Nurse Leaders Research Articles

Retooling a Clinical Nurse Leader Curriculum in Response to the Nursing Faculty Shortage.

Our school had increased full-time and adjunct faculty vacancies. To deal with this crisis, we recruited our clinical nurse leader (CNL) graduates. Many reported not feeling prepared to teach. This article describes changes made in a CNL curriculum to better prepare graduates for positions in academic nursing education. While the CNL skill set was created for care of patient populations, it is also transferable to nursing education. Previously, our curriculum used only clinical experiences to teach aspects of CNL practice. We added academic educational experiences and content into our curriculum as another means of teaching the skill set. The size of our CNL program doubled. Students reported gaining confidence about the CNL role in both clinical and academic settings. This curricular change allows CNL students to "try on" the role of nurse educator. This exposure may increase their desire to pursue a career in academia. [J Nurs Educ. 2024;63(X):XXX-XXX.].

School Nurse Leadership and the Implementation of School-Based Support for LGBTQ+ Students.

In 2021, the National Association of School Nurses published an updated position statement affirming the unique position of school nurses to support the health and well-being of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) students who are faced with a variety of health disparities rooted in experiences of stigma, discrimination, and bias. The 5-year cluster randomized controlled trial "Reducing LGBTQ+ Adolescent Suicide" leveraged school nurses as leaders to facilitate the uptake of six evidence-informed, LGBTQ-supportive practices in New Mexico high schools. We analyzed 5 years of interview data from 24 school nurses in 13 intervention schools to examine what factors impacted their ability to serve as an effective leader for this initiative. Several factors including job characteristics, leadership and organizational skills, relationships and reputation, and personal commitments emerged from analysis. Contextual factors, such as working in urban or rural school, and the size of the school also influenced nurses' leadership.

Internet-Based Trauma Recovery Intervention for Nurses: A Randomized Controlled Trial

Introduction: Nurses, who care for patients with various traumas, may also experience post-traumatic stress disorder due to indirect or direct exposure to traumatic situations. This study examined the effectiveness of an Internet-based trauma recovery intervention for Korean nurses. Methods: This randomized controlled trial was conducted with 112 nurses aged 23–40 years who were randomly assigned to the intervention (n = 56) or control group (n = 56) from May 7 to December 20, 2020. Nurses in the intervention group attended eight sessions, and the same intervention was administered to the control group. Repeated measures were collected at pre-test, post-test 1 (immediately after the intervention), and post-test 2 (4 weeks after the intervention). A total of 102 nurses (intervention group: n = 49; control group: n = 53) were completed because 10 nurses dropped out before the first session. Data were analyzed using the χ2 test, Fisher’s exact test, t-test, Mann-Whitney U test, and repeated measures ANOVA (intention-to-treat and per protocol). Results: There were significant changes in functional health, resilience, post-traumatic stress, depressive symptoms, state anxiety, and trait anxiety over time and in the group-by-time interactions (intention-to-treat and per protocol). There was a significant difference in social support in the group-by-time interactions, but there were no significant changes between the two groups or over time (intention-to-treat and per protocol). Conclusion: The Internet-based trauma recovery nursing intervention is effective in clinical and community settings for nurses who cannot participate in fixed-schedule programs due to shift work. This study’s findings are relevant for implementing Internet-based trauma recovery programs for nurses and the general population, including survivors and relatives of patients who suffered from COVID-19. This program will also be very useful for people in other high-stress situations. Nurse leaders should consider different populations and situations when offering effective coping strategies suitable for changing environments.

Practical Strategies for Nurse Leaders to De-Implement Low-Value Nursing Practices.

Practical Strategies for Nurse Leaders to De-Implement Low-Value Nursing Practices.

Leadership Strategies to Increase Psychological Safety of Nurses: A Longitudinal Study.

