ability to attract and retain nurses, have been operating for nearly 20 years. Although research on their success, particularly related to job satisfaction and retention of nurses, is available, research on magnet nurse leader effectiveness has been limited to the pivotal role the nurse leader plays in supporting a magnet culture. To enhance the research groundwork in magnet hospitals and nursing leadership, 16 nurse leaders from magnet and nonmagnet hospitals were interviewed. They were asked to identify leadership qualities they considered valuable in today's healthcare setting. The author contrasts the opinions of magnet and nonmagnet leaders relating to their leadership traits, organizational structures they discern as being supportive of professional nursing practice, and their perceptions of how a successful organization is created.     

Nursing team leader handover in the intensive care unit contains diverse and inconsistent content: An observational study

BackgroundDespite a proliferation of evidence and the development of standardised tools to improve communication at handover, evidence to guide the handover of critical patient information between nursing team leaders in the intensive care unit is limited.ObjectiveThe study aim was to determine the content of information handed over during intensive care nursing team leader shift-to-shift handover.DesignA prospective observational study.SettingA 21-bed medical/surgical adult intensive care unit specialising in cardiothoracic surgery at a tertiary referral hospital in Queensland, Australia.ParticipantsSenior nurses (Grade 5 and 6 Registered nurses) working in team leader roles, employed in the intensive care unit were sampled.MethodAfter obtaining consent from nursing staff, team leader handovers were audiotaped over 20 days. Audio recordings were transcribed and analysed using deductive and inductive content analysis. The frequency of content discussed at handover that fell within the a priori categories of the ISBAR schema (Identify-Situation-Background-Assessment-Recommendation) was calculated.ResultsForty nursing team leader handovers were recorded resulting in 277 patient handovers and a median of 7 (IQR 2) patients discussed at each handover. The majority of nurses discussed the Identity (99%), Situation (96%) and Background (88%) of the patient, however Assessment (69%) content was varied and patient Recommendations (60%) were discussed less frequently. A diverse range of additional information was discussed that did not fit into the ISBAR schema.ConclusionsDespite universal acknowledgement of the importance of nursing team leader handover, there are no previous studies assessing its content. Study findings indicate that nursing team leader handovers contain diverse and inconsistent content, which could lead to inadequate handovers that compromise patient safety. Further work is required to develop structured handover processes for nursing team leader handovers.     

The clinical nurse leader: a response from practice.

In October 2003, over 200 nurse leaders from education and practice met at the invitation of the American Association of Colleges of Nursing. A newly released white paper, describing the role of the clinical nurse leader, was discussed at the conference. This article outlines a response to that white paper from one practice setting. The article shares information about another role, that of team coordinator, that is similar to clinical nurse leader and has been implemented at an integrated not-for-profit health care system in 5 hospitals. The comparison of the team coordinator role to the clinical nurse leader role might assist in visualizing such a role in practice. Although the roles are not identical, many of the driving forces for change were similar; these included the need to meet the changing demands for improved patient outcomes and nurse retention. The team coordinator role has 4 domains of practice that are crosswalked against the clinical nurse leader 15 core competencies. An evaluation of the team coordinator role showed changes that need to be made, such as placing more emphasis on clinical progression of patients. Lessons learned are shared, including keeping the scope of the role manageable, providing documentation standards for new roles, and the leadership required of the nursing executive to implement change.     

Succession planning for academic nursing

Academic nursing must plan for the future by retaining, developing, and recruiting academic nurse leaders, utilizing best practices in succession planning. This article presents a case study in which an evidence-based model was developed to provide academic nurse leaders with a guide for succession planning. A formal succession plan gives purposeful direction in identifying and developing emerging leaders and is especially useful for individuals who are new to a major leadership role. The author collaborated with an academic nurse leader at a selected College of Nursing in gathering information essential to forecasting future leadership needs. An Executive Summary report, highlighting recommendations, was provided to the academic leader in order to initiate a formal succession plan. The model provides a means for the assessment of current leadership skills and talents, analysis of future needs for academic nurse leaders, and development of evidence-based recommendations to strengthen and improve an academic succession plan. The succession planning model lays the groundwork for academic nursing leaders to achieve and uphold a highly qualified nursing leadership workforce to meet the future needs.     

