Management Competencies Research Articles

An evaluation of the impact of the Lambeth PCN pharmacist anticoagulation skills development project

Abstract Background Atrial Fibrillation (AF) is a prevalent heart condition linked to significant morbidity and mortality due to its association with stroke.1 Despite the clear benefits of anticoagulation in reducing stroke risk, its underuse and suboptimal monitoring remain a concern.2 Aim This study aims to evaluate the impact of a pharmacist-led training programme in Lambeth, London, focusing on improving pharmacists' competency and confidence in managing Direct Oral Anticoagulants (DOACs). It assesses if the training met pharmacists' needs, evaluates current monitoring patterns to determine if training was warranted, and identified areas for further training improvement. Methods The study involved 41 GP practices across 9 Primary Care Networks (PCNs) in Lambeth. Practices were eligible based on their involvement in the management of AF patients prescribed DOACs. All pharmacists at these practices who were actively engaged in anticoagulation management and willing to participate in pre- and post-training assessments were invited to take part. Recruitment involved direct communication through practice managers and emails detailing the study’s objectives and benefits. DOAC monitoring data was extracted from patient medication records and subsequently compared to the South East London anticoagulation guidelines3 to establish compliance percentages. A competency assessment was conducted on pharmacists using a pre- and post-training checklist framework devised by the Consultant Anticoagulant Team at Guy’s and St Thomas’ NHS Foundation Trust (GSTT). The Wilcoxon signed-rank test analysed this paired data, with a p < 0.05 set for statistical significance. Additionally, semi-structured interviews were conducted to gather insights on their training experience and perceptions. Transcripts were coded using NVIVO software to identify themes. Ethical approval was obtained from Kingston University London. Results Of the 2,987 AF patients across the 41 GP practices, 87.6% were on DOACs. Prescribing and monitoring trends were consistent across all GPs, with scope to improve compliance across all parameters, such as CHA₂DS₂-VASc score assessment prior to DOAC initiation. The competency assessment, completed by ten pharmacists, showed a significant improvement post-training, with mean scores rising from 3.3 to 4.1 (p< 0.00001). Improvements were seen across all domains, particularly in explaining the rationale for anticoagulation, showing CHA₂DS₂-VASc and HASBLED scores, and discussing modifiable HASBLED factors. Competency in patient communication remained highest, while managing particular cases like reversal procedures and patients with cancer showed lower competency, indicating areas for training improvement. The interviews, conducted with ten pharmacists, revealed three main themes: (1) Confidence and competence in anticoagulant prescribing and optimisation, (2) Evaluation of the training programme's effectiveness, and (3) Professional growth and career development. Pharmacists reported greater confidence in managing DOACs post-training, though challenges remained in patient engagement and collaboration with GPs lacking DOAC knowledge. Discussion / Conclusion The evaluation proved a positive impact on pharmacists' competency and confidence in DOAC management. Suboptimal monitoring practices in Lambeth highlighted the need for this training programme and its crucial role in improving patient outcomes. Limitations include a small interview sample and potential biases in self-reported evaluations. A longitudinal study is recommended to assess long-term impacts. Ongoing training and systematic data collection are essential, and similar training should be extended to other healthcare professionals.

Cross-cultural competencies in public management, the concept of training and competencies in the public sector, the role of national schools in Balkans

Cross-cultural competencies in public management, the concept of training and competencies in the public sector, the role of national schools in Balkans

Emotional management and clinical communication among nursing students: a single institution experience

BackgroundThe development of emotional and clinical communication is crucial for being a nurse. The aim of this study is to evaluate the influencing factors of emotional management and clinical communication competencies among nursing students, to inform strategies for enhancing the management and nursing care practices.MethodsThis study was a cross-sectional survey. The study period was from December 1 to December 31, 2022, during which nursing students were the population of the survey. The assessments of the emotional management and clinical communication competencies of the nursing students were conducted using the validated Emotion Management Ability Questionnaire and the Clinical Communication Ability Scale, respectively.ResultsA total of 356 nursing students were investigated in this study. The nursing students had moderate ability of emotional management and clinical communication. The emotional management ability was correlated with the clinical communication ability of nursing students (all p<0.05). The results of multivariate regression analysis indicated that gender, educational level and home place were the independent influencing factors on the emotional management ability in the nursing students (all p<0.05). Family structure, internship time and personality were the independent influencing factors for the clinical communication ability among the nursing students (all p<0.05).ConclusionsThe competencies in emotional management and clinical communication among clinical nursing students warrant enhancement. It is imperative to implement tailored educational and training programs to optimize the development and performance of nursing students in their clinical training.

