Comparisons of raw span (i.e., number of staff who report directly to a manager) within and across organizations can misrepresent managerial capacity to support staff because managers may not allocate the same amount of time to staff contact. The purpose was to examine the influence of alternative measures of managerial span on nurse satisfaction with manager’s supervision and on multidisciplinary teamwork. The alternative measures were (a) raw span as a measure of reporting structure and (b) time in staff contact as a measure of closeness of contact by the manager. The main effects of the alternative measures, leadership, hours of operation, and other covariates on outcomes were examined. The interaction effects of the alternative measures with leadership and hours of operation were investigated. The study framework was based on Open System Theory and the boundary spanning functions of managers. A descriptive, correlational design was used to collect survey and administrative data from employees, managers, and organizations. Managerial time allocation data were collected through self-logging and validated through observation. Acute care hospitals were selected through purposive sampling. For supervision satisfaction, the final sample size was 31 first-line managers and 558 nurses. For teamwork, the final sample size was 30 first-line managers and 754 staff. The Leadership Practices Inventory, the Satisfaction with my Supervisor Scale, and the Relational Coordination Scale were used. Hierarchical linear modeling was the main type of analysis conducted. Raw span interacted with leadership and hours of operation to explain supervision satisfaction. Teamwork was explained by leadership, clinical support roles, hours of operation, total areas, and non-direct reports, but not by raw span or time in staff contact. Large acute care hospitals can improve satisfaction with supervision and teamwork by modifying first-line management positions.

Comparisons of raw span (i.e., number of staff who report directly to a manager) within and across organizations can misrepresent managerial capacity to support staff because managers may not allocate the same amount of time to staff contact. The purpose was to examine the influence of alternative measures of managerial span on nurse satisfaction with manager’s supervision and on multidisciplinary teamwork. The alternative measures were (a) raw span as a measure of reporting structure and (b) time in staff contact as a measure of closeness of contact by the manager. The main effects of the alternative measures, leadership, hours of operation, and other covariates on outcomes were examined. The interaction effects of the alternative measures with leadership and hours of operation were investigated. The study framework was based on Open System Theory and the boundary spanning functions of managers. A descriptive, correlational design was used to collect survey and administrative data from employees, managers, and organizations. Managerial time allocation data were collected through self-logging and validated through observation. Acute care hospitals were selected through purposive sampling. For supervision satisfaction, the final sample size was 31 first-line managers and 558 nurses. For teamwork, the final sample size was 30 first-line managers and 754 staff. The Leadership Practices Inventory, the Satisfaction with my Supervisor Scale, and the Relational Coordination Scale were used. Hierarchical linear modeling was the main type of analysis conducted. Raw span interacted with leadership and hours of operation to explain supervision satisfaction. Teamwork was explained by leadership, clinical support roles, hours of operation, total areas, and non-direct reports, but not by raw span or time in staff contact. Large acute care hospitals can improve satisfaction with supervision and teamwork by modifying first-line management positions.

