<p> Leadership in today&rsquo;s health care system is faced with challenges that require adequate educational training / preparation and practical experience. These challenges are manifested by a constant state of change which adds pressures and additional responsibilities to all health care providers. Adequate training / preparation can make a significant difference in the ability to appropriately and effectively improve and maintain work responsibilities. Historically, management opportunities have been available for adequately trained qualified personnel; however, consistent adequately trained first line nurse managers has not been the case. First line nurse managers are often promoted to their management position as a result of several characteristics; longevity in the nursing profession, exemplary clinical practice, or through a process of seniority, all of which may not be entirely management oriented. The literature states that promotion from nurse to a first line nurse manager position without management training may result in burnout, mistrust among colleagues, lack of respect, lack of leadership, division among departments, and overall poor performance. This study will examine the perceptions about the quality of nurse management training, and the problems encountered when such training does not occur. The study will also provide a basis for a review of the current literature to validate previous studies, provide current studies to include new input, and explore educational training ideas and suggestions addressing training concerns. This quantitative research will survey staff nurses seeking their individual perceptions of the competencies needed for first line nurse managers to be successful in their role. Data provided from staff nurses&rsquo; perceptions of the managerial skills and techniques of their current manager will be collected using a survey approach. The data will be used to analyze if there is an absence of needed managerial skills education and resolutions for a better approach. The target population for this study is staff / bedside registered nurses administering first level bedside care for patients in the hospital and/or clinical setting and from this population a sample of registered nurses currently enrolled or have been recently enrolled (within the last two years) in an associate degree to a baccalaureate nursing program.</p>

<p> The American Association of Colleges of Nursing (2016) contends meeting the challenge to transform care will require the successful leadership development, preparation, and role support of the next generation of nurse leaders. Despite the urgency to transform care, meeting the challenge to lead this charge cannot be accomplished without the successful recruitment and retention of Millennial nurses to leadership positions. Identifying the leadership role expectations and support variables that are important to these young managers and creating the milieus that support these views serve to address many pressing succession planning needs. </p><p> This study explored the experience of being a Millennial nurse manager, seeking to understand how these young nurse managers make meaning of their lived experience. This was a qualitative interpretative phenomenological research study. Three theoretical perspectives contributed ideologies that framed this inquiry: Ray&rsquo;s (1989) theory of bureaucratic caring, generational cohort theory (Strauss &amp; Howe, 1991), and authentic leadership theory (Avolio &amp; Gardner, 2005). A purposeful targeted national sample of 25 Millennial nurse managers with a minimum of one year of nurse manager experience in the role participated in audio-recorded telephone interviews. Content analysis identified seven themes: <i>Coming into the Role, Learning as I Go, Having the Support of My Director, Making an Impact, Helping Staff Succeed, Managing Change</i>, and <i>Trying to Stay Balanced</i>. </p><p> Findings from this study suggest Millennial nurse managers gauge role success and satisfaction in relation to their perceived levels of support and development and their ability to master role expectations. Additional findings suggest adequate succession planning for the nurse manager role remains challenged by the lack of formal mandated requisites for the role. </p><p> The nurse manager role as it stands varies significantly among organizational settings regarding responsibilities, mechanisms of support, number of direct reports, and span of control. Recommendations included the need to address the nurse manager role, academic requisites, and developmental variances in practice. Additionally, re-evaluating the organizational responsibility to the leadership development of these young nurse leaders is recommended to ensure their retention and success in the role.</p><p>