Critical crisis management competencies: Perspectives from universities of technology leadership

AbstractThe South African Higher Education sector has faced challenging times recently, notably the #FeesMustFall student protest crisis, which inflicted damages exceeding R1 billion, and the COVID‐19 pandemic, claiming over 102,000 lives in the nation. Against this backdrop, a critical investigation has been initiated to discern the indispensable crisis management competencies required by executive management members of Universities of Technology (UoT) in South Africa. This exploratory study emphasises the higher education landscape, recognising its pivotal role in national development. Employing qualitative face‐to‐face interviews, the research aims to delve into the experiences of executive management members, providing insights into the nuanced demands of crisis management within the higher education context. In response to the challenges posed by the COVID‐19 pandemic, the study adapted by utilising online face‐to‐face meetings, ensuring a thorough exploration of crisis management competencies. Beyond mere identification, the research attempts to elucidate the profound significance of these competencies within the unique context of higher education institutions during crises. The findings contribute not only to the broader understanding of crisis management but also underscore the particular relevance and implications for the resilience and adaptability of South African UoT in the face of multifaceted challenges.

Advanced Financial Management Competencies of Graduate School Students in Business Administration: A Case Study

Advanced Financial Management Competencies of Graduate School Students in Business Administration: A Case Study

Entrepreneurial Competencies for Managing Business in Informal Economy: A Study of B40 Women Entrepreneurs in Malaysia

Globally, the lack of participation among women in entrepreneurship is credited to a series of factors, including a lack of education, inadequate competencies, gender stereotypes, and inadequate access to resources. This study aims to assess the current competencies level of women entrepreneurs in the informal economy in Malaysia. The informal economy—also referred to as the shadow economy- is far more significant than the formal economy and a way of livelihood for many people in most developing countries. Second, this study aims to discover the skills and knowledge required by women entrepreneurs. This study employed a qualitative research approach and purposive sampling technique where 20 women entrepreneurs were selected as key informants. This study only focuses on women entrepreneurs from B40 groups in Kuala Lumpur with more than one year of business experience and involved in informal businesses such as street vendors, hawkers, and home-based businesses. The interviews were analysed using thematic analysis. The study first found that most informants have limited business management competencies. The findings also have categorized the main competencies needed into seven main themes, namely, 1) communication, 2) strategic management, 3) financial management, 4) product innovation, 5) ICT skills, 6) time management, and 7) customer relationship management.

Informing infodemic management capacity building by piloting an adaptable capability tool

Abstract Background Infodemic management competencies and indicators have been included in key WHO pandemic preparedness documents and guidance such as the Preparedness and Resilience for Emerging Threats (PRET) initiative, the Health Emergency preparedness and response (HEPR) framework and in the WHO benchmarks for strengthening health emergency capacities. Training and capacity building is needed to strengthen infodemic management skills and capacity, and a tool to define capabilities and inform training needs was needed. Objectives An adaptable tool was developed and piloted to measure infodemic management capacity to inform training and capacity building needs. The tool was informed by previous work and adapted to cover a wide set of capabilities. It was piloted in March - May 2024. Results The tool was developed to cover the breadth of infodemic management work practice and structural support and included: who is conducting infodemic management work; structures in place to support; main activities; health topics focus areas; partnerships with other organisations; social listening and infodemic insights generation; as well as challenges, opportunities and training needs. The tool can be adapted to the specific situation, with a full survey able to be disseminated via an online survey platform as well as a modified interview guide for key informants or settings where that is more appropriate. Conclusions Preliminary results show that this tool can be a useful way to measure infodemic management competencies and to inform training and capacity building needs. The ability to adapt to specific settings is important to ensure the results are as useful and tailored as possible. As further testing in different setting continues the tool will continue to be iterated upon. Key messages • Infodemic management is an important component of pandemic preparedness and resilience and across the whole emergency response cycle. • A new adaptable tool to measure capabilities can help inform infodemic management trainings and capacity building.

