Abstract The leadership practices of nurse managers and the association with nursing staff retention and the promotion of quality care in two Saskatchewan hospitals? Doctor of Philosophy, 2009, Karen Eisler Graduate Department of Faculty of Nursing, University of Toronto The purpose of this descriptive correlational study was to explore the relationship between nurse managers’ leadership practices as measured by Kouzes and Posners’ (2001) Leadership Practice Inventory and staff nurses’ intent to leave the job, absenteeism, medication errors and the quality of care. A total of 450 RNs and LPNs responded to a mailed survey. The respondents were representative of the target population; 54% were 46 years of age or older, 81% RNs and 19% LPNs, 95% female, over 65% had at least 11 years of nursing experience, and 65% worked fulltime. Staff nurses gave low ratings of their managers’ use of the five transformational leadership practices. There was a weak or non significant relationship between the five leadership practices and staff nurses’ intent to leave, absenteeism or medication errors. Results of hierarchical multiple regression analyses revealed that some of the leadership practices had a significant positive relationship with perceived quality of patient care and nursing care on the unit. The strongest predictors of quality of patient care (23% of the variance) were the leadership practices, Challenge the process, Inspire a shared vision, Enable others to act and Model the way. The strongest predictors of the quality of nursing care (16% of the variance) were the leadership practices, Model the way and Challenge the process. The results of this study indicated that managers’ use of transformational leadership practices can affect the staff nurses’ perception of the quality of patient care and nursing care on a unit. It is important that nurse managers develop leadership practices to promote high quality care in Saskatchewan hospitals.

Abstract The leadership practices of nurse managers and the association with nursing staff retention and the promotion of quality care in two Saskatchewan hospitals? Doctor of Philosophy, 2009, Karen Eisler Graduate Department of Faculty of Nursing, University of Toronto The purpose of this descriptive correlational study was to explore the relationship between nurse managers’ leadership practices as measured by Kouzes and Posners’ (2001) Leadership Practice Inventory and staff nurses’ intent to leave the job, absenteeism, medication errors and the quality of care. A total of 450 RNs and LPNs responded to a mailed survey. The respondents were representative of the target population; 54% were 46 years of age or older, 81% RNs and 19% LPNs, 95% female, over 65% had at least 11 years of nursing experience, and 65% worked fulltime. Staff nurses gave low ratings of their managers’ use of the five transformational leadership practices. There was a weak or non significant relationship between the five leadership practices and staff nurses’ intent to leave, absenteeism or medication errors. Results of hierarchical multiple regression analyses revealed that some of the leadership practices had a significant positive relationship with perceived quality of patient care and nursing care on the unit. The strongest predictors of quality of patient care (23% of the variance) were the leadership practices, Challenge the process, Inspire a shared vision, Enable others to act and Model the way. The strongest predictors of the quality of nursing care (16% of the variance) were the leadership practices, Model the way and Challenge the process. The results of this study indicated that managers’ use of transformational leadership practices can affect the staff nurses’ perception of the quality of patient care and nursing care on a unit. It is important that nurse managers develop leadership practices to promote high quality care in Saskatchewan hospitals.

As nursing leaders, nurse managers are critical to the future of the healthcare system, as well as the nursing profession. Becoming a new manager or leader requires considerable development (Conners, Dunn, Devine, & Osterman, 2007); however, there is limited literature that focuses on the development of the nurse manager (Cadmus & Johansen, 2012). The purpose of this study was to explore the development of self-efficacy in nursing leaders, specifically new nurse managers. Albert Bandura’s (1997) self-efficacy theory was used to guide this study. Qualitative content analysis was used to analyze the data. Two themes emerged from the data, describing experiences of self-efficacy, and the development of self-efficacy. A positive connection between experiencing a mentoring relationship and perceived self-efficacy emerged from the data. The findings of this study provide healthcare stakeholders an in-depth understanding of the importance of mentoring and it outcomes related to the development of self-efficacy in new nurse managers.