Change is a common feature of nursing, influenced by prevailing governments as part of their political agendas. These changes have impacted both on the context within which nursing takes place as well as on the actual role of the nurse. For change agents who are implementing these changes, it is imperative that they are aware of how nurses respond to change in order that they can plan the most effective strategies. This thesis investigated how nurses understand their own practice changes, the process that they undergo, how resistance to change manifests and if nursing rituals have an impact on the process. Finally the thesis made recommendations based on the findings to facilitate effective practice change and development. The study was conducted in two parts. In-depth interviews with eight nurses from one acute NHS Trust made up the first part of the study. A further two interviews were conducted with eleven mental health nurses from an early intervention team in one NHS Mental Health Partnership Trust, and this constituted the second part of the study. Constructivist grounded theory was the research method employed in the design of the study. An underpinning theoretical framework of structural anthropology with specific reference to the work of Levi-Strauss was used to present the final grounded theory. The study found that nurses understood the process of practice change as a spiral with the most significant aspects of practice change at the bottom. These were the day-to-day changes that may or may not lead to permanent change. At the top of the hierarchy and of least significance were the changes imposed by their employing organisations or nationally. The overall personal process of practice change and development was identified from the study as a process that centres on the experiences that participants have in their workplace, a process of sense making, learning and intuition. A Practice Change Model in the form of a continuum was developed that described how nurses respond to practice change and development. The significance of this study is that the thesis was able to identify strategies for promoting effective practice change and development, aimed at nurses in practice, change agents at an organisational and national level, and the clinical link role within higher education.

<p> Transformational leadership style is widely believed to be the most effective leadership style. Using this style tends to bring about positive outcomes, increased job satisfaction, and decreased staff turnover. Intent to turnover of staff may not be solely dependent on leadership styles as other factors may also influence one&rsquo;s decision to leave a job or workplace. A significant concern of companies despite their locality, number of employees or type of business is turnover intention. High nursing turnover is a continuous and an increasing problem in the Emergency Department (ED). The purpose of the quantitative non-experimental study is to explore and describe the factors that influence ED nurse retention and their intention to leave (ITL). Therefore, it is important to identify key factors that influence ED nurse retention and ITL. The sample consisted of 100 Emergency Department Registered Nurses. Results of the T-test for research question one indicated no statistical significance between transformational leadership and turnover intention scores; Nurse Managers who exhibit characteristics of a strong transformational leader retain more ED Nurses than those Nurse Managers who do not exhibit characteristics of a transformational leader. Results of the T-test for research question two indicated no statistical difference in Nurse Managers who practice nursing engagement strategies (nursing management, professional practice, physician collaboration, staffing resources, and shift work) with ED Nurses would have equal or similar Turnover intention scores than those who do not practice nursing engagement strategies. Overall, the findings of this study suggested that nursing engagement strategies are key factors in retaining nurses in the ED. Therefore, in developing strategies for retention, it is critically important for nurse managers to focus on the influencing factors of engagement: nursing management, professional practice, collaboration with physicians, staffing resources and shift work.</p>

<p> Today's nurse leaders face many challenges and concerns that require a new type of leadership &mdash; authentic leadership. Nurse leaders who are authentic are behaviorally altruistic, transparent, have personal integrity, possess attributes of caring, ethical moral values, shared and balanced decision making, effective communication, and integral relationships. The purpose of this research was to explore, develop and validate an instrument measuring perceived authentic leadership, by staff nurses, that is grounded in a nursing theoretical framework that supports clinical practice and knowledge development. In addition, to validation of the instrument, hypotheses investigated in this research examined the extent in which the Authentic Nurse Leadership Questionnaire, is supported by the Authentic Nurse Leadership conceptual framework, and its relationship between authentic nurse leaders' attributes, nurse engagement, and nurse work-life. The methodology included Polit and Beck's method of multi-item scale development. A cross-over design was employed to compare the Authentic Nurse Leadership Questionnaire, this new instrument, with Authentic Leadership Questionnaire was implemented in the pilot and full study phase. Sample included: an expert panel (n =19) which included clinical nurse leaders, faculty and researchers, pilot study (n = 20) registered staff nurses and full study (n = 309) registered staff nurses who provide 50% or more direct patient care. Study results indicated: the average Content Validity Indices (CVI) for the final 29-item scale, its subscales and individual questions, all surpassing the .9 bench mark. The Cronbach's alpha coefficients ranged from .89 to .99, and the Intra Class Coefficients (ICCs) for 3 week test-retest reliability from 0.87 to .94. Findings indicated the ANLQ was reliable and valid instrument to measure authentic nursing leadership. Overall the ANLQ demonstrated better nursing values as indicated by a stronger relationship with nursing areas of work-life and nurse engagement than what ALQ did. The ANLQ concepts were statistically supported by both exploratory and confirmatory factor analyses. Nurse leaders who incorporate Authentic Nurse Leadership into their practice are uniquely positioned to influence nurse work-life environment and nurse engagement.</p>