The Determinants of Mental Illness Self-Management for Patients With Schizophrenia and Type 2 Diabetes: A Self-Determination Theory Approach.

This study based on self-determination theory aimed to assess the relationship between motivation, competence in diabetes management and perceived autonomy support respectively and mental illness self-management; furthermore, the authors intended to explore the determinants of mental illness self-management for patients with schizophrenia and diabetes. This was a cross-sectional study. One hundred ten participants were recruited at the psychiatric hospital and assessed with the Illness Management and Recovery Scale, the Treatment Self-Regulation Questionnaire, the Perceived Competence Scale for Diabetes and the Health-Care Climate Questionnaire. Patients with lower educational levels, who were admitted to the chronic ward, were unemployed, had lower motivation in illness management, lower competence in diabetes management and perceived lower autonomy support all had lower mental illness self-management. Competence in diabetes management, employment status, autonomy support, educational levels and living alone were the determinants of mental illness self-management. Recovery from schizophrenia and comorbid diabetes is an enduring and complicated process requiring support from healthcare providers. Health professionals should assess the levels of illness self-management and provide integrated care interventions for patients with schizophrenia and diabetes, helping them manage both conditions. The illness management programme could apply to patients with schizophrenia and diabetes and address patients' characteristics such as low levels of education, living alone and being unemployed while additionally promoting motivation and competence, and providing supporting autonomy. The STROBE checklist was followed. Patients with schizophrenia and diabetes were recruited for this study and voluntarily completed the questionnaire.

Developing Leadership and Management Competencies in Maritime Vocational Education: A Qualitative Study

This research investigates the effectiveness of maritime vocational education in developing leadership and management competencies, focusing on ethical decision-making, global competence, and innovation. A qualitative approach was used to gather insights from 24 participants, including maritime professionals, lecturers, graduates, and senior government officers. The results reveal that maritime vocational schools are highly effective in fostering leadership skills, with an overall average score of 9/10 across various indicators. However, graduates indicated a need for more practical, hands-on learning experiences to better transition into professional leadership roles. The study suggests that further collaboration between maritime vocational schools and industry stakeholders is essential to ensure curriculum relevance and alignment with industry demands. By enhancing practical learning opportunities and addressing gaps in leadership training, maritime vocational education can continue to play a critical role in preparing future leaders for the complexities of the global maritime industry.

Planning For The Development Of Technical Competence In Land Management (Case Study At The Regional Office Of The National Land Agency, DKI Jakarta Province)

This study aims to design a development plan for technical competencies in land management, specifically within the Regional Office of the National Land Agency (BPN) DKI Jakarta Province. The complexity of land issues in urban areas like Jakarta necessitates the improvement of technical competencies among functional land administrators to ensure effective performance and service delivery. Using a qualitative research approach, data was gathered through interviews, observations, and document analysis. The research highlights the absence of a structured competency development plan for land administrators and suggests the need for tailored training programs. Findings emphasize the importance of digital literacy, land administration skills, legal expertise, and communication skills to meet the demands of modern land management. The study concludes with recommendations for competency development that aligns with organizational goals, proposing a competency framework tailored to the challenges faced in Jakarta.

Competencies for sustainable financial and economic management: Their impact on human capital development and national security

The relevance of the study is determined by the orientation of modern society towards the strategy of sustainable development. The advent of the era of “globalization through sustainable development” is accompanied by the strengthening of “old” threats and the emergence of “new” ones. According to the article, the sustainability viewpoint systemically links the social, economic, and environmental domains into a dynamic, long-term view, which is the fundamental contribution of the perspective to the examination of security challenges. It also signifies a paradigm change in how public administration functions when analyzing security risks at the state and federal levels. Competences for sustainable financial and economic management are considered in frames of sustainable public management, implying, in particular, positive impact on human capital and contributing to national security through ESG paradigm implementation.

Examining the Relationship Between Project Complexity and Project Success: The Moderating Role of Project Management Competencies in Ghana’s Construction Sector

ABSTRACT This study seeks to examine the relationship between project complexity and project success in construction projects in Ghana while assessing the moderating role of project management competencies (PMC). Using a quantitative cross-section research design, data was collected from 141 respondents in organizations that undertake construction projects in Ghana. Responses were analyzed using IBM SPSS (v.23.0) and Smart PLS 3.0. The results established a negative relationship between Technological, Organizational, and Environmental complexity and project success. Technological complexity was seen as the dimension of complexity that significantly affects the success outcomes of projects. PMC’s moderating influence was insignificant. The findings suggest that, for projects to have an increased success rate, organizations must thoroughly investigate the kind of project complexity expected to be present in the project, and this will inform decisions on the caliber of skills/competencies needed for a successful execution of the project.