A work environment where employees feel comfortable taking chances without fear and with sufficient protection from retaliation is psychologically safe. The objective of this study was to investigate the effects of leader training for nurse managers on psychological safety of clinical registered nurses. The study was designed a longitudinal outcomes approach to assess nurse leader intervention (classes on leadership methods and psychological safety) with pre- and post-intervention measurement of nurse psychological safety at each time point. The intervention and nurse leader rounding were shown to increase individual psychological safety climate scores of clinical nurses. Psychological safety is an important component to consider in a nursing leadership role. Leadership interventions that focus on the tenets of psychological safety and include methods of being present, such as nurse leader rounding, can foster a sense of a psychologically safe environment for clinical registered nurses.

The DAISY Award: Meaningful Recognition's Impact on Patients, Nurses, and Organizations.

This review demonstrates the impact of The DAISY Award and how meaningful recognition (MR) through gratitude affects nurse engagement, healthy work environments (HWEs), and patient/families' (PFs) experiences. MR has mutual benefits for nurses and PFs, promoting therapeutic healing and resiliency. MR in HWEs can impact organizations' care quality, fiscal health and influence public perceptions. Nurse leaders should create an environment where MR is a core strategic imperative that impacts nurse, patient, and organizational outcomes.

Effective nursing leadership as a catalyst for person-centered care and positive nursing-patient interactions: evidence from a public Ghanaian hospital

Person-centered care (PCC) is crucial to patient engagement in healthcare enhancing patients’ participation in critical care decision-making, increasing care disclosure, reducing medication errors, and promoting satisfaction with care outcomes. Healthcare management and leadership practices contribute to effective communication and interactions between healthcare providers and patients, which is vital for quality PCC outcomes and patient perceptions of care providers. However, little is known about how nursing leadership influences PCC and clinical interactions in the Ghanaian setting, which this study saw as a gap and aims to fill. This paper reports data from interdisciplinary exploratory qualitative research to examine the impacts of nursing leadership practices on nurse-patient relationships and care outcomes. Nurses (11), patients (22), and caregivers (11) participated in the study. Data were gathered in Ghana through interviews, focus groups, and participant observations and analyzed thematically. The three themes which emerged were: hospital leadership and the nursing staff, healthcare management practices, and communication barriers regarding how nursing leadership impacts PCC. Poor relationships between nurses and hospital leaders affected nurses’ caring practices. Management practices, including an annual rotation of nurses across different patient wards and exigent patient record management routines, negatively impacted care delivery and patient-provider interactions. These leadership practices and the strained relationships between nurses and hospital leaders potentially derail effective PCC. Nursing and hospital managers must embrace transformational leadership and healthcare management practices, especially in resource-scare settings, that foster a trusting care culture and/or environment for therapeutic nurse-patient relationships to thrive and for PCC to be actualized.

Development of an Online Nursing Leadership Program for Global Health in the Western Pacific Region.

Global health highlights the transnational determinants, issues, and possible solutions for improving health outcomes. Addressing global health issues requires population-based approaches coupled with individualized healthcare across settings, including strategies for achieving health equity. Designing and implementing global health solutions requires competent nurse leaders who can facilitate multi-disciplinary collaborations, engage in policy development, and lead advocacies that support the global health agenda. Thus, this paper examined the stakeholder perspectives that informed the development of a leadership program on global health for nurse leaders in the Western Pacific Region (WPR). The study used a descriptive qualitative approach to generate key recommendations for a context-appropriate, multi-country capacity-building program for nurse leaders on global health. The Analysis Design, Development, Implementation, and Evaluation (ADDIE) model and reflexive approach were employed to guide the development of the training design. Twenty-five nurse leaders from World Health Organization Collaborating Centers (WHO-CC) in the Western Pacific participated. Qualitative data were collected from participant feedback and post-activity sessions throughout program implementation. Thematic analysis of stakeholder data revealed that the program (1) capitalized on equipping nurse leaders with the concepts related to global health and developing competencies in leadership, policy engagement, and advocacy; (2) ensured learning strategies by having participants from varied contexts and experiences; and (3) reflected on the strengths and limitations of the use of the online platform. This paper contributed to the growing literature on global health and programs that support addressing global health issues. The findings underscored the urgent need to capacitate nurses in leadership positions who contribute to addressing emerging issues in global health. The paper recommended improvements in the design and implementation of the Global Health Nursing Leadership Program to engage more nurse leaders across the region and enhance content and delivery.

