Well-being in acute care nurse managers: A risk analysis of physical and mental health factors.

BACKGROUND: Nurse managers have experienced tremendous stress during the COVID-19 pandemic, contributing to negative psychological outcomes. Positive professional well-being is a construct that can be promoted to mitigate poor psychological outcomes and burnout in nurses. Little is known about the health, healthy behaviors, effects of stress on homelife, and well-being of nurse managers in the United States (U.S.). AIMS: The aims of the study were to explore nurse managers' well-being related to self-reported stress and health perceptions and habits. METHODS: A sample of 80 (41% response rate) nurse managers responded to a cross-sectional web-based survey sent via email in a southwestern U.S. 13-hospital system. Nurses answered 39 quantitative questions about demographics, well-being (9-item Well-Being Index [WBI]), perceptions of stress affecting homelife, and perceptions of health and health-related behaviors. RESULTS: Mean WBI (2.9 [2.7]) indicated risk for poor psychological outcomes. Managers (75%) reported stress from work affected their personal lives and a decline in overall health during the pandemic. Most (80%) reported burnout and emotional problems. Nurse managers had 8.1 times increased risk of poor WBI scores if stress from work affected their personal life than if they reported no spillover stress into their personal life (OR = 8.1, 95% CI [2.6, 25.0]). LINKING EVIDENCE TO ACTION: Findings from this study add a nuanced understanding of nurse managers' well-being. The strongest risk factor for poor WBI scores was stress levels affecting personal life. Interventions to improve well-being in nurse managers are needed. Limitations are the convenience sampling, limited geographic location, and response rate of <50%. Further research is needed to support nurse managers in stress reduction and development of boundaries that prohibit the spillover effect of workplace stress. Organizations may consider a combination of administrative support and changes as well as provision of on-the-job training of interventions that support individual well-being.

The experience of moral distress by chief nurse officers during the COVID-19 pandemic: A descriptive phenomenological study.

AIM: The aim of this study is to explore the moral distress experiences of nurse officers during the COVID-19 pandemic. BACKGROUND: Moral distress has emerged as a challenge for nurses ad nurse leaders, revealing the need for health professionals and health care managers to examine, understand and deal with moral distress un Nurse leaders. METHODS: It is a descriptive phenomenological study that used content analysis. RESULTS: Thirteen chief/assistant nurse officers were interviewed, and four themes were identified: being a manager in the pandemic, situations that cause moral distress, effects of moral distress and factors that reduce moral distress. CONCLUSION: Faced with various expectations, such as the management of unusual and uncertain processes, and the management of the psychological responses of both employees and themselves, chief nurse officers struggled significantly to maintain their moral integrity and experienced moral distress during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Extraordinary situations such as pandemics have factors that led to moral distress for a Chief Nursing Officer (CNO). Health care systems in which nurse managers are excluded from decision-making processes have a traditional hierarchical structure that ignores CNOs professional autonomy, contributing to the development of moral distress. Therefore, CNOs should engage in self-reflection to recognize their own moral distress experiences, examine the existing health system to identify the factors that cause moral distress and take actions to implement changes to eliminate these factors. To cope with moral distress, CNOs should also improve their communication skills, team collaboration skills and the use of scientific knowledge and take responsibility in their managerial role.

Reflections From the Middle: Exploring the Experience of Nurse Managers Across the United States During the COVID-19 Pandemic.

OBJECTIVE: The objective of this multisite study was to explore the professional and personal experiences of US nurse managers (NMs) during the COVID-19 pandemic. BACKGROUND: NMs are the most accessible and visible nurse leaders to the frontline staff during this pandemic. METHODS: Thirty-nine NMs from 5 health systems across the US participated in focus groups in this qualitative study. Data were analyzed using a constant comparative method. RESULTS: Three major themes were identified: challenges, feelings and emotions, and coping. Subthemes emerged within each major theme. CONCLUSION: NMs across the country accepted considerable responsibility at great professional and personal consequence during the pandemic. NMs experienced challenges, ethical dilemmas, and expressed negative emotions. As the usual coping strategies failed, NMs reported that they are considering alternative career choices. This work provided evidence to help senior leaders strategize about mechanisms for reducing managerial dissonance during times of stress.

In the Eye of the Storm: Leadership Lessons From the Front.

New York City (NYC) was in the eye of the COVID-19 pandemic storm in the spring of 2020. Since that time, the country has seen wave after wave of outbreaks and concurrent psychosocial crises. Clinical nurses and nurse leaders delivered extraordinary care with grit, innovation, agility, and resilience. When in the eye of the storm, staff have to feel safe and have a voice even in command-control, adaptive modes. Nurses and nurse leaders have been resilient, and organizations have to play their part in decreasing work burden and creating positive work environments. Non-value-added work as well as barriers to practice should be eliminated permanently. This article describes the many challenges including intensive care unit capacity, staffing, well-being, and lack of visitation, as well as leadership lessons such as the importance of presence, based on the NYC experience of a chief nursing officer in a large academic medical center. These lessons and their implications for our workforce, for public health, and for leadership development and competencies and have taught us how to lead into the future.

Rethinking Resilience: Nurses and Nurse Leaders Emerging From the Post-COVID-19 Environment.

Nurses and nurse leaders are working in unprecedented intense and demanding environments, and the COVID-19 pandemic continues to place strain on their mental well-being. If stressful work conditions remain at extraordinary high levels, nurses and leaders may ultimately leave their positions, creating even more uncertainty in the workforce. Enhancing individual resilience has become a superficial response in retaining nurses during a global nursing shortage. We argue that resilience is not solely an individual responsibility. Rather, resilience it is a mutual responsibility between the individual and the organization. In this article, we discuss how nurse leaders can foster organizational resilience while also enhancing their own individual resilience within the current pandemic environment, and as we transition to a post-COVID environment.