Engendering project management competencies in Saudi Arabian construction professionals

Purpose Persisting construction performance shortcomings in the Saudi Arabian construction industry requires engendering project management competencies in construction professionals’ roles and responsibilities. The purpose of this study was to determine significant construction project management competencies for Saudi Arabian construction professionals. Design/methodology/approach A cross-sectional questionnaire survey used project managers’ competencies from the literature. Construction professionals participated in the survey. Normalisation was used to determine the critical individual competencies. Statistically significant differences due to designations and organisations were analysed. Factor analysis revealed the relationships among significant competencies. Findings The most critical individual competencies included communication, team building and leadership skills. However, Project managers and all other construction professionals had statistically significant differences in insights on some of the critical competencies. The results revealed seven components: behaviour and attitude-related competencies; fundamental project management-related competencies; pro-active, knowledge and creativity-related competencies; political and organisational-related competencies; stakeholder management and experience-related competencies; management-related competencies; and confidence, commitment and negotiation-related competencies. Research limitations/implications Evidently, inculcating project management competencies is essential for construction professionals to enhance project performance. The failure to get insights from the National Project Management Office officials was a limitation; however, views from construction professionals were sufficient as they are the most affected stakeholders. Originality/value The study determined project management competencies necessary for Saudi Arabian construction professionals to improve their project delivery performance.

Políticas de liderazgo y gestión en instituciones de educación superior de México y Costa Rica

Educational policies focused on management and leadership in higher education have gained significant importance in recent years. Decision-making, planning, organizing, and executing strategies are the responsibility of the leadership of schools, units, and faculties within various university bodies. The knowledge, skills, and competencies in management and leadership of these leaders are essential elements for implementing development strategies for research, teaching, and outreach. This study aims to compare educational leadership policies in higher education in Mexico and Costa Rica, focusing on regulations, policies, and professional development at the University of Guadalajara, the National University of Costa Rica, and the University of Costa Rica, as well as to identify a binational model. The research was conducted from a naturalistic approach with a comparative methodology, using the case study technique through document analysis. The findings conclude that the three universities are characterized by a diversity of styles and approaches in their policies, regulations, training programs, and curricula to address management and leadership, ranging from more traditional models to more participatory and collaborative approaches. They address university organization indifferent and varied ways, each with a specific logic. It was not possible to determine a binational university leadership model, nor are there institutional policies directly aimed at management and leadership for university authorities, thus opening a research avenue for future academic and interinstitutional practice.

Japanese Clinical Physical Therapists With the Mechanical Diagnosis and Therapy License Are More Competent and Confident in Pain Management Than Those Without It: A Cross-Sectional Study.

Background The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) has long been misunderstood as a biomedical approach. In fact, it is a biopsychosocial approach with an up-to-date evidence-based educational curriculum. Recently, it has become possible to partially measure competence in clinical decision-making based on contemporary pain understanding and confidence in pain management using the Pain Understanding and Confidence Questionnaire (PUnCQ). The primary aim of this study was to compare the following outcomes between physical therapists with and without credential license in MDT (Cred.MDT) and the PUnCQ as well as attitudes toward the biopsychosocial perspective, adherence to evidence-based management for low back pain (LBP), and knowledge of modern pain science. The secondary aim was to explore relevant factors in the PUnCQ. Methodology Clinical physical therapists who were managing patients with pain were recruited from two associations (the Japanese Society of Allied Health and Rehabilitationand the Japan Branch of the International McKenzie Institute, who had all acquired at least the Cred.MDT). The following outcomes were measured: (1) the PUnCQ-1 for partial competence in evidence-based clinical decision-making for pain management; (2) part 2 scores of the PUnCQ for confidence in pain management; (3) the Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT) biopsychosocial/biomedical ratio for treatment perspectives; (4) the Knowledge and Attitudes of Pain (KNAP) for knowledge of modern pain science; and (5) a questionnaire for adherence to LBP practice guidelines. Two group comparisons were conducted for the primary aim and a multiple regression analysis for the independent variable of the PUnCQ-1 was conducted for the secondary aim. Results Data from 122 physical therapists (63 and 59 participants with and without the Cred.MDT, respectively) were analyzed. Statistically significantly higher scores were detected for physical therapists with Cred.MDT compared to those without (all p<0.05) for all of the above outcomes. The multiple regression analysis demonstrated that statistically significant contributors to the PUnCQ-1 were part 2 scores of the PUnCQ for the pain management factor (p = 0.016) and acquisition of the Cred.MDT (p = 0.038) (R2 = 0.12). Conclusion Competence and confidence in pain management, attitudes toward biopsychosocial approaches, knowledge of modern pain science and guideline adherence are higher in physical therapists with the Cred.MDT than those without it. Confidence in pain management and acquisition of the Cred.MDT contributed to competence in evidence-based clinical decision-making for pain management.

