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.     

Impact of the Leading an Empowered Organisation programme

AIM: To evaluate the impact of the Leading an Empowered Organisation (LEO) programme on the role of grade G nurses and their multidisciplinary colleagues in one NHS trust. The LEO programme encourages and promotes leadership skills among NHS staff. METHOD: A purposive sample of four grade G nurses, one from each of the hospital's four clinical divisions, was included. Each grade G nurse, and his or her matron, nominated eight colleagues for interview. The final sample comprised four grade G nurses and 32 of their colleagues. Data were analysed using the principles of thematic analysis described by Attride-Stirling (2001). FINDINGS: The LEO programme improved the grade G nurses' approach to their work in relation to competence, communication strategies, problem solving, risk taking, leadership and management style. Factors that affected the grade G nurses' implementation of the LEO principles included: relationships, personality, experience, work context, staffing levels, autonomy and authority. CONCLUSION: This study provided insight into how the grade G nurses applied the principles of the LEO programme in their daily work. Their ability to apply the LEO principles was both restricted and assisted by the culture in which they worked. A partnership between theory and practice is needed. This finding has implications for the LEO programme and the need for it to be implicit in the local working philosophy, that is, the context in which its principles are to be used. This is so that the working context and people within it are intimately engaged with the individual undertaking the course.     

Leadership moments: Understanding nurse clinician-scientists' leadership as embedded sociohistorical practices

Nurse clinician-scientists are increasingly expected to show leadership aimed at transforming healthcare. However, research on nurse clinician-scientists' leadership (integrating researcher and practitioner roles) is scarce and hardly embedded in sociohistorical contexts. This study introduces leadership moments, that is, concrete events in practices that are perceived as acts of empowerment, in order to understand leadership in the daily work of newly appointed nurse clinician-scientists. Following the learning history method we gathered data using multiple (qualitative) methods to get close to their daily practices. A document analysis provided us with insight into the history of nursing science to illustrate how leadership moments in the everyday work of nurse clinician-scientists in the “here and now” can be related to the particular histories from which they emerged. A qualitative analysis led to three acts of empowerment: (1) becoming visible, (2) building networks, and (3) getting wired in. These acts are illustrated with three series of events in which nurse clinician-scientists' leadership becomes visible. This study contributes to a more socially embedded understanding of nursing leadership, enables us to get a grip on crucial leadership moments, and provides academic and practical starting points for strengthening nurse clinician-scientists' leadership practices. Transformations in healthcare call for transformed notions of leadership.     

Older women with breast cancer: perceptions of the effectiveness of nurse case managers

BACKGROUND: There are many challenges that an older woman and her family face when diagnosed with breast cancer. Utilizing community-based nurse case managers may influence the older client and her family to adapt to the many challenges associated with the diagnosis and treatment of breast cancer. PURPOSE: The purpose of this qualitative study is to describe how older breast cancer clients perceive community-based nurse case managers. From findings generated, recommendations were developed to improve the practice of community-based nurse case managers. METHOD: A randomized prospective trial to evaluate the effect of nurse case management on the treatment of 106 older women with breast cancer provided data for this content analysis. Older women (>65 years of age) newly diagnosed with breast cancer cared for by 60 surgeons practicing at 13 community and 2 public hospitals in southeast Texas were invited to participate. DISCUSSION: Community-based nurse case managers made a positive impact on older women with breast cancer by helping in managing coexisting medical conditions, providing support, providing education, giving assistance with activities of daily living (ADLs), and helping to navigate through the health care system. To increase their effectiveness, it was recommended that nurse case managers communicate well, be well educated about breast cancer, have standard gerontology nurse case management training, and integrate multiple support systems when caring for older clients with breast cancer. CONCLUSION: There are unique challenges that an older woman and her family face when diagnosed with breast cancer. Utilizing community-based nurse case managers may influence the client and her family to adapt to the many challenges associated with the diagnosis and treatment of breast cancer. Community-based nurse case managers can make a positive difference on the outcomes of older women with breast cancer.     

