Nurse Leaders Research Articles

Commentary on “Racial and ethnic diversity in academic nursing leadership: A cross-sectional analysis” by Travers and colleagues (2024)

The purpose of this commentary is to highlight key points made by Travers and colleagues (2024) in their study entitled, “Racial and ethnic diversity in academic nursing leadership: A cross-sectional analysis” and provide additional recommendations for future research and policy related to diversity in academic nursing leadership. While there is a significant underrepresentation of racial and ethnic minoritized populations in academic leadership in nursing, the level of underrepresentation and contributors to underrepresentation are not the same across racial and ethnic minoritized populations. As we design strategies to promote diversity in academic nursing it is important to benchmark efforts to ensure representation from groups who experience the most significant health inequities, create tailored strategies that consider the unique historical and contemporary barriers to leadership in academic nursing across and within minoritized groups, and build upon evidence-based strategies, especially the important role that minority serving institutions have played.

Knowing, Being and Becoming a Person-Centred Nurse Leader: Findings from a Transformative Professional Development Programme.

Background/Objectives Leadership is central to the development of effective workplace cultures and as such should be viewed as a practice that is relational, exercised through a process of mutual and reciprocal influence. Person-centred leadership is an approach to leadership that supports a way of being that is authentic, prioritising values lived out in action. However, there is an increasing recognition that leadership development has not been impactful in relation to workplace culture. This paper reports on the ongoing evaluation of an innovative development programme (Queen's Nurse Development Programme), the overall aim of which was to illuminate the participants' experiences of engaging in transformative learning and development and identify the technical and transformative outcomes arising. The programme focused on developing leadership capacity for societal change and maximising the health impact of community nursing leaders. Methods The methodological framework for evaluation was underpinned by a Collaborative Critical Creative Inquiry. Twenty community nurses were selected to undertake the programme during 2020. The collection and analysis of data was consistent with the Collaborative Critical Creative Inquiry and was conducted as a one-day workshop, with participants engaged in a cycle of creative hermeneutic analysis. Results A total of seven themes were identified, including: sense of belonging; personal growth; developing new skills; finding voice; importance of self-care; and creating a safe place. This illuminated how the transformative learning and development processes within this programme were experienced and how these enabled participants to explore how they influence their practice and workplace. It is the journey with self that generates a sense of belonging and enables personal growth and the ability to care for self and others. Conclusions The key learning from this innovative development programme is the importance of focusing on the attributes of practitioners and the key building blocks for knowing, being, and becoming a person-centred practitioner.

Exploring Organisational Agility's Impact on Nurses' Green Work Behaviour: The Mediating Role of Climate Activism.

To examine the relationship between organisational agility and nurses' green work behaviour and to assess how climate activism mediates this relationship. Understanding this relationship is crucial for promoting sustainable practices in healthcare. A cross-sectional research design was employed. This approach was chosen to examine how organisational agility and climate activism simultaneously influence green work behaviour in the present context, providing a snapshot of their synergistic interactions. This study was conducted in 2024 at eight hospitals in Egypt, with a total of 781 nurses conveniently selected for participation. Data were collected using validated instruments: the Agility Survey, Employee Green Behaviour Scale and Environmental Action Scale. Correlation and path analyses were utilised to test the study hypotheses. Nurses reported moderate levels of organisational agility, climate activism and green work behaviour. Statistically significant positive correlations were found between organisational agility, climate activism and green work behaviour. Organisational agility and climate activism emerged as significant predictors of green work behaviour, with climate activism acting as a partial mediator between organisational agility and green work behaviour. This study contributes to the growing body of knowledge on fostering sustainable nursing practices as results indicate that agile organisations, which embrace flexibility and nurse-led climate initiatives, are better positioned to promote sustainable behaviour. Practical strategies include selecting nurses with high climate literacy, designing agile working strategies and promoting eco-conscious behaviours. Nurse leaders should develop policies that integrate climate initiatives into everyday practice to enhance green work behaviour. The healthcare sector faces increasing environmental challenges, making it crucial to foster green work behaviour. Our study addresses a gap in the literature by revealing that organisational agility and climate activism are essential drivers of green behaviour among nurses, offering actionable insights for greening healthcare practices. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). No patient or public contribution.