고위직 경찰공무원 필요역량 분석

This study aims to identify the competencies of senior police officers. Through qualitative research methods, including domestic and international literature reviews on competencies using bibliometric mapping, in-depth interviews applying phenomenological research methods, and verification of competency importance by a group of subject matter experts, the competencies of senior police officers were derived. The competencies identified are categorized into public security competencies and management competencies. Public security competencies include integrated command capabilities, risk management abilities, communication skills, analytical and evaluation abilities, and organizational planning abilities. Management competencies include strategic thinking abilities, change management capabilities, coordination and integration skills, citizen-oriented competencies, and public service ethics. The derivation of these competencies is expected to enhance the fairness of the promotion system for senior police officers and to promote a competency-based personnel system. This will contribute to increasing organizational competitiveness and improving police services for citizens.

Teacher Professional Development Through Writing Scientific Papers

Objektive: This research aims to develop teacher professionalism through the writing of scientific papers. Theoretical Framework: Professional teachers will be reflected in the implementation of the service of tasks characterized by the presence of expertise, both in materials and methods. In addition, it is also shown through his responsibility in carrying out all his devotion. Professional teachers should be able to bear and carry out their responsibilities as teachers to their learners, parents, society, nation, state, and religion. Professional teachers have personal, social, academic, moral, and spiritual responsibilities. Method: The design used in this research is descriptive qualitative. The data sources are 139 Indonesian language teachers from the Gorontalo Province. The research data consists of scientific papers written as part of the development of teacher professionalism, with the sources being 139 teachers. Data analysis is based on three processes, namely data reduction, data display, and verification, focusing on scientific papers to develop teacher professionalism. Results and Discussion: The teacher is one of the components of education in schools that has an important and strategic role. Among a number of competencies of professional teachers, the most important thing we emphasize is competence in learning management. A profession is a skill and authority in a certain position that requires certain competencies (attitudes, knowledge, and skills) specifically obtained from intensive academic education. In relation with that compiling scientific work is one of the forms of teacher professional development activities. Writing scientific papers for teachers is actually a basic necessity for developing their profession. Furthermore, the development of the ability to write scientific papers for teachers will have two main impacts, namely (a) teachers earn additional income from writing scientific papers if they are published in the mass media and win competitions and (b) teachers’ insight and understanding of the world of education and learning more deeply and comprehensively. Research Implications: This research has implications for increasing teacher professionalism through the writing of scientific papers. Teachers' ability to correctly write scientific papers significantly impacts their professionalism in teaching. Teachers will have better teaching skills if their scientific writing skills are also good. Additionally, teachers will serve as exemplary role models for their students in scientific writing. Originality/Value: This research significantly contributes to the improvement of teacher professionalism. Teachers with previously low professionalism can be continuously improved through their ability to write scientific papers. Gradually but surely, the persistent training in scientific writing will lead to increased professionalism. This professionalism is