Leading through the COVID-19 pandemic: Experiences of UK Executive Nurse Directors.

To explore the challenges experienced by Executive Nurse Directors during the COVID-19 pandemic, and to inform future nursing leadership strategies. A qualitative research project involving interviews with 21 Executive Nurse Directors from England and Wales. Participants were purposively sampled and recruited through Chief Nursing Officers and nursing leadership networks. Semi-structured interviews were conducted and recorded online via Teams. Braun and Clarke's approach to thematic reflexive analysis was applied to data analysis. Executive Nurse Directors played a critical role during the COVID-19 pandemic. Six themes are explored: tensions, and adaptive response to personal leadership styles; uncertainty and support at the board level; responding to national political decision-making; the personal and emotional impact of the role and the sources of effective support; the voice and public profile of nursing; lessons learnt and strategies for future leadership development. Enablers of decision-making included effective multidisciplinary working, freedom from normal organizational constraints, support for innovation, and the development of stronger bonds with colleagues. Barriers to decision-making included limited knowledge of the virus and its impact and lack of guidance, particularly at a national level. Priorities, strategies and actions for recovery include recognizing the emotional impact of being in a high-level decision-making role, protecting staff from burnout and understanding the long-term implications of pandemic work for nurse leaders. Future strategies for nursing leadership during public health, national and global emergencies are recommended. This study contributes to the literature exploring the Executive Nurse Director role and their experiences of leading through the COVID-19 pandemic, and identifies priorities, strategies and actions for recovery and learning for the future of senior leadership. The study adhered to the Consolidated Criteria for Reporting Qualitative Research. No patient or public contribution.

Nurse leadership: Pitfalls and solutions

Consider these solutions to three common mistakes.

Diversity Research Scholars: A path to finding our voice

Exposure to diverse nursing leaders builds confidence and inspires professional growth.

How to undertake an effective coaching session.

Nurse leaders and managers are being encouraged to adopt developmental and transformational leadership styles, and coaching is one tool that they can use to that effect. Beyond formal coaching relationships, the principles of coaching can be relevant to a variety of conversations with staff, for example during appraisals, clinical supervision or training. Applying the principles of coaching as a nurse leader or nurse manager appears to have benefits for all involved. Coaching can help build trusting relationships and empower staff to set themselves meaningful and solution-focused goals and actions and therefore facilitate change. However, the practice of coaching is sometimes misunderstood, while coaching that is unplanned or implemented ineffectively may compromise relationships. •Coaching is not a directive approach, instead the coach needs to adopt a non-judgemental, supportive and collaborative stance. •Coaching requires both parties to enter a learning process aimed at bringing about change and should be built on a commitment to that learning process. •Asking 'curious' questions, encouraging critical reflection and using active listening form the basis of an effective coaching conversation. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: •How this article might improve your practice when coaching a member of your immediate team or a colleague. •How you could use this information to educate nursing students and colleagues on the appropriate techniques and evidence base relating to coaching.

The impact of evidence-based nursing leadership in healthcare settings: a mixed methods systematic review

BackgroundThe central component in impactful healthcare decisions is evidence. Understanding how nurse leaders use evidence in their own managerial decision making is still limited. This mixed methods systematic review aimed to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurse leaders and their performance, organizational, and clinical outcomes.MethodsWe included articles using any type of research design. We referred nurses, nurse managers or other nursing staff working in a healthcare context when they attempt to influence the behavior of individuals or a group in an organization using an evidence-based approach. Seven databases were searched until 11 November 2021. JBI Critical Appraisal Checklist for Quasi-experimental studies, JBI Critical Appraisal Checklist for Case Series, Mixed Methods Appraisal Tool were used to evaluate the Risk of bias in quasi-experimental studies, case series, mixed methods studies, respectively. The JBI approach to mixed methods systematic reviews was followed, and a parallel-results convergent approach to synthesis and integration was adopted.ResultsThirty-one publications were eligible for the analysis: case series (n = 27), mixed methods studies (n = 3) and quasi-experimental studies (n = 1). All studies were included regardless of methodological quality. Leadership problems were related to the implementation of knowledge into practice, the quality of nursing care and the resource availability. Organizational data was used in 27 studies to understand leadership problems, scientific evidence from literature was sought in 26 studies, and stakeholders’ views were explored in 24 studies. Perceived and measured effects of evidence-based leadership focused on nurses’ performance, organizational outcomes, and clinical outcomes. Economic data were not available.ConclusionsThis is the first systematic review to examine how evidence is used to solve leadership problems and to describe its measured and perceived effects from different sites. Although a variety of perceptions and effects were identified on nurses’ performance as well as on organizational and clinical outcomes, available knowledge concerning evidence-based leadership is currently insufficient. Therefore, more high-quality research and clinical trial designs are still needed.Trail registrationThe study was registered (PROSPERO CRD42021259624).

