Le leadership clinique infirmier au point de dispensation des soins est important afin d’assurer des soins de qualité et sécuritaires dans les organisations de santé (ACN, 2015 ; RNAO, 2013). Des études mettent en évidence qu’un leadership exercé par l’ensemble des professionnels de la santé, qui prennent la responsabilité individuelle et collective d’offrir des soins efficaces et de haute qualité, serait plus adapté aux réalités contemporaines des milieux de soins (West et al., 2014 ; West et al., 2015). Or, le leadership clinique des infirmières est, jusqu’à ce jour, étudié selon des rôles spécifiques, ce qui ne permet pas de comprendre comment l’ensemble des infirmières d’une unité de soins exercent leur leadership au point de dispensation des soins. Le but de l’étude était de décrire l’exercice du leadership clinique infirmier dans des unités de soins hospitaliers, les facteurs qui le favorisent et ceux qui le contraignent, ainsi que la perception qu’ont les infirmières des résultats de cet exercice du leadership pour les patients, les infirmières, l’équipe interprofessionnelle et l’organisation. Pour soutenir cette étude, l’adaptation du modèle pour le développement et le maintien du leadership proposé par l’Association des infirmières et infirmiers autorisés de l’Ontario [RNAO] (2013) a été réalisée en y intégrant les pratiques de leadership clinique énoncées par Patrick et al. (2011). Une étude de cas multiple (Stake, 1995; 2016) a été réalisée auprès de trois équipes infirmières dans un centre hospitalier universitaire québécois. L’échantillon (N = 36) se composait de 22 infirmières soignantes, de 7 assistantes infirmières-chefs, de 4 infirmières en pratique avancée et de 3 infirmières-chefs d’unité. Trente-six entrevues, 120 heures d’observation ainsi qu’une analyse documentaire ont été effectuées. Une analyse pour chaque cas (Paillé et Mucchielli, 2016) et transversale (Stake, 2016) a permis la formulation de thèmes et une modélisation de l’exercice du leadership clinique infirmier. Nos résultats indiquent que le leadership clinique infirmier se manifeste sous cinq formes actives, quel que soit le rôle de l’infirmière sur l’unité : 1) prendre des initiatives de l’ordre de la pensée réflexive et de l’intervention ; 2) influencer l’atteinte des objectifs de soins du patient/famille et le développement professionnel des collègues en leur offrant du coaching ; 3) participer et mobiliser ses collègues à contribuer à des activités d’amélioration de la qualité des soins ; 4) s’impliquer afin de promouvoir une synergie et une cohésion d’équipe optimale ; 5) mobiliser des capacités personnelles et collaboratives. Des ressources multiniveaux, une organisation du travail qui prône l’autonomie professionnelle, le leadership clinique ainsi qu’un climat de travail positif seraient favorables à l’exercice du leadership. Finalement, les infirmières perçoivent de multiples résultats positifs (ex. : diminution des complications des patients, développement professionnel des infirmières). Cette étude propose une perspective collective du leadership clinique infirmier dans des unités de soins hospitaliers, met en évidence son effet de levier pour celui-ci ainsi que pour l’atteinte de résultats positifs. Elle propose aussi une modélisation pouvant servir d’outil pragmatique. Plusieurs pistes de réflexion et d’interventions sont présentées pour la gestion, la formation, la recherche et la pratique. / Clinical nursing leadership at the point of delivery of care is important to ensure safe, quality care in health care organizations (ACN, 2015; RNAO, 2013). Recent studies show that a leadership exercised by the entire team of health professionals, taking individual and collective responsibility for providing effective and high quality care, would be more suited to the contemporary realities of care settings (West et al., 2014; West et al., 2015). However, up until now, clinical leadership of nurses has only been studied according to specific roles. This does not allow us to understand how all the nurses working in a care unit exercise their leadership at the point of delivery of care. The aim of the study is to describe the exercise of clinical nursing leadership in the context of hospital care units, the factors that favor and those that constrain it, and how nurses perceive the effects of this exercise of leadership on patients, nurses, the interprofessional team and the organization. To support this study, the conceptual model for the development and maintenance of leadership proposed by the Registered Nurses Association of Ontario [RNAO] (2013) was adapted by incorporating clinical leadership practices identified by Patrick et al. (2011). A multiple case study (Stake, 1995; 2016) was conducted with three nursing teams in a Québec university hospital center. The sample (N = 36) was composed of 22 bedside nurses, 7 assistant unit nurse managers, 4 advanced practice nurses and 3 unit nurse managers. Thirty-six interviews, 120 hours of observation and a documentary analysis were conducted. For each case, an analysis (Paillé and Mucchielli, 2016) and a cross-case analysis (Stake, 2016) permitted to formulate themes and to offer a model of the exercise of clinical nursing leadership. Our results indicate that clinical nursing leadership manifests itself in five forms, regardless of the unit nurse’s role: 1) taking initiatives involving reflective thinking and intervention; 2) influencing the achievement of patient/family care goals and the professional development of colleagues by offering coaching; 3) participating and mobilizing colleagues to contribute to activities that improve the quality of care; 4) becoming involved in order to promote optimal synergy and team cohesion; and 5) mobilizing personal and collaborative capacities. Multilevel resources, a work organization that promotes professional autonomy, clinical leadership, as well as a positive work climate were found to be favorable to the exercise of leadership. Finally, nurses perceive multiple positive results (ex. a decrease in complications for the patients and professional development for the nurses). This study suggests a collective perspective of clinical nursing leadership in hospital care units, it highlights the leverage effect for itself and the achievement of positive outcomes. It also offers a model that could serve as a pragmatic tool. Finally, various suggestions for reflection and intervention are proposed for management, training, research and practice.

