Leadership behaviours and practices assessment among nurse managers in riyadh second health cluster

In 2004 the Institute Of Medicine called for healthcare leaders to embrace and adopt transformational leadership practices to promote quality of care and favorable patient outcomes. Nurse managers are accountable for 24-hour operations of their departments and influence patient outcomes. The purpose of this research was to examine the relationships among nurse manager transformational leadership practices, patient outcomes and hospital types (Magnet, On The Journey, and Non-Magnet). A correlational study examined relationships between self-reported transformational leadership practices of nurse managers and patient outcomes by hospital types. The study was conducted using a purposive sample of Association of California Nurse Leader membership database. In addition nurse managers at one San Diego based hospital participated in the study after IRB approval was received. The measurement tools utilized for this study include the Leadership Practices Inventory (LPI) and an investigator designed demographic questionnaire. A One-Way ANOVA showed no statistically significant differences in transformational leadership practices of nurse managers among hospital types and patient outcomes. Levene's test confirmed that there were no differences in the mean variances between hospital types. Pearson's correlation was conducted and showed a positive correlation between the LPI sub-scale Encourage Others to Act (EOA) and patient falls that was moderate and statistically significant, r(22)=.421, p<.05; and a positive correlation between the LPI sub-scale Inspire a Shared Vision (ISV), and hospital acquired pressure ulcers was moderate and statistically significant, r(22)=.406, p<.05. A multiple linear regression analysis was conducted to explore to what extent the LPI total scores predicted patient fall rates and HAPU. Nurse manager experience and LPI scores did not account for a significant amount of variance in HAPU rates, F=.666, p=.678, R2=.190. Nurse manager experience and LPI scores did not account for a significant amount of variance in patient falls, F=2.446, p=.069, R2=.463. Further research should explore transformational leadership practices of nurse managers assessed by the staff that report directly to the manager. Nurse managers should eliminate barriers to support the delivery of quality patient care utilizing transactional and transformational leadership practices. A larger sample size is needed to further explore impact of leadership practices and patient outcomes.

In 2004 the Institute Of Medicine called for healthcare leaders to embrace and adopt transformational leadership practices to promote quality of care and favorable patient outcomes. Nurse managers are accountable for 24-hour operations of their departments and influence patient outcomes. The purpose of this research was to examine the relationships among nurse manager transformational leadership practices, patient outcomes and hospital types (Magnet, On The Journey, and Non-Magnet). A correlational study examined relationships between self-reported transformational leadership practices of nurse managers and patient outcomes by hospital types. The study was conducted using a purposive sample of Association of California Nurse Leader membership database. In addition nurse managers at one San Diego based hospital participated in the study after IRB approval was received. The measurement tools utilized for this study include the Leadership Practices Inventory (LPI) and an investigator designed demographic questionnaire. A One-Way ANOVA showed no statistically significant differences in transformational leadership practices of nurse managers among hospital types and patient outcomes. Levene's test confirmed that there were no differences in the mean variances between hospital types. Pearson's correlation was conducted and showed a positive correlation between the LPI sub-scale Encourage Others to Act (EOA) and patient falls that was moderate and statistically significant, r(22)=.421, p<.05; and a positive correlation between the LPI sub-scale Inspire a Shared Vision (ISV), and hospital acquired pressure ulcers was moderate and statistically significant, r(22)=.406, p<.05. A multiple linear regression analysis was conducted to explore to what extent the LPI total scores predicted patient fall rates and HAPU. Nurse manager experience and LPI scores did not account for a significant amount of variance in HAPU rates, F=.666, p=.678, R2=.190. Nurse manager experience and LPI scores did not account for a significant amount of variance in patient falls, F=2.446, p=.069, R2=.463. Further research should explore transformational leadership practices of nurse managers assessed by the staff that report directly to the manager. Nurse managers should eliminate barriers to support the delivery of quality patient care utilizing transactional and transformational leadership practices. A larger sample size is needed to further explore impact of leadership practices and patient outcomes.

DONs Build Teams Even in Challenging Times

Call to Improve LTC Leadership Development

Aligning Healthcare Safety and Quality Competencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credentialing Center (ANCC) Magnet® Standards Crosswalk