The Personal Faculty Mentor (PFM) Role: Advanced Support for Individualized Student Care

Background - Given the complexity of student responsibilities and backgrounds, the need for additional support during graduate education is evident for overall success. An innovative role that addresses these complexities and mitigates issues facing today’s nursing student was developed. Purpose - The Personal Faculty Mentor (PFM) role was developed to provide one, specific point of contact in an effort to support students throughout their MSN journey by completing new student orientation, individualized student outreach, frequent personal communication, and development of success plans. The PFM role also supports the faculty or instructor role by providing additional support and outreach with student concerns (low participation or scores). The overall purpose of the PFM is to improve student outcomes including pass rates, persistence rates, and satisfaction. Methods - Within the University’s Master of Science in Nursing Accelerated Track (MSN AT) Advanced Generalist and Clinical Nurse Leader (CNL), the PFM role was implemented to support student success. The MSN AT has flexible due dates for assignments which lends for more intensive student support. Results – Since the PFM role has been in place since program inception (July 2019), persistence and program completion are on average 12% higher, as high as 29%, with those students who actively participate with their PFM. Through survey, students report high satisfaction with the PFM role and attribute part of their success to this supportive role. Each session, students who actively participate with their PFM have better persistence than those who do not. Limitations – While the anecdotal feedback and positive outcomes are noteworthy, this strategy did not involve an empirical research investigation. As a result, a causative relationship may not be concrete. There is clearly an improvement in the retention and persistence of students who engage regularly with the PFM; however, there are additional variables that may be impacting the outcomes that would be helpful to identify. Conclusions / Implications for Practice - Student support promotes success. The role of the PFM provides individualized, student-centered support. Students who participate and interact with their PFM are more likely to be successful in the MSN AT.

Nurses as UN champions: Increasing nursing presence and influence at the United Nations.

Representing half of the global health workforce, nurses are critical to health promotion, disease prevention, and the economic and social needs of populations. However, nursing expertise is underutilized in the UN System, and nurses are underprepared for roles in policy to influence global health and sustainable development. Innovative education strategies are necessary to address the sidelining of nursing expertise in these spaces and build nursing literacy in shaping global policy. This quality improvement project aimed to develop and evaluate a model to build a USA-based school of nursing's literacy and engagement with the United Nations (UN) System. A Doctor of Nursing Practice (DNP) student developed an innovative educational model, the United Nations Essentials for Global Nursing Leadership, in partnership with a school of nursing (SON), to build faculty knowledge and skills on initiating and sustaining bidirectional engagement with the UN. In 2023, SON faculty piloted the model, and pre-/post-intervention survey data were utilized for improvement. Participants reported increased knowledge, awareness, and confidence related to the UN System and their ability to engage as policy influencers, health diplomats, and global citizens. In total, 100% of participants volunteered to hold the role of UN champion for the SON. This innovative model advances nursing knowledge and coherence in the UN System and key areas of policy, diplomacy, and global governance for meaningful UN engagement. CONCLUSION AND IMPLICATIONS FOR NURSING, HEALTH, AND SOCIAL POLICY: Models that invest in closing the global nursing leadership preparation gap can raise the profession's visible UN presence and strategic policy influence at a critical time for people and theplanet.

Unit Leadership and Climates for Evidence-Based Practice Implementation in Maternal-Infant Health Units: A Cross-Sectional Descriptive Study.

