Stroke unit Nurse Managers' views of individual and organizational factors liable to influence evidence‐based practice: A survey

The uptake of evidence into practice may be impeded or facilitated by individual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence‐based practice (EBP) and readiness for change. Overall Nurse Managers reported high‐level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff; and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP.     

Leadership practices and staff nurses' intent to stay: a systematic review

cowden t., cummings g. & profetto-mcgrath j (2011) Journal of Nursing Management 19 , 461–477
Leadership practices and staff nurses’ intent to stay: a systematic review Aim The aim of the present study was to describe the findings of a systematic review of the literature that examined the relationship between managers’ leadership practices and staff nurses’ intent to stay in their current position. Background The nursing shortage demands that managers focus on the retention of staff nurses. Understanding the relationship between leadership practices and nurses’ intent to stay is fundamental to retaining nurses in the workforce. Methods Published English language articles on leadership practices and staff nurses’ intent to stay were retrieved from computerized databases and a manual search. Data extraction and quality assessments were completed for the final 23 research articles. Results Relational leadership practices influence staff nurses’ intentions to remain in their current position. Conclusion This study supports a positive relationship between transformational leadership, supportive work environments and staff nurses’ intentions to remain in their current positions. Incorporating relational leadership theory into management practices will influence nurse retention. Advancing current conceptual models will increase knowledge of intent to stay. Clarifying the distinction between the concepts intent to stay and intent to leave is needed to establish a clear theoretical foundation for further intent to stay research. Implications for Nurse Managers Nurse managers and leaders who practice relational leadership and ensure quality workplace environments are more likely to retain their staff. The findings of the present study support the claim that leadership practices influence staff nurse retention and builds on intent to stay knowledge.     

Nurse Managers’ prerequisite for nursing development: a survey on pressure ulcers and contextual factors in hospital organizations

gunningberg l., brudin l. & idvall e. (2010) Journal of Nursing Management  18, 757–766
Nurse Managers’ prerequisite for nursing development: a survey on pressure ulcers and contextual factors in hospital organizations Aim To describe and compare pressure ulcer prevalence in two county councils and concurrently explore Nurse Managers’ perspective of contextual factors in a hospital organization. Background Despite good knowledge about risk factors and prevention of pressure ulcers, the prevalence of pressure ulcers remains high. Nurse Managers’ have a key role in implementing evidence-based practice. Methods The present study included five hospitals in two Swedish county councils: county council A (non-university setting) and county council B (university setting). A pressure ulcer prevalence study was conducted according to the methodology developed by the European Pressure Ulcer Advisory Panel. The Nurse Managers’ answered a (27-item) questionnaire on contextual factors. Results County council B had significantly less pressure ulcers grade (2–4) (7.7%) than county council A (11.3%). The Nurse Managers’ assessed only two out of the 27 general contextual items significantly differently. Some significant differences were observed in ward organization. Conclusions In county council B, the Nurse Managers’ seemed more aware of prevention strategies compared with Nurse Managers’ in county council A. The Nurse Managers’ should take more responsibility to develop the prerequisite for quality improvement in nursing. Implication for nursing management Nursing outcomes (e.g. pressure ulcers) should be incorporated into national quality registries for benchmarking and Nurse Managers’ competence in evidence-based practice and research methodology increased.     

Nurse consultants 10 years on: an insight to the role for nurse managers

mullen c., gavin-daley a., kilgannon h. & swift j. (2011) Journal of Nursing Management 19, 820–831
Nurse Consultants 10 years on: an insight to the role for Nurse Managers Aims To evaluate the Non-Medical Consultant role in the North West of England. The objective was to identify the current number of Non-Medical Consultants, what they do and the impact of the role in practice. Background The Non-Medical Consultant role for nursing and midwifery was introduced in the UK in 2000 to provide better outcomes for patients by improving service and quality; strengthening clinical leadership; and providing a new career opportunity to help retain experienced and expert professionals in practice. Design A combined qualitative and quantitative design was adopted. This included desktop review of previous studies, a survey questionnaire to current consultants, focus group meetings with Non-Medical Consultants, sponsors and champions. Results The role is effective, flexible, responsive and outward facing both internal to the organization and externally on a local, regional and national basis. A key challenge for the Non-Medical Consultants was organizational understanding of the role. The small size of the Non-Medical Consultant workforce can limit individual organizations experience of establishing and supporting the role. Conclusion Effective Non-Medical Consultants lead, drive and support quality improvement, increased productivity and service effectiveness. Other impacts include sharing and promoting best practice with colleagues, income generation and financial savings through service redesign and/or staff skill mix changes. Implications for Nursing Management Managerial issues identified may assist Nurse Managers seeking to introduce new consultant roles and/or support, and retain existing consultants to reach their full potential.     