<p> In the United States, the high turnover rate of registered nurses and indications of a future shortage of registered nurses is detrimental to healthcare organizations. The purpose of this correlational study was to examine whether, in hospitals, work engagement and job satisfaction predicted registered nurse turnover intention. The theoretical framework was Fishbein and Ajzen&rsquo;s theory of reasoned action. Probability sampling was used to identify 155 participants, all full-time registered nurses with 2 or more years of employment in New York hospitals. Data, obtained from surveys, were analyzed via multiple linear regression. The results revealed that only job satisfaction predicted turnover intention among the nurses sampled, (<i>F</i> (5,154) = 12.008, <i> p</i> &lt;.001. <i>R²</i> = .287. The results indicated that low work engagement is not necessarily an indication of job dissatisfaction or of an individual&rsquo;s intention to leave a job. Leaders of healthcare organizations might lower nurse turnover intention by focusing on improving job satisfaction. Specifically, by addressing the issues identified from regular job satisfaction surveys, and by a greater emphasis on creating a satisfying workplace, overall job satisfaction might be increased. The potential increased stability of the registered nurse workforce and the potential cost savings resulting from lower turnover could contribute to positive social change by improving the delivery of health services and by enhancing the healthcare experiences of patients, their families, and the surrounding communities.</p><p>

Traditionally analgesics have been the main stay of postoperative pain management. Taught non-pharmacological strategies have also been used. The possibility that patients may have a repertoire of self-generated strategies has tended to be overlooked. The aim of this study was to identify whether patients possess and utilise self-generated strategies for acute pain, and if so, to ascertain the effect of engaging patients in their postoperative pain management by supporting their strategies. To empower nurses to deliver effective pain management, and to promote evidence based practice, a second aim was to actively engage nursing staff in the process. A collaborative action research design based on critical theory was used to facilitate practitioner participation, enable practice development and generate a theoretical understanding of the issues. Three action research cycles were identified, each containing various methods and involving both patients and staff. The first cycle, entitled “telling the situation as it is”, described current practice from the ward staff’s perspective and identified 10 strategy themes through an outpatient survey. Cycle two focused upon “testing the proposed changes”. In contrast to many action research studies, a randomised controlled trial was undertaken to test the effect of incorporating patients’ self-generated strategies into postoperative pain management. The nursing staff were pivotal in both the decision to undertake the trial and in its management. The results indicated that identifying and supporting patients’ self-generated strategies significantly reduced postoperative anxiety, pain intensity and distress. Fewer experimental subjects required opiates, although non-steroidal anti-inflammatory consumption was increased in this group. Staff understanding and awareness of pain and their ability and confidence to manage pain increased. Certain staff also gained research skills. The third and final cycle, “creating change in practice: implementation and implications”, is being led by the nurses. The potential of action research to engage nurses in practice developments related to patient-centred care has been demonstrated.

