Fractures in the Faultline: Addressable Issues in Nursing.

The nursing profession is at a paradigm shifting moment. The cracks in the profession and the health system were exacerbated by the global pandemic of COVID-19 and chronic workforce issues. Nursing must explicitly acknowledge the broken systems and work specifically to address them. Through innovation leadership, health care leaders can identify the issues and create novel solutions to lead nursing into our desired future.

Evaluation of workplace opioid prevention and response training for union and employer instructors and leadership.

OBJECTIVE: Opioids and the Workplace Prevention and Response (OWPR) Train-the-Trainer (TTT) and Leadership programs were piloted to improve trainees' abilities to conduct opioid awareness training and to introduce policies and programs in their workplaces. METHODS: The TTT (N = 54) and Leadership (N = 19) pilot trainees were administered voluntary pre- and post-training surveys and observed for discussion on knowledge and confidence regarding teaching and on workplace policies and workplace injury prevention related to opioids. RESULTS: Percentage agreement with correct responses for all TTT and 10 out of 14 (71.4 percent) Leadership knowledge and confidence questions increased significantly from pre- to post-test. CONCLUSION: We found some evidence that the OWPR TTT and Leadership training programs and materials were effective in improving trainee's abilities to conduct opioid awareness training and to introduce policies and programs to address opioids and the workplace.

Factors of a physician quality improvement leadership coalition that influence physician behaviour: a mixed methods study.

BACKGROUND: A coalition (Strategic Clinical Improvement Committee), with a mandate to promote physician quality improvement (QI) involvement, identified hospital laboratory test overuse as a priority. The coalition developed and supported the spread of a multicomponent initiative about reducing repetitive laboratory testing and blood urea nitrogen (BUN) ordering across one Canadian province. This study's purpose was to identify coalition factors enabling medicine and emergency department (ED) physicians to lead, participate and influence appropriate BUN test ordering. METHODS: Using sequential explanatory mixed methods, intervention components were grouped as person focused or system focused. Quantitative phase/analyses included: monthly total and average of the BUN test for six hospitals (medicine programme and two EDs) were compared pre initiative and post initiative; a cost avoidance calculation and an interrupted time series analysis were performed (participants were divided into two groups: high (>50%) and low (<50%) BUN test reduction based on these findings). Qualitative phase/analyses included: structured virtual interviews with 12 physicians/participants; a content analysis aligned to the Theoretical Domains Framework and the Behaviour Change Wheel. Quotes from participants representing high and low groups were integrated into a joint display. RESULTS: Monthly BUN test ordering was significantly reduced in 5 of 6 participating hospital medicine programmes and in both EDs (33% to 76%), resulting in monthly cost avoidance (CAN$900-CAN$7285). Physicians had similar perceptions of the coalition's characteristics enabling their QI involvement and the factors influencing BUN test reduction. CONCLUSIONS: To enable physician confidence to lead and participate, the coalition used the following: a simply designed QI initiative, partnership with a coalition physician leader and/or member; credibility and mentorship; support personnel; QI education and hands-on training; minimal physician effort; and no clinical workflow disruption. Implementing person-focused and system-focused intervention components, and communication from a trusted local physician-who shared data, physician QI initiative role/contribution and responsibility, best practices, and past project successes-were factors influencing appropriate BUN test ordering.

Exploration of System Chief Nurse Executive's Leadership Practices to Support, Mentor, Develop, and Retain Nurse Leaders.

In 2019, the National Academy of Science identified clinician burnout as a growing public health concern. The COVID-19 pandemic has only compounded this crisis and transformed it into an escalating fracture within the US health care system. Concurrently evolving with this emergency is a rise in the number of nurses who intend to leave the profession. Frontline nurse leaders are the lynchpin in ensuring health care systems function. These leaders have accountability over patient care and clinician well-being. Focused efforts must address clinician burnout. However, without addressing the well-being of frontline nurse leaders, the fault line in our health care system becomes a vast chasm. Recently, published literature began to emerge describing and addressing frontline clinician burnout. Unfortunately, only a few, if any, address issues related to leaders. The aim of this qualitative case study research was to explore and discover general themes in system chief nurse executive leadership practices that support, mentor, develop, and retain nurse leaders as a basis for future research. Three major themes were identified for future study and exploration: enhancing leadership development programs; improving leader work environments; and focusing on leader well-being and support. Further research is needed to evaluate the effectiveness of these themes.

Leadership Development Recommendations for Clinical Nurse Managers to Bolster the Postpandemic Workforce.