Denna studie är en magisterexamen i företagsekonomi med inriktning ledarskap, skriven av Sanna Svensson under vårterminen 2022. Studiens titel är; “Distansarbetets påverkan på utövandet av ledarskap under covid-19, betraktat utifrån ett ledningsperspektiv”. Distansarbete har under covid-19 blivit den nya normalen. Detta har resulterat i många olika utmaningar som ledare har varit tvungna att hantera. Syftet med studien är att bidra med kunskap om hur distansarbete har påverkat utövandet av ledarskap under covid-19 utifrån ett ledningsperspektiv. Studien forskningsfråga är; ”Hur har distansarbete under covid-19 påverkat utövandet av ledarskap utifrån ett ledningsperspektiv?”. För att kartlägga kunskapen innanför ämnesområdet har det genomförts en litteraturgenomgång. I den teoretiska referensramen presenteras resultatet av litteraturgenomgången i form av tre ledarskapsbeteenden; kommunikation, tillit och stöd. Dessa tre ledarskapsbeteenden är viktiga vid övergången till distansarbete. Ledares förmåga att tillhandahålla tydlig kommunikation till medarbetare under covid-19 är viktig för att medarbetare ska kunna hantera krisen effektivt, mästra övergången till distansarbete och upprätthålla medarbetarnas produktivitet och arbetsvilja med distansarbete. För att medarbetare ska kunna arbeta på distans är det viktigt att organisationer litar på sina medarbetare och har tillit till att de utför sitt arbete på distans. Vidare är det viktigt att ledare är tillgängliga och ger medarbetare det stöd och den hjälp de behöver för att hantera arbetssituationen med distansarbete, detta för att uppnå produktivitet och framgång med distansarbete. Denna studie baseras på en kvalitativ metod i form av semistrukturella intervjuer med åtta HR-ledare i offentlig sektor i Norge. I empiriavsnittet presenteras respondenternas svar utifrån kategorierna kommunikation, tillit och stöd. Det framgår av intervjumaterialet att dessa tre kategorier har varit viktiga för samtliga respondenter under distansarbetssituationen. I analyskapitlet diskuteras och jämförs den teoretiska referensramen med datan från den empiriska undersökningen utifrån de tre underrubrikerna som presenterades i teori- och empiriavsnittet. Analysen utgör grunden för studiens slutsats. Studiens slutsats visar att respondenterna under distansarbetssituationen har varit mer tillgängliga för sina medarbetare och försett dem med mer stöd. Vidare framgår det av studiens resultat att samtliga respondenterhar använt Microsoft Temas för att informera om statusuppdateringar och upprätthålla mötesverksamhet, kommunikation och samarbete med distansarbetande medarbetare. Slutsatsen visar även att ledare måste ha en hög grad av tillit till distansarbetande medarbetare. Vidare framgår det av slutsatsen att tre respondenter under pandemin har givit sina distansarbetande medarbetare ökad autonomi. De medarbetare som inte har fungerat på hemmakontor, har tre av respondenterna följt upp extra genom ett mer kontrollerande och styrande beteende. Detta avviker från teorin som visar att ledare under distansarbetssituationen har haft ett mindre kontrollerande och styrande beteende. / This study is a master thesis in business administration with a focus on leadership, written by Sanna Svensson during the spring semester of 2022. The title of the study is; "Teleworks impact on the exercise of leadership during covid-19, viewed from a management perspective". Teleworking has become the new standard during covid-19. This has resulted in many different challenges that leaders have had to deal with. The purpose of the study is to contribute with knowledge of how telework has affected the exercise of leadership during covid-19 from a management perspective. The study research question is; "How has teleworking during covid-19 affected the exercise of leadership from a management perspective?". In order to map the knowledge within the subject area, a literature review has been carried out. In the theoretical frame of reference, the results of the literature review are presented in the form of three leadership behaviors: communication, trust and support. These three leadership behaviors are important in the transition to teleworking. Managers' ability to provide clear communication to employees during covid-19 is important for employees to be able to handle the crisis effectively, master the transition to teleworking and maintain employees' productivity and willingness to work remotely. For employees to be able to work remotely, it is important that organizations trust their employees and have confidence that they are performing their work as intended. Furthermore, it is important that leaders are available and give employees the support and help they need to handle the work situation during covid-19, this to achieve productivity and success in the telework situation the pandemic has created. This study is based on a qualitative method in the form of semi-structured interviews with eight HR leaders in the public sector in Norway. In the empirical section, the respondents' answers are presented based on the category’s communication, trust and support. It appears from the interview material that these three categories have been important for all respondents during the telework situation. The analysis chapter discusses and compares the theoretical frame of reference with data from the empirical study based on the three subheadings presented in the theory and empirical sections. The analysis forms the basis for the study's conclusion. The study's conclusion shows that the respondents during the teleworking situation have been more accessible to their employees and provided them with more support. Furthermore, the results of the study show that all respondents have used Microsoft Teams to inform teleworkers about status updates and maintain meeting activities, communication and collaboration with their employees. The conclusion also shows that leaders must have a high degree of trust in teleworkers. Furthermore, it appears from the conclusion that three respondents during the pandemic have given their teleworkers increased autonomy. The employees who have not functioned during the teleworking situation, have been followed up by three of the respondents through a more controlling and governing behavior.