Moral distress is a negative emotional and somatic response to external constraints on moral action. The constraints are typically identified as a component of the work environment, called the ethical climate. Moral distress is identified as a primary reason for job attrition by up to one-quarter of registered nurses who leave their jobs. One strategy suggested to staff nurses who experience moral distress is to consult their Nurse Manager (NM). However, the moral distress of NMs who are employed in acute care hospitals is poorly understood. The purpose of this qualitative study was to examine NMs' perceptions of the external constraints on moral agency, specifically the hospital ethical climate, which leads to their experience of moral distress and how attributes of the ethical climate facilitated or impeded resolution of their moral distress. Semi-structured, audio-recorded telephone interviews were conducted with 17 NMs from across United States. An interpretive description design using an iterative process between data collection and data analysis was used. Data were analyzed through descriptive coding and thematic analysis. The participants in this study were 15 women and 2 men with a mean age of 46.4 years. The mean length of time in their current positions was slightly less than 5 years. Of the 17 hospitals represented, 6 were affiliated with a university and 4 had a religious affiliation. Fifteen of 17 NMs described situations in which the implicit and explicit values of the hospital were incongruent with their personal moral values and professional ethics. Common themes describing factors contributing to moral distress were administrative policies, negative communication patterns and relationships with physicians, issues related to staff nurses, issues related to patients and families, and multiple competing job obligations. Respondents described strategies to navigate through their moral distress. The strategies included taking a positive perspective, seeking the advice of NM colleagues, reliance on a positive relationship with a supervisor, and talking it through with family members. For 5 of the 15 NMs who experienced moral distress, their final strategy included plans to resign from their positions. Issues within the ethical climate of the hospital that were perceived to contribute to the development of moral distress among this cohort of NMs differed from those reported for staff nurses. Further examination of strategies used by NMs to improve the ethical climate may yield insights into effective ways to address moral distress for this population.

Indiana University-Purdue University Indianapolis (IUPUI) / The implementation of evidence into practice is a complex process. Estimates indicate that it takes seventeen years on average for research to be translated into practice. Delay in implementation of evidence-based practice (EBP) results in poor patient outcomes and negative impacts to healthcare systems. While many factors contribute to delayed implementation of evidence, organizational characteristics of healthcare institutions have a significant impact on implementation. Leaders play a critical role by influencing these organizational characteristics to support evidence-based practice implementation. A key leadership role within acute care healthcare organizations is that of the front-line nurse manager (NM). Front-line nurse managers have responsibility for nursing unit operations and clinical nurses who deliver patient care under the nurse managers supervision. The relationship between NM leadership competencies and implementation of EBP is not well understood. Therefore, there is a critical need to identify how NM leadership behaviors influence the implementation of EBP. This dissertation examined the relationship between NM leadership behaviors and implementation of EBP. Results link the role of the NM to evidence-based clinical practice, and describe competencies and education needed for NM development. With an understanding of the NM leadership behaviors associated with implementation of EBP, healthcare leaders can develop education, processes, and interventions to increase competencies on NM leadership behaviors. Better implementation support by NMs will result in an improvement in use of EBPs. To examine the NM leadership behaviors that are associated with implementation of EBP, the following activities were completed: (1) an integrative review of the literature related to NM competencies associated with implementation, (2) identification and description of nurse manager competencies associated with EBP implementation using the Delphi method, and (3) examination of NM leadership behaviors associated with implementation of EBP during the COVID-19 pandemic response through a multi-site descriptive correlational survey of NMs and their nursing staff. Results of these studies demonstrate the importance of NM leadership characteristics and behaviors on EBP implementation.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18195号 / 人健博第12号 / 新制||人健||1(附属図書館) / 31053 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 任 和子, 教授 若村 智子, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Nurse managers face numerous challenges and stressors in their daily practice. The support services offered to managers to facilitate coping in stressful situations vary among employers and may be ineffective depending on the stressors faced. Implementation of evidence-based best practices may positively impact nurse managers' ability to manage stress. The purpose of this project was to develop an evidence-based stress reduction education program to empower nurse managers to handle work-related stressors and reduce burnout. The primary theory used to inform this project was the job demands-resource model, which explains how job demands and resources have multiple effects on job stress, ultimately impacting a worker's level of engagement. Sources of evidence included peer-reviewed journals, evidence-based studies, and published documents or programs. Education was synthesized based upon evidence obtained during the literature review. Consistent with the evidence, topics covered in the education were; nurse manager-initiated methods of stress reduction, methods of modifying a workplace environment to decrease stress, nurse manager peer support, senior leadership involvement in nurse manager stress reduction, and the inclusion of future leader development as a stress management method. The focused learning objectives were nurse manager specific, measurable, and supportive of an adult learner. The social change impacted by this project will be derived from fostering a nurse managers ability to better cope with stressful situations, thus enhancing their role as a nursing leader.