The postpandemic atmosphere has created a perfect storm that has necessitated a renewed prioritization to bolster support for the role of the clinical nurse manager. Role transition, competencies, mentorship, and ongoing development for the clinical nurse manager have been solidly supported in nursing leadership literature for decades. Preparing competent, ready-to-respond, people-oriented, transformational nurse leaders for these positions is essential to survival of our health care workforce. This article includes a summative review of comprehensive published findings related to nurse manager competency, development, and support. Findings have been correlated with one health system's postpandemic internal surveys, focus groups, reaction panels, and gap analysis to validate historic recommendations and prepare for program development. The purpose of this project was to endorse manager support and development recommendations and implement an evidence-based program to better prepare clinical nurse managers in today's health care leadership reality.

Transformative Change in Nursing: New Mindsets, Visionary Goals, and the Future of Nursing.

Addressing today's challenges in nursing requires a new mindset and a renewed commitment to improving the quality, safety, and equity of health care. Together, this approach can achieve truly transformational change in nursing that will last for generations. Setting visionary, future-oriented goals can draw upon key scholarship from the past as well as from fresh thinking on what is needed to improve health care at every level. Nurses are essential in this pursuit, given their central role in providing direct care and their leadership role in codesigning new models and systems of care.

Building resilient hospital information technology services through organizational learning: Lessons in CIO leadership during an international systemic crisis in the United States and Abu Dhabi, United Arab Emirates.

BACKGROUND: The COVID-19 pandemic was an international systemic crisis which required an unprecedented response to quickly drive the digital transformation of hospitals and health care systems to support high quality health care while adhering to contagion management protocols. OBJECTIVE: To identify and assess the best practices during the COVID-19 pandemic by Chief Information Officers (CIOs) about how to build resilient healthcare IT (HIT) to improve pandemic preparedness and response across global settings and to develop recommendations for future pandemics. METHODS: We conducted a qualitative, interview-based study to sample CIOs in hospitals. We interviewed 16 CIOs from hospitals and health systems in the United States and Abu Dhabi, United Arab Emirates. We used in-depth interviews to capture their perspectives of the preparedness of hospitals' information technology departments for the pandemic and how they lead their IT department out of the pandemic. RESULTS: Results showed that healthcare CIOs were ambidextrous IT leaders who built resilient HIT by rapidly improving existing digital business practices and creating innovative IT solutions. Ambidextrous IT leadership involved exploiting existing IT resources as well as exploring and innovating for continuous growth. IT resiliency focused on four inter-related capabilities: ambidextrous leadership, governance, innovation and learning, and HIT infrastructure. CONCLUSIONS: We propose conceptual frameworks to guide the development of healthcare IT resilience and highlight the importance of organizational learning as an integral component of HIT resiliency.

Relationship between leadership-member exchange (LMX) and flow at work among medical workers during the COVID-19: the mediating role of job crafting.

Based on relational leadership theory and self-determination theory, this study aims to investigate the relationship between leader-member exchange (LMX), job crafting, and flow at work among medical workers in the context of the COVID-19 pandemic. Participants in the study consisted of 424 hospital employees. The results showed that: (1) the LMX positively predicted flow at work; (2) two types of job crafting (increasing structural job resources and challenging job demands) played a mediating role between the LMX and flow at work; and (3) gender did not moderate these mediating effects as suggested by previous studies. These results indicate that the LMX can not only directly predict flow at work, but also indirectly predict work-related flow through job crafting by increasing structural job resources and challenging job demands, thus providing new insights for enhancing flow experiences of medical workers.

The association between nurse managers' transformational leadership and quality of patient care: A systematic review.

AIM: To examine and summarize the reported association of nurse managers' transformational leadership and quality of patient care based on the perceptions of registered nurses. BACKGROUND: Transformational leadership behaviors of nurse managers result in staff nurses' satisfaction and retention and patient satisfaction. Patient safety and quality of care are vital to high-performing healthcare organizations. Perceptions of registered nurses are important because nurses are frontline healthcare providers fundamental to patient safety and quality of care and are considered the final line of defense in preventing adverse events and errors and improving the safety of patients. MATERIALS AND METHODS: We  searched the CINAHL, ProQuest, PubMed, Science Direct, and Web of Science databases for evidence published between 2018 and 2022 in the English language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in carrying out this meta-analysis. RESULTS: Nine quantitative studies were appraised using the Joanna Briggs Institute checklists and were included in the final review that involved a total sample of 3633 registered nurses. The included studies were reported across Asian, Middle East, and European countries within the past five years. The association between the transformational leadership behaviors of nurse managers and the quality of patient care was found in varying degrees (i.e., insignificant, weak, indirect, and strong direct association) based on the perceptions of registered nurses. CONCLUSIONS: There is a direct and indirect association between the transformational leadership behaviors of nurse managers and the quality of patient care internationally. This association is influenced by confounding and mediating factors, including gender, organizational culture, structural empowerment, and job satisfaction. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Healthcare organizations need to support nursing leaders to have a stronger transformational leadership style by considering several factors that influence their leadership to improve the quality of patient care their staff nurses provide at the bedside.