Nurse executive transformational leadership and organizational commitment

OBJECTIVE: To investigate the relationship between nurse executive leadership and organizational commitment among nurses in acute care hospitals. BACKGROUND: A key challenge for organizations is to maximize the contributions of all workers by cultivating their commitment. Nurse leaders are in a position to influence organizational commitment among nurses. METHODS: The theoretical constructs underlying this study are the transformational leadership theory and the Etzioni's organizational theory. A cross-sectional, field survey of nurse executives, nurse managers, and staff nurses was conducted to assess nurse executive transformational and transactional leadership and their relationship to organizational commitment. Hypotheses were tested using correlational analysis, and univariate statistics were used to describe the sample. RESULTS: An inverse relationship between nurse executive transformational and transactional leadership and alienative (highly negative) organizational commitment was statistically significant. A positive association was demonstrated between nurse executive leadership and nurse manager leadership. CONCLUSIONS: This study supports the effect of nurse executive leadership on nurse manager leadership and on organizational commitment among nurses despite role distance. To the extent that transformational leadership is present, alienative organizational commitment is reduced. This relationship shows the importance of nurse executive leadership in organizational involvement among nurses in the dynamic context of contemporary hospital settings.     

Effectiveness of nurse executives: measurement of role factors and attitudes.

This article describes the outcome of a survey of 40 nurse executives and 56 influential colleagues. Both groups agreed that leadership was the most important quality for the executive role. The nurses' primary focus was resolution of patient care problems. Influential colleagues stated resource allocation and initiation of change were two qualities needing improvement. The nurses rated themselves high in confidence about their job responsibilities, scored relationships as the most satisfying attribute, and cited provision of quality health care as the greatest advantage of their position. The greatest disadvantage was lack of administrative support. The results suggest the educational preparation needed for nurse executives.     

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.     

Leadership styles of Finnish nurse managers and factors influencing it

Aim  The purpose of the present study was to explore nurse managers' perceptions of their leadership styles and factors influencing it.
Background  It is a challenge for nurse managers to retain nurses in hospitals and to ensure a high quality of care in nursing practice. Leadership style is an important part of leadership. Knowledge concerning nurse managers' resonant and non-resonant leadership styles provides nurse managers with tools to reflect on their own leadership style.
Method  Open-ended, tape-recorded interviews were conducted with 13 nurse managers from five Finnish hospitals and two long-term care facilities. The data were analysed using qualitative content analysis.
Results  Five categories of leadership style were discerned: visionary, coaching, affiliate, democratic, commanding. Factors that influence leadership style were identified: earlier superiors, values, information, cooperation, employees and education.
Conclusions  The results of this study show that Finnish nurse managers use both resonant and non-resonant leadership styles.
Implications for nursing management  The findings of this study show that nurse managers use a variety of leadership styles. The study demonstrates the importance of knowledge about leadership styles and factors influencing it among nurse managers providing future leadership and management education.     

Mentorship as a teaching strategy

Nursing is facing challenges perhaps unparalleled in its history. As we face the opportunities of the future, mentors play a more important role than ever. Mentors have "provided inspiration, support, and encouragement during high and low points of my development." "have forever changed the course of our practice," taught through "her commitment to the advancement of her students and colleagues, her gentle but persistent encouragement to grow, and her generosity in providing pivotal opportunities," "taught me three lessons: caring gets results, family comes first, and passionate commitment is contagious," offers a potential buoy in the sea of change in health care, and possibly enhances clinical outcomes. Mentors can be found in your boss, teacher, spouse, friend, colleague, or peer. Mentorship is a gift between two people and must be given and accepted as such. Not everyone should act as a mentor; the relationship cannot occur and develop when there is no desire to share. Nursing is about learning and teaching. "The spirit of the nursing profession dies when it is reduced to a set of abstract theories, legal requirements, and expert skills. These are the results, not the goals, of scholarship and leadership. Scholarly endeavors always occur amidst communities of learners engaged in being better practitioners of their discipline." Mentors are the leaders amidst the community of nursing.     

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.     

Leadership in British nursing: a historical dimension

A historical overview of nurse leadership in the late 19th and late 20th centuries is presented, supported by relevant material from the literature. The 19th century material revealed the following main themes: emphasis on practical and domestic aspects of management; prominent input of religious ideals and social conscience and, autocratic and feminized style of leadership. The main themes in the contemporary literature examined were: role models in history, dysfunctional leadership styles, importance of knowledge, gender as an influencing factor on nurse leadership and threats to the autonomy of nurse leaders. It was concluded that formal nurse professionalization has progressed steadily during the past hundred years with associated evolution of nurse leaders to fit in with contemporary needs. It is hoped that future policies for nursing will encourage decision-making nearer the 'bed-side', more resource-driven care and value-based leadership.     

Continuing the journey of leadership: song of degrees.

