Associations between nurse managers' leadership styles, team culture and competence planning in Norwegian municipal in-patient acute care services: A cross-sectional study.

BACKGROUND: Increased complexity in the primary healthcare services has followed in the wake of health reforms and reveals the need for competence enhancement in the nursing services. Effective and visionary leadership, sufficiently qualified staff and cooperation among professionals are considered as key measures to safeguard quality in the services. AIMS: To identify which leadership styles characterise first-line nurse managers in Norwegian municipal in-patient acute care (MipAC) units and to investigate how first-line nurse managers' leadership styles are associated with team culture and documented nursing competence planning. METHODS: A cross-sectional survey was distributed to all the first-line nurse managers in Norwegian MipAC units (n = 229). Data were collected between March and June 2019. The response rate was 80.5% (n = 182). First-line managers' background information and data about their focus on team culture and competence planning were recorded. Furthermore, we noted organisational structural characteristics, and managers' transformational (relational) leadership and transactional (task-oriented) leadership styles. RESULTS: The managers exhibited a high degree of transformational leadership behaviour, which was significantly associated with team culture. No significant associations between leadership behaviours and documented competence planning were found. Notably, we found a significant correlation between transformational and transactional leadership styles, indicating that the managers adapt their leadership behaviours to actual requirements and situations. Organisational structural factors: the share of registered nurses (RNs) on the staff and having a position for a professional development nurse were positively associated with competence planning. CONCLUSION: A relational leadership style promotes team culture and both factors may empower the professional nursing environment. However, first-line nurse managers need to acknowledge nursing competence planning as a central part of effective leadership. Having a professional development nurse position seems to complement leadership and ease the manager's responsibilities regarding team culture and competence planning.

Nursing competence in municipal in-patient acute care in Norway: a cross-sectional study.

BACKGROUND: The primary health care services are becoming increasingly complex, which presents challenges for the municipal nursing services. In Norway, municipal in-patient acute care (MipAC) has been introduced in all municipalities, and the competence at the services has been questioned. Few studies have examined the nursing services in the units. This study aims to get an overview of the nursing competence in those units across geographical regions, and different groups of organisation and localisation. METHODS: A cross-sectional study was conducted, and an ad hoc questionnaire was distributed to first-line leaders in all the MipAC units in Norway. Data were collected in the period between 6 March 2019 to 6 June 2019. Measures to get an overview of the nursing competence were ratio of registered nurses (RNs) in staff, count of shifts with only one RN on duty and count of RNs with master's degrees/specialisation. Descriptive comparative statistics were used. RESULTS: Of all 226 first-line leaders invited to participate, 207 (91.6%) responded to the questionnaire. Overall a considerable variance across the sample was revealed. The median ratio of RNs in staff was 56 (IQR = 40-70), the count of shifts with only one RN on duty median 28 (IQR = 5-49), and the count of RNs with a master's degree or specialisation median 3 (IQR = 0-5). The regions of Northern and Central Norway, MipACs located in nursing home and MipACs organised at long-term care units, showed significantly lower nursing competence in staff compared to the remaining institution and organisations. CONCLUSION: This study generates knowledge that can inform planning, priorities and interventions that may be initiated at all organisational and political levels concerning the MipAC services. An overall conclusion is that advanced nursing competence is lacking. The study also highlights the most urgent direction for improvements regarding nursing competence in the services. It seemed to be MipACs in Northern and Central Norway, and those located at nursing homes organised together with long-term care units, that needed improvements the most.