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Nurse unit managers’ work and impacts on clinical leadership: A cross-sectional study

      ABSTRACT

      Problem/Background

      Nurse unit managers are critical to clinical leadership and play an important role in the contemporary context of health care management. Lack of role satisfaction and reports of excessive workloads place this crucial role at risk; it is therefore essential to understand the workplace factors that influence the important work of nurse unit managers, and the stressors that impact their leadership practices.

      Aim

      To capture and explore nurse unit managers’ perceptions of their work and leadership practices within a large, multi-facility tertiary healthcare organisation.

      Methods

      A cross-sectional study with a convenience sample of nurse unit managers (n=34) in an Australian health service was undertaken. A multi-dimensional instrument included socio-demographics, validated scales (perceived organisational support, work engagement, intentions to stay), purposefully developed scales (administrative workload, clinical leadership profile), and an open-ended question (clinical leadership aspirations). Nurse unit managers’ demographics and scales were analysed descriptively; content analysis was used to code the qualitative data.

      Findings

      Nurse unit managers were clinically experienced, had limited postgraduate education, worked excessive hours, had high administrative loads, and enacted multiple leadership categories. Work engagement was characterised by absorption and dedication, nurse unit managers were ambivalent in their perceptions of organisational support. Nurse unit managers expressed aspirations for clinical leadership and wished to retain their positions in the organisation.

      Discussion

      Due to the critical role of nurse unit managers within health systems, it is vital that knowledge of nurse unit managers’ work and leadership practices are investigated. Nurse unit managers’ clinical leadership activities and aspirations require ongoing clarification. Relationships between perceived organisational support, work engagement, and nurse unit managers’ intentions to stay need further exploration. The level of post-registration qualification in the workforce needs to be raised.

      Conclusion

      Increased awareness of leadership realities and workplace factors that influence nurse unit managers could be used for advancing clinical leadership and ongoing role development.

      Keywords

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      References

        • Adriaenssens J.
        • Hamelink A.
        • Van Bogaert P.
        Predictors of occupational stress and well-being in first-line nurse managers: A cross-sectional survey study.
        International Journal of Nursing Studies. 2017; 73: 85-92https://doi.org/10.1016/j.ijnurstu.2017.05.007
        • Ahern N.
        Using the internet to conduct research.
        Nurse Researcher. 2005; 13: 55-69
        • Australian Nursing and Midwifery Federation - Victorian Branch
        The role of the nurse/midwife unit manager. 2013;
        • Brady G.P.
        • Cummings G.G.
        The influence of nursing leadership on nurse performance: a systematic literature review.
        Journal of Nursing Management. 2010; 18: 425-439https://doi.org/10.1111/j.1365-2834.2010.01100.x
        • Brunetto Y.
        • Xerri M.
        • Shriberg A.
        • Farr-Wharton R.
        • Shacklock K.
        • Newman S.
        • et al.
        The impact of workplace relationships on engagement, well-being, commitment and turnover for nurses in Australia and the USA.
        Journal of Advanced Nursing. 2013; 69: 2786-2799https://doi.org/10.1111/jan.12165
        • Cummings G.G.
        • Tate K.
        • Lee S.
        • Wong C.A.
        • Paananen T.
        • Micaroni S.P.M.
        • et al.
        Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review.
        International Journal of Nursing Studies. 2018; 85: 19-60https://doi.org/10.1016/j.ijnurstu.2018.04.016
        • Cupit T.
        • Stout-Aguilar J.
        • Cannon L.
        • Norton J.
        Assessing the nurse manager's span of control: A partnership between executive leadership, nurse scientists and clinicians.
        Nurse Leader,. 2019; 17: 103-108https://doi.org/10.1016/j.mnl.2018.12.004
        • Duffield C.
        • Gardner G.
        • Doubrovsky A.
        • Wise S.
        Manager, clinician or both? Nurse managers’ engagement in clinical care activities.
        Journal of Nursing Management. 2019; 27: 1538-1545https://doi.org/10.1111/jonm.12841
      1. Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Trust public inquiry: Executive summary, volume 947. Available from: https://webarchive.nationalarchives.gov.uk/ukgwa/20150407084231/http://www.midstaffspublicinquiry.com/report, Accessed Aug 30th, 2017

