The influence of authentic leadership and areas of worklife on work engagement of registered nurses

Aim To examine the relationships among nurses’ perceptions of nurse managers’ authentic leadership, nurses’ overall person–job match in the six areas of worklife and their work engagement. Background Reports have highlighted the impact of demanding and unsupportive work environments on nurses’ wellbeing, resulting in a need for strong nursing leadership to build sustainable and healthier work environments. Methods A secondary analysis of data collected from a non-experimental, predictive design survey of a random sample of 280 registered nurses working in acute care hospitals was conducted. Results An overall person–job match in the six areas of worklife fully mediated the relationship between authentic leadership and work engagement. Further, authentic leadership, overall person–job match in the six areas of worklife and years of nursing experience explained 33.1% of the variance in work engagement. Conclusions Findings suggest that nurses who work for managers demonstrating higher levels of authentic leadership report a greater overall person–job match in the six areas of worklife and greater work engagement. Implications for nursing management As nurse managers’ play a key role in promoting work engagement among nurses, authentic leadership development for nurse managers focusing on self-awareness, relational transparency, ethics and balanced processing would be beneficial.     

Leadership and management in mental health nursing

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

Reflection on how clinical nursing supervision enhances nurses' experiences of well-being related to their psychosocial work environment

Aim The aim of this study was to make a synthesis of three studies that deal with the following research question: ‘How does clinical nursing supervision enhance nurses’ experiences of well‐being in relation to their psychosocial work environment?’ Background Clinical nursing supervision is one way to support nurses in coping with their stressful work situation. Method A hermeneutic approach was used to reflect and interpret nurses’ experiences of well‐being in relation to clinical nursing supervision and psychosocial work environment. Results The findings suggest that clinical nursing supervision has an influence on nurses’ experiences of well‐being and in relation to their psychosocial work environment. Nurses attending clinical nursing supervision reported increased satisfaction with their psychosocial work environment. Conclusions The significance of caring and nursing becomes evident when nurses realize and understand that clinical nursing supervision positively influences their existence and well‐being. The value of work becomes clear when nurses reflect on themselves as professionals and as authentic human beings in clinical nursing supervision. This will lead to the emergence of self‐recognition.     

Authentic leadership,empowerment and burnout: a comparison in new graduates and experienced nurses

Aim To examine the effect of authentic leadership and structural empowerment on the emotional exhaustion and cynicism of new graduates and experienced acute-care nurses. Background Employee empowerment is a fundamental component of healthy work environments that promote nurse health and retention, and nursing leadership is key to creating these environments. Method In a secondary analysis of data from two studies we compared the pattern of relationships among study variables in two Ontario groups: 342 new graduates with <2 years of experience and 273 nurses with more than 2 years of experience. Results A multi-group path analysis using Structural Equation Modelling indicated an acceptable fit of the final model (χ² = 17.52, df = 2, P < 0.001, CFI = 0.97, IFI = 0.97 and RMSEA = 0.11). Authentic leadership significantly and negatively influenced emotional exhaustion and cynicism through workplace empowerment in both groups. Conclusions The authentic behaviour of nursing leaders was important to nurses’ perceptions of structurally empowering conditions in their work environments, regardless of experience level, and ultimately contributed to lower levels of emotional exhaustion and cynicism. Implications for nursing management Leadership training for nurse managers may help develop the empowering work environments required in today’s health-care organizations in order to attract and retain nurses.     

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.     

