Nurse Manager Leadership Research Articles

Exploring the Quality of Care and the Nursing Practice Environment in Saudi Arabia

The practice environment significantly influences healthcare quality, particularly in nursing. In Saudi Arabia, the quality of nursing services faces challenges due to a high ratio of expatriate nurses and unique workplace conditions. This study analyzes the Nursing Work Index Scale (NWIS) to evaluate the Practice Environment Scale (PES) and its subscales. Additionally, it explores the relationship between demographic variables and subscale outcomes. A descriptive, cross-sectional study was conducted using a self-administered questionnaire distributed to 573 staff nurses in a public hospital (1200-bed capacity) managed by the Ministry of Health. Data was collected in October 2021, with 384 nurses responding. The PES-NWIS was utilized to measure nurses' perceptions of their work environment on a four-point scale. The overall mean score for the PES-NWIS was 2.94 (SD ± 0.753), with all five subscale scores exceeding the midpoint of 2.5. The highest scores were observed for "Nursing Foundations for Quality of Care" (3.02, SD ± 0.753), followed by "Collegial Nurse–Physician Relations" (2.99, SD ± 0.822), and "Nurse Manager Ability, Leadership, and Support" (2.98, SD ± 0.819). The lowest score was for "Staffing and Resource Adequacy" (2.56, SD ± 0.993). A healthy work environment positively impacts nursing outcomes and healthcare quality. Promoting a supportive nursing practice environment benefits patients, nurses, and the broader healthcare team, emphasizing the need for targeted interventions in Saudi hospitals.

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.

Migration Intentions, Practice Environment, and Satisfaction among Nigerian Nurses: A Case Study

Background: Nursing workforce migration is a function of the nursing practice environment and satisfaction with the general situation of their country of practice. There is a need to provide empirical data on the intent to migrate among nurses and satisfaction with the working environment in Nigeria.Purpose: This study assessed migration intention, favorability of practice environment, and level of satisfaction with the Nigerian environment among nurses in a private teaching hospital in Nigeria.Methods: This descriptive cross-sectional study recruited participants using a simple random sampling technique. In all, 124 nurses participated in the study. Data was collected using the migration intention questionnaire, nursing practice environment scale, and satisfaction with Nigeria environment questionnaire. All ethical principles were adhered to. Data was analyzed using Statistical Package for Social Sciences. Descriptive statistics (frequency, mean and standard deviation) were used. Results: An overwhelming majority (95.2%) have the intention to migrate to other countries with 63.6% of them already in the migration process. Canada (34.8%) and the United Kingdom (33.9%) were the most sought-after countries. Nurse manager ability, leadership, and support scored highest on the favourability of the nursing practice environment (2.92±0.80) while staffing and resources inadequacy has the lowest score (2.63±0.68). Overall, 75.8% of the nurses describe their practice environment as favourable. Political conflicts and wars are the most dissatisfying areas of Nigeria's environment. Also, the majority 61.3% were dissatisfied with the Nigerian environment.Conclusion: The majority of the nurses who participated in the study are planning to migrate to another country. The majority of the nurses are not satisfied with Nigeria’s environment and they opined that their practice environment is unfavourable. There is a need to make the nursing practice environment more favorable to the nurses.

Exploring Determinants of Nurse Retention: The Influence of Personal and Professional Values, and Work Environment in Predicting Intent to Leave.

Nurse retention remains a pivotal issue, necessitating urgent strategies aimed at the recruitment and retention of highly qualified nurses. However, there is limited knowledge regarding the influence of nurses' personal and professional values, along with work environment, on predicting intent to leave an organization. Utilizing a secondary analysis approach, this study employed logistic regression to predict intent to leave among registered nurses (n=671) using results from the Short Schwartz's Value Survey, the Nurses Professional Values Scale-3, and the Practice Environment Scale of the Nursing Work Index. Regression analysis indicates that the work environment including "Participation in Hospital Affairs" (B=-.665, odds ratio=.514), "Nurse Manager Ability, Leadership, and Support" (B=-.448, odds ratio=.639), and "Staffing and Resource Adequacy" (B=-.589, odds ratio=.555) are significant predictors of nurses' intentions to leave. Establishing and maintaining supportive work environments is essential for retention, highlighting the importance of effective leadership.

