<p><strong>A</strong><strong>BSTRACT</strong></p> <p>In healthcare organizations, the first–line nurse manager role is pivotal. The role links management and employees, and has a direct impact on organizational performance, including quality of care, financial stability, and patient satisfaction (Gallo, 2007). The first-line nurse manager interfaces with a variety of professions including physicians, and is expected to be clinically proficient, and to demonstrate non-nursing knowledge in areas such as labour relations, information technology, financial and business management (Gould, Kelly & Maidwell, 2001). When retirement projections are applied to the first-line nurse manager population, Canada will face a serious nursing management shortage this decade (CNA, 2009). In light of the paucity of research studies pertaining to this subject, an exploratory descriptive qualitative research study was conducted in a large regional health care organization in Central South Ontario to determine the factors that attract and retain Registered Nurses in this role. The findings revealed a discrepancy between the factors that attract and retain Registered Nurses in the first-line nurse manager role, underscored the importance of the mentor role, and confirmed the challenges encountered by first-line nurse managers practicing in the current healthcare environment. Several recommendations are presented at the individual, program, organization and policy levels to inform Registered Nurses who are interested in pursuing a career in nursing management, and to assist healthcare leaders to create environments that attract and support Registered Nurses in this important role.</p> / Master of Science (MSc)

<p>Bakgrund: Sjuksköterskor är genom författningar ålagda att utföra sitt arbete i enlighet med vetenskap och beprövad erfarenhet. Omvårdnadsforskning har ökat i omfattning men resultaten har inte omsatts i praktisk användning i lika stor utsträckning. Betydelse har sjuksköterskans inställning, typ av ledarskap, organisationens förväntningar men också traditionen av att inte betrakta sjuksköterskeyrket som akademiskt.</p><p>Syftet med studien var att undersöka dels avdelningschefers, dels sjuksköteskors/barnmorskors inställning till forskningsanvändning samt att undersöka om skillnader fanns i utbildningsnivå, ledningsstöd och forskningsanvändning.</p><p>Metoden var en beskrivande och jämförande tvärsnittsundersökning. Respondenterna bestod av samtliga avdelningschefer (n=50) anställda på tre landstingsdrivna akutsjukhus i Mellansverige och samtliga sjuksköterskor (n=284) på vårdavdelningar på ett av dessa sjukhus. Svarsfrekvens 79% respektive 63%. En enkät bestående av delar av etablerade instrument samt frågor utarbetade av författarna användes. Data bearbetades statistiskt i SPSS, icke- parametriska test valdes eftersom data var på ordinalskalenivå.</p><p>Resultatet av undersökningen visade att sjuksköterskor med utbildning i omvårdnadsvetenskap ≥ 40 poäng hade mer positiv inställning till forskning och utveckling inom omvårdnad. Fler sjuksköterskors faktiska forskningsanvändning ökade om avdelningschefen hade en positiv inställning. Ingen skillnad i sjuksköterskors inställning till forskning och utveckling inom omvårdnad kunde ses i förhållande till om avdelningschefens inställning var positiv eller negativ. Avseende ledningsstöd hade avdelningschefer och sjuksköterskor skilda uppfattningar om vilket stöd som fanns tillgängligt. Exempelvis ansåg 47 % av sjuksköterskorna att avdelningschefen stödjer sjuksköterskor som vill bedriva vårdutveckling medan 87 % av avdelningscheferna ansåg att så gjordes.</p><p>Konklusion: Resultatet indikerar att om avdelningschefen har positiv inställning till forskning och utveckling inom omvårdnad samt att sjuksköterskor har minst 40 poängs utbildningsnivå i omvårdnadsvetenskap ökar det möjligheten för sjuksköterskor att arbeta med forskningsrelaterade aktiviteter.</p> / <p>Background: Nurses are ruled by statutes to carry out nursing in accordance with science and proven experience. The extent of nursing research has increased but the implementation of research results in nursing practice has not increased to the same degree. Important in this context are the nurses’ attitudes, type of leadership, organizational expectations and also the tradition of not viewing the nursing as an academic profession.</p><p>The aim of the study was to investigate nurse managers’, nurses’/midwives’ attitudes towards research and development within nursing, and to study if there were differences in level of education, management, support and utilisation of research.</p><p>Method: The design was a descriptive, cross-sectional study using parts from an established instrument (questionnaire) completed with questions constructed by the authors. The respondents were all nurse managers (n=50) in three county council hospitals in a province in mid-Sweden and all nurses (n=284) in the wards of one of the hospitals. The response rate was 79% respectively 63%. Data were analysed with the software Statistical Package for Social Sciences, SPSS. Non-parametric tests were used to analyse the ordinal data.</p><p>The results of the study showed that nurses with an education in nursing science comprising 40 or more (Swedish) credit points had a more positive attitude towards research and development within nursing. The nurses’ actual research use increased if the nurse manager had a positive attitude towards research and development within nursing. No difference in nurses’ attitudes towards research and development within nursing could be seen in relation to whether the nurse manager had a positive or negative attitude. With regard to management support the nurse managers and nurses had different opinions about the availability of support. For example, 47 % of the nurses believed that the nurse managers support nurses who want to develop the nursing care while 87 % of the nurse managers believed so.</p><p>Conclusion: The results indicate that when the nurse manager has a positive attitude towards research and development within nursing, and when nurses have an education of at least 40 credit points in nursing science, the possibility for nurses to work with research related activities increases.</p>