Health-care leaders' experiences of the competencies required for crisis management during COVID-19: a systematic review of qualitative studies.

PURPOSE: This paper aims to synthesize health-care leaders' experiences of the competencies required for crisis management. DESIGN/METHODOLOGY/APPROACH: The systematic review followed the joanna briggs institute (JBI) guidance for systematic reviews of qualitative evidence. The search strategy included free text words and medical subject headings and peer-reviewed qualitative studies published in English, Finnish and Swedish and was not limited by year or country of publication. The databases searched in March 2022 were Scopus, PubMed, CINAHL, ABI/INFORM and the Finnish database Medic. Gray literature was searched using MedNar and EBSCO Open Dissertations. Studies were screened by title and abstract (n = 9,014) and full text (n = 43), and their quality was assessed by two independent reviewers. Eight studies were included. The data was analyzed using meta-aggregation. FINDINGS: Fifty-one findings (themes and subthemes) were extracted, and 11 categories were created based on their similarities. Five synthesized findings were developed: the competence to comprehend the operational environment; the competence to stay resilient amidst change; the competence to adapt to and manage change; the competence to manage and take care of staff; and the competence to co-operate and communicate with diverse stakeholders. ORIGINALITY/VALUE: This systematic review produced novel information about health-care leaders' experiences of the competencies required for crisis management during COVID-19. This study complements the field of research into crisis management in health care by introducing five original and unique competency clusters required for crisis management during the acute phase of COVID-19.

An empirical study of entrepreneurial leadership and fear of COVID-19 impact on psychological wellbeing: A mediating effect of job insecurity.

The empirical study proposes a model for investigating the effect of entrepreneurial leadership on job insecurity and employee psychological wellbeing during COVID-19 based on the combined theoretical grounds of The Conservation of Resources Theory and Social Learning. To explore the job insecurity relationship with psychological wellbeing, and measure the impact of Fear of COVID-19, an empirical study was conducted on a sample of 408 employees in Croatia. The data of the cross-sectional study was collected in November and December 2020. A strong influence of job insecurity on the psychological wellbeing of employees has been identified. Furthermore, fear of COVID-19 was found to have adverse psychological effects on wellbeing. The theorized positive impact of entrepreneurial leadership on job insecurity was not supported by the evidence. The strong point of our contribution lies in the finding that the entrepreneurial leadership style alone does not buffer against job insecurity, thus pointing that the more comprehensive inquiry into other organizational factors, such as coping, learning abilities, developmental opportunities, personal disposition, and pressure bearing. The research is the first step toward enhancing our understanding of the entrepreneurial dimension of transactional psychology. The observations we recorded have implications for research into the study of the mental processes and their impact on organizational proactive behavior.

Domains of professional practice: analysis of publications in the Journal of the Medical Library Association from 2010 to 2019.

The Medical Library Association (MLA) has defined 7 domain hubs aligning to different areas of information professional practice. To assess the extent to which content in the Journal of the Medical Library Association (JMLA) is reflective of these domains, we analyzed the magnitude of JMLA articles aligning to each domain hub over the last 10 years. Bibliographic records for 453 articles published in JMLA from 2010 to 2019 were downloaded from Web of Science and screened using Covidence software. Thirteen articles were excluded during the title and abstract review because they failed to meet the inclusion criteria, resulting in 440 articles included in this review. The title and abstract of each article were screened by two reviewers, each of whom assigned the article up to two tags corresponding to MLA domain hubs (i.e., information services, information management, education, professionalism and leadership, innovation and research practice, clinical support, and health equity & global health). These results inform the MLA community about our strengths in health information professional practice as reflected by articles published in JMLA.

MCH Leadership Training Program: An Innovative Application of an Implementation Science Framework.

INTRODUCTION: MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises). PURPOSE: This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program. ASSESSMENT: Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships. CONCLUSION: Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems.