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Leadership in Nursing: Qualities of a Good Nurse Leader

two nurse leaders talking with a clipboard

Effective nursing leadership is essential for quality outcomes in healthcare. Outstanding leadership is demonstrated every day when nurses rise to challenges and accept opportunities to make a meaningful difference in the health care of our population. The importance of leadership in nursing cannot be overstated. 

Qualities of a good nurse leader include:

  • Commitment to patients and families
  • Perseverance and a humble mindset
  • Aptitude for conflict resolution
  • Empathy and professional communication
  • Strong clinical skills
  • Dedication to evidence-based practice

From an educational perspective, graduate nursing programs are available to train nursing educators and clinical nurse leaders (CNLs). With a Master of Science in Nursing (MSN) degree , a world of possibilities for specialization and increased practice autonomy becomes available to registered nurses (RNs) who aspire to formalize their leadership roles.

These are two distinct pathways that aspiring nurse leaders can take to develop their professional skills and gain additional experience for vital leadership roles in the community and within our nation’s existing healthcare systems. 

Qualities of a Good Nurse Leader

Are you a registered nurse with a desire to develop your leadership skills in nursing beyond the bedside? You are well-positioned to pursue additional training that can set you apart in the job market and grow your confidence to take on new challenges. 

Nursing leadership qualities can be encouraged through faculty mentorship and further developed through nursing experience and graduate education. 

Let’s look at some of the best qualities of a good nurse leader. 

Empathy and Compassion

Empathy is the ability to understand a situation from another person’s perspective, including the emotions experienced and potential motivations for decisions. Good nurses can empathize with others and express compassion in how they communicate, both verbally and nonverbally. When a nurse is empathetic it enables meaningful connection with another person on a human-to-human level.

In nursing leadership, empathy promotes ethical and professional conduct. Good leaders can see problems from multiple angles and consider how various potential solutions may impact several different stakeholders. The ability to empathize also helps a nurse leader implement sensible decisions when there are multiple approaches that can make the best decision more difficult to discern.

Nurse leaders are also advocates for patients and other nurses, and advocacy allows a good nurse leader to:

  • Suggest processes, policies and interventions that are in the best interest of patients and staff
  • Connect patients and staff with helpful community resources
  • Encourage self-care and participation in programs designed to reduce nurse burnout
  • Help patients and families articulate their needs for quality health care

Closely linked to the skills of empathy and compassion are excellent communication skills. Effective communication is a hallmark of quality nursing care and quality leadership.

Communication Skills

Nurses communicate daily with many different people and through different modalities. A good nurse can communicate with other clinicians about patient status clearly and accurately and also relay this information to their patients in ways they can understand, all while empowering and educating them in their health care. 

Written communication is also critical for leadership in nursing as documentation of the nursing plan of care is recorded in medical records where nurses need to be thorough yet succinct. 

Nursing leaders mentor other nurses to promote professional development and continuity of care through shift changes and between visits (depending on the area of nursing practice). Strong leaders maintain open lines of discussion and work to resolve interpersonal conflict in ways that encourage teamwork and mutual understanding. Communication-savvy nurses can motivate, inspire and urge collaboration for a positive work environment.

busy nurse leader and nurse station

Adaptability and Resilience

Nursing is a profession where adaptability to change and flexibility in daily activities are essential qualities. Good nurses can prioritize urgent actions and important details of their schedules as drawbacks occur. This can include:

  • Declines or improvements in the health status of patients
  • New patient admissions and discharges
  • Nurse staffing and regular shift changes
  • Assessment initiatives for quality improvement
  • Accreditation audits and other regulatory reviews

Each of these instances would require a nurse to reevaluate priorities and adapt to the changing needs of patients and families within the healthcare facility. A good nurse can critically think about the urgency and importance of tasks to achieve quality patient care within the changing environment. 

Nurse leaders must be adept in strategic thinking, as well. As there are changes in staffing or new needs for facility accreditation, nursing leadership needs to proactively plan unit-based and organizational strategies for successfully navigating change.

Decision-Making and Problem-Solving Abilities

Within a team of healthcare personnel, there are many valuable viewpoints to consider when making decisions. A nurse leader will observe and request input from the departments and disciplines involved when working to solve problems effectively. 

Problem-solving is as much about the problem itself as it is about the professional relationships and collaboration that may be required. Skills for nursing leaders that can aid in effective problem-solving include:

  • Active listening to understand what others are communicating and why
  • Willingness to consider differing viewpoints on a situation
  • Self-awareness to understand personal motives and potential bias
  • Emotional regulation and a propensity toward conflict resolution

Nurses who make good leaders are also those who give attention to detail. Many times, the details are often where the root cause of a problem can be identified and solutions can be proposed. Good leaders are willing to try potential solutions and honestly evaluate when a different route may be better. Proposing data-driven solutions, admitting faults and learning from mistakes are critical abilities for nursing leadership to possess.

csu student working on computer

Importance of Continuing Education for Nurse Leaders

Another quality of a good nurse leader is the expertise and knowledge gained through continuing education. Skills in health informatics allow nursing leadership to access and analyze available data to report measurable progress and identify areas for improvement in health care delivery. 