<p>The aim was to study personal and organizational conditions for first-line nurse managers and to identify and assess the skills and abilities important for leadership and management. Interviews were conducted with 5 first-line nurse managers, 5 registered nurses, 5 assistant nurses and one head of department delineating their perceptions of current and ideal roles of first-line nurse managers. Factor analysis was conducted to estimate validity and reliability of the Leadership and Management Inventory, developed in the context of this thesis, in one sample of 149 registered nurses and one sample of 197 health care personnel. Interviews and questionnaires to study expectations, experiences and outcomes of two different development programmes for 13 first-line nurse managers in a Training Programme, 14 in a Leadership Development Programme and 14 in a Comparison group were conducted. Letters and questionnaires from 32 former first-line nurse managers were analysed to describe their reasons for leaving their posts. First-line nurse managers, registered nurses and assistant nurses’ descriptions of the first-line nurse manager’s role were corresponding; the main focus was on service on the ward. The head of department described the first-line nurse manager’s responsibility towards the staff with focus on development and co-operation. Analysis of the Leadership and Management Inventory resulted in three factors: “interpersonal skills and group management”, “achievement orientation” and “overall organizational view and political savvy”. Validity and reliability were considered acceptable. Expectations concerning the development programmes were generally met; improvements corresponding to the content of the programmes were reported. Reasons to leave were personal, organizational and linked to the relationship with the head of department. Conclusion: The first-line nurse managers’ individual experiences, skills, abilities and ambitions are important, but so are the conditions in which she/he practices her/his leadership and management. It is important that the interplay between person and organization functions well.</p>

The aim was to study personal and organizational conditions for first-line nurse managers and to identify and assess the skills and abilities important for leadership and management. Interviews were conducted with 5 first-line nurse managers, 5 registered nurses, 5 assistant nurses and one head of department delineating their perceptions of current and ideal roles of first-line nurse managers. Factor analysis was conducted to estimate validity and reliability of the Leadership and Management Inventory, developed in the context of this thesis, in one sample of 149 registered nurses and one sample of 197 health care personnel. Interviews and questionnaires to study expectations, experiences and outcomes of two different development programmes for 13 first-line nurse managers in a Training Programme, 14 in a Leadership Development Programme and 14 in a Comparison group were conducted. Letters and questionnaires from 32 former first-line nurse managers were analysed to describe their reasons for leaving their posts. First-line nurse managers, registered nurses and assistant nurses’ descriptions of the first-line nurse manager’s role were corresponding; the main focus was on service on the ward. The head of department described the first-line nurse manager’s responsibility towards the staff with focus on development and co-operation. Analysis of the Leadership and Management Inventory resulted in three factors: “interpersonal skills and group management”, “achievement orientation” and “overall organizational view and political savvy”. Validity and reliability were considered acceptable. Expectations concerning the development programmes were generally met; improvements corresponding to the content of the programmes were reported. Reasons to leave were personal, organizational and linked to the relationship with the head of department. Conclusion: The first-line nurse managers’ individual experiences, skills, abilities and ambitions are important, but so are the conditions in which she/he practices her/his leadership and management. It is important that the interplay between person and organization functions well.