Learning from history: Frances Gillam Holden,a leadership perspective then and now

BackgroundCritical evaluation of leadership styles through a historical lens is uncommon. There could be missed opportunity for current and emerging nurse leaders to critically evaluate the leadership styles of the past in order to discerningly reflect on their own current leadership.AimTo critically examine the work of Australian nurse Frances Gillam Holden as she developed her vision for servant leadership for nursing in Australia in the late 19th century.MethodsExploration of, and critical reflection on, literature outlining Frances Gillam Holden's work.FindingsHolden's work and experience demonstrate the challenges faced by the profession's leaders at the turn of the century as they attempted to negotiate new ‘scientific’ knowledge and integrate this into nursing leadership. An examination of Holden's experience also demonstrates the difficulties faced by Australian nurse leaders during this time and consideration is given to what leadership in nursing looks like in the present day.DiscussionWithin the wealth of historical narratives, along with their complexities, the impact of this knowledge can have a demonstrated effect that can be far reaching and long lasting. This is particularly evident in regard to the role of nurses, nursing, and the development of modern approaches to nursing leadership, particularly with regard to the rise of nurse leaders in the form of ‘e-nurses’ and the use of social media to inform and lead the profession.ConclusionUnderstanding the influence and impact of nursing history, and historical nursing leaders such as Holden, on current leadership practices is being recognised more as contributing to contemporary nursing identity.     

Role and Training of Emergency Department Charge Nurses: A Mixed Methods Analysis of Processes,Needs, and Expectations

IntroductionCharge nurses (CNs) are shift leaders who manage resources and facilitate patient care, yet CNs in EDs receive minimal training, with implications for patient safety and emergency nursing practice. The purpose of the study was to describe the experiences of emergency nurses related to training, preparation, and function of the CN role.MethodsAn explanatory sequential mixed methods design using survey data (n = 2579) and focus group data (n = 49) from both CN and staff nurse perspectives.ResultsParticipants reported minimal training for the CN role, with divergent understandings of role, required education and experience, the need for situational awareness, and the acceptability of the CN taking on other duties.ConclusionsThe ED CN is critical to the safety of both nursing environment and patient care. Nurses in this pivotal role do not receive adequate leadership orientation or formal training in the key areas of nurse patient assignment, communication, and situational awareness. Formal training in nurse-patient assignment, communication, and situational awareness are critical to appropriate patient care and maintenance of interprofessional trust necessary for successful execution of the CN role. ED nurse managers should advocate for this training.     

Quality of cardio-pulmonary resuscitation (CPR) during paediatric resuscitation training: Time to stop the blind leading the blind

AimsRecent evidence suggested that the quality of cardio-pulmonary resuscitation (CPR) during adult advanced life support training was suboptimal. This study aimed to assess the CPR quality of a paediatric resuscitation training programme, and to determine whether it was sufficiently addressed by the trainee team leaders during training.MethodsCPR quality of 20 consecutive resuscitation scenario training sessions was audited prospectively using a pre-designed proforma. A consultant intensivist and a senior nurse who were also Advanced Paediatric Life Support (APLS) instructors assessed the CPR quality which included ventilation frequency, chest compression rate and depth, and any unnecessary interruption in chest compressions. Team leaders’ response to CPR quality and elective change of compression rescuer during training were also recorded.ResultsAirway patency was not assessed in 13 sessions while ventilation rate was too fast in 18 sessions. Target compression rate was not achieved in only 1 session. The median chest compression rate was 115 beats/min. Chest compressions were too shallow in 10 sessions and were interrupted unnecessarily in 13 sessions. More than 50% of training sessions did not have elective change of the compression rescuer. 19 team leaders failed to address CPR quality during training despite all team leaders being certified APLS providers.ConclusionsThe quality of CPR performance was suboptimal during paediatric resuscitation training and team leaders-in-training had little awareness of this inadequacy. Detailed CPR quality assessment and feedback should be integrated into paediatric resuscitation training to ensure optimal performance in real life resuscitations.     

