Implementing Strengths-Based Nursing and Healthcare Leadership Values to Promote Equitable, Diverse and Inclusive Workplaces: A Guide for Healthcare Leaders.

Inequities in healthcare persist despite equity, diversity and inclusion (EDI) being embedded in the nursing code of ethics (CNA 2017). Strengths-Based Nursing and Healthcare Leadership (SBNH-L) is "a unique, value-driven, embodied approach that guides leaders and managers to create equitable and safe workplace cultures and environments that honour, develop, mobilize and capitalize on the strengths of individuals and their team" (Gottlieb et al. 2021a: 173) that can be used as a framework to promote EDI in the workplace. Herein, we present concrete suggestions for focusing on EDI through an SBNH-L lens in order to improve healthcare environments for practitioners.

Talking About Strengths-Based Nursing and Healthcare Leadership: What Canadian Nurse Leaders Have to Say.

Nursing leadership is essential to improving nurse retention, their well-being, the quality of nursing care and patient safety. As healthcare leaders become increasingly aware of Strengths-Based Nursing and Healthcare Leadership (SBNH-L), we dialogued with Canadian nurse leaders to understand their views on this leadership approach. Five senior nursing leaders representing practice, academic and health policy contexts were interviewed. Five themes emerged: connections, opportunities for growth, humanism, optimism and hope for the future. Leaders shared that SBNH-L is a valuable, timely leadership approach that will promote system-wide health and healing post-pandemic. A call to action is offered to advance adoption of this essential leadership approach.

Determinants of Nurse Managers' Transformational Leadership: The Role of Individual Unit and Organizational Characteristics.

OBJECTIVE: The aim of this study was to examine the relationship between various factors and self-perceived transformational leadership among a sample of Filipino nurse managers (NMs). BACKGROUND: Transformational leadership plays a crucial role in promoting positive outcomes in healthcare settings, particularly for NMs. Understanding the factors that influence NMs' self-perceived transformational leadership is essential for improving leadership practices and enhancing organizational effectiveness. METHODS: A cross-sectional research design was used to collect data from 260 NMs using standardized measures. RESULTS: Employment status, the number of units managed, the type of hospital employment, psychological distress, and job satisfaction were factors that significantly influenced their leadership perceptions. CONCLUSION: By addressing the identified factors, nursing organizations can create an environment that promotes effective leadership practices, ultimately enhancing patient outcomes, staff satisfaction, and overall organizational performance.

Crisis management competencies needed in a hospital setting during the COVID-19 pandemic: A qualitative study of nurse leaders.

AIM: To describe the crisis management competencies needed in a hospital setting during the COVID-19 pandemic from the perspective of nurse leaders. BACKGROUND: The COVID-19 pandemic generated many challenges for nurse leaders in hospitals, and management competencies are highlighted. However, there is little evidence available about nurse leaders' perceptions of the crisis management competencies needed in such situations. METHODS: A qualitative, descriptive, semi-structured interview study of nurse leaders (n = 20) was conducted between June and October 2021 in one Finnish central hospital. The data were analysed using inductive content analysis. RESULTS: The analysis yielded five main categories of crisis management competencies needed in a hospital setting during the pandemic: interactive communication competence, psychological resource management competence, systematic and proactive organising competence, active networking abilities and practices and change management approach in crisis management. CONCLUSIONS: Nurse leaders need new and different crisis management competencies in hospital organisations. The COVID-19 pandemic changed the working culture of nurse leaders, as they faced challenges that needed knowledge and skills beyond their previous management competence. IMPLICATIONS FOR NURSING MANAGEMENT: Additional training for nurse leaders in crisis management is needed. This training should reflect the competencies identified as necessary in crisis situations so that nurse leaders will be able to manage crisis situations effectively in future. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used in reporting the findings. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Nurse Managers' Professional Quality of Life During the COVID-19 Pandemic.