Facing Challenges, Creating Connections: An Interview With Joanne Disch, PhD, RN, FAAN.

Mary Beth Kingston, PhD, RN, NEA-BC, FAAN, chief nurse executive of Advocate Aurora Health and past president of the American Organization for Nursing Leadership (AONL), interviews her mentor, Joanne Disch, PhD, RN, FAAN, who serves on the Advocate Aurora Health Board of Directors and was the inaugural chair. Dr Disch also serves as chair of the Chamberlain University Board of Trustees and is professor ad honorem at the University of Minnesota School of Nursing. This is an abridged version of the interview, which took place at the AONL Virtual Conference in 2020.

Long-Term Care Nurse Leaders Find Calm in Chaos: Reflections from a CEO during a Global Pandemic.

Loch Lomond Villa is one of the largest long-term care communities within the province of New Brunswick. Our organization supports caring living environments for over 450 clients and their family members along with 354 employees.

Introduction: Creating Effective Ways to Support Nurses' Mental Health during COVID-19.

Unprecedented is one of the words that has been most frequently heard during the COVID-19 pandemic. We read daily about the ongoing challenges nurses and nurse leaders face in ways that one could not have imagined 15 months ago. With each wave of rising COVID-19 cases, we are reminded of the toll that this pandemic is having on nurses. Nurse leaders have described being scared of failing and not being able to guide or support their staff through the pandemic while recognizing the need to be a strong leader, resilient and adaptable to change every single day (Lapum et al. 2021). The uncertainty and complexity have been overwhelming, and throughout this crisis, nurse leaders have been continually asked to reach into their leadership toolboxes to find ways to support nurses within contexts that have rapidly changed over and over again.

After the surge: How leaders promote healing and growth.

The new nurse manager survival guide, part III.

Nurse Leaders Employ Contemplative Practices to Promote Healthcare Professional Well-being and Decrease Anxiety.

OBJECTIVE: The purpose of this study was to test the effectiveness of a daylong resilience retreat on healthcare professionals' anxiety levels, intention to engage in mindfulness practices, and self-efficacy around mindfulness. BACKGROUND: Caregiver burnout is a concern that needs to be addressed at the organizational level so that professionals can reduce their risk of psychological injury while providing high-quality care. The COVID-19 (novel coronavirus) pandemic has exacerbated symptoms of burnout among nurses nationally. METHODS: Ten sessions of daylong resilience retreats were delivered to independent groups of nurses, nurse practitioners, and other healthcare professionals. Preretreat and postretreat assessments were completed using a 19-item survey developed by the research team to assess state anxiety, intention to engage in mindfulness practices, and self-efficacy around mindfulness. RESULTS: One hundred six healthcare professionals completed the resilience retreats. There was a statistically significant decrease in state anxiety scores following the retreat. The majority of the participants reported high intentions to engage in mindfulness practices and felt confident about incorporating mindfulness in their lives. CONCLUSIONS: Brief resilience retreats endorsed by nurse leadership can reduce perceived anxiety and facilitate engagement in contemplative practices, which are associated with a decrease in the risk of burnout.

Perceptions of Authentic Nurse Leadership and Work Environment and the Pandemic Impact for Nurse Leaders and Clinical Nurses.

OBJECTIVE: The aim of this study was to determine the pandemic impact on the relationship between nurses' perception of the authentic nurse leadership (ANL) of their manager and their perception of the work environment. BACKGROUND: Both ANL and healthy work environment (HWE) contribute to staff and patient outcomes. Our 1st study of these 2 variables revealed a positive relationship. Will this be upheld in a pandemic year? METHODS: More than 5000 nurses from a national sample participated in a cross-sectional, correlational, descriptive study using the Authentic Nurse Leadership Questionnaire, the Critical Elements of a Healthy Work Environment Scale, and a pandemic impact on practice question. RESULTS: Overall, nurses perceived ANL and HWE were present despite a high level of pandemic impact; however, when clinical nurses were separated from managers/directors, HWE was not present for frontline nurses. The moderate correlation of ANL and HWE was replicated in this larger study. CONCLUSIONS: This is the 2nd study of the positive relationship between ANL and HWE using these models, supporting ANL as an essential standard of a HWE. ANL was present for clinical nurses in a pandemic year signaling that nurse leaders rose to meet frontline leadership needs. HWE was present overall, but not for clinical nurses. Leadership is essential to work environments and outcomes especially in times of crisis and significant change.

The Dual Epidemics of 2020: Nursing Leaders' Reflections in the Context of Whole Person/Whole Systems.

The Greater Boston Nursing Collective, a consortium composed of university nursing deans and chief nursing officers within academic medical centers and specialty hospitals in Boston, Massachusetts, was formed in 2014. Since the group's inception, our mission has been to create and reinforce whole-person/whole-system healing environments to improve the health of all communities. Through our collaboration in navigating the dual epidemics of COVID-19 and structural racism within our respective organizations, and across the United States and the world, we share experiences and lessons learned. Our common mission is clearer than ever: to create safe and joyful work environments, to protect the dignity of those we are privileged to serve, and to generate policies to advance health equity to rectify societal forces that have shaped this dual epidemic. We are humbled by the many who persist despite limited rest and respite, and whose stories, innovations, and leadership we are honored to witness and share. They have defined our generation, just as nurses in earlier crises have done: leading through service to others as our purpose and privilege.

What Lies Ahead for Nursing.

This is the last of three articles exploring ways in which frontline nurses may be affected by recommendations of the forthcoming National Academy of Medicine Future of Nursing 2020-2030 study. For this third article, interviews were conducted with nurse leaders from diverse practice areas to see how their thinking about the future had shifted as 2020 drew to a close.