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The purpose of this paper is to characterize issues related to head nurses’ decision making when managing ethical dilemmas.

The study is qualitative descriptive, in which researchers stay close to the data. The data were collected in the format of unstructured written reflections. Inductive conventional latent qualitative content analysis was applied to the data.

The issues of head nurses’ management of decision making in ethical dilemmas relate to the following aspects: taking risks in deviating from the formalities, balancing power and humaneness, maintaining the professional hierarchy, managing resistance to change, managing with limited options, and experiencing the decline of nurse’s professional and/or human dignity.

Reflections in written form were preferred to semi-structured interviews and the researchers were unable to contact the participants directly and to ask additional questions. All the reflections were produced in a language other than English.

The issues of head nurses’ management of decision making in ethical dilemmas reveal the gap between societal expectations and the opportunities to improve nursing leadership in health care organizations.

The issues of head nurses’ decision making when managing ethical dilemmas are related to contexts that reflect the attitudes of society and health care system toward nursing management.

The study adds to the understanding of issues of the management of decision making in ethical dilemmas. It is an ongoing systematic process that encourages head nurses to learn from practice and manage the quality of care by empowering themselves and nurses to take responsibility for leadership.

The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.

This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.

Drawing on a previous study of organising processes and the construction of identity in a Swedish geriatric clinic, the impact of emotions is brought to the fore in the interpretation of power relations among professional groups. The purpose of this paper is to find a way to interpret emotions as discursively constructed in organising processes.

A sequence of critical events is described where leading positions were negotiated at the clinic. Senior physicians and head nurses are highlighted as opposing forces in a struggle where envious emotions seemed to be a driving force in the political interplay. The empirical material in this paper comes from the previous study. It is a set of participant observations and parts of interviews that took place before and after the implementation of a new organisational plan for the clinic.

The envious and regressive undertone in the relationships between the actors made them act for egocentric reasons instead of creating new ways of collaborating and learning new leading roles. The power relations of the medical hierarchy were reproduced, which made new ways of relating threatening and difficult to achieve.

The results of the study confirm that people involved and perhaps in conflict with each other have to be able to, or get help to, make sense of their emotional experiences to employ them constructively. Otherwise they fall back into well-known patterns in order to feel secure. A vital part of learning in change processes is the support to individuals and groups in gaining emotional understanding of themselves and others. Leaders and managers who often are initiators of change ought to be aware of the importance of emotional support in change processes. If they are not, they are destined to be a part of the confusion and unable to lead or support their staff in change processes.

This paper sets out to explore health professionals' views and experiences regarding the work culture that exists in their hospital units, and further how patients influence these experiences.

The paper employs a qualitative approach involving individual interviews with 60 health professionals in Canada employed in what is conceptualised as “open” (emergency room and maternity care) and “closed” (intensive care, head and neck surgery) units.

The paper finds that the influence of the hospital unit outweighs the influence of professional boundaries but for some groups more than for others. Health professionals in more open units tend to be less satisfied with their work, have more difficult relations with patients, and experience tensions with co‐workers and management. Those in closed units tend to be more satisfied with their work, have relatively better relations with patients and co‐workers, and tend to have more cooperative relations with management. The different structural conditions of work in open and closed units are also clearly important.

The sample for the study was self‐selected from one hospital, which may limit the generalisability of some of the findings.

The insights garnered from the study may help professionals and managers to develop unit‐specific policies to create a more positive workplace culture.

There is a growing body of research on professional culture and oganisational culture that often does not clearly delineate how the two exist concurrently. The paper explicitly investigates this issue by examining work culture across various health professional groups and also across hospital units, and further how patients figure in these experiences.

In the healthcare management domain, there is a lack of knowledge concerning the role of resilience practices in improving patient safety. The purpose of this paper is to understand the capabilities that enable healthcare resilience and how digital technologies can support these capabilities.

Within- and cross-case research methodology was used to study resilience mechanisms and capabilities in healthcare and to understand how digital health technologies impact healthcare resilience. The authors analyze data from two Italian hospitals through the lens of the operational failure literature and anchor the findings to the theory of dynamic capabilities.

Five different dynamic capabilities emerged as crucial for managing operational failure. Furthermore, in relation to these capabilities, medical, organizational and patient-related knowledge surfaced as major enablers. Finally, the findings allowed the authors to better explain the role of knowledge in healthcare resilience and how digital technologies boost this role.

When trying to promote a culture of patient safety, the research suggests healthcare managers should focus on promoting and enhancing resilience capabilities. Furthermore, when evaluating the role of digital technologies, healthcare managers should consider their importance in enabling these dynamic capabilities.

Although operations management (OM) research points to resilience as a crucial behavior in the supply chain, this is the first research that investigates the concept of resilience in healthcare systems from an OM perspective, with only a few authors having studied similar concepts, such as “workaround” practices.

The purpose of this paper is to interpret employees’ resistance using the perspective of a Foucaultian/post-structuralist approach in critical management studies. The authors examine the relationship between management of diversity, based on employment contract, emotional construction of identity and processes of resistance. The authors explore the ways in which temporary agency nurses understand and experience their contract, respond to tensions regarding temporary employment, develop collective emotions and show processes of resistance.