BACKGROUND: Health systems cannot effectively support nurse managers without understanding psychosocial effects of the COVID-19 pandemic. OBJECTIVE: The objective of this study was to describe the professional quality of life of frontline nursing management during the COVID-19 pandemic. METHODS: A cross-sectional online survey of 54 nurses in management positions at a large Midwest academic medical center during 2022 was conducted. Participants completed an electronic survey including demographics, Professional Quality of Life Measure Version 5, and items assessing past consideration of and future intent to leave their position, organization, or profession. RESULTS: Most participants had previously considered changing roles (80%) or leaving the organization during the pandemic (76%). Fewer respondents reported that changing role (24%) or organization (20%) was likely during the upcoming 6-12 months. Most participants scored in moderate ranges of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress scales (85%, 89%, and 74%, respectively). Higher Compassion Satisfaction was associated with extreme unlikelihood of leaving for an internal non-management role. Higher Burnout scores were associated with more time working and past consideration or future likelihood of leaving for an external non-nursing position. Secondary Traumatic Stress scores were higher for nurse managers and house operation managers than assistant nurse managers and associated with past consideration of moving to an internal non-management role or external non-nursing position and future likelihood of moving to an external non-nursing position. CONCLUSIONS: Nurse management occupies a demanding position between frontline staff needs and administrative requirements, profoundly impacted by COVID-19. Health care researchers, administration, and policymakers must learn how to support, retain, and sustain nursing management in a post-pandemic world.

Role-Related Value Conflicts: A Qualitative Study of the Experiences of Perianesthesia Nurse Managers.

PURPOSE: Value conflicts with the potential to elicit moral distress are among the factors that contribute to burnout and threaten nurse manager retention. Little is known about the value conflicts faced by nurse managers working in the perianesthesia environment. Using the process model of managerial dissonance and responsibility attribution as a framework of inquiry, this study explored the types of value conflicts experienced by perianesthesia nurse managers and how they worked to reduce the accompanying distress. DESIGN: Qualitative, descriptive design. METHODS: Data were collected by means of semi-structured interviews from 14 participants meeting inclusion criteria. Thematic analysis was used to analyze data. FINDINGS: Eleven subthemes were identified and mapped onto the four phases of process model of managerial dissonance: Phase 1 Harm Doing Event: (1) Operational management strategies, (2) Patient care management strategies, (3) Standardized organizational practices; Phase 2 Dissonance: (4) Questioning my leadership, (5) Altered well-being, (6) Just do something; Phase 3 Attribution, (7) Consider organizational viewpoint, (8) Consider role and responsibilities, and Phase 4 Outcomes, (9) Commit to act, (10) Value the organization, and (11) Forgotten by leadership. CONCLUSIONS: Perianesthesia nurse managers experience similar types of value conflicts as inpatient nurse managers; however, some aspects of their experiences reflect the uniqueness of their practice environment. The process model of managerial dissonance and responsibility attribution serves as a useful framework for understanding the psychological difficulties and processes by which nurse managers seek to resolve the distress associated with mandated actions likely to induce harm in employees. Executive leaders must act to implement strategies to mitigate the associated psychological difficulties and prevent the increased potential in nurse managers for work-role disengagement and potential exit from the organization.

Acute care nurse managers' definitions of and barriers to well-being: A thematic analysis of open-ended survey questions.

BACKGROUND: During the COVID-19 pandemic, acute care nurse managers functioned in a critical role by helping to advance the mission and goals of their organization while navigating a rapidly evolving healthcare landscape. This resulted in high levels of ongoing job-related stress which is linked to negative physical, psychological, and job-related outcomes. Little is known about the perceptions regarding their own professional well-being during this time. AIM: The aim of this study was to qualitatively describe acute care nurse managers' perceptions of and barriers to their professional well-being. METHODS: Using a qualitative descriptive approach, nurse managers from a hospital system in the southwestern United States responded to two short-answer, survey-based questions in 2022: (1) "Describe the definition of nurse-manager well-being in your own words" and (2) "What do you feel is your biggest barrier to professional well-being?" Reflexive thematic analysis was utilized to analyze participant responses (N = 80). RESULTS: Professional well-being is a complex concept influenced by the nurse manager's ability to navigate work-life balance; care for their own physical, emotional, and spiritual selves; give and receive support from stakeholders; and manage feelings of thriving vs. struggling in the role. Barriers most cited as influencing well-being included having too little time to get things done coupled with increasing workloads, feeling stuck in the middle among stakeholders, and coping with ongoing staffing challenges. LINKING EVIDENCE TO ACTION: The definition of and barriers to well-being are influenced by the specific needs and experiences of the nurse manager. While not all barriers can be immediately removed, the identification of individual and organization-specific barriers needs to be taken seriously, reviewed by those who can promote change, and evidence-based solutions for improvement piloted or implemented when feasible.