Bakgrund: Våld mot kvinnor i nära relation är ett globalt hälsoproblem. Ett svenskt universi- tetssjukhus har tagit fram en handlingsplan för omhändertagande av våldsutsatta kvinnor och det finns evidens för att avdelningschefer spelar en stor roll för implementeringen av hand- lingsplaner. Syfte: Syftet med föreliggande studie är att undersöka avdelningschefers erfarenheter av att implementera en handlingsplan om våldsutsatthet; “Våldsutsatta kvinnor - en handlingsplan för omhändertagande”, samt att undersöka vilka hinder och underlättande faktorer som ligger bakom implementeringen. Metod: Studien genomfördes med en kvalitativ metod i form av semistrukturerade intervjuer. Sju avdelningschefer från sju olika avdelningar inom fem divisioner intervjuades vid ett svenskt universitetssjukhus som har en handlingsplan för omhändertagande av våldsutsatta kvinnor. Intervjuerna genomfördes med stöd av en intervjuguide, och resultatet analyserades med hjälp av en kvalitativ innehållsanalys. Huvudresultat: Majoriteten av informanterna hade inte implementerat handlingsplanen. För- sök till implementering hade genomförts dels genom att föra in frågan om våld i ett inskriv- ningsformulär eller genom att ta upp handlingsplanen på arbetsplatsträffar eller andra perso- nalmöten. De rapporterade hinder och underlättande faktorer som finns i samband med im- plementeringen av handlingsplanen för våldsutsatta kvinnor berodde på avdelningsschefen själv, verksamheten, dokumentationen och olika resurser. Slutsats: Idag går det inte att implementera handlingsplanen full ut. Informanterna upplevde detta som frustrerande och menar att en tydlig struktur av handlingsplanen från sjukhusled- ningen krävs för att kunna förankra handlingsplanen i verksamheten. Fler studier bör genom- föras på fler avdelningar då verksamhetens patientgrupp påverkade hur informanterna förhöll sig till handlingsplanen. / Background: Intimate partner violence against women is a global health problem. A Swedish university has developed a guideline for the care of abused women and there is evidence that nurse managers play a major role in the implementation of guidelines. Aim: The aim of the present study is to investigate the nurse managers' experiences of im- plementing a guideline on domestic violence; "Abused women - a guideline for disposal" and to explore the barriers and facilitating factors behind the implementation. Method: A qualitative study was conducted. Seven nurse managers from seven different wards within five divisions were interviewed at a Swedish university hospital that has a guideline for the care of abused women. Data were collected through semi-structured intervi- ews using an interview guide, and the results were analyzed using a qualitative content analy- sis. Main result: The majority of respondents had not implemented the guideline. Attemts to im- plement the guideline had been carried out, partly by bringing in the issue of violence in an enrollment form, or by taking up the guideline at workplace meetings and other staff mee- tings. The reported barriers and facilitating factors that are associated with the implementation of the guideline for abused women was due to the nurse manager, operations, documentation and various resources. Conclusion: Today it is not possible to implement the guideline completley. The informants experienced this as frustrating and believes that a clear structure of the guideline from the hospital management is required to anchor the guideline into the wards activity. More intervi- ews should be conducted in other wards as the group of patients, treated at the ward, affected how informants conducted the guideline.

Kompetencija yra svarbus žmogiškųjų išteklių valdymo elementas, padedantys samdyti, vertinti, tobulinti darbuotojų veiklą bei didinti jų lojalumą organizacijai. Sparčiai senstant visuomenei, didėjant žmonių, sergančių lėtinėmis ligomis skaičiui, slaugytojų vaidmuo tampa akivaizdus. Slaugytojai sudaro didžiausią sveikatos priežiūros sistemos dalį. Jų vadovai – vyresnieji slaugytojai-slaugos administratoriai yra atsakingi už slaugos proceso kokybę ir tęstinumą bei sveikatos priežiūros organizacijos tikslų įgyvendinimą skyriaus lygmenyje. Tai gali padaryti tik kompetetingi savo srities profesionalai. Magistro baigiamojo darbo objektas yra vyresniųjų slaugytojų-slaugos administratorių kompetencijos. Iškelta hipotezė, kad panaudojus Chase slaugos vadybininko anketą, galima nustatyti vyresniųjų slaugytojų-slaugos administratorių nuomone labiausiai reikalingas jų darbui kompetencijas. Darbo tikslas buvo nustatyti svarbiausias vyresniojo slaugytojo-slaugos administratoriaus kompetencijas. Siekiant atskleisti darbo temą, buvo iškelti šie uždaviniai: remiantis moksline literatūra išanalizuoti kompetencijos teorinius aspektus; aptarti slaugos darbo teisinį reglamentavimą Lietuvoje ir išskirti svarbiausias mokslinėje literatūroje nurodomas vyresniųjų slaugytojų-slaugos administratorių kompetencijas; apklausos metu sužinoti vyresniųjų slaugytojų-slaugos administratorių nuomonę apie būtinas jų darbui kompetencijas bei kompetencijų vertinimo sąsajas su demografiniais rodikliais; nustatyti... [toliau žr. visą tekstą] / Competence is a major human resource management element, important in personnel recruitment, evaluation, improvement and decrease of the retention in the organization. Society is getting old rapidly and number of people with chronic diseases is increasing, so the role of nurses becomes obvious. Nurses belong to the largest part of medical personnel. First level nurse managers are responsible for nursing process quality and continuity, and for the implementation of goals of health care organization in unit level. Only competent professionals can handle such task. The research object of Master Thesis is first level nurse manager competencies. The hypothesis is defined based on Chase nurse manager competency instrument. This instrument could help to identify the most important first line nurse manager competencies, using the answers received from the nurse managers survey. The objective of the current work was to identify the most important nurse manager competencies. In order to fulfill the topic of this Thesis, particular tasks were raised: to analyze competency theoretical aspects; to identify the most important competencies of first level nurse managers according to the scientific literature; during the survey to select essential first line nurse manager competencies according to the answers given by the managers and to find out the link of competencies evaluation to demographical factors; to identify the most important first line manager competencies and to compare the... [to full text]