To describe unit leadership and climates for evidence-based practice implementation and test for differences in unit leader and staff nurses' perceptions within maternal-infant units. A cross-sectional descriptive study. A convenience sample of maternal-infant unit leaders and nurses (labour, postpartum, neonatal intensive care, paediatrics) from four Midwestern United States hospitals completed a survey including the Implementation Leadership Scale (ILS) and Implementation Climate Scale (ICS). Descriptive statistics described items, subscales and total scores. Independent t-tests with Bonferroni correction tested for differences in perceptions. A total of 470 nurses and 21 unit leaders responded, representing 17 units. Ratings of unit leadership and climates for implementation were modest at best [ICS: M = 2.17 (nurses), 2.41 (leaders); ILS: M = 2.4 (nurses), 2.98 (leaders)]. Unit leader ratings were statistically significant and higher than nurse ratings. This study is one of the first to describe unit leadership and climates for implementation in maternal-infant health. To improve outcomes and equity in maternal-infant health, attention on leadership behaviours and unit climates for evidence-based practice implementation is needed. Nurse leaders are encouraged to evaluate their leadership behaviours and the unit climates they facilitate, and work to improve areas of concern or where staff perceptions differ. Staff nurses should work with their leaders to identify resources and rewards/recognition which support and facilitate EBP implementation. This study addressed a gap in research examining the social dynamic factors of unit leadership and climate for evidence-based practice implementation in maternal-infant units. Leadership behaviours for implementation and unit climate were rated moderately by both staff and leaders. Unit leaders rated their implementation leadership and climates higher in almost all items. This study is relevant to unit leaders and nurses in maternal-infant units in the United States. This study adhered to STROBE guidelines. No patient or public contribution.

Resilience, compassion fatigue, moral distress and moral injury of nurses.

Background: Compassion fatigue, moral distress, and moral injury are interconnected phenomena that have a detrimental impact on the delivery of nursing care. Nurses possess the inherent resilience necessary to effectively handle these three adverse occurrences. Aim: To determine the mediating impact of resilience on compassion fatigue, moral distress, and moral injury among nurses in Saudi Arabia. Design: The final product was a structural equation model (SEM) generated using a quantitative correlation cross-sectional design, and we followed the STROBE guidelines for this study. Methods: The study involved a sample of 511 staff nurses, who were selected using consecutive sampling. The study was conducted in three government hospitals in Saudi Arabia. Ethical considerations: This study received approval from Ethics Committee under approval number H-2021-151 on March 5, 2021. The survey's description and consent statements were clearly presented on Google survey forms in both English and Arabic. Results: Results showed that resilience negatively influenced moral distress, while compassion fatigue and moral injury had a positive influence. Likewise, compassion fatigue had a direct, positive effect on moral distress and moral injury, and moral distress had a direct, positive effect on moral injury. Analyses also showed that resilience had positive, indirect effects on moral injury through the mediation of both compassion fatigue and moral distress. Similarly, compassion fatigue had a positive, indirect effect on moral injury through the mediation of moral distress. Conclusion: Because resilience enables nurses to adapt, it helps them overcome obstacles in their career and professional lives. Resilience is frequently cited by nurses as a protective quality. Moral injury, compassion fatigue, and moral distress can negatively impact the health of nurses. Implications for the profession and/or patient care: Nurse leaders should develop programs and initiate efforts to improve nurses' resilience as an important protective trait against compassion fatigue, moral distress, and moral injury. Patient or Public Contribution: There was no public or patient participation in this study.

Investigation of Resonant Leadership, Work Engagement and Employee Performance in Nurses

The aim of this study is to examine the relationships between resonant leadership, work engagement and employee performance and to reveal whether work engagement has a mediating effect on the effect of resonant leadership perception on employee performance. Another aim of the study is to determine whether nurses’ perceptions of resonant leadership, work engagement and employee performance differ according to various socio-demographic characteristics (such as age, gender and educational status). The study was carried out on 310 nurses working in a university hospital in Edirne, Turkey. According to the analyses made in the study, resonant leadership explained 8.7 per cent of the total variance on work engagement and 2 per cent of the total variance on employee performance; it was determined that work engagement explained 22.2 per cent of the total variance on employee performance. As a result of the analyses, it was determined that the effect of resonant leadership perception on employee performance was mediated by work engagement.

Effectiveness of Cognitive Rehearsal in Addressing Nursing Incivility: An Integrative Review.