Toxic leadership and its relationship with outcomes on the nursing workforce and patient safety: a systematic review.

PURPOSE: This study aims to appraise and synthesize evidence examining the effects of toxic leadership on the nursing workforce and patient safety outcomes. DESIGN/METHODOLOGY/APPROACH: This is a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases (SCOPUS, PubMed, Web of Science, CINAHL and Psych INFO) were searched to identify relevant articles. Two independent researchers conducted the data extraction and appraisal. A content analysis was used to identify toxic leadership outcomes. FINDINGS: The initial literature search identified 376 articles, 16 of which were deemed relevant to the final review. Results of the content analysis identified 31 outcomes, which were clustered into five themes: satisfaction with work; relationship with organization; psychological state and well-being; productivity and performance; and patient safety outcomes. Seven mediators between toxic leadership and five outcomes were identified in the included studies. PRACTICAL IMPLICATIONS: Organizational strategies to improve outcomes in the nursing workforce should involve measures to build and develop positive leadership and prevent toxic behaviors among nurse managers through theory-driven strategies, human resource management efforts and relevant policy. ORIGINALITY/VALUE: The review findings have provided modest evidence suggesting that working under a leader who exhibits toxic behaviors may have adverse consequences in the nursing workforce; however, more research examining if this leadership style influences patient safety and care outcomes is warranted.

Structural and Psychological Empowerment of Learners Enrolled in Continuing Nursing Leadership Education in Finland: A Quasi-Experimental Longitudinal Study.

BACKGROUND: This study was conducted to assess structural and psychological empowerment among learners enrolled in a continuing leadership education program. Although the number of nurse leadership development interventions has increased, there is little evidence on how they influence leaders' empowerment. METHOD: A longitudinal study was employed, with learners (N = 85) enrolled in a continuing leadership education program as the participants. Data were collected in the beginning, at the end, and 8 months after the completion of the program using internationally validated instruments. Data were analyzed statistically. RESULTS: A total of 25 learners (29%) responded to the questionnaire at all three data collection points. The education significantly increased psychological and structural empowerment across all dimensions except formal power. These increased levels of empowerment were partially sustained at the 8-month follow-up time point. CONCLUSION: Continuing education seems to benefit nurse leaders, and the continuing nursing leadership education program was positively associated with learners' perceived empowerment. [J Contin Educ Nurs. 2023;54(10):462-471.].

Exploring the role of the nurse unit manager in forensic mental health inpatient units: A qualitative study.

Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting.

Nurse managers' experience during the COVID-19 pandemic in China: A qualitative study.

AIMS: The aim of the study was to explore the experiences of female new nurse managers during the COVID-19 pandemic. DESIGN: This was a phenomenological study, and qualitative descriptive analysis was used. METHODS: New nurse managers were defined as new nurse managers with less than 3 years of management experience in this study. During November and December of 2021, 18 female new nurse managers were interviewed face-to-face with a semi-structured interview guide in three municipal hospitals. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for evaluating qualitative research reports. Data analysis was performed using Colaizzi's seven-step method. RESULTS: Four main themes and 10 sub-themes were extracted from the collected data. The four major themes were as follows: (1) a shift in stress; (2) work-related physical and psychological discomfort; (3) reflection on the cause; (4) coping and struggles. CONCLUSIONS: New nurse managers were experiencing great stress and exhaustion in their roles. It is important that they are helped to handle situations. Providing them with readily accessible support, addressing their psychosocial needs and addressing exhaustion is necessary. Considering their short management time, the hospital should provide adequate support in human, financial and material areas and provide training to help new nurse managers better adapt to their new roles. In addition, nurse directors should create a culture of mutual respect, identify workplace bullying and create a harmonious and cooperation-oriented work environment for new nurse managers. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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.

