Relationships influencing caring in first‐line nursing leadership: A visual hermeneutic study

Abstract

Aim: To explore and interpret relationships that influence caring in nursing leadership, in the context of Nordic municipal health care, from first-line nurse managers' perspectives. Design and method: We chose a visual hermeneutic design. A three-stage interpretation process outlined by Drew and Guillemin, based on Rose, was used to analyse drawings and the following reflective dialogue from three focus groups, with a purposive sample of 11 first-line nurse managers. The study was conducted from February to May 2018. Results:The findings demonstrated that first-line nurse managers struggled to balance their vision with administrative demands. Caring for patients implied caring for staff; however, they often felt as if they were drowning in contradictory demands. First-line nurse management could be a lonely position, where the first-line nurse managers longed for belonging based on increased self-awareness of their position within an organisation. Superiors' support enabled first-line nurse managers' in their primary aim of caring for patients. Conclusion:First-line nurse managers showed deep roots to their identities as nurses.Caring for patients included caring for staff and was their main concern, despite demanding reforms and demographic changes affecting leadership. Superiors' support was important for FLNMs' self-confidence and independence in leadership, so the first-line nurse managers can enact their vision of the best possible patient care. This study adds knowledge of the significance of caring in nursing leadership and the caritative leadership theory. Impact: In order to recognise FLNMs as vulnerable human beings and provide individual confirmation and support, a caring organisational culture is needed. FLNMs need knowledge based on caring and nursing sciences, administration and participation in formal leadership networks. These findings can serve as a foundation for developing educational programmes for nurse leaders at several organisational levels.

Associations between nurse managers’ leadership styles, team culture and competence planning in Norwegian municipal in‐patient acute care services: A cross‐sectional study

“…Only one participant had an educational background lower than a bachelor's degree, and no one had a PhD. Their mean (SD) age was 47 [ 8 ] years, and 90% were females. Six managers (3.3%) did not know whether a standard for minimum competence requirements had been prepared in their unit; five managers (2.7%) did not know whether a written competence plan had been prepared; and three (1.6%) did not know whether a training plan was available.…”

“…However, one fifth of the managers scored in the lower third on both leadership styles. One explanation may be that the nurse managers’ heavy administrative workload and resource scarcity overburden them; restrict their freedom of action; and divert their attention from being a clear and visible leader [ 8 , 21 ].…”

“…However, a lack of professional nursing competence in primary healthcare [ 4 , 5 ] challenges the quality of these services and reveals an urgent need to focus on nursing competence enhancement [ 1 , 2 , 3 , 4 , 5 , 6 ]. Likewise, the structural changes in the wake of health reforms reveal the need for visible and supportive nursing management and leadership [ 7 , 8 , 9 ] and mean that nursing leaders must be held accountable for a range of activities in the organisation [ 10 ]. In a qualitative study performed in Norwegian MipAC units [ 11 ], competence enhancement, staffing and team culture were identified as important leadership responsibilities.…”

“…The leadership capabilities of first‐line nurse managers may prove crucial if high quality care is to be realised, especially establishing a direction and applying strategies. Despite being constrained by budget restrictions, resource scarcity and heavy administrative workloads [ 8 , 21 ], first‐line nurse managers are expected to ensure sufficient competence in their staff to achieve goals [ 21 ] and to promote the health and well‐being of their employees [ 20 ]. Examples of their roles include competence enhancement and planning, staff retention, recruitment, career planning and the promotion of the professional growth of staff.…”

Exploring the role of managers in quality and safety work in nursing homes and homecare services; A multiple case study

“…Arenas and time for competence development were described by both managers and employees as difficult due to lack of time and the need to prioritise patient-related tasks. In addition, the homecare setting by its nature has few meeting points with employees (Solbakken et al, 2019;Solbakken et al, 2021). The physical and technological challenges mentioned by managers and employees were the lack of computers and unreliable internet; these presented a potential risk of harm due to insufficient documentation (Paper II).…”