LEADERSHIP TRAITS OF NURSE MANAGERS AND NURSE STAFF COMMITMENT IN THE PHILIPPINES HOSPITALS

Background: Effective nurse leadership significantly influences healthcare service quality. Nurse managers' leadership impacts staff nurse commitment, patient outcomes, and organizational success. Aims: To examine nurse manager leadership traits and their relationship with staff nurse commitment in a government hospital. Methods: Descriptive-inferential correlation research with stratified and randomized nurse managers (n = 21) and staff nurses (n = 117) as participants from five selected hospitals at Lanao del Norte. Adopted questionnaires on leadership traits and commitment were used and data were analyzed using frequency, percentage, mean, and standard deviation in SPSS v.25. Results: The result shows that nurse manager leadership qualities are usually valid for a leader who encourages others to do what is right, gives subordinates continuing education, and is an ethical and self-confident leader. Their staff nurses believed positive components of the leadership traits of nurse managers were sometimes true. Staff nurses were generally still deciding whether they were committed to their work effectively, continuously, or normatively. Nurse managers' leadership traits are significantly related to the staff nurses' affective, continuance, and normative commitment. Conclusion: Fostering positive leadership through education and supportive environments enhances staff nurse commitment and job satisfaction, reducing nurse turnover and improving nursing care quality. Keywords: commitment, leadership traits, leadership qualities, nurse manager, nurse staff

Role of Magnet®-recognized hospital nurse managers in implementing evidence-based practice: A mixed-method study.

Healthcare systems recognize evidence-based practice (EBP) as the prestigious standard for providing safe and high-quality patient care, nursing excellence, and Magnet Recognition. Despite the well-documented benefits, implementation of EBP is inconsistent and remains elusive in the US and throughout the world and many patients still fail to receive evidence-based care. The literature revealed a huge gap between nursing science and practice but provided evidence that nurse managers (NMs) had a pivotal leadership role in implementing EBP. To gain a deeper understanding of Magnet-recognized hospital nurse managers' (MRHNMs) leadership roles, the influencing factors, and their experience in implementing EBP to enhance EBP initiatives and sustain Magnet recognition. This mixed-method study guided by Goodall's (Australasian Psychiatry, 2016. 24, 231) theory of expert leadership used a sequential explanatory method with a quantitative-driven design based on a national correlational survey augmented by a qualitative descriptive component using semi-structured interviews. The findings of the study demonstrated that MRHNMs had a 54.6% effective leadership role in implementing EBP and produced numerous themes indicating that MRHNMs did implement EBP with struggle. MRHNMs in this study viewed EBP as a healthcare priority and leadership of NMs is necessary to promote EBP. However, lack of knowledge, difficulties with the EBP process, time constraints, and staffing issues negatively impacted EBP. Postgraduate degree, formal EBP education, critical care units as workplace, collaboration with doctorally prepared nurses, and Magnet culture enhanced EBP among MRHNMs. EBP is essential for Magnet recognition and is a hallmark of nursing excellence, however, is a complex and challenging process. The leadership of NMs is necessary to shape evidence-based care, and NMs require EBP preparation during leadership training, necessary resources, and time to complete the EBP process. EBP cannot become a reality without leaders being engaged, supportive, and persistent.

Nurses' Risk Perception of Adverse Events and Its Influencing Factors: A Cross-Sectional Study.

To investigate clinical nurses' perception of adverse event risk and to analyze its influencing factors. A proportional stratified random sampling method was applied to recruit nurses from a hospital in Shiyan City, Hubei Province, China. The Nursing Adverse Event Risk Perception Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout scale was used to investigate 1084 nurses. Univariate analysis, Pearson correlation analysis, and multiple linear regression analysis were used to analyze the influencing factors. The scores of the Nurses' Risk Perception of Adverse Nursing Event Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout Scale were 14.98 ± 5.39, 52.57 ± 10.00, 88.98 ± 21.08, 56.42 ± 5.03, 30.90 ± 21.49, respectively. According to the correlation analysis, nurses' perception of adverse nursing events was positively correlated with the sense of organizational support (r = .457, P < .01), head nurses' leadership behavior (r = .348, P < .01), and nurse safety behavior (r = .457, P < .01), and negatively correlated with the level of burnout (r = -.384, P < .01). According to the Regression analysis, nurses' departments (β = .226, P < .001), daily working hours (β = 1.122, P < .001), adverse events experience (β = -1.505, P < .001), organizational support (β = .105, P < .001), head nurses' leadership behavior (β = .072, P < .001), and burnout (β = -.052, P < .001) held an influence on nurses' risk perception of adverse nursing event. These factors explained 42.5% of the total variation. Nurses' risk perception of adverse nursing events needs to be improved. Nursing managers need to strengthen organizational support for nurses, change the leadership behavior of nurse managers, reduce nurses' burnout, improve nurses' risk perception of adverse nursing events, prevent adverse events, and ensure patient safety.