Bakgrund: Sjuksköterskor är genom författningar ålagda att utföra sitt arbete i enlighet med vetenskap och beprövad erfarenhet. Omvårdnadsforskning har ökat i omfattning men resultaten har inte omsatts i praktisk användning i lika stor utsträckning. Betydelse har sjuksköterskans inställning, typ av ledarskap, organisationens förväntningar men också traditionen av att inte betrakta sjuksköterskeyrket som akademiskt. Syftet med studien var att undersöka dels avdelningschefers, dels sjuksköteskors/barnmorskors inställning till forskningsanvändning samt att undersöka om skillnader fanns i utbildningsnivå, ledningsstöd och forskningsanvändning. Metoden var en beskrivande och jämförande tvärsnittsundersökning. Respondenterna bestod av samtliga avdelningschefer (n=50) anställda på tre landstingsdrivna akutsjukhus i Mellansverige och samtliga sjuksköterskor (n=284) på vårdavdelningar på ett av dessa sjukhus. Svarsfrekvens 79% respektive 63%. En enkät bestående av delar av etablerade instrument samt frågor utarbetade av författarna användes. Data bearbetades statistiskt i SPSS, icke- parametriska test valdes eftersom data var på ordinalskalenivå. Resultatet av undersökningen visade att sjuksköterskor med utbildning i omvårdnadsvetenskap ≥ 40 poäng hade mer positiv inställning till forskning och utveckling inom omvårdnad. Fler sjuksköterskors faktiska forskningsanvändning ökade om avdelningschefen hade en positiv inställning. Ingen skillnad i sjuksköterskors inställning till forskning och utveckling inom omvårdnad kunde ses i förhållande till om avdelningschefens inställning var positiv eller negativ. Avseende ledningsstöd hade avdelningschefer och sjuksköterskor skilda uppfattningar om vilket stöd som fanns tillgängligt. Exempelvis ansåg 47 % av sjuksköterskorna att avdelningschefen stödjer sjuksköterskor som vill bedriva vårdutveckling medan 87 % av avdelningscheferna ansåg att så gjordes. Konklusion: Resultatet indikerar att om avdelningschefen har positiv inställning till forskning och utveckling inom omvårdnad samt att sjuksköterskor har minst 40 poängs utbildningsnivå i omvårdnadsvetenskap ökar det möjligheten för sjuksköterskor att arbeta med forskningsrelaterade aktiviteter. / Background: Nurses are ruled by statutes to carry out nursing in accordance with science and proven experience. The extent of nursing research has increased but the implementation of research results in nursing practice has not increased to the same degree. Important in this context are the nurses’ attitudes, type of leadership, organizational expectations and also the tradition of not viewing the nursing as an academic profession. The aim of the study was to investigate nurse managers’, nurses’/midwives’ attitudes towards research and development within nursing, and to study if there were differences in level of education, management, support and utilisation of research. Method: The design was a descriptive, cross-sectional study using parts from an established instrument (questionnaire) completed with questions constructed by the authors. The respondents were all nurse managers (n=50) in three county council hospitals in a province in mid-Sweden and all nurses (n=284) in the wards of one of the hospitals. The response rate was 79% respectively 63%. Data were analysed with the software Statistical Package for Social Sciences, SPSS. Non-parametric tests were used to analyse the ordinal data. The results of the study showed that nurses with an education in nursing science comprising 40 or more (Swedish) credit points had a more positive attitude towards research and development within nursing. The nurses’ actual research use increased if the nurse manager had a positive attitude towards research and development within nursing. No difference in nurses’ attitudes towards research and development within nursing could be seen in relation to whether the nurse manager had a positive or negative attitude. With regard to management support the nurse managers and nurses had different opinions about the availability of support. For example, 47 % of the nurses believed that the nurse managers support nurses who want to develop the nursing care while 87 % of the nurse managers believed so. Conclusion: The results indicate that when the nurse manager has a positive attitude towards research and development within nursing, and when nurses have an education of at least 40 credit points in nursing science, the possibility for nurses to work with research related activities increases.

This study proposed an activity competency model (ACM) to investigate the perceived importance of managerial activities and skills required of three levels of nurse managers from three levels of hospitals. A survey instrument was designed based on the ACM for data collection that encompasses forty-two initial nursing management activities and twelve managerial skills required to effectively perform these management activities that were identified through literature review, job analysis, and iterative personal interviews with domain experts. Our findings indicate that the importance of nurse managerial activities is significantly different from the levels of management, but not significantly different from the levels of hospitals. In particular, top and middle levels of management perceived the human resources management related activities as more important than the supervisory management. Middle management perceived the importance of operation management significantly higher than supervisory management. Top management perceived the importance of goal setting & planning significantly higher than middle management. Middle management perceived the importance of goal setting & planning significantly higher than supervisory management. Supervisory management perceived the importance of material & environment management significantly higher than top and middle managements. The results from this study provide implication guidelines for management development programs, training, and the career planning for nurse managers. They also can serve as guideline for recruiting and selecting the effective nurse managers.