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

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

Clinical nursing leaders', team members' and service managers' experiences of implementing evidence at a local level

kitson a., silverston h., wiechula r., zeitz k., marcoionni d. & page t. (2011) Journal of Nursing Management 19 , 542–555
Clinical nursing leaders’, team members’ and service managers’ experiences of implementing evidence at a local level Aim To describe the experiences of 14 clinical nursing leaders introducing a knowledge translation (KT) project into one metropolitan acute care hospital in South Australia. The study also explored team members’ and service managers’ experiences. Background KT strategies assume that local (nursing) clinical leaders have the capacity and capability to champion innovation combining positional leadership roles (ward leader) with a project lead role. There is limited evidence to support these assumptions. Method Semi-structured interviews of clinical nursing leaders and managers were undertaken at month 4 and 12 of the project. Data were also collected from the interdisciplinary team members (n = 28). Results Clinical nursing leaders identified risks and anxieties associated with taking on an additional leadership role, whereas managers acknowledged the multiple pressures on the system and the need for local level innovation. Team members generally reported positive experiences. Conclusions With support, clinical nursing leaders can effectively embrace KT project leadership roles that complement their positional leadership roles. Clinical nursing leaders’ experiences differed from nursing and medical managers’ experiences. Implications for nursing management Managers need to be more attuned to the personal risks local leaders experience, providing support for leaders to experiment and innovate. Managers need to integrate local priorities with broader system wide agendas.     

Nursing leadership in an academic hospital in Gauteng

Aim This study was aimed at describing nursing leadership in an academic hospital in Gauteng, South Africa. Background Nurse managers’ leadership styles affect nurses’ attitudes, behaviour and work performance. However, little is known about how nurses experience nurse leadership and what leadership styles are found in academic hospitals in Gauteng. Methods The study was based on Maxwell’s framework of leadership (relationships, equipping, leadership and attitude). A qualitative design was used in order to describe the experiences of registered nurses and nurse managers. The population of the study was all registered nurses and nurse managers of the hospital in which the study was conducted. In phase one of the study, a discussion group with 35 registered nurses using the nominal group technique was held to respond to the following statement: ‘Please explain how you have experienced leadership by nurse managers in this hospital’. In phase two of the study, five nurse managers were interviewed individually, using a semi-structured interview guide. Results Some nurse managers were practising autocratic leadership in this hospital. Implications for nursing management The nurse managers need to be taught about contemporary leadership styles such as transformational leadership and visionary leadership and also about supervision, role modelling and caring.     

Authenticity,Creativity and a Love of the Job: Experiences of Grassroots Leaders of Mental Health Nursing in Queensland

The strength of mental health nursing and its potential contribution to improved consumer outcomes depends upon strong and clearly articulated leadership. However, studies of leadership have tended to focus on nurses holding senior positions rather than exploring the leadership embedded in clinical work. A qualitative exploratory study was undertaken with identified mental health nurse leaders in one Australian state, in order to explore their experiences and what they found to be most meaningful in their work. This article reports the findings from this study. The data was analysed thematically to yield insights significant to mental health nursing and identity. The findings suggest these leaders find intrinsic rewards in the role; aspire to making authentic connections with consumers; appreciate the position of trust that they hold in bearing witness to individuals’ distress; and use creative means to solve problems and achieve therapeutic outcomes. Sharing these themes builds knowledge on values that are embedded in mental health nursing practice and offers scope for integrating leadership attributes into the education, supervision and development of all mental health nurses. These findings also reveal the complexity of mental health nursing as a profession and the difficulties that might be encountered in attempts to define it in terms of its component tasks and functions.     

Authentic leadership and nurses' voice behaviour and perceptions of care quality

wong c.a ., laschinger h. & cummings g.g . (2010) Journal of Nursing Management 18, 889–900
Authentic leadership and nurses' voice behaviour and perceptions of care quality Aim The purpose of the present study was to test a theoretical model linking authentic leadership with staff nurses’ trust in their manager, work engagement, voice behaviour and perceived unit care quality. Background Authentic leadership is a guide for effective leadership needed to build trust and healthier work environments because there is special attention given to honesty, integrity and high ethical standards in the development of leader–follower relationships. Methods A non-experimental, predictive survey design was used to test the hypothesized model in a random sample of 280 (48% response rate) registered nurses working in acute care hospitals in Ontario. Results The final model fitted the data acceptably (χ² = 17.24, d.f. = 11, P = 0.10, IFI = 0.99, CFI = 0.99, RMSEA = 0.045). Authentic leadership significantly and positively influenced staff nurses’ trust in their manager and work engagement which in turn predicted voice behaviour and perceived unit care quality. Conclusions These findings suggest that authentic leadership and trust in the manager play a role in fostering trust, work engagement, voice behaviour and perceived quality of care. Implications for nursing management Nursing leaders can improve care quality and workplace conditions by paying attention to facilitating genuine and positive relationships with their staff.     