<p> The specific problem under study results from the growth of multinational workforces in U.S. hospitals and the gap in the literature explaining how the presence of these workforces impacts hospital leadership, decision-making, and financial performance. The purpose of this qualitative embedded multi-case study was to discover and describe hospital nursing leader&rsquo;s beliefs from their experiences about how having employees from multiple national cultures affects nursing leadership, decision-making, and departmental financial performance in the hospital. The challenge faced by many hospitals is that the U.S. workforce is becoming culturally diverse as the global workforce increases its geographical mobility. The current research was important because results revealed nurse leaders&rsquo; beliefs about a link between the cultural dimensions of a multinational workforce and the decision-making, financial performance, and patient care within a hospital nursing department. The sample included eight nursing leaders from seven hospitals where the workforces are multinational and culturally diverse. The cultural dimensions by Hofstede were used to study the impact of a multinational workforce on the organizational practices of a nursing department in a hospital setting. Results revealed nine core themes, expected from the literature, and two emerging themes provided answers to the research questions. The nine core themes were Hofstede&rsquo;s cultural dimensions, workforce values, nursing organization impact, immigration/migration, nursing leadership, nursing workforce, organization culture, change, and develop multicultural organization attributes. The two emerging themes were familismo (family loyalty influences multinational workforce decision making) and hospital refusal to hire multicultural nurses whose national culture conflict with the organization&rsquo;s culture.</p>

<p> The purpose of this exploratory qualitative study was to identify experiences or barriers that arise during the first year as Certified Registered Nurse Anesthetists (CRNAs) transition into management and; if these shared experiences can prepare future CRNA managers by providing insight into what knowledge, skills, and abilities are necessary to ensure a smooth and successful career transition. </p><p> A representative sample by email and Facebook (FB) elicited 18 phone interviews of current and past Certified Registered Nurse Anesthetist (CRNA) managers. One interviewer asked 16 questions: seven demographic and nine open-ended. Survey information was (1) transcribed, (2) reviewed and de-identified, and (3) coded for content and classical analysis by two experienced independent coders. A coding tree was developed by coders after independent and random assessment of codes with an IRR (0.93). NVivo 11 software was used to assist with analysis of codes. </p><p> CRNA participants (66%) had less than five years of CRNA management experience, and 61% had no previous management experience or education before accepting their first role as a CRNA manager. An incidental finding, 83% of participants were reluctant managers and 76% of CRNA managers devoted greater than 50% of their time to performing clinical duties over managerial duties. Two resources that CRNA participants agreed were helpful resources during transition included: mentors (83%) and previous education or experiences (44%), especially in business, finance, or management. The skills CRNA participants believed were important during transition included people skills (56%), financial knowledge (33%), and communication (28%). </p><p> CRNA managers are more likely to be reluctant managers that may be relatively new in the role, and with no previous management experience or education. Recommendations for new CRNA managers during transition included; mastering &ldquo;people skills,&rdquo; either through relationship management or communication skills. Derailment may be avoided if new managers consider the results of this investigation.</p><p>

<p> The current study focused is on the underrepresentation of registered nurses in hospital CEO positions. There are several existential gaps in chief executive officer (CEO) leadership in the United States. The gender gap in CEO positions across all sectors demonstrates that females represent 31% of CEO positions in the United States. However, females represented only 12% of hospital CEOs in 2007 (Plant, 2008). In 2016, females represented 36% of hospital CEOs. Nevertheless, a far greater gap exists as registered nurses represented 2.5% of hospital CEOs in 2007 (Plant, 2008), and 3.0% of hospital CEOs in 2016. The chronic underrepresentation of registered nurses (RNs) is irrespective of education, experience preparation, knowledge, attitude, skills, and habits as RN executives aspiring to become hospital CEOs often have more education and experience than their non-registered nurse counterparts have. The sample for the current qualitative grounded theory study had 30 participants including 10 RN executives currently employed and holding the title of hospital CEO, 10 non-RN executives currently employed holding the title of hospital CEO, and 10 decision-makers who have authority over the hospital CEO candidate selection process. The current study employed grounded theory method to develop a substantive grounded theory of why the phenomenon of the underrepresentation of registered nurses in hospital CEO positions exists. The substantive grounded theory developed in the study might help decision-makers involved in the hospital CEO selection process adjust their selection strategies so they evaluate hospital CEO candidates equitably. Registered nurses aspiring to become hospital CEOs might also benefit from the study by altering their career development strategies so the decision-makers perceive them as qualified candidates for the position of hospital CEO.</p><p>