Statistical testing of the full-range leadership theory in nursing

The aim of this study is to test statistically the structure of the full-range leadership theory in nursing. The data were gathered by postal questionnaires from nurses and nurse leaders working in healthcare organizations in Finland. A follow-up study was performed 1 year later. The sample consisted of 601 nurses and nurse leaders, and the follow-up study had 78 respondents. Theory was tested through structural equation modelling, standard regression analysis and two-way anova . Rewarding transformational leadership seems to promote and passive laissez-faire leadership to reduce willingness to exert extra effort, perceptions of leader effectiveness and satisfaction with the leader. Active management-by-exception seems to reduce willingness to exert extra effort and perception of leader effectiveness. Rewarding transformational leadership remained as a strong explanatory factor of all outcome variables measured 1 year later. The data supported the main structure of the full-range leadership theory, lending support to the universal nature of the theory.     

Composition and performance of a small resuscitation team in a deployed military hospital

The Royal Australian Navy deployed a 5-person resuscitation team, including 2 nursing officers, to East Timor from February to August 2000 as part of the United Nations Military Hospital. The team managed a wide variety of emergency presentations, effectively utilising the Advanced Trauma Life Support (ATLS) model. The 2 nursing officers, in addition to using their clinical skills, also provided leadership, enhancing communication and cohesion within the team and ultimately providing an essential contribution to the team's excellent patient outcomes.     

Impact of clinical leadership development on the clinical leader, nursing team and care-giving process: a case study

Aim This study explored the dynamics related to a leadership development programme and their impact on the clinical leader, the nursing team and the care‐giving process. Background While there is a growing conviction about the need to invest in transformational leadership in nursing, further insight into the true complexity of leadership development and, more specifically, how leadership can make a difference in nursing and patient outcomes is essential. Method A single instrumental case study was conducted in a unit of a large academic hospital where a Clinical Leadership development Project (CLP) was implemented successfully. We used mixed methods with multiple sources of data to capture the complexity of leadership development. Data were collected through individual interviews, focus groups and observation of participants. A purposive sample of 17 participants representing a wide variety of team members has permitted data saturation. The data were categorized and conceptualized and finally organized into a framework describing leadership development on the unit and its impact on the leader, the nursing team and the care‐giving process. Results Leadership development is an ongoing, interactive process between the clinical leader and the co‐workers. The head nurse became more effective in areas of self‐awareness, communication skills, performance and vision. The nursing team benefited because more effective leadership promoted effective communication, greater responsibility, empowerment and job clarity. Improved clinical leadership seemed also to influence patient‐centred communication, continuity of care and interdisciplinary collaboration. Conclusions The results of the study give more insight into the processes underlying the leader’s progress towards attaining a transformational leadership style and its impact on the team members. The impact of leadership on the care‐giving process, however, remains difficult to describe. Implications for nursing management The interactive nature of leadership development makes CLP a challenge for the leader as well for the team members. Through its impact on the leader and the nursing team, CLP is a valuable instrument for improving work environments of nurses, contributing positively to patient‐centred care.     

Leading towards the future: implementing nursing leadership principles at the front line

Federal and provincial professional bodies of nursing and healthcare are examining the role of nursing leadership and its relation in creating and sustaining quality work environments for nursing. Using the findings and recommendations of the Canadian Nursing Advisory Report Committee (2002) as a catalyst, nurse leaders from Children's and Women's Health Centre of British Columbia (C&W) have collaborated to develop principles of nursing leadership to be used as a resource in determining roles and functions of front-line nurse leaders throughout the organization. In this paper, the process of creating those nursing leadership principles is described with a focus on the unit-based operational leader. Suggestions are made on how to evaluate the effectiveness of principle-based nursing leadership as implemented at C&W and its utility to the unit-based operational leader.