The author discusses how her experiences at Project LEAD have improved her ability to be an effective administrator and faculty member through her "songs of degrees." She discusses her journey as an African American leader and how the principles learned in Project LEAD impacted her leadership style and ability to collaborate with peers and colleagues. Leaders who spoke during workshops provided blueprints for mentoring and discussed the journeys of notable leaders, which provided attendees with insights into the successes and challenges of leadership. During Project LEAD, Dr. Hattie Bessent focused upon five leadership principles and applied Structural, Human Resource, Political, and Symbolic Frames. The author determined she primarily used the Structural and Political Frames after studying the frames of Bolman and Deal (2003) discussed by Dr. Bessent. The Project LEAD model focused allowed her to grow as a mentor and guided mentees to the successful completion of projects.     

Head nurse leadership style with staff nurse burnout and job satisfaction in neonatal intensive care units

Leadership style has been defined as a two-factor construct composed of "consideration" and "initiating structure." Research has suggested that these factors affect the behavior and attitude of subordinates. This study's purpose was to quantify the relationships of head nurse leadership style with self-reported staff nurse burnout and job satisfaction in Neonatal Intensive Care Units (NICUs). Three instruments--the Minnesota Satisfaction Questionnaire, the Tedium Scale, and the Leadership Opinion Questionnaire--were voluntarily completed by 283 registered nurses employed by 14 level-III NICUs in the United States. The leadership dimensions of consideration and structure were distinct (r = -.10). Staff nurse satisfaction and burnout were related (r = -.41). Head nurse consideration was clearly related to staff nurse satisfaction (r = -.55) and to a lesser extent to burnout (r = -.29). Initiating structure alone was not related to satisfaction or burnout. Aggregate perceptions of head nurse leadership were ranked across NICUs in order to classify the head nurses on consideration and structure. The 14 head nurses were separated into four groups: high consideration-high structure, high consideration-low structure, low consideration-high structure, and low consideration-low structure. Satisfaction and burnout of staff nurses in each of the leadership-style groups were then compared. Analysis of variance for satisfaction (F(3,279) = 3.10, p = .03) and burnout (F(3,279) = 3.90, p = .01) were both significant. For both satisfaction and burnout, the head nurse leadership classification of low consideration-high structure was most deviant.(ABSTRACT TRUNCATED AT 250 WORDS)     

Crossing boundaries to improve mental health in the Americas: international collaborative authorship.

A nurse anthropologist with a background in international collaborations attended Project LEAD for two years, which enabled her to continue to serve as an advocate for the mentally ill in Belize. The anthropologist collaborated with a psychiatrist from Belize to develop a cross-cultural, cross-discipline publication, "Mental Health in Belize: A National Priority, " which highlights the work of psychiatric nurse practitioners in the country. The researcher learned to collaborate with her peer in Belize through face to face discussions and e-mail and overcame technological difficulties and cultural barriers to produce an international publication. Project LEAD gave the author a sense of self-discovery and self-knowledge, reinforced core values, and developed a frame of reference for leadership. The author also benefited from discussions by local, national, and international leaders on leadership in terms of its key components, contexts, challenges, triumphs, and styles.     

Leadership in action: students learn with resource persons

The faculty maintain close contact with the resource persons and are aware of their interaction with students on a weekly basis. Faculty and resource persons exchange observations, assessments, suggestions and problems they have either anticipated or experienced. The resource persons report that as students gain from the experiences, so do they. In particular, resource persons state interactions with students have stimulated them to increase their own clinical inquiry. A head nurse, functioning as a resource person, recently told the members of the Nursing Curriculum Committee she wished she had had such a course seven years ago when she was a senior in the program (S. Collier, personal communication, October 1987). She further elaborated that the learning opportunities she sees students experiencing today would have been invaluable to her and her peers as they began their professional nursing careers. We, the authors, believe individual learning opportunities with nurse leaders as resource persons is a unique, invaluable experience for nursing leadership students. These interactions provide a variety of learning opportunities sufficient for undergraduate students to develop beginning leadership skills, while also narrowing the education-practice gap. These experiences enhance the students' orientation to "real-world" nursing leadership and management. Students recognize the uniqueness of this teaching-learning strategy and value the time spent with resource persons. They frequently report never dreaming "that such problems have to be dealt with." They agree that learning with resource persons provides an essential ingredient for reinforcing the theoretical concepts of nursing leadership and putting classroom lectures into action.