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The current study evaluated (1) characteristics of the community leadership development program associated with successful participant recruitment, (2) active ingredients that promoted fellow engagement and program completion and (3) how the program addressed blackness and racism.

Individual interviews were conducted with a representative subset of former program fellows.

Results indicated that offering training in small cohorts and matching fellows with individual mentors promoted program interest. Program strengths and unique ingredients included that the program was primarily led by people from the Black community, program malleability, and that the program was a partnership between fellows and leadership. Additionally, the program was responsive to fellows’ needs such as by adding a self-care component. Fellows also noted dedicated space and time to discuss race and racism. Results offer a unique theoretical perspective to guide leadership development away from the uniform or standardized approach and toward one that fosters diversity and equity in leadership.

Altogether, this work demonstrates how leadership development programs can be participant-informed and adapted to participants’ social and cultural needs.

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.