[Continued education of nurses for leadership positions in nursing homes. Continued postgraduate and leadership education is a necessity].
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The Moral of the Story-Perception of Leadership With Moral Distress in Registered Nurses: A Qualitative Systematic Review.
AIM: To understand how Registered Nurses perceive the impact of nursing leadership on managing moral distress and mitigating burnout. BACKGROUND: Moral distress and burnout are pervasive issues in nursing, compromising well-being, patient safety and workforce sustainability. Leadership is a critical factor in shaping workplace culture and mitigating these challenges, yet evidence remains limited. DESIGN: Qualitative systematic review. METHODS: A qualitative systematic review was conducted following JBI methodology and PRISMA guidelines. Comprehensive searches across MEDLINE, PsycINFO, Embase, CINAHL and Scopus identified 5927 articles, with two studies meeting the inclusion criteria. Data were appraised using the JBI Critical Appraisal Checklist and synthesised via meta-aggregation. Confidence in findings was assessed using the ConQual approach. RESULTS: Four major themes emerged: (1) Behind the barriers, (2) Breaking point, (3) Weathering the storm and (4) Leadership for lasting change. Leadership influenced nurses' psychological safety, ethical decision-making and resilience. Inadequate support amplified moral distress, and effective strategies included authentic communication, team solidarity and systemic interventions. CONCLUSIONS: Leadership plays a pivotal role in mitigating moral distress and burnout. Evidence highlights the need for structural changes and support to sustain registered nurses' well-being and retention. RELATIVE TO CLINICAL PRACTICE: Findings offer direction for leadership strategies that promote ethical workplaces, shared decision-making and mental health supports to enhance resilience and patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Strengthening leadership capability is vital for workforce sustainability, care quality and nurse retention. REPORTING METHOD: Authors have adhered to relevant EQUATOR guidelines. PATIENT OR PUBLIC CONTRIBUTION: This study did not involve patients or the public in its design, conduct or reporting.
Leadership↗
Sharing leadership influence: a life-cycle model.
We have described the effective leader in terms of several concepts: (1) leadership style as a means of sharing the influence of leadership with a ready group; (2) the readiness of a group to successfully exert influence on the practice; (3) the matching of leadership styles with group readiness; and (4) the impact of the environment on the readiness of a group. We have described how all of these elements combine to determine a leader's effectiveness. All elements interact and present the leader with a situation for which he must adopt an appropriate leadership style (Table 1). Several elements combine to change the readiness of a group through four phases - unready, ready, mature, and professional. The leader then matches leadership styles I through IV to these levels of readiness. We believe a dentist will be effective as a leader in proportion to his success in matching an appropriate leadership style to the readiness of his group to perform in its particular environment.
Behavior↗
Ward tension and staff leadership in a therapeutic community for hospitalized adolescents.
Mental health workers on inpatient units spend a great deal of time trying to cope with interpersonal tensions that disrupt ward life. We have focused our attention on two aspects of this problem. The first is clarifying the nature of the social processes that underlie periods of increased tension and conflict on wards. The second is clarifying the kinds of staff leadership required to manage these tensions. We are sure that those who have worked on interactive treatment wards will recognize this situation: for a period of weeks or more there is an uneasy tension; patient cliques form and disruption occurs between cliques and with the staff. Often there is a climax of disruptive behavior, such as a day or weekend when a large number of patients break ward rules. Trouble seems to be contagious. Throughout the period staff members disagree about how to manage the patients and the disruption, and usually this disagreement is tinged with old philosophical or personal differences. No one feels very confident about taking leadership initiatives, and the formal leaders are blamed for various failures and lacks. Eventually, often after a climactic disturbance is resolved, ward life returns to "normal" and people feel much better about living and working on the ward. In this paper we review previous work on this kind of ward process and discuss some of the problems involved in conceptualizing it. We report on two period of ward observation that illustrate the sequence from low to high tension and back to relative calm. We then discuss our ideas about the kinds of staff leadership needed to manage different phases of this sequence and the problems of developing and integrating multiple ward leadership roles.
Adaptation, Psychological↗
Impact of a management-oriented course on knowledge and leadership skills exhibited by baccalaureate nursing students.
This study evaluated the impact of a one-month management concept course on 80 senior baccalaureate nursing students. Findings revealed that leadership values held by nursing students did not affect their leadership behaviors. Nursing students who took the course demonstrated significantly more leadership behaviors and knowledge of leadership concepts than students who did not take the course. Reasons for the findings are discussed.