EXEMPLAR: our shared experience of implementing action learning sets in an acute clinical nursing setting: approach taken and lessons learned

Abstract This paper outlines the process employed by a Nurse Unit Manager and her senior nursing team to introduce action learning sets (ALSs) to the nursing staff of an inpatient medical unit. During the process, a workplace culture creative visioning exercise was also facilitated. A key finding of the exercise was that the process enabled others to act while challenging the process and encouraging the heart. Effective leadership enabled staff involved to foster growth.     

Development and psychometric evaluation of supportive leadership scales.

The purpose of this study was to develop and evaluate the psychometric properties of 2 supportive leadership scales, the Charge Nurse Support Scale and the Unit Manager Support Scale, designed for long-term-care environments. These 6-item self-report scales were administered to 70 nursing staff and their internal consistency reliability, test-retest reliability, content validity, factor structure, and construct validity investigated. Content validity was established with the assistance of experts. Both scales were deemed reliable. As hypothesized, a significant relationship was found between the measure of how nursing staff related to residents and measures of charge nurses' supportive behaviours (r = .42, p = .05). Reliable and valid measures of supportive leadership could be developed for use in identifying the quality of support provided to staff in long-term-care environments.     

Evaluation of the Manchester clinical supervision scale: Norwegian and Swedish versions

severinsson e. (2012) Journal of Nursing Management 20, 81–89
Evaluation of the Manchester clinical supervision scale: Norwegian and Swedish versions Aim To develop Norwegian and Swedish versions of the Manchester Clinical Supervision Scale (MCSS) and to test and verify its hypothesized seven-factor structural model. Background Nurse managers are responsible for upholding and ensuring quality of care as well as for maintaining staff competence, thus safeguarding the standard of care. Methods The research process included a translation-back-translation procedure with monolingual and bilingual tests in addition to psychometric evaluation. The sample consisted of 150 student and registered nurses (RNs) from Norway and Sweden, and confirmatory factor analysis was performed. Results The translated versions did not exhibit satisfactory validity and reliability. The confirmatory factor analysis failed to show a good model fit. Low α-values were revealed except for factors 1, 2, 3 and 7. The most important factors of the MCSS were Trust/Rapport, Supervisor advice/Support, Improved care/Skills and Reflection. Conclusion Translation of an instrument for cross-cultural nursing research is important, although there are methodological limitations associated with construct validity. Implication for Nurse Managers Instruments for the evaluation of nursing care are necessary in order to formulate strategies at a managerial level. Nurse managers who encourage nurses to attend supervision promote professional development and enhance patient safety.     

Growing leaders in a professional membership organization

shekleton m .e ., preston j .c . & good l .e . (2010) Journal of Nursing Management  18, 662–668
Growing leaders in a professional membership organization Aims This study describes the background, development and delivery of an innovative approach to prepare elected state association leaders for their new leadership roles in their respective state organizations. Background State-based professional associations face unprecedented threats to scope of practice in the current volatile healthcare environment. In 2009 the American Association of Nurse Anesthetists (AANA) began offering a Leadership Development ‘Boot Camp’ for all nurse anesthetist state association presidents-elect designed with the intent of providing the participants with information, resources and tools they need in their new role. Methods An organizational assessment examined the philosophy of and need for leadership development across the entire organizational structure. Results Recommendations from the assessment included the need for intensive leadership development at the state level. A 3-day intensive workshop was designed and implemented. Adult learning theory was used for its development. Conclusions The success of this programme has lead to its implementation as part of leadership development of the AANA. Implications for nursing management Nurse managers and elected volunteer leaders in state-based professional associations face similar challenges requiring sound leadership ability. Principles applied to the development of the AANA programme can be applied to leadership development for new nurse managers.     

Development and psychometric evaluation of the Core Nurse Resource Scale

simpson mr . (2010) Journal of Nursing Management 18, 1048–1059
Development and psychometric evaluation of the core nurse resource scale Background The Core Nurse Resource Scale was developed to further what we know about the relationship between the nursing work environment and quality outcomes. Aims To examine the factor structure, internal consistency reliability and concurrent-related validity of the Core Nurse Resource Scale. Methods A cross-sectional survey study design was used to obtain a sample of 149 nurses and nursing staff [Registered Nurse (RNs), Licensed Practical Nurse (LPNs) and Certified Nursing Assistant (CNAs)] working in long-term care facilities. Exploratory factor analysis, Cronbach’s alpha and bivariate correlations were used to evaluate validity and reliability. Results Exploratory factor analysis yielded a scale with 18 items on three factors, accounting for 52% of the variance in scores. Internal consistency reliability for the composite and Core Nurse Resource Scale factors ranged from 0.79 to 0.91. The Core Nurse Resource Scale composite scale and subscales correlated positively with a measure of work engagement (r = 0.247–0.572). Conclusions The initial psychometric evaluation of the Core Nurse Resource Scale demonstrates it is a sound measure. Further validity and reliability assessment will need to be explored and assessed among nurses and other nursing staff working in other practice settings. Implications for nursing management The intent of the Core Nurse Resource Scale is to evaluate the presence of physical, psychological and social resources of the nursing work environment, to identify workplaces at risk for disengaged (low work engagement) nursing staff and to provide useful diagnostic information to healthcare administrators interested in interventions to improve the nursing work environment.     