Relationship of the nursing practice environment with the quality of care and patients’ safety in primary health care

BackgroundNursing practice environment has impact on the quality of nursing care and on patients’ and nurses’ outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients’ outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal.MethodsWe conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing.ResultsNurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients’ safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients’ safety.ConclusionsThe perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses’ outcomes, improving the quality of nursing care to patients in the Primary Health Care units.

The Factors of Job Satisfaction Among Nurses

Introduction: Hospital as health service center must really pay attention to the importance of health services to patients that rely on human resources. Job satisfaction among nurses is one of the factors that contribute to maintaining the quality of health services. As health workers who are directly involved in providing care to patients, nurses have a very strategic role in meeting patient needs and creating a safe, comfortable, and effective care environment.&#x0D; Methods: Research uses an analytical survey design with a cross sectional approach. The population was all 559 nurses. The number of samples was 233, using the proportional sampling method. Data collection using questionnaires, has been tested for validity and reliability test with r value above 0.361. Analysis techniques using chi-square and binary logistic regression analysis.&#x0D; Results: Perception of the nursing manager leadership variable shows an average value of 2.31, which means that the nursing manager leadership is good category. Based on the Chi-Square results, it is known that nursing manager leadership, social support, work family conflict, have a significant relationship with nurse job satisfaction with a p value ≤0.05. Meanwhile, the gender variable does not have a significant relationship with nurses job satisfaction with p value&gt; 0.05 Multivariate analysis with ordinal regression test shows that social support with a p value = 0.00 &lt;0.25 and Wald (OR) value of 15.856 is the largest.&#x0D; Conclution: There is a significant relationship between leadership and job satisfaction of nurses and there is also a significant relationship between social support and job satisfaction of nurses.&#x0D; Keywords: Job Satisfaction, Manager, Leadership, Social Support, Nurses

Socio-demographic profiles and nurse practice environment among Filipino Staff Nurses

Background: COVID-19 is an unprecedented health crisis that has strongly shaken the whole world. There is a paucity of studies comparing the perception of the nurse practice environment in the Philippines. Aim: To determine Filipino nurses' practice environment and compare the respondents' perceptions according to socio-demographic profiles. Design: This study utilized a descriptive-comparative design, using the Practice Environment Survey- Nurse Work Index (PES-NWI). Results: Staff nurses perceived the most favorable perception of Nurse Manager Ability, Leadership, and Support of Nurses (x=3.3, SD=0.63), while, staffing and resources adequacy (x=2.8, SD=.71) were viewed as less favorable. The participants agree they experienced a favorable nurse practice environment (x=3.1, SD=0.59). There is no significant difference in the perception of the practice environment when grouped according to age (H=3.87, p =0.14), sex (U = 9855.50, z = -1.54, p =.125), civil status (H =.31, p =.96). educational attainment (H =2.58, p =.275) and committee involvement (U = 5913.50, z= -1.54, p =.123). A significant difference was observed when grouped according to the length of nursing practice (H =11.48, p =.043), nurse level (U = 10358.00, z= -2.52, p =.012), and area of assignment (H = 25.62, p =.002). Conclusion: The study demonstrates that the practice environment of Filipino nurses varied accordingly. Length of nursing practice, nurse level, and area of assignment impact nurses' perceptions of their practice environment. Recommendation: It is recommended to optimize the practice environment by providing continuous education and training programs, policies and work environments, and ensuring adequate staffing levels.

Impact of Nurse Manager Leadership Styles on Work Engagement: A Systematic Literature Review

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

간호⋅간병통합서비스 병동 간호사의 셀프리더십과 이직의도 관계에서 역할갈등의 매개효과

Objectives The purpose of this study is to confirm the mediating effect of role conflict in the relationship between self-leadership and turnover intention of nurses in the integrated nursing care service ward. Methods To this end, self-leadership, role conflict, and turnover intention were measured using a structured questionnaire targeting 114 nurses working in the integrated nursing care service ward of a general hospital with more than 300 beds located in 3 cities. The collected data were analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and regression analysis using the SPSS 25.0 program, and bootstrapping was used to verify the significance of the mediating effect. Results It was the total clinical experience of nurses that showed significant differences in self-leadership, role conflict, and turnover intention according to the general characteristics of the subjects. Self-leadership and turnover intention had a significant positive correlation Self-leadership and role conflict and role conflict and turnover intention had a significant positive correlation. Self-leadership had a significant effect of about β=.33 on turnover intention, and when role conflict was involved, it was found to have an effect of about β=.22, confirming the partial mediating effect of role conflict. Conclusions It was confirmed that when the self-leadership of nurses in the integrated nursing care service ward increased and exerted influence on themselves in an undesirable direction, role conflict increased and turnover intention increased. Therefore, there is a need to establish a nursing manager's leadership program and seek support measures so that nurses in the integrated nursing care service ward can exert influence on themselves in a desirable direction for self-leadership.