InCHARGE: Co-creating, implementing and evaluating interventions to utilize nurses' competence and achieve person-centred fundamental care-A research protocol describing an action research approach.

This research protocol presents an action research project with the aim to demonstrate the value of person-centred fundamental care to nurses and nurse managers in surgical care units to encourage a far-reaching change in this direction. The objectives are to describe this process and to evaluate the effects on missed nursing care and person-centred fundamental care. In a novel collaboration between nursing science and medical humanities the action research design will be used to interact with nursing staff and leaders in three surgical care units and design interventions with the purpose to affect the direction of nursing. Initially, the care units will be presented with interactive workshops including evidence-based education on person-centered fundamental care, person-centredness, nurse role responsibility and leadership. This will be followed by cocreation of interventions to stimulate person-centered fundamental care. The Fundamentals of Care framework will be used as the overarching theoretical framework. Data on missed nursing care, person-centred climate and person-centered fundamental care will be collected repeatedly from patient- and nursing stakeholders through interviews and validated questionnaires. Additionally, data from written reflections following clinical observations and focus group interviews will be included. The duration of the study will be approximately five years from ethical approval. It has been previously reported that the current working environments of registered nurses are forcing them to ration their caring responsibilities, leading to a lack of fulfillment of patients' fundamental care needs, with possible severe consequences for patients. The action research design helps researchers gain an understanding of the contextual factors important for forthcoming interventions, enabling reflective processes and cocreation of interventions with stakeholders. This may lead to feasible interventions and strengthen nursing leadership in the involved units.

Outcome Evaluation of a Health System Clinical Nurse Specialist Fellowship Program.

Healthcare is a complex adaptive system, requiring agile, innovative leaders to transform care. Clinical nurse specialists (CNSs) are uniquely positioned to influence change and achieve high-quality outcomes. Nurse leaders need strategies to onboard and retain CNSs considering high demand across the nation. The purpose of this program evaluation was to describe the core components and outcomes of CNS fellowship programs. This program evaluation used the Kirkpatrick Model as a framework to assess learning and knowledge translation. The study was conducted within 3 Indiana healthcare organizations. Clinical nurse specialist leaders from each organization identified fellowship core components and analyzed team composition (ie, percentage of CNS team that was current/past fellows). Current and past CNS fellows were invited to participate in a survey evaluating program effectiveness, impact on role transition, project leadership, and outcomes achieved. Overlap was identified among 85% (17/20) of the core components, team composition was 71% (25/35) past/current fellows, and retention was 100% (12/12). Of the 23 invited, 18 (78%) participated in the program evaluation. Program effectiveness was evaluated as very/extremely effective by 94% (17/18) of participants. Themes salient to independent practice transition were applying learning, achieving influence, and developing relationally, contributing to incremental gain of the CNS perspective (ie, CNS values and guiding principles influencing critical thinking and behavior). Nurse leaders should consider fellowship implementation to recruit and retain CNS talent within organizations.

The Relationship between Servant Leadership and Self-Efficacy of Staff Nurses

The Relationship between Servant Leadership and Self-Efficacy of Staff Nurses

Resonant Leadership and Workplace Friendship of Nurses at Al-Ahrar Teaching Hospital

Resonant Leadership and Workplace Friendship of Nurses at Al-Ahrar Teaching Hospital

Assessing the success of a research leadership programme for senior nurses and midwives: A mixed methods programme evaluation.