        • El Haddad M.
        • Wilkinson G.
        • Thompson L.
        • Faithfull-Byrne A.
        • Moss C.
        • et al.
        Perceptions of the impact of introducing administrative support for nurse unit managers: A qualitative evaluation.
        Journal of Nursing Management. 2019; 27: 1700-1711https://doi.org/10.1111/jonm.12860
        • Gunawan J.
        • Aungsuroch Y.
        Managerial competence of first-line nurse managers: A concept analysis.
        International Journal of Nursing Practice. 2017; 23 (1-7): e12502https://doi.org/10.1111/ijn.12502
        • Harvey G.
        • Kelly J.
        • Kitson A.
        • Thornton K.
        • Owen V.
        Leadership for evidence-based practice – Enforcing or enabling implementation.
        Collegian. 2020; 27: 57-62https://doi.org/10.1016/j.colegn.2019.04.004
        • Havaei F.
        • Dahinten V.S.
        • Macphee M.
        The effects of perceived organisational support and span of control on the organisational commitment of novice leaders.
        Journal of Nursing Management. 2015; 23: 307-314https://doi.org/10.1111/jonm.12131
        • Institute of Medicine.
        The future of nursing: Leading change advancing health.
        The National Academies Press, Washington, DC2010 (Available from:)
        • Kelly L.A.
        • Wicker T.L.
        • Gerkin R.D.
        The relationship of training and education to leadership practices in frontline nurse leaders.
        Journal of Nursing Administration. 2014; 44: 158-163https://doi.org/10.1097/NNA.0000000000000044
        • Kouzes J.M.
        • Posner B.Z.
        Leadership practices inventory: Psychometric properties.
        Wiley, San Francisco, CA2000
      2. Health Workforce Australia. (2013). Health LEADS Australia: The Australian health leadership framework. Available from: https://www.aims.org.au/documents/item/352, Accessed on Aug 11th, 2017

      3. LEADS Canada. (2016). LEADS leadership capabilities framework. Available from: https://leadscanada.net/uploaded/web/Resources/LEADS_Corporate_Brochure_2016_final.pdf

        • Martin J.S.
        • McCormack B.
        • Fitzsimons D.
        • Spirig R.
        Evaluation of a clinical leadership programme for nurse leaders.
        Journal of Nursing Management. 2012; 20: 72-80https://doi.org/10.1111/j.1365-2834.2011.01271.x
        • Moore L.W.
        • Sublett C.
        • Leahy C.
        Nurse managers’ insights regarding their role highlight the need for practice changes.
        Applied Nursing Research. 2016; 30: 98-103https://doi.org/10.1016/j.apnr.2015.11.006
        • Mutwiri B.
        • Denysek C.
        • Halferdahl S.
        • McLeod K.M.
        Development and implementation of the Saskatchewan Leadership Program: Leading for healthcare transformation.
        Healthcare Management Forum. 2016; 29: 23-27https://doi.org/10.1177/0840470415617404
      4. National Health and Medical Research Council. (2015). National statement on ethical conduct in human research 2007 - Updated May 2015. Available from: www.nhmrc.gov.au/guidelines/publications/e72, Accessed Sept 22nd, 2017

        • Patrician P.A.
        • Pranpanjaroensin A.
        • Dawson M.
        • White-Williams C.
        • Miltner R.S.
        Mapping and sustaining leadership development – An innovative academic service partnership.
        The Journal of Nursing Administration. 2018; 48: 567-573https://doi.org/10.1097/NNA.0000000000000681
        • Pegram A.M.
        • Grainger M.
        • Sigsworth J.
        • While A.E.
        Strengthening the role of the ward manager: a review of the literature.
        Journal of Nursing Management. 2014; 22: 685-696https://doi.org/10.1111/jonm.12047
        • Penconek T.
        • Tate K.
        • Bernardes A.
        • Lee S.
        • Micaroni S.P.M.
        • Balsanelli A.P.
        • et al.
        Determinants of nurse manager job satisfaction: A systematic review.
        International Journal of Nursing Studies. 2021; 118103906https://doi.org/10.1016/j.ijnurstu.2021.103906
        • Queensland Government
        Review of the nurse unit manager role, final report.
        Queensland Government, Brisbane2008
      5. NSW Department of Health. (2009). “Take the lead” – Strengthening the nursing/midwifery unit manager role across NSW. Available from: https://www.health.nsw.gov.au/nursing/projects/Publications/taketheleadrpt.pdf, Accessed Sept 5th 2017