Masters in nursing degrees: an evaluation of management and leadership outcomes using a retrospective pre-test design

drennan j. (2012) Journal of Nursing Management 20, 102–112
Masters in nursing degrees: an evaluation of management and leadership outcomes using a retrospective pre-test design Aim The aim of the present study was to measure the leadership and management abilities of graduates who had completed a master’s degree in nursing. Background A number of reports have recommended that leadership competencies be integrated into education programmes for nurses at a master’s level. In spite of the growth in the number of graduates from higher degrees in nursing, there is a paucity of evidence on the management and leadership outcomes that develop as a result of undertaking a master’s degree. Methods A cross-sectional survey using a retrospective pre-test design was used to measure self-reported leadership and management outcomes from the graduates’ educational programmes. Results Results found that graduates had gained significantly on their ability to change practice, communicate and work as part of a team and to problem solve as an outcome of completing a master’s degree in nursing. Conclusion Graduates make substantial gains in leadership and management capabilities as a consequence of their higher degree. These capabilities are necessary as nurses take the lead in many areas of healthcare. Implications for nursing management The masters in nursing degree now has a pivotal role in providing effective continuing education to the nursing profession; especially for those who occupy or intend to occupy senior positions within clinical, management or education branches of the profession.     

Leading nurses in dire straits: head nurses' navigation between nursing and leadership roles

sørensen e.e., delmar c. & pedersen b.d. (2011) Journal of Nursing Management 19 , 421–430
Leading nurses in dire straits: head nurses’ navigation between nursing and leadership roles Aim The present study reports selected findings from a doctoral study exploring the negotiation between nursing and leadership in hospital head nurses’ leadership practice. Background The importance of bringing a nursing background into leadership is currently under debate. In spite of several studies of nursing and clinical leadership, it is still unclear how nurses’ navigate between nursing and leadership roles. Method An 11-month-long ethnographic study of 12 head nurses’ work: five worked at a first line level and seven at a department level. Results At the first line level, leadership practices were characterized by an inherent conflict between closeness and distance to clinical practice; at the department level practises were characterized by ‘recognition games’. On both levels, three interactive roles were identified, that of clinician, manager and a hybrid role. Conclusions Where clinician or manager roles were assumed, negotiation between roles was absent, leading to reactive, adaptive and isolated practices. The hybrid role was associated with dialectical negotiation of roles leading to stable and proactive practices. Implications for nursing management Nursing leadership practises depend on leaders’ negotiation of the conflicting identities of nurse and leader. Successful nursing leaders navigate between nursing and leadership roles while nourishing a double identity.     

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.     

The novice nurse and clinical decision-making: how to avoid errors

saintsing d., gibson l.m. & pennington a.w. (2011) Journal of Nursing Management  19 , 354–359
The novice nurse and clinical decision-making: how to avoid errors Aim The purpose of this integrative review is to present the evidence in relation to novice nurses’ errors when faced with clinical decision-making in the first years of a nursing career. Background Recent studies identify a need for nursing schools to produce 30 000 new graduates each year to keep up with the nursing shortage. Novice nurses may be at greater risk for errors than experienced nurses. As the novice nurse moves into practice, it is imperative to recognize potential mistakes in order to prevent errors. Evaluation Articles selected included information regarding types of errors, causes of errors and potential interventions for the novice nurse. Key issues The primary types of errors committed by the novice nurses include medication errors, patient falls and delay in treatment. The causes of such errors are complex. Implications for nursing management Improved patient outcomes, reduced liability and higher retention/satisfaction are all potential benefits of reducing the errors made by novice nurses. Simply being aware of the type of problems may be an important first step in improving the care by novice nurses.     