KAP ANALYSIS AND DECISION-MAKING OF NURSES REGARDING SEPSIS ASSESSMENT AND MANAGEMENT IN CRITICALLY ILL PATIENTS

Sepsis is a life-threatening condition that requires prompt identification and management, particularly in critically ill patients. Nurses play a pivotal role in sepsis management, and their knowledge, attitudes, and practices directly impact patient outcomes. However, there is limited data on the awareness and competency of nurses regarding sepsis assessment and management, especially in low-resource settings. Objective: This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of nurses towards the assessment and management of sepsis in critically ill patients. Methods: A cross-sectional study was conducted in the Intensive Care Unit (ICU) and emergency department of DHQ Hospital, Narowal, from July 2023 to July 2024. A total of 100 ICU and CCU nurses were selected using convenience sampling. Data were collected through a 32-item questionnaire that assessed knowledge, attitudes, and practices related to sepsis. Additionally, the 24-item Nursing Decision-Making Instrument (NDMI) was used to evaluate decision-making skills. Descriptive statistics were calculated, and relationships between variables were analyzed using t-tests and ANOVA. Results: The mean knowledge score was 5.1 ± 1.8, with 83% of nurses demonstrating poor awareness of sepsis. The mean attitude score was 2.0 ± 0.9, with 85% of nurses displaying negative attitudes toward sepsis management. The mean practice score was 79 ± 17.8, with 72% of nurses showing poor practice skills. The mean decision-making score on the NDMI was 63.3 ± 19.6. Qualifications (p=0.010, p=0.00) and work experience (p=0.005, p=0.050) significantly influenced knowledge and practice scores. Moreover, knowledge and practice scores varied significantly with different modes of decision-making (p&lt;0.001, p=0.020). Conclusion: The study revealed that ICU and emergency department nurses had insufficient knowledge, negative attitudes, and inadequate practices concerning sepsis assessment and management. Training programs, targeted educational interventions, and policy reforms are urgently required to improve nurses' competency and decision-making skills in sepsis management, ultimately enhancing patient outcomes.

Pharmacy barriers for transgender and gender diverse young adults

BackgroundTransgender and gender diverse (TGD) individuals face substantial physical and mental health care barriers. Community pharmacies are one of the most accessible health care settings; however, concern for discrimination at the pharmacy has been reported. It is important to gain a better understanding of TGD individual’s perspectives and experiences at the pharmacy to ensure optimal and inclusive care. ObjectiveTo identify TGD individual experiences and barriers at the pharmacy. MethodsThis institutional review board−approved qualitative study recruited TGD young adults in the United States between ages 18 and 29 years for semi-structured focus group discussions. Questions focused on barriers to obtaining medications at the pharmacy and negative or positive experiences with pharmacists. Interviews were recorded, transcribed, and transcripts were analyzed for common themes amongst participants. ResultsNine 1.5- to 2-hour focus groups were conducted and included 30 participants (2–6 participants in each group). All participants reported having been prescribed medications by a physician or mental health provider. Participants self-reported issues at pharmacies and with pharmacy personnel. Major themes included issues accessing medications and supplies (needles, syringes), questioning of prescription validity and patient identity, and lack of education or understanding of TGD individuals by pharmacy staff. ConclusionTGD individuals experience barriers at the pharmacy and concerning issues with pharmacy staff. Education, structural competency, and improvements in gender-related data management are necessary for pharmacists and pharmacy staff to provide equitable and inclusive care for TGD individuals.

Leadership and Management Competencies of Nurse Managers: A Cross-sectional Study in Northern and Central Vietnam

Objective: The competence of nurse managers is essential to ensure outstanding patient care and the key contributors to the healthcare organization’s success. This study aimed to adapt the Chase Nurse Manager Competency Instrument (CNMCI) to Vietnamese situations and then to examine the leadership, management, and related characteristics of nurse managers. Material and Methods: A cross-sectional study was conducted in 17 Children and Obstetric and Pediatric hospitals in northern and central area of Vietnam using the CNMCI. Nurse managers (n=227) who were working in these hospitals participated in this study. Data were collected from July 2022 to August 2022. Results: Nurse managers had 3.51 ± 0.42 level of knowledge and 2.95 ± 0.48 level of ability to apply leadership and management competencies. However, only level of hospital and number of employees were significant related factors of leadership and management competencies of nurse manager. Conclusion: This study was the first in Vietnam which we examined the leadership competencies of nurse managers in Obstetric and Pediatric Hospitals. The results suggested that Vietnamese version of CNMCI was a reliable, valid instrument to assess competencies of nurse managers. It is necessary to have an effective leadership and manager training program to improve the competencies of nurse managers.