The COVID-19 pandemic – A focus on nurse managers’ mental health,coping behaviours and organisational commitment

BackgroundThe emergence of COVID-19 has substantially impacted frontline health care workers, including nurse managers. To date, no studies have been conducted to examine the impact COVID-19 has had on Nurse Managers’ mental health, coping strategies and organisational commitment.AimTo investigate the mental health, coping behaviours, and organisational commitment among Nurse Managers during the COVID-19 pandemic.MethodsCross-sectional study involving 59 Nursing Managers from one Local Health District in Sydney Australia during the first wave of the COVID-19 pandemic. Data were collected relating to demographics, anxiety, coping strategies and organisational commitment.ResultsOverall, approximately three quarters of the Nurse Managers had high anxiety scores. Managers who had worked longer as a nurse had higher scores for adaptive coping strategies and 41% of Nurse Managers considered leaving their jobs.ConclusionsStrategies to minimise anxiety and enable coping as part of organisational disaster, emergency or crisis planning for Nurse Managers may result in decreased anxiety and stress levels, increased use of adaptive coping strategies and lower intent to leave the organisation and the nursing profession.     

The Importance of Communication for Clinical Leaders in Mental Health Nursing: The Perspective of Nurses Working in Mental Health

Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants’ experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.     

Increased adoption of smoke-free policies on campuses with schools of nursing

BackgroundIn 2015, the majority of U.S. American Association of Colleges of Nursing (AACN)-accredited schools of nursing resided on campuses without smoke-free policies.PurposeTo determine the presence of smoke-free policies at AACN-accredited after resolutions from AACN and the American Academy of Nursing, and the creation of online resources.MethodsSmoke-free policies (2015-2017) were determined through listings on the ANRF College Campus Policy Database© and survey responses from nursing deans.ResultsSmoke-free policies for 689 schools of nursing increased from 36% in 2015 to 91% in 2017. There were no significant differences by nursing program types or geographic area. Twenty percent of deans reported using the resources, with over 1700-page views.ConclusionSmoke-free policies increased after support from two national nursing organizations. Learning in a smoke-free environment should be an expectation for nursing students to protect their own health, and to support their future critical role in tobacco control.     

Mediating the effects of work-life conflict between transformational leadership and health-care workers' job satisfaction and psychological wellbeing

munir f., nielsen k., garde a.h., albertsen k. & carneiro i.g. (2012) Journal of Nursing Management  20, 512–521 Mediating the effects of work–life conflict between transformational leadership and health-care workers’ job satisfaction and psychological wellbeing Aim To explore the mediating effects of work–life conflict between transformational leadership and job satisfaction and psychological wellbeing. Background The importance of work–life balance for job satisfaction and wellbeing among health-care employees is well-recognized. Evidence shows that transformational leadership style is linked to psychological wellbeing. It is possible that transformational leadership is also associated with employees’ perceptions of work–life conflict, thereby influencing their job satisfaction and wellbeing. Methods A longitudinal design was used where staff working within Danish elderly care completed a questionnaire at baseline and 18-month follow-up (N = 188). Results Regression analyses showed that transformational leadership style was directly associated with perceptions of work–life conflict, job satisfaction and psychological wellbeing. Work–life conflict mediated between transformational leadership and wellbeing, but not job satisfaction. Conclusion The findings suggest transformational leadership style may improve perceptions of work–life balance and employee wellbeing. Implications for nursing management Managers should adopt transformational leadership styles to reduce work–life conflict and enhance the wellbeing of their staff.     

Newly qualified Project 2000 staff nurses in Scottish nursing homes: issues for education

The contribution of nursing homes to nurse education in the UK is growing. This article presents educational issues raised by nine senior Nurse Managers from nursing homes in one Scottish health board. The Managers were interviewed as part of a larger Scottish study of employers' views of the skills of newly qualified Project 2000 staff nurses. Perceptions of the adequacy of the skills of newly qualified diplomates in first staff nurse posts in nursing homes following registration were explored. Impressions were mixed but generally favourable. The perceived strengths - confidence, knowledge and a questioning approach, and perceived limitations - in practical and organisational skills, matched closely those of senior Nurse Managers in the NHS sector. Managers noted the significance for learning of the business and customer care ethos of nursing home care and of the exacting skill requirements of specialist and increasingly acute care demands within this sector. There was uncertainty about and concern to strengthen preceptorship support. Matters for debate include the adequacy of telephone support versus in person on-site support for newly qualified nurses, whether expectations of initial performance are realistic and whether skill requirements differ between independent and NHS sectors. The potential value of NHS and independent health care inter-sectoral dialogue and networking is suggested.