Incivility is detrimental to nurses, patients, and health care organizations. Cognitive rehearsal has shown promise in addressing incivility, yet the most recent review of cognitive rehearsal training contained articles published in 2014 and earlier. This review integrates current knowledge of the effectiveness of cognitive rehearsal training in addressing nursing incivility. Four databases were searched from January 2018 to April 2023. Thematic analysis was used to analyze 22 studies. Three main themes emerged: (a) theoretical frameworks, (b) participant responses to cognitive rehearsal training, and (c) work culture influences. Nine theoretical frameworks uncover the mechanism behind nursing incivility and provide guidance on how to remedy it. Cognitive rehearsal training that includes four core components can foster skills and confidence to address nursing incivility and, in turn, decrease its occurrence, but training alone is not sufficient. Nurse managers and leaders need to model civil behavior, support zero tolerance, create a safe environment for reporting incivility, and intervene effectively. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

Advancing State Policy through Nurse Leader Influence: Exemplars from a Regional Nursing Organization in New England

Nurse leaders and professional nursing organizations are committed to influencing policy. Understanding how these commitments are actualized can accelerate success, and strategies can be replicated. The Organization of Nurse Leaders – New England (ONL)1, has strategic commitments and a strong track record of influencing state-level policy. Member input informs the organization's policy priorities, and engagement in Government Affairs Committee meetings supports learning. Policy and advocacy successes recognized through member communications and an annual award. This article provides detail about ONL's approach to policy and advocacy work, its processes for supporting nurse leader influence, and exemplars highlighting policy success in New England.

Nurse Well-Being Interventions: The Nurse’s Voice

BackgroundMoral injury negatively influences nurse well-being, which may increase nurse burnout. Nurse leaders are acutely aware of moral injury impact; however, few studies represent the direct care nurse’s recommendations for interventions. MethodsA cross-sectional study was conducted surveying direct care nurses from 7 hospitals exploring nurse moral injury and preferences for nurse well-being interventions including an open-text format. ResultsNurses selected pet therapy (58%) and mindfulness reflection (44.3%) as priority interventions. Two core interventional themes emerged: well-being and work environment. ConclusionManageable workloads and healthy unit cultures are desired, alongside well-being interventions to mitigate moral injury.

Building Bridges to Connect and Transition Nurse Leaders From Practice to Academia

The pervasive nursing workforce shortage impacts clinical and academic settings due to the pace of aging faculty, retirement, advance degrees, and wage/pay gaps. Developing nurse educators is essential to accommodate the surge of potential nursing students and combat the shortage of nurses. Establishing academic-practice partnerships is a key strategy for facilitating the transition of clinical nurse leaders into academia. To promote their success, innovative pathways are needed. This article briefly describes challenges facing the nurse workforce; how academic-practice partnerships can be leveraged to address the nurse shortage; and focuses on strategies for transitioning from practice to academia.

Caring Leadership in a Nonlinear World.

This introduction discusses the results of a survey of Italian nurses' views of their work performance and correlates those perceptions with their reported age, gender, and years of nursing work experiences, considering nursing leadership theory based on caring science and quantum leadership. Implications for nurse managers at the site of care are provided.

Refinement and Validation of the Team Effectiveness Scale for Nursing Units.

Understanding that the complexity and dynamic nature of the nursing care setting creates diverse conditions for teamwork is important when developing tools to measure nursing unit team effectiveness. The Team Effectiveness Scale for Nursing Units (TES-NU), based on the Integrated Team Effectiveness Model, was developed without confirmatory factor analysis and only tested on one nursing organization. It needs further research to prove its validity and reliability. This study aims to refine and validate the TES-NU in various nursing organizations. We designed this methodological study to refine the TES-NU by establishing its validity and reliability. The study included 330 clinical nurses from six general hospitals in South Korea, selected via convenience sampling. The TES-NU's refinement process includes item analysis, exploratory factor analysis, confirmatory factor analysis, item analysis, and convergent validity. The KMO of 22 preliminary items was 0.89, the cumulative variance of the five factors was 67.58%, and the commonality was >0.40. Confirmatory factor analysis indicated the revised model fit well with better indices: CMIN/DF = 1.687, CFI = 0.936, TLI = 0.924, RMSEA = 0.059, and SRMR = 0.057. We simplified the refined scale to 22 items in 5 subdomains: "head nurses leadership", "job satisfaction", "cohesion", "work performance", and "nurses competence". Convergent validity (r = 0.69, p < 0.001) and reliability (Cronbach's alpha = 0.92) were validated for the revised TES-NU. A refined TES-NU has tested their validity and reliability. Nursing managers can use this tool to manage the performance of individual nurses as well as nursing units, which will contribute to improving the work performance of the nursing organization.