Nurse management and leadership play a critical role in shaping nurses’ work environments, patient safety, and organizational performance in hospital settings. In recent years, there has been a growing shift from traditional hierarchical management toward more relational and clinically oriented leadership practices. However, empirical evidence regarding dominant leadership styles, associated outcomes, and remaining research gaps remains dispersed across the literature. This systematic review aimed to synthesize existing evidence on nurse management and leadership practices in hospital settings, with a focus on dominant leadership styles, reported outcomes, and identified research gaps. A systematic review was conducted following the PRISMA 2020 guidelines. Literature searches were performed in PubMed/MEDLINE, Scopus, and CINAHL databases. A total of 524 articles were initially identified. After removal of duplicates and screening of titles and abstracts, 45 articles were assessed for full-text eligibility. Ten studies met all inclusion criteria and were included in the final synthesis. Data were analyzed using a narrative thematic approach. The synthesis revealed three main themes. First, transformational leadership emerged as the most frequently examined leadership style in nurse management, with increasing attention to clinical leadership among bedside nurses. Second, leadership practices were associated with nurse-related outcomes (work engagement, reduced burnout, and job performance), patient-related outcomes (quality of care, patient safety, and satisfaction), and organizational outcomes (innovative work behavior and reduced counterproductive behaviors). Third, several research gaps were identified, including the predominance of cross-sectional designs, reliance on self-reported measures, limited multicultural perspectives, and insufficient evidence on the long-term impact of leadership during and after healthcare crises such as the COVID-19 pandemic. Evidence from this systematic review indicates that relational and transformational leadership practices are consistently associated with positive outcomes for nurses, patients, and healthcare organizations in hospital settings. Strengthening leadership development and advancing longitudinal and intervention-based research are essential to better understand causal mechanisms and support sustainable improvements in nursing management and leadership.

Background: In today's ever changing and demanding healthcare environment, developing leadership qualities of unit charge nurses is important for achieving organizational success. One way of enhancing leadership skills and behaviors is by administering transformational educational programme. The aim of this study is to evaluate the effect of transformational leadership programme on unit charge nurses’ leadership practices. A targeted leadership development programme is developed based on leadership theory and strong evidence to be implemented to enhance charge nurses’ leadership skills which in turn impacts staff nurses’ work engagement and quality of care for patients. Research methodology: This randomized controlled trial will enroll 184 participants, with 82 in the experimental group and 82 in the control group. A baseline pretest will be conducted using demographic profile, Leadership Practices Inventory and Utrecht work engagement scale. The study participants will receive transformational leadership educational programme, whereas it will be withheld from control group subjects. Instead, they will be provided with standard educational booklets for self-study. Comparison of leadership practice skills will be done before and after the intervention in both groups. Results: Data analysis will be done using appropriate descriptive and inferential statistical methods. Discussion: The primary outcome is expecting an increase of 10% leadership scores among study group subjects from pretest and post- test as assessed by the (LPI) Leadership Practice Inventory by (Kouzes &amp; Posner 2012). The secondary outcome is expecting an increase by 5% Work engagement among study group subjects from the pretest and posttest mean as assessed by (UWES) Utrecht Work Engagement Scale. Conclusion: Transformational Educational Intervention will be an effective approach for enhancing the transformational leadership practices among Charge Nurses to develop future leaders

The practice environment of primary care nurses: A cross-sectional study of five health care districts in San Paulo, Brazil

Problem: Unit Practice Councils (UPCs) are foundational to Nursing Professional Governance (NPG), a structure that is designed to foster autonomy, accountability and authority for nurses. These councils are vital for empowering nurses to engage in decision-making and implementing practice changes. At one large pediatric hospital, UPC effectiveness varied across units, largely due to differences in nurse manager engagement and support. This variation highlighted a critical gap in how nurse managers were supporting UPCs within their unit. To close this gap, it was important to identify leadership best practices and behaviors that lead to successful UPCs. The following PICOT question was developed: “What are the best practices and leadership behaviors of nurse managers to support Nursing Professional Governance Unit Practice Councils?” Literature/Evidence: Utilizing OVID and databases, CINAHL and PubMed, a comprehensive review of 22 articles, including integrative reviews and qualitative studies, was conducted to explore leadership behaviors that support NPG and UPCs. Across literature, empowerment, accountability, and presence are frequently highlighted as essential leadership behaviors for effective shared governance that enhances engagement and growth. Clavelle and Tarasenko (2024) emphasized accountability as key to advancing NPG, while Rollins et al. (2024) stressed the importance of adaptable leadership styles. Practice Change: To address the variation in UPC effectiveness across units, a practice change initiative was implemented to examine whether the leadership behaviors demonstrated in high-performing UPCs aligned with those identified in the literature. The evidence highlighted key behaviors such as effective communication and collaboration, relational leadership practices, leadership support, empowerment and shared decision-making. To explore this alignment, a questionnaire was developed consisting of open-ended questions aimed at uncovering recurring themes in leadership behaviors that contribute to the success and sustainability of UPCs within the organization. Implementation: Using the developed questionnaire, structured interviews were conducted with UPC leaders and nurse managers from four high-performing units to explore alignment between leadership behaviors demonstrated in practice and those identified in the literature. The qualitative data collected was thematically coded and analyzed across roles to identify the recurring themes. Outcomes: Following the interviews, a consensus emerged regarding the leadership behaviors that contributed to the individual success of the UPCs. Relational leadership, consistent support and shared decision-making emerged as key drivers of UPC effectiveness, aligning closely with evidence from literature. UPC leaders consistently expressed that feeling supported and empowered by their nurse manager was crucial for their ability to lead. These best practices were integrated into annual NPG training to elevate and standardize UPC performance. Recommendations: The findings from this initiative underscored the critical role of leadership behaviors in the success and sustainability of UPCs. It is recommended to integrate these best practices into leadership development programs and ongoing NPG training. Nurse managers should be equipped with tools and strategies to cultivate relational leadership, provide visible and meaningful support, and facilitate collaborative decision-making. By standardizing these leadership behaviors, organizations can strengthen the foundation of NPG, enhance nurse engagement, and improve patient outcomes. Continued evaluation and feedback from UPC leaders will be essential to refine these practices and ensure their sustained impact across the organization.