Curriculum↗
The nursing explosion-technology, knowledge, and practice: its implications for leadership in aerospace nursing.
Authorities agree that we are experiencing a tremendous upheavel in numerous fields of endeaveor, health care in particular, resulting from the rapid growth of human information and capabilities since the 1950s. This upgrowth has touched nursing. This nursing explosion, in terms of technological advancement, increased knowledge, and expanded practice, demands the leadership of aerospace nursing to reexamine it posture and direction. A fresh look at its past and present successes and failures is essential to meet the challenges of the future. For "not to decide is to decide". There are two basic assumptions which underlie this challenge for leadership caused by the nursing explosion. First, as a self-directing profession, nursing can define its philosophical base, determine its goals, and identify the means for attaining those goals. Second, as the largest of the health professions, nursing has the right and responsibility to respond to the quantity and quality of global health care delivery systems. The analysis of this challenge for leadership shall be attempted in the light of three perspectives--organizationally, socio-politically, and professionally. The nursing explosion has dramatized the realization that nursing has the knowledge, power, resources in numbers, and dedication to service to move health care systems in the direction necessary. As Prof. Bell of Harvard has noted, the current revolution of rising entitlement to health care will have a marked influence on the nursing effort and vice versa. The call to leadership "a loud call and a clear call and it cannot be denied."
Aerospace Medicine↗
Changes in leadership appraisal as a function of the stress of a simulated panic situation.
Research by Mintz and Kelley, Condry, Dahke, and Hill left unresolved the question of what level of personal threat leads to group incoordination of "panic behavior." The present study set out to resolve this issue and to explore the additional relationship between leadership and behavior in the panic situation. The dependent variables were Likert-type questionnaire items designed to investigate the level of responsibility attributed to a leader by members of a group as a function of four variables: (a) two levels of stress (threat of shock or of small monetary loss); (b) two levels of leadership authority (elected or appointed); (c) two conditions of leadership ("me-last" or "me-first"); and (d) group success or failure. The specific questions were adapted from earlier pilot work by Sulzer and Sisti. One hundred and forty-four males were run in this 2 X 2 X 2 X 2 factorial design with a nonfactorial control group. The task setting, which required subjects to retrieve their wooden cones through the same hole, was designed to be analogous to the kind of situation that would occur in a theater fire where only one narrow exit existed. The results support the contention of Kelley that group incoordination (panic) increases under personal threat. Additional results were: (a) Leaders facilitated achieving the goal of safe exit; (b) elected leaders were given more responsibility and were seen as more competent than appointed leaders, but only when the stress is comparatively low, as otherwise the difference in evaluation narrows and reverses; and (c) success or failure seems to have had little effect on the leader's evaluation by the group.
Adolescent↗
Changes in life goals as related to success in a nursing leadership role.
Based on questionnaire returns from 50 nurses in leadership positions, this study revealed major differences in the life goals of successful nurses before and after assuming a leadership role. Our reason for success, the study found, was the nurses' ability to develop life goals consistent with their leadership role.
Follow-Up Studies↗
Leadership and interpersonal need compatibilities between optometrists and optometric assistants.
A comparison of optometrists' leadership style and the preferred leadership style of their optometric assistants as well as both groups' interpersonal need orientations indicated: 1) optometrists' consideration and initiating structure orientations were lower than those preferred by their assistants, structure was significantly lower (p less than .01) while consideration approached significance (p = .08); 2) optometrists had significantly lower needs for expressing control than their assistants had for wanting to be controlled (p less than .01), assistants had significantly higher needs for expressing participation and inclusion than optometrists had for wanting to be included (p less than .05), and optometrists had significantly higher needs for wanting to be controlled and influenced than their assistants had to control and influence them (p less than .05). Implications for the optometrist-assistant working relationship are discussed.
Allied Health Personnel↗
Staff development for leadership.
Leadership, that amorphous concept so essential to nursing and so difficult to describe in its broadest context, can be learned if viewed as a set of behaviors that may be applied selectively to assist a group to move toward its goals. Given a supportive climate, a variety of approaches are effective, including one-to-one consultation, role modeling, goal orientation, and workshops on specific leadership behaviors.
Humans↗
Personality profiles and leadership potential of medical-surgical and psychiatric nursing graduate students.
