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Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

The Covid-19 pandemic generated significant changes in the operating methods of hospital logistics departments. The objective of this research is to understand how these changes took place, what collaboration mechanisms were developed with clinical authorities and, to what extent, logistics and clinical care activities should be decoupled to maximize each area's contribution?

The case study is selected to investigate practices implemented during the COVID-19 pandemic in hospitals in Canada. The pandemic presented an opportunity to contrast practices implemented in response to this crisis with those historically used in this environment.

The strategy of decoupling logistical tasks of an operational nature from clinical activities is well-founded and helps free clinical staff from tasks for which they are not trained. However, the decoupling of operational tasks should be combined with an integration of the clinical information flow to the logistics hub players. With this clinical information, the logistics hub can generate its full potential enabling better inventory management decisions to be made.

The concept of decoupling is studied to identify configurations that offer the best benefits for clinical staff.

This study aims to appraise and synthesize evidence examining the effects of toxic leadership on the nursing workforce and patient safety outcomes.

This is a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases (SCOPUS, PubMed, Web of Science, CINAHL and Psych INFO) were searched to identify relevant articles. Two independent researchers conducted the data extraction and appraisal. A content analysis was used to identify toxic leadership outcomes.

The initial literature search identified 376 articles, 16 of which were deemed relevant to the final review. Results of the content analysis identified 31 outcomes, which were clustered into five themes: satisfaction with work; relationship with organization; psychological state and well-being; productivity and performance; and patient safety outcomes. Seven mediators between toxic leadership and five outcomes were identified in the included studies.

Organizational strategies to improve outcomes in the nursing workforce should involve measures to build and develop positive leadership and prevent toxic behaviors among nurse managers through theory-driven strategies, human resource management efforts and relevant policy.

The review findings have provided modest evidence suggesting that working under a leader who exhibits toxic behaviors may have adverse consequences in the nursing workforce; however, more research examining if this leadership style influences patient safety and care outcomes is warranted.

This study aims to examine nurses’ motivation for leadership and explore important challenges nurses face in leadership positions.

Semi-structured interviews were conducted with 20 nurses in leading positions. Thematic analysis was used to analyse the data.

Nurse leaders are recruited from clinical settings, and the transition process from clinical nurse to leader is demanding. Their motivation for leadership seems to be in human values and caring for others. Lack of strategic focus might be a challenge. Nurses in leadership positions emphasize the importance of good relationships with the staff and require an increased focus on strategic leadership.

Studies have revealed the frustration associated with the role of a nursing leader. According to an evaluation of a clinical leadership development programme, nurses were found to be inadequately prepared for their roles. They had not experienced positive role models, they felt overwhelmed and they regarded colleagues and nursing management structures as unsupportive. There is a need for further research into effective measures to strengthen nurse managers.

The role of leaders has changed over time. There are now increasing requirements and objectives with regard to laws, action plans, improvement projects and cost-effectiveness. A nurse leader has both many tasks and great responsibility. Good leadership relies on skilled nurse leaders meeting statutory requirements in patient care and delivering good quality and patient-safe services. Engaging in process-oriented guidance, such as mentoring, is one way to become more aware of oneself as a professional leader (Mathena, 2002).

By identifying and understanding the specific challenges that nurse leaders face, this study can contribute to the development of interventions and strategies to improve leadership practices, thereby enhancing organizational effectiveness.

While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators’ perspectives on implementing a transition program for newly graduated nurses.

An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding.

The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation.

This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

This paper aims to describe the design and evaluation of a pilot leadership development programme for infection prevention and control (IPAC) professionals during the COVID-19 pandemic. The programme’s aim was to improve IPAC knowledge and capacity in the health-care system by developing the leadership skills and capacities of novice and advanced Infection Control Professionals (ICPs), to respond flexibly, and competently, in their expanding and ever-changing roles.

The leadership programme was piloted with seven nurses, who were part of a clinical nursing team in New South Wales, Australia, over a 12-month period between 2021 and 2022. The programme was designed using a leadership development framework underpinned by transformational leadership theory, practice development approaches and collaborative and experiential learning. These principles were applied during programme design, with components adapted to learners’ interests and regular opportunities provided for collaboration in active learning and critical reflection on workplace experiences.

The authors’ evaluation suggests that the programme was feasible, acceptable and considered to be effective by this cohort. Moreover, participants valued the opportunities to engage in active and experience-based learning with peers, and with the support of senior and experienced ICPs. The action learning sets were well-received and allowed participants to critically reflect on and learn from one another’s experiences. The mentoring programme allowed them to apply their developing leadership skills to real workplace challenges that they face.

Despite a small sample size, the authors’ results provide empirical evidence about the effectiveness of using a practice development approach for strengthening ICP leadership capacity. The success of this pilot study has paved the way for a bigger second cohort of participants in the programme, for which further evaluation will be conducted.

The success of this leadership programme reflects both the need for leadership development in the IPAC professions and the applicability of this approach, with appropriate facilitation, for other professions and organizations.

ICP leadership programmes have not been previously reported in the literature. This pilot study builds on the growing interest in IPAC leadership to foster health system responsiveness and change.