      6. Richey, K. & Waite, S. (2019). Leadership development for frontline nurse managers promotes innovation and engagement. Nurse Leader, 17(1), 37-42. https://doi.org/10.1016/j.mnl.2018.11.005

        • Schaufeli W.
        • Bakker A.
        Utrecht work engagement scale (UWES).
        Preliminary Manual. 2004; ([Version 1.1, December 2004])
        • Shacklock K.
        • Brunetto Y.
        The intention to continue nursing: Work variables affecting three nurse generations in Australia.
        Journal of Advanced Nursing. 2012; 68: 36-46https://doi.org/10.1111/j.1365-2648.2011.05709.x
        • Shacklock K.
        • Brunetto Y.
        • Teo S.
        • Farr-Wharton R.
        The role of support antecedents in nurses’ intentions to quit: The case of Australia.
        Journal of Advanced Nursing. 2014; 70: 811-822https://doi.org/10.1111/jan.12239
        • Shaughnessy M.K.
        • Griffin M.T.Q.
        • Bhattacharya A.
        • Fitzpatrick J.J.
        Transformational leadership practices and work engagement among nurse leaders.
        Journal of Nursing Administration. 2018; 48: 574-579https://doi.org/10.1097/NNA.0000000000000682
        • Simmons A.M.
        Doctoral dissertation.
        City University of, New York2013
      7. University of Delaware. (1984). Format for the 8-item survey of perceived organizational support. http://classweb.uh.edu/eisenberger/wp-content/uploads/sites/21/2015/04/SPOS_8.pdf

        • Vitale T.R.
        The impact of a mentorship program on leadership practices and job satisfaction.
        Nursing Management. 2019; 50: 12-14https://doi.org/10.1097/01.NUMA.0000552745.94695.81
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies.
        PLoS Medicine. 2007; 4: e296https://doi.org/10.1371/journal.pmed.0040296
        • Warshawsky N.
        • Cramer E.
        Describing nurse manager role preparation and competency: Findings from a national study.
        Journal of Nursing Administration. 2019; 49: 249-255https://doi.org/10.1097/NNA.0000000000000746
        • Wise S.
        • Duffield C.
        Has the search for better leadership come at the expense of management?.
        International Journal of Nursing Studies. 2019; 97: A1-A2https://doi.org/10.1016/j.ijnurstu.2019.04.002
        • Wong C.A.
        • Cummings G.G.
        • Ducharme L.
        The relationship between nursing leadership and patient outcomes: a systematic review update.
        Journal of Nursing Management. 2013; 21: 709-724https://doi.org/10.1111/jonm.12116
        • Wong C.A.
        • Spence Laschinger H.K.
        The influence of frontline manager job strain on burnout, commitment and turnover intention: A cross-sectional study.
        International Journal of Nursing Studies. 2015; 52: 1824-1833https://doi.org/10.1016/j.ijnurstu.2015.09.006
        • Worley J.A.
        • Fuqua D.R.
        • Hellman C.M.
        The survey of perceived organisational support: Which measure should we use?.
        SA Journal of Industrial Psychology. 2009; 35: 112-116https://doi.org/10.4102/sajip.v35i1.754
        • Yoder-Wise P.S.
        • Scott E.S.
        • Sullivan D.T.
        Expanding leadership capacity: educational levels for nurse leaders.
        Journal of Nursing Administration. 2013; 43: 326-328https://doi.org/10.1097/NNA.0b013e3182942ca4