Carol A. Wong

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

CONTEXT Numerous policy and research reports call for leadership to build quality work environments, implement new models of care, and bring health and wellbeing to an exhausted and stretched nursing workforce. Rarely do they indicate how leadership should be enacted, or examine whether some forms of leadership may lead to negative outcomes. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments. METHODS The search strategy of this multidisciplinary systematic review included 10 electronic databases. Published, quantitative studies that examined leadership behaviours and outcomes for nurses and organizations were included. Quality assessments, data extractions and analysis were completed on all included studies. FINDINGS 34,664 titles and abstracts were screened resulting in 53 included studies. Using content analysis, 64 outcomes were grouped into five categories: staffsatisfaction with work, role and pay, staff relationships with work, staff health and wellbeing, work environment factors, and productivity and effectiveness. Distinctive patterns between relational and task focused leadership styles and their outcomes for nurses and their work environments emerged from our analysis. For example, 24 studies reported that leadership styles focused on people and relationships (transformational, resonant, supportive, and consideration) were associated with higher nurse job satisfaction, whereas 10 studies found that leadership styles focused on tasks (dissonant, instrumental and management by exception) were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes. CONCLUSION Our results document evidence of various forms of leadership and their differential effects on the nursing workforce and work environments. Leadership focused on task completion alone is not sufficient to achieve optimum outcomes for the nursing workforce. Efforts by organizations and individuals to encourage and develop transformational and relational leadership are needed to enhance nurse satisfaction, recruitment, retention, and healthy work environments, particularly in this current and worsening nursing shortage.

The relationship between nursing leadership and patient outcomes: a systematic review update

AIM Our aim was to describe the findings of a systematic review of studies that examine the relationship between nursing leadership practices and patient outcomes. BACKGROUND As healthcare faces an economic downturn, stressful work environments, upcoming retirements of leaders and projected workforce shortages, implementing strategies to ensure effective leadership and optimal patient outcomes are paramount. However, a gap still exists in what is known about the association between nursing leadership and patient outcomes. METHODS Published English-only research articles that examined leadership practices of nurses in formal leadership positions and patient outcomes were selected from eight online bibliographic databases. Quality assessments, data extraction and analysis were completed on all included studies. RESULTS A total of 20 studies satisfied our inclusion criteria and were retained. Current evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, restraint use and hospital-acquired infections. CONCLUSIONS The findings document evidence of a positive relationship between relational leadership and a variety of patient outcomes, although future testing of leadership models that examine the mechanisms of influence on outcomes is warranted. IMPLICATIONS FOR NURSING MANAGEMENT Efforts by organisations and individuals to develop transformational and relational leadership reinforces organisational strategies to improve patient outcomes.

Factors Contributing to Nursing Leadership: A Systematic Review

Objectives: Leadership practices of health care managers can positively or negatively influence outcomes for organizations, providers and, ultimately, patients. Understanding the factors that contribute to nursing leadership is fundamental to ensuring a future supply of nursing leaders who can positively influence outcomes for health care providers and patients. The purpose of this study was to systematically review the multidisciplinary literature to examine the factors that contribute to nursing leadership and the effectiveness of educational interventions in developing leadership behaviours among nurses. Methods: The search strategy began with 10 electronic databases (e.g. CINAHL, Medline). Published quantitative studies were included that examined the factors that contribute to leadership or the development of leadership behaviours in nurse leaders. Quality assessments, data extraction and analysis were completed on all included studies. Results: A total of 27,717 titles/abstracts were screened resulting in 26 included manuscripts reporting on 24 studies. Twenty leadership factors were examined and categorized into four groups - behaviours and practices of individual leaders, traits and characteristics of individual leaders, influences of context and practice settings, and leader participation in educational activities. Specific behaviours and practices of individual leaders, such as taking on or practising leadership styles, skills and roles, were reported as significantly influencing leadership in eight studies. Traits and characteristics of individual leaders were examined in six studies with previous leadership experience (three studies) and education levels (two of three studies) having positive effects on observed leadership. Context and practice settings had a moderate influence on leadership effectiveness (three of five studies). Nine studies that examined participation in leadership development programs all reported significant positive influences on observed leadership. Conclusion: These findings suggest that leadership can be developed through specific educational activities, and by modelling and practising leadership competencies. However, the relatively weak study designs provide limited evidence for specific factors that could increase the effectiveness of current nursing leadership or guide the identification of future nurse leaders. Robust theory and research on interventions to develop and promote viable nursing leadership for the future are needed to achieve the goal of developing healthy work environments for health care providers and optimizing care for patients.

Compassion Satisfaction, Compassion Fatigue, Work Life Conditions, and Burnout Among Frontline Mental Health Care Professionals

Frontline mental health care professionals (FMHPs) in a variety of roles such as nursing, social work, psychology, psychiatry, case managers and mental health workers are often required to provide ...

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.

Authentic leadership: a new theory for nursing or back to basics?