Establishment of Nurse Manager Leadership Competencies to Support Clinicians in Evidence-Based Practice

JONA: The Journal of Nursing Administration 52(10S):p S34-S41, October 2022. | DOI: 10.1097/NNA.0000000000001205

Unfinished nursing care reasons as perceived by nurses at different levels of nursing services: Findings of a qualitative study.

This study aimed to investigate reasons for unfinished nursing care across the whole levels of the nursing service as perceived by clinical nurses, ward managers and executive nurses. Even though unfinished nursing care has been considered an issue affected by the system, no studies to date have attempted to investigate reasons across the whole levels of the nursing service by involving clinical nurses, ward managers and executive nurses. A descriptive qualitative approach was performed in 2021 according to the COnsolidated criteria for REporting Qualitative research guidelines. A large public health care trust was approached, and a purposeful sample of clinical nurses, ward managers and executive nurses was invited to attend face-to-face or online interviews. Twenty-nine interviews were performed (19 clinical nurses, 7 ward managers and 3 executive nurses) and transcribed verbatim. Then, a content analysis was conducted by considering all narratives together followed by an analytic process to identify themes and subthemes at the clinical, ward manager and executive levels. Reasons for unfinished nursing care have emerged at five levels: system (e.g., poor support towards nursing care), unit (e.g., ineffective models of nursing care delivery), nurse managers (e.g., inadequate nurse manager leadership), nurses (e.g., weaknesses in education) and patients (e.g., increased demand for patients' care). The evidence available should be expanded to include also unfinished nursing care reasons identified at the system and at the ward manager levels, that both can complete the perceptions of the clinical nurses. The actors composing the nursing service perceive different reasons and therefore should be involved in detecting and contrasting the unfinished nursing care. The reasons applied or established at the upper level influence the bedside levels: Therefore, strategies to prevent or minimize the unfinished nursing care should be designed at multi-levels in a system-inclusive approach.

Pengembangan Kompetensi Kepemimpinan Perawat Manajer Melalui Panduan Kompetensi

This study aims to develop the leadership competence of nurse managers through guidelines. The method used is a case study, using an action research approach. The results showed that the head of the room needed leadership competency development on average 42% strongly agreed, 58% agreed. Analysis of the problem of optimizing the manager's leadership competence with the development of a draft guide to the manager's leadership competence as a desire to implement leadership. Conclusions, support from required fields, and things that are needed to achieve the development of a nurse manager leadership competency guide draft.&#x0D; &#x0D; Keywords: Leadership Competence, Guide Development, Nurse Manager

Impacts of Nursing Work Environment on Turnover Intentions: The Mediating Role of Burnout in Ghana.

Background The nursing practice environment supports excellence and decent work and has the influence to entice and retain the quality nursing workforce. Appreciating the dynamics that affect the turnover intention of RNs offer reasonable solutions to the challenges of the nursing shortage, which directly influence the quality of nursing care. There is a paucity of information on the impacts of these concepts among RNs in Sub-Saharan African. The study therefore aimed at determining the impacts of work environment and burnout on turnover intentions among RNs in Ghana. Methods A descriptive cross-sectional design using a simple random and proportionate stratified sampling with a sample of 232 RNs from Municipal and Regional Hospitals, Sunyani, West-Central part of Ghana completed validated instruments measuring work environment, burnout, and turnover intentions. Descriptive analysis was done to find out RNs' perceptions of their work environment and turnover intentions. Mediation analysis by Baron and Kenny's approach was used to determine the mediating effect of burnout on the relationship between the domains of PPE and the turnover intention of RNs. STROBE checklist was used as the reporting tool. Results While most RNs had a positive perception about their work environment, greater number of them had turnover intentions. There were significant associations between some nursing work environment facets and turnover intention. The results also showed a statistically significant relationship between nurse-physician relation (β = .353, t = 5.476, p ≤ .001), nurse manager leadership (β = −0.485, t = −8.192, p ≤ .001), nursing foundation for quality care (β = .400, t = 7.059, p ≤ .001), staffing and resource adequacy on (β = 0.485, t = 8.183, p ≤ .001), and turnover intention as mediated by burnout. Conclusion Burnout resulting from an unsafe work environment impact RNs' turnover intention. This phenomenon can potentially affect the human resource management and quality of nursing care. Policy strategies aimed at ensuring a professional practice environment and decreased burnout can therefore improve retention of RNs at their workplace.