The study adopted an interpretive and qualitative approach. The authors analysed empirical material collected in the Haematology Department of a hospital in Naples, Italy, to illustrate actual experiences in the workplace.

Fear turns out to be the discursive resource through which resistance is actually exerted. Through emotions, temporary nurses build a community of coping and enhance their collective identity. They use fear to develop solidarity and to mobilize collective resistance in the workplace. Although no traditional resistance behaviours are reported, they aim to undermine the reputation of top managers and challenge and re-write the prevailing discourses of the organization.

The paper contributes to the critical literature because the authors analysed a relationship that is rarely theoretically and empirically examined in literature, that between employment contract, collective identity-building dynamics and processes of resistance. We showed that the creation of a community of coping enabled minorities to voice their distance from and opposition to management.

Four psychoanalytic consultants, each utilizing one the most prevalent theoretical orientations used in the field of psychoanalytic consulting are asked to explain why a consultation succeeded. Using differing theories the four psychoanalysts reach the same conclusion. They conclude the consultation succeeded because of the consultants ability to manage and benefit from the intense transference reactions of the organization’s staff. These analysts suggest that the work of psychoanalytic consulting may be much more similar to the work of clinical psychoanalysis than previously assumed and that the key to understanding why a consultation succeeds or fails can be found in the analysis of the transferences in the relationship between the consultant and consultees.

Nurses are a significant part of the professional workforce, but leaders may be promoted without the requisite competencies. This study aims to explore the perspectives of nurse managers about the core competencies necessary for promotion as leaders in health.

This was a mixed-methods study that targeted nurses (N = 126) who were promoted in four Caribbean countries over the past five years. A 30-item questionnaire was used for quantitative data collection and analyzed using SPSS version 25. Interviews yielded the qualitative data, which were analyzed using open coding and thematic analysis. Ethical approvals were received from ethics committees at the university and country level.

Most participants were female (n = 112), had 15 or more years’ experience (n = 71) and an associate degree/diploma in nursing (n = 62). Leadership was the most important competency required of nurse leaders in spite of their position within the organization, followed by team building and motivation. Challenges to the transitioning into leadership positions included the prevailing culture and a lack of a systematic approach to building capacity in leadership. There was also between-group statistical significance, as determined by one-way ANOVA for delegation, motivation and leadership as core competencies based on occupations roles.

Notwithstanding the importance of the findings from this research, there were some limitations. While the researchers considered implementing this study in eight Caribbean countries, approvals were received for only four countries. This will affect the ability to generalize the findings to the wider Caribbean countries. One of the strengths of this research was the use of mixed methods for data collection. However, the qualitative component of the findings may be limited by the number of focus groups conducted, notwithstanding the richness of the data collected.

The findings can be used as a framework from which the health system in developing countries can begin to examine practical solutions to developing 21st century leadership competencies in nursing. While there may be remanence of the colonial past in the way systems function, the complexity of health systems requires leadership that is rooted in competence that is multidimensional.

This paper provides an important contribution to the literature on leadership and competencies from the perspective of low- to middle-income resource settings. The qualitative component of the research added richness to the nuances and understanding of the phenomenon of competencies for nurse leaders.

What makes employees feel well within an organization? The aim of the present chapter is to start from a paradigm that emphasizes human relationality, affectivity, and intersubjective systems, and accordingly focuses on how well-being is emerging from contextual interrelations between employees. Applying this perspective to a qualitative study of nurses in a nursing home, I came to see the work community as a well-being-generating system in which the well-being of individual members is constructed together as an ongoing social accomplishment. In addition, I identified four systemic processes within the work community that greatly influence the well-being-generating capacity of the system.

Few definitions in the HRM literature have reached as much consensus as the term “devolution”. However, devolution is a phenomenon that has been defined from the perspective of HRM specialists, with little or no contribution from middle managers. This paper seeks to explore what is behind the commonly shared definition of devolution, by examining not only the actual tasks that are being devolved, but also by trying to establish different degrees of devolution according to a number of dimensions.

An approach that facilitated the exploration of the extent of devolution and impact on middle managers' perceptions was required. A qualitative approach was adopted. Specifically, a case study of a hospital in Spain was undertaken. The research methods included in‐depth interviews, participant observation and internal documentation.

The findings emphasize the importance of reflecting on the reality and the rhetoric of devolution. The results indicate that it is worthwhile to break down the concept of devolution into dimensions (tasks and responsibilities, decision‐making power, financial power and expertise power) and to specify what dimensions are devolved.

There is a clear difference between the rhetoric of devolution and what actually happens in practice. In order to distinguish between those organisations that go beyond the rhetoric of devolution, it is important to differentiate between the devolution of tasks and the devolution of decision‐making power and autonomy in order to undertake these tasks. This differentiation facilitates the identification of those companies which display superficial levels of devolution and take steps to advance the process.

This paper questions the traditional definition of devolution. It proposes a new definition of devolution based on the identification of various dimensions and incorporates the perspectives of all the actors involved in the process.