Thesis (Ph.D.)--Indiana University, 2009. / Title from screen (viewed on August 28, 2009). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Anna M. McDaniel (Chair), Mary L. Fisher, Patricia R. Ebright, Bradley N. Doebbeling. Includes vita. Includes bibliographical references (leaves 140-154).

Abstract The purpose of the study was to describe and analyse the leadership styles of nurse managers as part of the leadership culture in health centre wards. The aim was to produce scientific knowledge about nurse managers’ leadership styles and the factors affecting them, and about the sufficiency of their leadership style knowledge and skills. The study was conducted using a mixed method approach. In the first phase, the leadership styles of nurse managers were examined systematically with the aid of a literature review. The material consisted of 45 scientific articles that focused on or touched upon leadership styles. The approach in the second phase of the study was qualitative. Data were collected from nurse managers (n =  13), nurse directors (n =  10) and nursing staff (n =  11) using themed interviews. The data were analysed using inductive content analysis. The approach in the third phase was quantitative. Data were collected from nurse managers (n =  252) in health centre wards using questionnaires. The data were collected using a stratified sample based on the number of nurse managers in the health centres. The data were analysed with descriptive statistics. The results indicated that nurse managers’ leadership styles were influenced by the flow of information, organisational values, previous supervisors, nurse managers’ training and values, the staff working under the nurse managers and collaboration. The nurse managers reported using four resonant leadership styles: visionary, coaching, affiliate and democratic leadership style, while commanding leaderhsip was used among dissonant styles. According to nurse directors and nursing staff, nurse managers also used isolating leadership style. Leadership styles affected collaboration, staff well-being and commitment to work, the operation of the work unit and development work as well as the atmosphere within the organisation. Nurse managers reported visionary leadership style as the most important and isolating leadership style as the least important leadership style. Through self-reflection, nurse managers could increase their knowledge on the use of different leadership styles and their effects and use them in an appropriate manner. Leadership styles where employees are seen as having a participatory and active role have become increasingly more common. Resonant leadership styles have a positive impact on staff work satisfaction, professional development and staff retention. These factors have a positive effect on the quality of patient care. The information generated by the study may be utilised in basic, continued and further nursing education. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja analysoida, mitä ovat hoitotyön osastonhoitajien johtamistyylit osana johtamiskulttuuria terveyskeskusten vuodeosastoilla. Tavoitteena oli tuottaa tieteellistä tietoa osastonhoitajien käyttämistä johtamistyyleistä ja niihin vaikuttavista tekijöistä sekä heidän johtamistyylitietojensa ja -taitojensa riittävyydestä. Tutkimuksessa on käytetty monimenetelmällistä tutkimusmenetelmää. Ensimmäisessä vaiheessa hoitotyön johtajien johtamistyylejä tarkasteltiin systemaattisen kirjallisuuskatsauksen avulla. Aineisto koostui 45 johtamistyylejä käsittelevästä tai niitä sivuavasta tieteellisestä julkaisusta. Toisen vaiheen lähestymistapa oli kvalitatiivinen ja aineistot kerättiin osastonhoitajilta (n =  13), ylihoitajilta (n =  10) ja hoitohenkilökunnalta (n =  11) teemahaastatteluilla. Aineistot analysoitiin induktiivisella sisällön analyysilla. Kolmannen vaiheen lähestymistapa oli kvantitatiivinen ja aineisto kerättiin kyselylomakkeilla terveyskeskusten vuodeosastojen osastonhoitajilta (n =  252). Aineisto kerättiin käyttäen ositettua otantaa terveyskeskusten osastonhoitajalukumäärittäin. Aineisto analysoitiin kuvailevan tilastotieteen menetelmillä. Tulosten mukaan osastonhoitajien johtamistyyleihin vaikuttivat tiedonkulku, organisaation arvot, aiemmat esimiehet, osastonhoitajien koulutus ja arvot, osastonhoitajien alaiset työntekijät sekä yhteistyö. Osastonhoitajat kuvasivat käyttävänsä neljää resonoivaa johtamistyyliä, jotka olivat visionäärinen, valmentava, välittävä ja demokraattinen, kun taas ei- resonoivista johtamistyyleistä he käyttivät komentavaa johtamistyyliä. Ylihoitajien ja henkilökunnan mukaan osastonhoitajat käyttivät myös eristäytyvää johtamistyyliä. Johtamistyylit vaikuttivat yhteistyöhön, työntekijöiden työhyvinvointiin ja sitoutumiseen, työyksikön toimintaan ja kehittämistyöhön sekä organisaation ilmapiiriin. Tärkeimpänä johtamistyylinä osastonhoitajat raportoivat visionäärisen ja vähiten tärkeänä eristäytyvän. Itsereflektion kautta osastonhoitajat voisivat vahvistaa tietojaan eri johtamistyylien käytöstä ja niiden vaikutuksista sekä käyttää niitä tarkoituksenmukaisella tavalla. Johtamistyylit, joissa työntekijät nähdään osallistuvassa ja aktiivisessa roolissa, ovat yleistyneet. Resonoivat johtamistyylit vaikuttavat positiivisesti työntekijöiden työtyytyväisyyteen, ammatilliseen kehittymiseen ja työssä pysymiseen. Nämä tekijät vaikuttavat potilaiden hoidon laatuun myönteisesti. Tutkimuksen tuottamaa tietoa voidaan hyödyntää hoitotyön johtamisen perus-, jatko- ja täydennyskoulutuksessa.