Nurse managers leadership styles and intention to stay among nurses at the unit in Ghana.

Enabling effective leadership is significant in contemporary healthcare delivery. Nurse Managers' (NMs) leadership styles are a major predictor of nurses' retention. Using the 'Full Range Leadership' model as the organising framework, this study explored NMs leadership styles and their influence on intention to stay among nurses in Ghana. A quantitative cross-sectional design using the Multifactor Leadership Questionnaire (MLQ-5x), was used to explore nurses' intention to stay at their current workplace. Data were collected from 348 nurses in 38 selected hospitals and analysed using Pearson correlation and multiple linear regression. NMs exhibited different leadership styles based on the circumstance, but mostly used a participative leadership style, followed by transformational and transactional leadership styles. Nurses showed a high level of intention to stay. The intention to stay at the current workplace was high (3.26 out of 4) among nurses. The findings show that 85.6% of the nurses had intended to stay. The leadership styles of NMs jointly predicted 20.9% of the variance in intention to stay among nurses. Regular in-service training programs in leadership is critical for NMs to strengthen their leadership skills. NMs should be encouraged to widely use participative leadership styles to foster inclusiveness of staff in the unit.

The Effects of a Participatory Intervention in Mental Health Units on Nurses' Perceptions of the Practice Environment: A Mixed Methods Study.

The practice environment influences the quality of care and the nursing outcomes achieved in their workplaces. To examine the perception of the clinical practice environment among nurses working in mental health units in the context of their participation in an action research study aimed at improving the nurse-patient relationship. An explanatory sequential mixed methods study was designed. The data were collected in three phases in 18 mental health units (n = 95 nurses). Quantitative data were collected through the Practice Environment Scale of the Nursing Work Index, and qualitative data were collected through reflective diaries and focus groups in the context of participatory action research. The nurses' assessment of their practice environment shifted from positive to negative. Nurse manager leadership was the aspect that worsened the most. In addition, the perception of their participation in the affairs of the center and nursing foundations for quality of care decreased. The nurses considered it essential to be able to influence decision-making bodies and that the institution should promote a model of care that upholds the therapeutic relationship in actual clinical practice. Nurses perceived that they should be involved in organizational decisions and required more presence and understanding from managers. Furthermore, nurses stated that institutions should promote nursing foundations for quality of care. This study contributes to understanding how nurses in mental health units perceive their work environment and how it affects the improvement of the nurse-patient relationship in clinical practice.

Establishment of Nurse Manager Leadership Competencies to Support Clinicians in Evidence-Based Practice.

This 2-part study was conducted to validate nurse manager (NM) leadership competencies that support clinicians in using evidence-based practice (EBP). Numerous studies validate the critical need for NM support among clinicians seeking to engage in EBP. In phase 1, a Delphi study was conducted to establish the validity of a set of NM leadership competencies that support EBP. In phase 2, descriptive analyses, tests of significance, and reliability coefficients were used to assess reliability. An expert panel achieved consensus on a set of 22 NM leadership competencies that constitute effective support for EBP. Further quantitative analyses demonstrated excellent levels of internal consistency and overall consistent outcomes across time. A valid set of 22 NM leadership competencies with evidence of reliability that successfully support clinicians to engage in EBP in clinical settings was established.

Exploring the Factors Influencing Saudi Nurses' Intentions to Leave Critical Care Units in Government Hospitals at Qassim Region

The health system is based on major pillars that it cannot continue without, the most important of which are doctors and qualified nursing staff. The departure of nursing staff is one of the dilemmas that threaten the health system. Another place, especially leaving work in intensive care. The current scoping review aims to identify relevant evidence related to the factors influencing nurses' intentions to leave critical care units at governmental hospitals at Saudi Arabia. In this study, the researcher explored that some factors were not covered, so the most of the knowledge gap regarding the factors that contribute to nurses’ intentions to leave their current occupations in critical care units at governmental hospitals in Saudi Arabia, are motivation and communication among staff members. As well as, conflict among staff members, Nurse Manager Ability, leadership and support of nurses, and nurse-physician relationships are some of the important factors that contribute to nurses’ intentions to leave their current occupations that needs to be studied.