Background: the quality of relationship between supervisors and subordinates and leadership of head nurses played an important role in their subordinates such as organizational commitment, job performance and promotions. Aim: the aim of this study was to determine relation between leadership styles and behaviors of nurse managers' and organizational commitment of staff nurses. Design: Descriptive correlational research design was used to achieve the aim of the current study. Setting: the study was conducted in Health Insurance Hospital, Minia governorate at Minia city. Subjects: the subject of study was included all nurse managers (head nurses) and staff nurses in Health Insurance Hospital (n=255), divided as (17 nurse managers + 238 staff nurses). Tools: three tools were used to collect data pertinent to the study as: Leadership Styles Questionnaire (Multifactor Leadership Questionnaire 5X), Leadership Behavior, and the Organizational Commitment of the Staff Nurses Questionnaire. Results: The study revealed that highest percentage of head nurses had high level for transformational (63%) and transactional style (59.7%); also, more than half (58.8%) of head nurses had high level of leadership behaviors and more than one third (39.9%) had moderate level. Moreover, it was noted that more than half (57.1%) had high level commitment, and more than one third (41.2%) had moderate level. Conclusion: there were positive correlations between leadership style as well as leadership behaviors with the organizational commitment. Recommendations: Periodic training courses should be provided in order to keep head nurses updating knowledge, skills, and attitudes regarding to leadership skill, behaviors and styles.

Aim: To study nurse managers' perceptions and experiences of staff nurse structural empowerment and its impact on the nurse manager leadership role and style.Background: Nurse managers' leadership roles may be viewed as challenging given the complex needs of patients and staff nurses' involvement in both clinical and organizational decision-making processes in interdisciplinary care settings.Design: Qualitative phenomenological study.Methods: Individual semi-structured interviews were conducted with 8 medical or surgical nurse managers in a 600-bed Belgian university hospital between December 2013 and June 2014. This hospital was undergoing conversion from a classical hierarchical, departmental structure to a flat, interdisciplinary model.Results: Nurse managers were found to be familiar with the structural empowerment of clinical nurses in the hospital and to hold positive attitudes toward it. They confirmed the positive impact of empowerment on their staff nurses, as evidenced by increased responsibility, autonomy, critical reflection and enhanced communication skills that in turn improved the quality and safety of patient care. Structural empowerment was being supported by several change initiatives at both the unit and hospital levels. Nurse managers' experiences with these initiatives were mixed, however, because of the changing demands with regard to their manager role and leadership style. In addition, pressure was being experienced by both staff nurses and nurse managers as a result of direct patient care priorities, tightly scheduled projects and miscommunication.Conclusion: Nurse managers reported that structural empowerment was having a favorable impact on staff nurses' professional attitudes and the safety and quality of care in their units. However, they also reported that the empowerment process had led to changes in the managers' roles as well as daily practice dilemmas related to the leadership styles needed. Clear organizational goals and dedicated support for both clinical nurses and nursing unit managers are imperative to maintaining an empowering practice environment which can ensure the best care and healthy, engaged staff.