Background: Unit nurse managers are in a key position to influence the implementation of evidence-based practice (EBP) in nursing. However, research indicates that nurse managers in China lack the competencies and behaviours to effectively lead implementation. The purpose of this study was to develop a prototype for an implementation leadership training program for unit nurse managers in China, and assess the prospective acceptability of the prototype. Methods: The dissertation was conducted in three study phases using multiple methods: 1) a mixed-methods systematic review of leadership development interventions for managers supervise nurses; 2) a qualitative descriptive study using an integrated knowledge translation (IKT) approach to develop a prototype for an implementation leadership training program based on the Ottawa Model of Implementation Leadership in Changsha, China; and 3) a qualitative descriptive study to investigate the prospective acceptability of the prototype among potential program deliverers and participants (n=14) from three tertiary hospitals in Changsha, China. Results: The systematic review analyzed 69 studies and found that leadership development interventions, including lectures, group work, and mentoring, positively impacted managers' leadership competencies in supporting, developing, and recognizing nurses. However, obstacles such as understaffing, time constraints, and lack of support hindered the application of these competencies in practice. In the co-development stage, nurse managers (n=7) identified all 14 O-MILe behaviours as important for EBP implementation, with some behaviours requiring modifications for clarity and cultural relevance. Managers outlined specific actions related to clinical practices, EBP, nurses, patients, interprofessional staff, incentives, resources, organization, and external entities. They emphasized the need for competencies in EBP, professional nursing, and implementation leadership. The training program prototype consisted of five interactive modules to be delivered through multimodal forms such as lectures, group discussions and coaching. Unit nurse managers (n=14) found the prototype acceptable, expecting it to enhance care provision and align with their professional values. Time constraints, the COVID-19 impact, and support from senior leadership were identified as influencing future participation. Conclusion: The prototype for the implementation leadership training program was perceived as acceptable to unit level nursing managers in the hospital context in Changsha, China. Future research is needed to explore the impact of the training program on enhancing implementation leadership competencies and behaviours of unit nurse managers, and the subsequent influence on nursing practice and patient outcomes.