To enable the nurse at least to perform her profession at a standard level, she needs not only material equipment, but also most of all the moral support of her superiors. Sufficient knowledge and experience are important for that profession as well. Another important aspect is to be able to see the meaningful tasks of her work and to have a feeling of certainty. My work has got three targets, which are: Target 1: To show, how the nurses of the middle management motivate their juniors to make them work more efficiently. Target 2: To analyze experience of middle management nurses with a team management. Target 3: To show whether, and in which way the nurses in the middle management motivate their juniors to increase their professional competence. I have used a qualitative research method for my study. A technique of an in-depth discussion was used for the collection of data. The research group contained 14 nurses in chief positions. The statements of individual nurses were categorized. They were divided into six basic groups, which are: Motivation factors, de-motivation factors, composition of the working team, work in a team, education and registration.

There is a high cost to nurse manager turnover and added to this challenge is the difficult tasks that hospitals have of recruiting and retaining nurse managers. These difficulties make it challenging for healthcare providing institutions to achieve consistent positive patient and staff outcomes. The current study examined the relationship between self-leadership, authentic leadership, and job satisfaction with nurse managers. Three elements making up the theoretical framework of this research were self-leadership, authentic leadership, and job satisfaction. The 2 predictor variables were self-leadership and authentic leadership. An evaluation of whether a relationship existed between the predictors and the criterion, job satisfaction, was made. A total of 76 nurse managers completed an online survey, and a linear regression was used to analyze the data. Results indicated that self-leadership was not a statistically significant predictor of job satisfaction at a CI of 95%. Authentic leadership and 3 of its 4 dimensions were found statistically significant as a predictor of job satisfaction at a CI of 95%. This study may have implications for positive social change through its indirect effect on the management and execution of patient care.

Healthcare leaders must establish a just culture to mitigate preventable medical deaths that occur at 250,000 per year, making medical errors the 3rd leading cause of death in the United States. However, there is a gap in knowledge regarding the attributes of nurse manager leadership styles that contribute to promoting a just culture at the unit level. Guided by the full range leadership theory and the just culture model, the purpose of this descriptive correlational study was to determine the relationship between nurse manager transformational, transactional, and laissez-faire leadership styles and unit level just culture perceptions and the differences between staff nurses’ and nurse managers’ perceptions of leadership styles and just culture. The Multifactorial Leadership Questionnaire and the Just Culture Assessment tool were administered to 165 U.S. hospital-based staff nurses and nurse managers. ANOVA revealed a statistically significant difference in the mean just culture scores between transformational, transactional, and/or laissez-faire leadership styles (p < .01). MANOVA outcomes were significant for the difference between the nursing staff’s and nurse managers’ perceptions of nurse managers’ leadership styles (p < .01). This study promotes positive social change identifying transformational and transactional nurse manager leadership skills as a predictor for maintaining a unit level just culture and clarifying the impact of nurse managers’ leadership styles on perceptions of patient safety among frontline nurses and hospital safety. Future research should focus on exploring the relationship between nurse-sensitive patient outcomes such as pressure injuries and hospital-acquired infections along with the unit level just culture and nurse manager leadership styles.

Military health care organizations need competent frontline managers with knowledge and skills to manage health care complexity and ensure evidence-based practice. With systematic, planned turn over of military managers, more civilian managers are needed to fill permanent positions in military hospitals. The purpose of this project was to provide a better understanding of the competencies perceived by nurse managers at a military medical center and whether they differed by military or civilian status. The American Organization of Nurse Executives competency model and framework provided the theoretical framework for the project. The design was nonexperimental, with an observational, descriptive, cross-sectional approach. The Chase Nurse Manager Competency Instrument was used to collect data from 53 military and civilian nurse managers who ranked the top 10 competencies needed for effective leadership. The top competencies chosen by the managers were the knowledge and ability to use effective communication, decision making, problem solving, nursing practice standards, time management, and effective staffing strategies. Using t test statistics, only minimal differences were identified between military and civilian nurse managers' perceptions of the top competencies, which allows the medical center to create one integrated leadership curriculum to assist in the development of a competent, unified leadership team of civilian and military managers. Social change to improve patient outcomes can occur within military health care organizations by assessing and developing leadership competencies in all nurse managers to ensure reliable cultures of safety, quality, and value-based productivity within their military hospital environments.