The purposes of this study were to (a) describe nurse manager (NM) leadership behaviors for evidence-based practice, NM evidence-based practice competencies, and unit climates for evidence-based practice implementation in acute care, and (b) test for differences in NMs' and staff nurses' (RNs') perceptions. A multisite cross-sectional design was used to collect data from a sample of 24 NMs and 553 RNs from 24 adult medical-surgical units in seven U.S. community hospitals. Responses were collected using electronic questionnaires, inclusive of the Nurse Manager Evidence-Based Practice Competency Scale (NM only), Implementation Leadership Scale, and Implementation Climate Scale. E-mail reminders and gift card lottery drawings encouraged response. Descriptive statistics described total and subscale scores by role. Differences in perceptions were evaluated using independent t-tests with Bonferroni correction (α = .05). 23 NMs and 287 RNs responded (95.8% and 51.9% response rates, respectively). NMs reported they were "somewhat competent" in evidence-based practice (M = 1.62 [SD = 0.5]; 0-3 scale). NMs and RNs perceived leadership behaviors (NM: M = 2.73 [SD = 0.46]; RN: M = 2.88 [SD = 0.78]; 0-4 scale) and unit climates for evidence-based practice implementation (NM: M = 2.16 [SD = 0.67]; RN: M = 2.24 [SD = 0.74]; 0-4 scale) as evident to a "moderate extent." RN and NM perceptions differed significantly on the Proactive (p = .01) and Knowledgeable (p < .001) leadership subscales. Evidence-based practice competencies and leadership behaviors of NMs, and unit climates for evidence-based practice were modest at best and interventions are needed. To close the research to practice gap, future studies should investigate the interplay between social dynamic context factors and implementation strategies to promote uptake of evidence-based practices. Critical attention is needed to build organizational capacity for evidence-based practices through development of unit leadership and climate for evidence-based practice to accelerate routine use of evidence-based practices for improving care delivery and patient outcomes. The three instruments described herein provide a foundation for nurse leaders to assess these dynamic context factors and design interventions or programs where there is opportunity for improvement.

BackgroundLeadership in nursing is crucial for delivering high-quality healthcare and ensuring positive outcomes for patients, staff, and institutions. Many nurses in leadership positions lack formal training, which can compromise their effectiveness. This study aims to evaluate the effect of a leadership development program utilizing 360-degree feedback on head nurses’ leadership practices.MethodsA true-experimental design was employed in three healthcare institutions. The study involved 80 head nurses (40 intervention, 40 control), 240 staff nurses, and 29 supervisors. The intervention group participated in a six-week leadership development program using 360-degree feedback. Data were collected pre- and post-intervention using the Leadership Development and 360-Degree Feedback Knowledge Questionnaire and the Leadership Practices Inventory (LPI).ResultsThe intervention group showed significant improvements in leadership knowledge and practices across all dimensions. Knowledge scores increased from 25.1 ± 8.8 to 93.0 ± 5.1 post-intervention, maintaining at 83.2 ± 7.1 at follow-up. Self-assessed leadership scores improved from 88.1 ± 6.0 to 97.5 ± 2.7, and 98.5 ± 2.0 at follow-up. Supervisor and staff assessments also showed substantial increases. Multiple linear regression analyses confirmed the strong positive impact of the intervention on leadership outcomes.ConclusionThe leadership development program using 360-degree feedback significantly enhanced head nurses’ leadership knowledge and practices. The results suggest that such programs can improve leadership capabilities in healthcare settings, leading to better patient care and organizational performance. Future research should address group homogeneity and explore long-term impacts on patient outcomes.

This systematic review aimed to identify, evaluate, and synthesise the results of the studies that examine the relationship between nurse managers' leadership practices and staff nurses' work engagement in hospital settings and to provide recommendations for improvement and further research. A lack of supportive leadership is identified as one of the most common reasons nurses leave employment. To meet the global shortage of nurses, nurse managers need to maximise staff retention and work engagement. Evaluation. A systematic review was conducted to identify research published between 2010 and 2021 and registered in PubMed, CINAHL, PsycINFO, Embase, EMCare, and Eric databases. The methodology guidelines outlined in the Joanna Briggs Institute (JBI) Methodology for Systematic Reviews were followed, and the results were reported using the PRISMA 2020 guidelines. The review protocol was registered with PROSPERO (ID CRD42021277463). Key Issue. Eleven (11) studies from 12 articles were included in this review. Three main leadership style themes were identified, and these showed statistically significant direct and indirect relationships with nurses' work engagement: relationally focused, task-focused, and lack of leadership. Work engagement was mainly assessed in terms of dedication, absorption, and vigour. The effects of leadership styles on work engagement were found to be mediated by trust in the leader, environmental resources such as structural empowerment, six work-life areas (workload, control, values, community, rewards, and fairness), person-job fit, organisational support, leader-member exchange, and personal resources such as self-efficacy and decision authority. This review found a significant correlation between positive nurse manager leadership style and the work engagement of registered nurses. Implications for Nursing Management. The results of this review suggest that nursing work engagement can be improved by implementing relational leadership behaviours. The findings of this review will be useful for developing appropriate nurse leaders' leadership styles, improving their workplace environments, and planning leadership training. It is essential to acknowledge the indirect effects of nurse leaders' leadership styles and their mediating factors on work engagement while developing interventions for staff nurses.

Evaluation of a charge nurse leadership development program.