Rising health care costs place increased burden on patients, health care personnel, administrators and policymakers. Decisions in health care are influenced by data which can be transferred into valuable information and knowledge. Data sets that facilitate data collection, information management and knowledge building are needed by nurse managers to support administrative decision- making. The Nursing Management Minimum Data Set (NMMDS,,¦) offers a standardized method to capture core data that can be collected in information systems, shared and reused for multiple purposes to support safe and cost-effective care. The purpose of this descriptive study was to adapt to Iceland and clinically test the NMMDS-ICE in all adult inpatient care units in the country of Iceland (excluding psychiatry). The aims of the study were to 1) translate the NMMDS from source language (English) to target language (Icelandic); 2) to validate the translated instrument; and 3) to describe the environment, nursing care resources, and financial resources across acute adult inpatient care units in Iceland. Instrument development consisted of translation, expert validation, and psychometric testing. The target population was all adult acute care units in hospitals in Iceland, and the nurse managers (n=38) representing these units. Data collection included a mailed survey. The sample equaled the population. Furthermore, 134 staff nurses on these units (excluding staff nurses at Landspitali) completed a job satisfaction survey. Return rate was 74% for nurse managers and 71% for staff nurses. Semantic and content equivalence of the NMMDS-ICE was established. Five of seven subscales of the instrument received Cronbach¡¦s alpha score of 0.70 or higher. Results indicated that it was feasible to collect the NMMDS-ICE in hospitals in Iceland, albeit, there was an issue with time commitment to do so. The specialty services that best described the patient population were medical-, surgical services, birthing, and geriatrics. Furthermore, nurse managers seem to perceive good control on their units, and both nurse managers and staff nurses are satisfied with their job. A positive correlation was found between autonomy and satisfaction with nursing management, nursing administration, and own level of autonomy. Statistical differences were identified in environmental and staffing resources between hospitals.

In this thesis I am concerned to examine the management behaviours and predilections of managers across the two settings of health and theatre considered to be divergent. To do this I explore and map methods, similarities and differences managers employ to ???manage??? workers across the industries. I also deconstruct creativity and its manifestations in both managerial behaviours and environmental contexts and map the complexity issues that managers face in different settings. Further, I explore the extent to which management activity is contextual to the identity of participant organisational aims and processes and examine the level of calculated chaos experienced by managers across the settings. Central to this approach is the utilisation of multi-method design incorporating interview, micro-ethnography, auto-ethnography and a RAND expert panel to assist with interpretation of the results. Core findings include high degrees of similarity in the roles and functions and support systems utilised by managers across the settings despite substantial differences in environmental contexts and organisational aims and processes. Differences were identified in the areas of: levels of chaos, interactions, purposes, and environmental characteristics. To account for these differences I apprehended seven metafactors grounded in the data sets. These seven metafactors can be found in each setting but emerge in different ways. The metafactors that I apprehend are order versus disorder; creativity; experimentation and change; risk; reflection; trust and respect; and time and pressure. While I discuss these seven metafactors as separate factors in reality they are fundamentally inter-related. Suggestions for future research are included.

In this thesis I am concerned to examine the management behaviours and predilections of managers across the two settings of health and theatre considered to be divergent. To do this I explore and map methods, similarities and differences managers employ to ???manage??? workers across the industries. I also deconstruct creativity and its manifestations in both managerial behaviours and environmental contexts and map the complexity issues that managers face in different settings. Further, I explore the extent to which management activity is contextual to the identity of participant organisational aims and processes and examine the level of calculated chaos experienced by managers across the settings. Central to this approach is the utilisation of multi-method design incorporating interview, micro-ethnography, auto-ethnography and a RAND expert panel to assist with interpretation of the results. Core findings include high degrees of similarity in the roles and functions and support systems utilised by managers across the settings despite substantial differences in environmental contexts and organisational aims and processes. Differences were identified in the areas of: levels of chaos, interactions, purposes, and environmental characteristics. To account for these differences I apprehended seven metafactors grounded in the data sets. These seven metafactors can be found in each setting but emerge in different ways. The metafactors that I apprehend are order versus disorder; creativity; experimentation and change; risk; reflection; trust and respect; and time and pressure. While I discuss these seven metafactors as separate factors in reality they are fundamentally inter-related. Suggestions for future research are included.