Intersectionality and Feminist Theory: A Framework for Understanding and Teaching Social Construct and Healthcare Policy

The continuing nursing shortage throughout the United States has affected all aspects of the healthcare sector, particularly nursing leadership. As the Baby Boomer generation of nurses retires, the profession is primed to need more experience, advocacy, and leadership. This leaves a critical gap for leaders who identify with and are wise to the factors that influence the dynamic power relationships inherent to American history. As the country continues to become increasingly diverse, women and minorities in leadership continue to be underrepresented. In one of the most significant threats to women’s health, the recent overturning of the Supreme Court landmark case, Roe v. Wade, has highlighted the marginalization of women and people of color that is deeply embedded in the nation’s history. The lack of women and minorities in leadership positions in healthcare that has resulted from vast power imbalances, gender stereotyping, discrimination, and patriarchal structures must be addressed. Intersectionality theory offers a lens through which to understand these factors of power for all nurses. Nurse leaders can understand complex social constructs and be prepared to address power relationships that inform healthcare policy.

The impact of the nursing work environment on compassion fatigue: The mediating role of general self-efficacy.

To explore the interplay between the perceived nursing work environment, general self-efficacy, and compassion fatigue among registered nurses in Chinese hospitals. Compassion fatigue emerges as a significant occupational stress response globally, with the nursing work environment being a pivotal influencer. There is a knowledge gap in understanding how the nursing work environment and general self-efficacy interrelate to affect compassion fatigue, particularly among Chinese nurses. Employing a cross-sectional, descriptive design, this study utilized validated questionnaires to gather data from 7085 nurses across public and private hospitals in China. The analysis focused on assessing the interrelations among the perceived nursing work environment, general self-efficacy, and different dimensions of compassion fatigue. More than half (65.67%) of the participants experienced moderate or high burnout levels, with 76.43% experiencing secondary traumatic stress. The lowest rating in the nursing work environment was for nurse/physician collaboration (10±2.07), while general self-efficacy scored higher (27.54±6.26). A positive relationship existed between the work environment and both general self-efficacy and compassion satisfaction, with a negative correlation to burnout and traumatic stress. General self-efficacy was a partial mediator in the link between work environment and compassion fatigue, suggesting that improving the work environment can decrease compassion fatigue by boosting nurses' self-efficacy. This study underscores the profound impact of the nursing work environment on compassion fatigue, mediated by general self-efficacy. It highlights the necessity of fostering a supportive work environment to enhance nurses' self-efficacy and overall well-being. Healthcare managers and institutions must create supportive work environments to reduce compassion fatigue among nurses. This includes professional development programs to enhance self-efficacy and job satisfaction. Policies should address high workloads and inadequate support. Nurse leaders should foster environments that promote psychological well-being, improving outcomes for both nurses and patients. Regular assessments and adjustments of work conditions are essential to maintain a healthy work environment.

Co‐Designing Nurse Practitioner Roles in a Tertiary Hospital: A Qualitative Exploration of Patterns and Underlying Dynamics