How do work-life balance programmes influence nurses' psychological well-being? The role of servant leadership and learning goal orientation.

AIMS: Our study aims to investigate the effect of work-life balance programmes on Chinese nurses' psychological well-being, directly and indirectly, via learning goal orientation. Our research also aims to investigate the moderating role of servant leadership, a holistic leadership style that prioritizes serving employees, in the association between work-life balance programmes and psychological well-being. DESIGN: A questionnaire-based, time-lagged study (1-week interval). METHODS: From September 2022 to October 2022, we collected a total of 211 matched and valid responses from nurses working for hospitals in Jiangsu Province, China. Data regarding work-life balance programmes, servant leadership, learning goal orientation and psychological well-being were gathered using a survey administered in two waves, 1 week apart. We utilized the PROCESS Model 5 to test the moderated mediation model. RESULTS: Work-life balance programmes significantly improved nurses' psychological well-being. Moreover, learning goal orientation mediated the relationship between work-life balance programmes and psychological well-being. However, servant leadership did not moderate the association between work-life balance programmes and psychological well-being. CONCLUSION: Our study contributes to extant nursing literature by attending to the organizational strategies that promote psychological well-being. This study is novel because it evaluates the mediating and moderating process through which work-life balance programmes improve nurses' psychological well-being. IMPACT: The provision of work-life balance programmes could enhance learning goal orientation, resulting in possible improvement in nurses' psychological well-being. Moreover, servant leadership styles may contribute to psychological well-being. Our study can help nurse managers enhance their organizational strategies (e.g. work-life balance programmes) and leadership resources (e.g. servant leadership styles) to address nurses' well-being issues. PATIENT OR PUBLIC CONTRIBUTION: This paper addresses the United Nations' Sustainable Development Goal 3 regarding 'Good Health and Well-being'.

Workplace social capital mediates the relationship between authentic leadership and three dimensions of organizational commitment of hospital nurses: A cross-sectional study.

AIM: This study aimed to examine the mediating effect of workplace social capital on the relationship between authentic leadership and the three dimensions of organizational commitment: affective, normative, and continuance. METHODS: In January 2019, anonymous self-reported questionnaires were distributed to 1220 nurses working in the general wards of two university hospitals in Japan. Structural equation modeling was used to examine the mediating effects of workplace social capital on the relationship between nurse managers' authentic leadership and the three dimensions of organizational commitment. RESULTS: Six hundred and fifty-nine data points were analyzed (valid response rate = 54.0%). Participants' average age was 28.6 years (standard deviation: 6.6), and 93.3% were female. The mediation indirect effect of workplace social capital between authentic leadership and organizational commitment was statistically significant in the models of affective organizational commitment and normative organizational commitment, but not in the model of continuance organizational commitment. CONCLUSIONS: The effects of authentic leadership and workplace social capital had different impacts on each of the three dimensions of organizational commitment. Nurse managers' authentic leadership and workplace social capital can enhance nurses' positive commitment to the organization.

The effect of talent management on the job satisfaction and organizational commitment of nurses.

AIM: To determine the effect of talent management on job satisfaction and organizational commitment of nurses and the mediating role of job satisfaction. BACKGROUND: Talent management plays a critical role in attracting, developing, and retaining nurses and is effective in the formation of job satisfaction and organizational commitment. METHODS: This correlational study sample consisted of 482 volunteering nurses who were selected through a convenience sampling method. Data were collected using an information form, the Talent Management Scale, the Minnesota Satisfaction Questionnaire, and the Organizational Commitment Scale. The data were analyzed using descriptive statistics, Pearson correlation analysis, single linear regression, and hierarchical regression analysis. The Baron and Kenny model was used to determine the mediation effect. FINDINGS: Talent management affected the intrinsic, extrinsic subdimensions of job satisfaction and the total score and the affective commitment, normative commitment, and continuance commitment significantly and positively. Job satisfaction had a full mediating role in the effect of talent management on affective commitment and continuance commitment and a partial mediating role in affecting normative commitment. CONCLUSION: Talent management in organizations can increase nurses' job satisfaction and organizational commitment and nurses' job satisfaction can play a mediating role in the effect of talent management on organizational commitment. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study demonstrates that nurse managers and decision-makers should adopt talent management practices in nursing. Desired results such as nurses' job satisfaction and organizational commitment can be achieved by focusing on the development of nurses' talents.