Building on a previous 1994 study, this descriptive study reflects on the ever-shifting sands of the nurse manager role. This national survey is based on the Katz (1955) conceptual framework of interrelated technical, human and conceptual competencies. An instrument developed by the investigator for determining important nurse manager competencies was validated using an expert panel of AONE nurse manager Fellows. The research used a web-based survey to collect information from hospital nurse managers via a self-administered competency instrument. Eighty one completed the online survey with complete data for a response rate of thirteen percent. Findings suggest the highest self-reported nurse manager competency ratings included effective communication, retention strategies, effective discipline and decision-making. In contrast, the lowest self-reported nurse manager competencies included nursing theory, case management and the research process. The associations of nurse manager competencies with individual and organizational variables were studied. The impact of organizational variables of hospital size and span of control had a medium effect. Magnet status impact was unremarkable. Individual variables of gender, age, education, tenure as an RN, and tenure in current position also did not significantly impact competency ratings. A large and medium effect was noted between tenure in the management role on all the competency ratings within the five constructs. The Chase Nurse Manager Competency Instrument underwent psychometric testing as none had been done since the original 1994 study. The 1994 and the 2010 study data was used to determine reliability and validity assessments with positive results. A crosswalk was also completed between the Chase Instrument and the 2005 AONE Nurse Manager Leadership Collaborative Framework and due to the similarities in the five categories the Chase Instrument was revised to reflect the parallel similar headings support the consistencies between the models. Study findings reveal Nurse managers have to deal with finance and budgeting, patient safety, quality improvement, staff retention, and many other tough topics. They are expected to achieve a blend of clinical and business management with little to no training. Based on the findings the following ten recommendations are provided and include, Provide realistic expectations of the role; Provide a skill assessment and form a plan based on competency development; Provide a structured orientation and development program which includes 30/60/90 day checkpoints; Establish long term mentorship building on the key ingredients of inspiration and role modeling; CNO involvement is critical; Teach Influence; Teach implementation strategies; Create the culture; Invest in Nurse Manager support for Development of Staffing, Financial Acumen and Compliance; Enhance communication skills at every level. Among nursing leadership, the nurse manager role has been identified as critical in the provision of high-performing, effective and efficient care in the patient care delivery setting. This individual is the unit-based CEO responsible for quality, safety, satisfaction and financial performance in alignment with regulatory and accrediting body requirements. Excellence in horizontal and vertical communication is required as this role represents the voice of the direct care nurse at the leadership table as well as the voice of the board of trustees at the unit level.

As a result of the chronic nursing shortage, the ongoing retirements of an aging generation, and a general lack of interest from nurses to become nurse managers, there is valid concern around the development and sustainability of future nurse managers. The purpose of this qualitative study was to explore nurse managers’ perceptions and experiences of assuming a nurse manager position. In addition, the study highlights the organizational leadership practices that influenced nurses to become nurse managers. Using a modified version of Collings and Mellahi’s (2009) strategic talent management framework, two major themes emerged from the data giving insight into nurses becoming nurse managers. Broadening a nurse’s professional lens was considered by nurse managers to be an important theme relevant to understanding factors that motivated participant’s to become nurse managers. Shaping a nurse’s career path was the second theme that captured the leadership practices of existing leaders that influenced nurse’s becoming a nurse manager. The findings of this research were consistent with the literature related to understanding work motivations, as well as effective leadership practices believed to support career aspirations in nursing leadership. Implications for nursing leadership and practice were shared; recommendations for further research were discussed.

MCur / Department of Advanced Nursing Science / Professional nurses have the responsibility of supervising the care that is rendered, the nursing personnel and patients throughout 24 hours of the day, for the purpose of ensuring quality patient care and patient safety. However, it seems that this is not happening as expected because there are continuous complaints from the patients about the poor quality of care. This study was aimed at exploring the challenges that are encountered by professional nurses during supervision of care in the district hospitals of Vhembe. A qualitative study was conducted which was explorative, descriptive, contextual and guided by an Appreciative inquiry approach. A purposive sample was used where thirty-six (36) participants were recruited and consent was obtained. Individual semi structured interviews were conducted. Data was analysed according to Tesch‟s eight steps. Trustworthiness was ensured through following the principles which are credibility, dependability, confirmability, transferability and authenticity. The findings revealed multiple challenges that professional nurses encountered during supervision of care. The main themes found were lack of resources, challenges related to the supervisees, cultural changes in nursing affecting supervision, and challenges related to education and training. Apart from challenges, there were positive aspects verbalised that enhance supervision The researcher recommended that nursing practice through the Department of Health should address issues such as shortage of staff, shortage of equipment and inadequate and/or poor infrastructure. Professional nurses should be trained on diversity management and emotional intelligence in order address the ever changing culture in nursing. Students‟ accompaniment and clinical exposure should be addressed. Future research should be conducted to outline what causes these challenges in supervision in other districts so that the findings could be representable. / NRF