The complexity and uncertainty of healthcare operations increasingly require agility to safeguard a high quality of care. Using a microfoundations of dynamic capabilities perspective, this study investigates the effects of nurses' implicit voice theories (IVTs) on the behaviors that influence their individual agility.

This research uses quantitative survey data collected from 2,552 Canadian nurses during the fourth wave of the Covid-19 pandemic in the fall of 2021. Structural equation modeling is used to test a conceptual model that hypothesizes the effects of three different IVTs on nurses' creativity, spontaneity, agility and the quality of care they deliver to patients.

The results reveal that voice-inhibiting cognitions (like “suggestions are criticisms for higher-ups”, “I first need a solution or solid data”, and “speaking up has negative repercussions”) negatively impact nurses' creativity and spontaneity in crafting solutions to problems they face daily. In turn, this affects nurses' individual agility as they attempt to adapt to changing circumstances and, ultimately, the quality of care they provide to their patients.

Even if organizations have little control over employees' pre-held beliefs regarding voice, they can still reverse them by developing and nurturing a voice-welcoming culture to boost their workers' agility.

This study combines two theoretical frameworks, voice theory and dynamic capabilities theory, to study how individual-level factors (cognitions and behaviors) contribute to nurses' individual agility and the quality of care they provide to their patients. It answers the recent calls of scholars to study the mechanisms through which healthcare operations can develop and sustain dynamic capabilities, such as agility, and better face the “new normal”.

This study aims to enhance understanding of malnutrition's effect on academic achievement of primary school students.

This is a descriptive, cross-sectional design built on Roy's adaptation model (RAM). This study uses a random cluster sample, consisting of 453 primary school students. Contextual stimuli (mother's educational level, income and child’s breakfast eating) and focal stimuli (wasting, thinness, body mass index and stunting) were examined regarding adaptive responses to student’s academic achievement.

The investigation revealed that Model 1, which took into account factors of age, gender, the frequency of breakfast, income, the number of family members and the education of mothers, explained 12% (R² = 0.12) of the variance in academic achievement. Stuntedness (β = −3.2 and p < 0.01), BMI (β = 0.94 and p < 0.001), family income per month (β = 5.60 and p < 0.001) and mother's education (β = 2.79 and p < 0.001) were the significant predictors in Model 2.

This study provides evidence that malnutrition is associated with ineffective academic achievement. Moreover, variables such as the mother's level of education, family income and the child’s breakfast consumption have a significant impact on academic achievements.

RAM is a useful framework for determining factors affecting people's reactions to difficult circumstances.

In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity.

A comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used.

Management in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union–management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies.

Finding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

Healthcare providers are under pressure due to increasing and more complex demands for services. Increased pressure on budgets and human resources adds to an ever-growing problem set. Competent leaders are in demand to ensure effective and well-performing healthcare organisations that deliver balanced results and high-quality services. Researchers have made significant efforts to identify and define determining competencies for healthcare leadership. Broad terms such as competence are, however, inherently at risk of becoming too generic to add analytical value. The purpose of this study is to suggest a holistic framework for understanding healthcare leadership competence, that can be crucial for operationalising important healthcare leadership competencies for researchers, decision-makers as well as practitioners.

In the present study, a critical interpretive synthesis (CIS) was conducted to analyse competency descriptions for healthcare leaders. The descriptions were retrieved from peer reviewed empirical studies published between 2010 and 2022 that aimed to identify healthcare services leadership competencies. Grounded theory was utilised to code the data and inductively develop new categories of healthcare leadership competencies. The categorisation was then analysed to suggest a holistic framework for healthcare leadership competence.

Forty-one papers were included in the review. Coding and analysing the competence descriptions resulted in 12 healthcare leadership competence categories: (1) character, (2) interpersonal relations, (3) leadership, (4) professionalism, (5) soft HRM, (6) management, (7) organisational knowledge, (8) technology, (9) knowledge of the healthcare environment, (10) change and innovation, (11) knowledge transformation and (12) boundary spanning. Based on this result, a holistic framework for understanding and analysing healthcare services leadership competencies was suggested. This framework suggests that the 12 categories of healthcare leadership competencies include a range of knowledge, skills and abilities that can be understood across the dimension personal – and technical, and organisational internal and – external competencies.

This literature review was conducted with the results of searching only two electronic databases. Because of this, there is a chance that there exist empirical studies that could have added to the development of the competence categories or could have contradicted some of the descriptions used in this analysis that were assessed as quite harmonised. A CIS also opens for a broader search, including the grey literature, books, policy documents and so on, but this study was limited to peer-reviewed empirical studies. This limitation could also have affected the result, as complex phenomenon such as competence might have been disclosed in greater details in, for example, books.

The holistic framework for healthcare leadership competences offers a common understanding of a “fuzzy” concept such as competence and can be used to identify specific competency needs in healthcare organisations, to develop strategic competency plans and educational programmes for healthcare leaders.

This study reveals a lack of consensus regarding the use and understanding of the concept of competence, and that key competencies addressed in the included papers are described vastly different in terms of what knowledge, skills and abilities they entail. This challenges the operationalisation of healthcare services leadership competencies. The proposed framework for healthcare services leadership competencies offers a common understanding of work-related competencies and a possibility to analyse key leadership competencies based on a holistic framework.