PURPOSE Authentic leadership is an emerging theoretical model purported to focus on the root component of effective leadership. The purpose of this paper is to describe the relevance of authentic leadership to the advancement of nursing leadership practice and research and address the question of whether this is a new theory for leadership or an old one in new packaging. DESIGN/METHODOLOGY/APPROACH The paper outlines the origins and key elements of the model, assesses the theoretical, conceptual and measurement issues associated with authentic leadership and compares it with other leadership theories frequently reported in the nursing literature. FINDINGS The emerging authentic leadership theory holds promise for explaining the underlying processes by which authentic leaders and followers influence work outcomes and organizational performance. Construct validity of authentic leadership has preliminary documentation and a few studies have shown positive relationships between authenticity and trust. Furthermore, the clarity of the authenticity construct and comprehensiveness of the overall theoretical framework provide a fruitful base for future research examining the relationship between authentic leadership and the creation of healthier work environments. ORIGINALITY/VALUE A clear focus on the relational aspects of leadership, the foundational moral/ethical component, a potential linkage of positive psychological capital to work engagement and the emphasis on leader and follower development in the authentic leadership framework are closely aligned to current and future nursing leadership practice and research priorities for the creation of sustainable changes in nursing work environments.

Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey.

AIM To test the psychometric properties of a newly developed measure of staff nurse clinical leadership derived from Kouzes and Posners model of transformational leadership. BACKGROUND While nurses have been recognized for their essential role in keeping patients safe, there has been little empirical research that has examined clinical leadership at the staff nurse level. METHODS   A non-experimental survey design was used to test the psychometric properties of the clinical leadership survey (CLS). Four hundred and eighty registered nurses (RNs) providing direct patient care in Ontario acute care hospitals returned useable questionnaires. RESULTS   Confirmatory factor analysis provided preliminary evidence for the construct validity for the new measure of staff nurse clinical leadership. Structural empowerment fully mediated the relationship between nursing leadership and staff nurse clinical leadership. CONCLUSION The results provide encouraging evidence for the construct validity of the CLS. IMPLICATIONS FOR NURSING MANAGEMENT Nursing administrators must create empowering work environments to ensure staff nurses have access to work structures which enable them to enact clinical leadership behaviours while providing direct patient care.

Factors influencing intentions to stay and retention of nurse managers: a systematic review

AIMS This systematic review aimed to explore factors known to influence intentions to stay and retention of nurse managers in their current position. BACKGROUND Retaining staff nurses and recruiting nurses to management positions are well documented; however, there is sparse research examining factors that influence retention of nurse managers. EVALUATIONS Thirteen studies were identified through a systematic search of the literature. Eligibility criteria included both qualitative and quantitative studies that examined factors related to nurse manager intentions to stay and retention. Quality assessments, data extraction and analysis were completed on all studies included. Twenty-one factors were categorized into three major categories: organizational, role and personal. KEY ISSUES Job satisfaction, organizational commitment, organizational culture and values, feelings of being valued and lack of time to complete tasks leading to work/life imbalance, were prominent across all categories. CONCLUSION These findings suggest that intentions to stay and retention of nurse managers are multifactoral. However, lack of robust literature highlights the need for further research to develop strategies to retain nurse managers. ImplICATIONS FOR NURSE MANAGEMENT: Health-care organizations and senior decision-makers should feel a responsibility to support front-line managers in relation to workload and span of control, and in understanding work/life balance issues faced by managers.

The Contribution of Hospital Nursing Leadership Styles to 30-day Patient Mortality

Background:Nursing work environment characteristics, in particular nurse and physician staffing, have been linked to patient outcomes (adverse events and patient mortality). Researchers have stressed the need for nursing leadership to advance change in healthcare organizations to create safer practice environments for patients. The relationship between styles of nursing leadership in hospitals and patient outcomes has not been well examined. Objective:The purpose of this study was to examine the contribution of hospital nursing leadership styles to 30-day mortality after controlling for patient demographics, comorbidities, and hospital factors. Methods:Ninety acute care hospitals in Alberta, Canada, were categorized into five styles of nursing leadership: high resonant, moderately resonant, mixed, moderately dissonant, and high dissonant. In the secondary analysis, existing data from three sources (nurses, patients, and institutions) were used to test a hypothesis that the styles of nursing leadership at the hospital level contribute to patient mortality rates. Results:Thirty-day mortality was 7.8% in the study sample of 21,570 medical patients; rates varied across hospital categories: high resonant (5.2%), moderately resonant (7.4%), mixed (8.1%), moderately dissonant (8.8%), and high dissonant (4.3%). After controlling for patient demographics, comorbidities, and institutional and hospital nursing characteristics, nursing leadership styles explained 5.1% of 72.2% of total variance in mortality across hospitals, and high-resonant leadership was related significantly to lower mortality. Conclusions:Hospital nursing leadership styles may contribute to 30-day mortality of patients. This relationship may be moderated by homogeneity of leadership styles, clarity of communication among leaders and healthcare providers, and work environment characteristics.

Workplace Incivility and New Graduate Nurses' Mental Health. The Protective Role of Resiliency

OBJECTIVE: The aim of this study was to examine the relationships between coworker, physician, and supervisor workplace incivility and new graduate nurses’ mental health and the protective role of personal resiliency. BACKGROUND: Positive interpersonal relationships in healthcare work environments are important for new graduate nurses’ career transition and commitment. Workplace incivility threatens new graduate nurses’ health and well-being. Personal resiliency helps employees to recover from negative stressors and may protect new nurses from the negative effects of workplace incivility. METHODS: We surveyed 272 new graduate nurses in Ontario to explore the influence of 3 forms of workplace incivility and personal resiliency on new nurses’ mental health. RESULTS: All sources of incivility were related to poor mental health. Results suggest that personal resiliency may protect nurses from the negative effects of incivility. CONCLUSIONS: New nurses are experiencing workplace incivility from a variety of sources in their work environments, which have detrimental effects on their workplace well-being.