ABSTRACTAimsTo explore patterns and dynamics during the co‐design process of nurse practitioners' role development in three departments in a Belgian tertiary hospital.DesignParticipatory action research was utilised in conjunction with principles of a Grounded Theory approach to explore patterns and dynamics.MethodsSixteen meetings were conducted between January and June 2021 with interdisciplinary teams to develop the roles. Thirteen exploratory interviews were held with the stakeholders involved between March and June 2022. All meetings and interviews were recorded and transcribed verbatim. Data were systematically analysed using researcher triangulation and thematic analysis.ResultsStakeholders' initial conception of the nurse practitioner roles affected development. A dynamic interplay of individual, team‐related and contextual (e.g., financial and legal) factors shaped these conceptions. Through co‐design, stakeholders' conception evolved as insights were shared, misconceptions challenged and perspectives broadened. Physicians generally the developmental process, while nursing leadership was more fragmented.ConclusionThis study identifies patterns and dynamics in interdisciplinary teams during the developmental process. The key findings underpin the crucial role of stakeholders' conceptions, use of co‐design and leadership in this process. Therefore, a thorough understanding of initial conceptions is ess, and efforts should be directed towards providing sufficient knowledge and experience to prevent misconceptions. Additionally, this study emphasises the significance of a balanced team composition that incorporates diverse conceptions of the role. Finally, actions should be taken to empower leadership among nurses.ImpactIdentified dynamics offer insights for healthcare organisations developing nurse practitioner roles. Educational institutions can use these insights to enhance healthcare professionals' curricula, preparing healthcare professionals for evolving advanced nursing roles and leadership. Additionally, it emphasises the necessity for policy work to establish a legal framework for nurse practitioners in Belgium.Reporting MethodThe ‘Standards for Reporting Qualitative Research’ were used for reporting.Patient or Public ContributionThis study did not involve direct participation from patients or the public.

Caring for the Unvaccinated During a Pandemic: Connecting Swanson's Theory of Caring.

Background and Purpose: Nurses frequently care for patients who make decisions against medical advice, a challenge that continues during and after the COVID-19 pandemic. This article explores U.S. nurses' experiences caring for unvaccinated COVID-19 patients and the resulting impacts using Swanson's Theory of Caring (STC). Methods: Data were gathered through an online survey collecting nurses' demographics, mental health screening data, and an open-ended question asking about a personal experience providing care to an unvaccinated COVID-19 patient. Researchers analyzed 128 responses using content analysis. STC served as the analytical framework. Results: Nurses' experiences were summarized into two main themes and four subthemes: (a) anger, frustration, fatigue, and resentment (24.2%) and (b) feeling a professional commitment to a nurse's duty (60.9%). Within the professional commitment theme, subthemes include the following: (a) patients can make an autonomous decision (15.6%); (b) feeling concerned for the patient (6.3%); (c) wanting to take action, educate, and vaccinate (29.7%); and (d) feeling moral conflict (9.3%). Results aligned with STC's five caring actions: knowing, doing for, being with, enabling, and maintaining belief. Implications for Practice: Nurses experienced emotional challenges caring for the unvaccinated during the pandemic resulting in psychological sequelae, including compassion fatigue and moral distress, in addition to positive outcomes of resilience and enhanced coping mechanisms. This study underscores the multifaceted nature of nurses' experiences and the emotional, ethical, and professional challenges they encountered when caring for unvaccinated COVID-19 patients. Nurse leaders should address these issues to enhance nurses' wellbeing and reduce compassion fatigue and dissatisfaction.

The Relationship Between Social Media Use, Nurse Characteristics, and Job Decision-Making.

To describe nurses' use of social media and examine the relationship between social media use, nurse characteristics, and job decision-making. Social media shares information, connects, and influences thought. A gap remains in understanding how nurses use social media for professional purposes. A national survey of RNs and advanced practice RNs included demographics, questions about which social media platforms respondents use personally and professionally, and engagement activities on each platform. Data analysis included descriptive statistics, Cramér's V test, and binomial logistic regression. Eight hundred twelve nurses participated. Platforms and activities used by nurses varied significantly by age, job title, and employment. The majority (61%) of respondents were satisfied or highly satisfied with their job, yet about one-third intended to leave their position or organization within 1 to 12 months. Nurse leaders should adopt a strategic, data-informed approach to leverage social media in attracting and retaining a diverse nursing workforce.

Growth of a Movement Through Spiritual Leadership: Faith Community Nursing in the United States.

Faith community nursing often is anchored in a community through local networks that support the development of both the ministry and the faith community nurse. Such local networks are established and sustained through the leadership of faith community nurses (FCNs). A research study interviewed nurses recognized as foundational to the development of FCNs in the United States from 1984 to 2000. The Waterwheel Model of Spiritual Leadership was used as a construct for interviewing 24 FCN leaders discovered through Delphi methodology. An adaptation of Colazzi's method of qualitative analysis was used to analyze data collected in videotaped format. Three predominant themes emerged that may be instrumental to developing future FCN leaders and growth of this specialty nursing practice.