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.     

Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy

gifford w., davies b., tourangeau a. & lefebre n . (2011) Journal of Nursing Management 19, 121–132
Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy Background Research describes leadership as important to guideline use. Yet interventions to develop current and future leaders for this purpose are not well understood. Aim To describe the planning and evaluation of a leadership intervention to facilitate nurses’ use of guideline recommendations for diabetic foot ulcers in home health care. Method Planning the intervention involved a synthesis of theory and research (qualitative interviews and chart audits). One workshop and three follow-up teleconferences were delivered at two sites to nurse managers and clinical leaders (n = 15) responsible for 180 staff nurses. Evaluation involved workshop surveys and interviews. Results Highest rated intervention components (four-point scale) were: identification of target indicators (mean 3.7), and development of a team leadership action plan (mean 3.5). Pre-workshop barriers assessment rated lowest (mean 2.9). Three months later participants indicated their leadership performance had changed as a result of the intervention, being more engaged with staff and clear about implementation goals. Conclusions and implications for nursing management Creating a team leadership action plan to operationalize leadership behaviours can help in delivery of evidence-informed care. Access to clinical data and understanding team leadership knowledge and skills prior to formal training will assist nursing management in tailoring intervention strategies to identify needs and gaps.     

Transformational leadership: the development of a model of nursing case management by the army nurse corps

Management philosophy and culture of any organization must match the nursing professions' core value of caring. Organizational conflict symptomology includes communication barriers and widely differing values. Employment of accountability based systems and bringing nurses into governance prevents conflict and improves job satisfaction. This article identifies the barriers to case management program development and discusses strategies for its successful implementation. Today's most successful organizations will implement an institution-wide commitment to a culture within which excellence flourishes. Creative staffing models and professional practice partnerships such as nursing case management will be supported and encouraged by executive leadership; they work as a team and will be jointly accountable for positive outcomes The United States Army Nurse Corps has the framework necessary to develop a premiere nursing organization. Case management departments may adopt these techniques to improve working relationships and leadership capacity within their organizations.     

选拔聘用护士当选护士长对护理管理的作用

探讨聘用护士当选护士长对护理管理的作用.从全院护士队伍中公开竞聘护士长,选拔政治思想好,业务技术精的聘用护士为护士长.聘用制护士长和在编护士长一样发挥着领导作用.充分认识聘用护士在医院发挥的作用,为聘用护士提供一个发展的平台,有利于稳定护理队伍和提高医疗护理质量.     

Factors influencing job satisfaction of front line nurse managers: a systematic review

Aim The purpose of this study was to systematically review the research literature that examined the determinants of front line nurse managers’ job satisfaction. Background Front line managers are the vital link between senior management and clinical nurses. They influence organizational culture and outcomes for patients and staff so their job satisfaction and ultimately retention is of importance. Evaluations A review of research articles that examined the determinants of front line nurse managers’ job satisfaction was conducted. These managers supervise staff nurses and have direct responsibility for the management of a nursing unit or team in any type of healthcare facility. Fourteen studies were included in the final analysis. Key issues Evidence of significant positive relationships were found between span of control, organizational support, empowerment and the job satisfaction of front line nurse managers. Conclusion The review suggests that job satisfaction of front line managers may be improved by addressing span of control and workload, increasing organizational support from supervisors and empowering managers to participate in decision‐making. Implications for Nursing Management Healthcare organizations may enhance the recruitment, retention and sustainability of future nursing leadership by addressing the factors that influence job satisfaction of front line managers.     

选拔聘用护士当选护士长对护理管理的作用

探讨聘用护士当选护士长对护理管理的作用.从全院护士队伍中公开竞聘护士长,选拔政治思想好,业务技术精的聘用护士为护士长.聘用制护士长和在编护士长一样发挥着领导作用.充分认识聘用护士在医院发挥的作用,为聘用护士提供一个发展的平台,有利于稳定护理队伍和提高医疗护理质量.