Perceptions of public health nursing Team Leaders (TLs) and Team Supervisors (TSs) on nurse's development in Fiji.

BACKGROUND: Nurse team leaders are responsible for contributing to managing the quality of service delivery and facility output of their nurses to ensure there is a high quality of care delivered by the health system. This study aimed to explore the perceptions of public health nursing Team Leaders (TLs) and public health nursing Team Supervisors (TSs) on nurses' development in Fiji. METHODS: A qualitative study was used to gather information using in-depth phone interviews among TLs and TSs comprising Chief Midwifery Nursing Officer (CMNO), Director of Nursing (DON), Sub-divisional Nursing Managers (SDNMs), acting SDNMs and Nursing Manager (NM) at Central health division in Fiji. The data was collected through semi-structured open-ended questionnaires and were audio recorded. The data was analyzed using manual thematic analysis process. RESULTS: The study comprised of 26 participants, which included 10 TSs and 16 TLs. Four themes were identified for the results amongst TSs and TLs: ethical development; professional development; psychological development; and recommendations. However, nine sub- themes were identified for TSs and eight sub-themes were identified for the result amongst TLs. CONCLUSION: This study highlighted that TLs and TSs elaborated on the need for the ethical, professional, psychological development, nursing development and also on the importance of policies and guidelines. Professional ethics should be integrated into the Continuous Profession Development (CPD) points that are used to renew yearly nursing licenses as well as exposing the need for having competencies on professional ethics in nurses' logbooks. Further research is needed to determine the in-depth barriers.

Exploring the working environment of Hospital Managers: a mixed methods study investigating stress, stereotypes, psychological safety and individual resilience.

BACKGROUND: Hospital managers are responsible for the delivery of organisational strategy, development of clinical services and maintaining quality standards. There is limited research on hospital managers, in particular how stress manifests and impacts managers and the presence of individual resilience. Managers must work closely with clinical colleagues, however these relationships can be hindered by the perception of stereotyping and differing priorities. This study aimed to explore the working environment of hospital managers, focusing upon the unique stresses faced, psychological safety and the presence of resilience. METHODS: This study utilised mixed methodology using an embedded approach. Participants were purposively recruited from all levels of hospital management within one National Health Service Trust in London, United Kingdom. An exploration of managers experiences was undertaken using semi-structured qualitative interviews. Psychological safety and individual resilience were additionally assessed using validated surveys. Qualitative data were analysed iteratively using inductive thematic analysis, and triangulated with quantitative data. Kruskal-Wallis statistical analysis was performed to evaluate differences in resilience and psychological safety according to seniority and background experience. RESULTS: Twenty-two managers were recruited and interviewed, with 20 returning completed surveys. Key findings from the thematic analysis included the importance of good working relationships with clinical colleagues, the persistence of some stereotyping, and feeling unsupported in times of challenge. Stresses described included the bureaucracy involved when delivering change, conflict with colleagues and target driven expectations. Participants described their own psychological safety as lower than desired, supported by quantitative data; but recognised its importance and strived to create it within their own teams. Sixteen participants had 'normal' scores for resilience, with senior managers more likely to have higher scores than those more junior (p=0.011). CONCLUSION: Positive working relationships, high psychological safety and individual resilience are important for organisational safety and individual wellbeing. Our data illustrate unique stressors faced by hospital managers, provide detail on sometimes challenging working relationships, and demonstrate scope to improve both the psychological safety and resilience of those in managerial positions. A map for senior healthcare leaders was constructed, facilitating the identification of modifiable areas within their organisation to promote good working relationships and improve the working environment of hospital managers.