When personality profiles and leadership potential of psychiatric and medical-surgical nursing graduate students were compared, using the California Psychological inventory (CPI) and the Managerial Key for the CPI, medical-surgical majors scored significantly higher on the CPI scale (p greater than .05). Overall, both groups scored higher than the norm and showed a more optimal personality development than has been observed in earlier studies of this kind. In the Managerial Key for the CPI, the test of leadership potential on both groups received a high rating, comparable to that of the top-management group in the original research.
Chicago↗
The MERMLS leadership institute for hospital librarians: a new concept in extension service.
This paper describes a pilot Leadership Institute conducted by the Mid-Eastern Regional Medical Library Service (MERMLS) and a consultant group from Temple University. The purpose of the institute was to instill some basic group leadership techniques in a selected group of geographically dispersed hospital librarians. The institute was conducted in two sessions totalling three days, with two months separating the two sessions. Extensive evaluations by participants at the end of both sessions resulted in general endorsement that the institute's objectives had been attained and that more institutes of this type should be provided.
Academies and Institutes↗
One brain, one mind: A joint EPA-EAN leadership perspective on brain health.
Neurology and psychiatry have operated as separate disciplines for over a century, yet this division reflects historical and institutional developments rather than the underlying biology of the brain. Contemporary neuroscience shows that brain and mental health disorders share genetic susceptibilities, inflammatory and metabolic pathways, environmental and social risk factors, and clinical features that cross diagnostic boundaries. Cognitive, emotional, sensory, and motor symptoms regularly appear across both neurological and psychiatric populations, and conditions such as seizures, psychosis, mood disorders, cognitive disorders, and sleep disorders are common to both. A brain health framework addresses this reality by treating the brain as a single biological organ whose function emerges from the interplay between genome and exposome - including stress, trauma, social context, existential meaning, pollution, and physical health - and which underlies perception, behaviour, cognition, emotion, resilience, and vulnerability. Translating this perspective into practice requires coordinated action across domains. Clinically, collaborative models such as joint neurology-psychiatry consultations and shared outpatient pathways can be implemented within existing resources to improve diagnostic clarity and continuity of care. In training, a more harmonised curriculum with shared foundations in neurobiology, joint seminars, and cross-rotations would equip clinicians with a common language while preserving specialist depth, and support the emerging fields of preventive neurology and preventive psychiatry. In research, organising studies around shared mechanisms and symptom dimensions, and launching joint funding calls, would enhance translational relevance and reduce duplication. To realise this vision, sustained leadership from European professional bodies is essential to establish collaboration as a shared professional standard.
Humans↗
Relationship between birth order and leadership style for nursery school children.
36 nursery school children were given a revised form of Fiedler's (1967) least preferred co-worker scale designated as the least preferred playmate scale. The purpose was to investigate the relationship between least preferred playmate scores and the birth order of young children. A 2 X 2 contingency table was constructed between birth order (first and later born) and leadership style (high and low). The resulting chi squares were insignificant for the total population and for males. However, for females the results were significant with a higher percentage of firstborns being task-oriented (low score) and a higher percentage of later borns being relation-oriented (high score).
Birth Order↗
Nursing leadership in the critical care setting.
The challenge of a nursing leadership role within the critical care setting is most unique in that two competencies are required--clinical and administrative talents. The development of such leaders also presents a challenge to administrators of health care settings. With administrative support of the nurse who aspires to such a role, we will continue to provide the caliber of care required by acutely ill and injured patients. Based on a philosophy of management that promotes both clinical and administrative talents, this plan will not only best serve the patient population of acute/critical care units but will also help foster the professional commitment of nurse practitioners and encourage them to aspire to such roles.
Critical Care↗
Application of leadership theory: integrating thought and action.
While the experienced nursing director may and can make decisions quickly and intuitively, the student and the novice supervisor or director need tools to facilitate the process. The theories are presented not as iron-clad rules, but rather as guidelines to be used in selecting leadership behavior appropriate to circumstantial needs, which can vary widely in nursing.
Humans↗
A systematic approach to leadership selection.
This article introduces a system for selecting nursing leaders that recognizes personal aspiration as the motivating force behind successful leadership. The nursing administrator relinquishes sole responsibility and asks others to share in the selection process. An objective and subjective assessment examines every aspect of the candidates' potential.
Humans↗
The trustee and the risks of persuasive leadership.
Boards of trustees are challenged to structure their leadership roles in such a way that they can help the institutions they lead to fulfill their potential. Coercion and persuasion are both tools that boards can use; but while coercion may be necessary in extreme situations, it is not useful for encouraging performance. Persuasion, as defined, is the means by which a board may guide an institution toward its highest possible performance level.
Governing Board↗