In 2018 the National Institute of Health and Care Research, United Kingdom, launched a 3-year Senior Nurse and Midwife Research Leader Programme to support nurse and midwifery research leaders to develop research capacity and capability within NHS organisations. We report the results of a service evaluation of the programme strengths, areas for improvement and achievement of programme aims. Partially mixed, concurrent mixed methods programme evaluation, including: (a) meeting evaluation (survey), (b) annual evaluation (survey) and (c) qualitative stakeholder interviews. Survey results were quantitatively analysed using descriptive statistics. Interviews were audio-recorded, transcribed, deductively coded using elements within the logic model and analysed using the seven-stage framework analysis method. Satisfaction with the programme was high (75%). The main perceived benefit of the programme was being part of a network. Challenges included accessing learning resources, lack of opportunity to network and lack of clarity about the programme aims. Meetings were evaluated as relevant and helpful (mean 93%), thought-provoking (92%), inspiring (91%), at the appropriate level (91%) and aligned with the programme aims (90%). All meetings were ranked as highly beneficial by attendees (92%). Stakeholder feedback on the programme success reflected the importance of leadership, the programme design and content, 'connection and community' and communication with and about the cohort. Overall, the anticipated programme aims were met, evaluating well from both the perspective of those on the programme and the wider stakeholder group. There has been a lack of investment in schemes to support research leadership development for nurses/midwives. A novel programme to support nursing/midwifery research leadership was positively evaluated. The programme is a useful model to support future capacity and capability building for nurses/midwives. The work is reported with reference to the SQUIRE 2 and SRQR checklists. No patient or public contribution.

Going Commando as Part of a Multifaceted Intervention to Reduce CAUTIs in Critically Ill Children

Background and Objectives: Catheter associated urinary tract infections (CAUTIs) are a source of preventable harm in children. Insertion and maintenance bundles have significantly reduced CAUTIs, but infections still occur. Starting in mid-2019, we experienced an increase in CAUTIs in our pediatric intensive care unit (PICU). The objective was to identify preventable causes of CAUTI and develop and test interventions to reduce them. Methods: This quality improvement project was initiated in the PICU of a large tertiary children’s hospital. Interdisciplinary rounds led by the hospital epidemiologist and unit nursing leader with the bedside nurse occurred weekly (starting October 2019) for patients with urinary catheters in place for greater than three days. Discussions included strategies to optimize maintenance of the urinary catheter and identify catheters that could be removed. Additional interventions included no diapers for patients with a urinary catheter (starting March 2021) and use of a urine collection device that prevented both urine stasis in the drainage tube and retrograde flow of urine into the bladder (starting August 2021). Hand hygiene and CAUTI prevention bundle compliance was measured by direct observation of staff. CAUTIs were identified by prospective surveillance by infection prevention using standard definitions. The rate of CAUTIs over time was analyzed using statistical process control charts. Results: The baseline CAUTI rate (January 2017 - June 2019) was 0.5 infections/1000 catheter days with an average of 349 days between CAUTIs. Between July 2019 and February 2021, the CAUTI rate increased to 3.3 with an average of 88 days between CAUTIs. Annual compliance with hand hygiene and the CAUTI prevention bundle elements remained above 90% throughout all time periods. No improvement was seen after the institution of weekly interdisciplinary rounds. Starting in March 2021 after removal of diapers and implementation of the urine collection device that prevented retrograde flow, the CAUTI rate decreased to 0.9 and an average of 200 days between CAUTIs. Currently, it has been 512 days since the last CAUTI. Conclusion: CAUTIs decreased after removing diapers in children with urinary catheters and use of the urine collection device. Removal of diapers likely reduced stool contamination around the catheter and urethral opening. The urine collection device prevented inadvertent retrograde flow of urine into the bladder. These interventions could augment current CAUTI prevention strategies.

Shifting a Culture From Bedside Nurse to Bedside Nurse Leader Through a Mentor-Enabled Leadership Development Program

Shifting a Culture From Bedside Nurse to Bedside Nurse Leader Through a Mentor-Enabled Leadership Development Program