The desire to enhance knowledge and skills is a motivational factor for continued development and growth in any career. It is especially important for nurse leaders to pursue and model this growth mindset as mentors for other nurses and to exemplify standards for professionalism. 

Areas for continuing education include:

  • Organizational leadership strategies
  • Teaching methods in patient care and academics
  • Soft skills for team building and working effectively with others
  • Clinical knowledge and advancements for managing specific conditions
  • Emerging technology with health care application

Research evidence for best practices continues to be published as discoveries are made and real-world interventions are implemented and evaluated. The ability to provide timely, evidence-based care is rooted in the practice of continuing education and willingness to learn. 

Next, let’s take an in-depth look at two pathways for becoming a nurse leader: Nursing Educator and Clinical Nurse Leader (CNL). 

Nursing Educator vs. Clinical Nurse Leader

If you are interested in a nursing career with ample opportunity for teaching, mentorship and leading individuals and teams toward improved health outcomes, both the nursing educator and clinical nurse leader roles will provide this. 

A CNL and a nurse educator are similar in that they both work to educate and train healthcare personnel through professional development opportunities and continuing education. 

A nursing educator may work in a clinical facility, such as a hospital or public health agency, or they may be found working in academic roles teaching student nurses. A clinical nurse leader is generally responsible for overseeing direct patient care and improving patient outcomes in a leadership position. 

Both roles are prepared through graduate education and require a master’s degree in nursing. 

Roles and Responsibilities of Nursing Educators

As a nursing educator , you may be responsible for conducting activities such as:

  • Designing coursework and curriculum for students and nurses
  • Researching best practices in teaching
  • Planning professional development activities
  • Teaching clinical skills for direct patient care
  • Process-outcome evaluations of learning in the classroom and clinical setting

The specific activities of a nursing educator's role are somewhat dependent on the setting in which they are employed. Academic settings carry additional responsibilities of student mentorship, grading assignments and regular communication with other faculty to ensure alignment of the educational content with academic accreditation standards. 

Within the hospital or clinical setting, a nursing educator may work with students. However, when nursing educators are positioned within clinical employment positions, they are also frequently responsible for ensuring opportunities for growth and development for a particular unit or nursing specialty. 

Summary of Nursing Education Role

Roles and responsibilities of clinical nurse leaders.

The CNL role is known for leadership commitment with the primary goal of improved patient outcomes through quality improvement, education and other methods for enhancing care delivery within healthcare systems. 

Some of the responsibilities of a CNL include:

  • Coordinating care and communication within interdisciplinary teams
  • Designing evidence-based care plans for patients and families
  • Identifying areas for quality improvement through data analysis and evaluation
  • Promoting patient safety through risk assessments
  • Facilitating transitions of care from one discipline or facility to another

In times of crisis, CNLs are on the front lines of nursing leadership as they stay abreast of current news and the latest recommendations for implementation. A CNL may be the person to suggest process changes for patient treatment plans and nursing care delivery based on an emerging technology or available community resource.

Summary of Clinical Nurse Leader Role

Leadership styles in nursing.

Many of the qualities of a good nurse and leader are important when implementing distinct styles of leadership in nursing. Depending on your personality or the unique dynamics of your workplace, different nursing leadership styles may be more effective than others. 

Leadership styles that are good for nursing leadership include:

  • Transformational - the leader focuses on mentorship to bring the best out of a team
  • Servant - the leader prioritizes meeting the needs of others and leads by example
  • Laissez-faire - the leader entrusts decision-making responsibilities to those they oversee
  • Democratic - the leader builds concensus and makes decisions by creating strong team dynamics

Transformational leadership is especially useful when visionary leaders are working to develop a strong nursing team for the future. Compassion and empathy are valuable qualities in many situations, especially when applying the servant leadership style. The laissez-faire style of leadership promotes a hands-off approach that is especially effective in situations with experienced and self-directed nurses. However, this style may provide too much autonomy for newer nurses who would benefit from greater direction and presence from a leader. 

Nursing leaders who can effectively apply a combination of styles can lead with the benefits of several styles while minimizing the shortcomings a particular style may have. 

If you are ready to embark on your journey to become a dynamic nurse leader, Cleveland State University (CSU) offers high-quality graduate nursing programs to help you reach your goals.

csu students and professor

Cleveland State University’s Online MSN - Nursing Education 

The Online Master of Science in Nursing - Nursing Education program at CSU prepares nurses to become educators in academic and clinical settings. This program prepares graduates to design and implement innovative teaching strategies, mentor future nurses and contribute to curriculum development. 

Program features include: 

  • Completion in two years on a part-time schedule
  • Experiential hands-on learning in your community
  • Accredited by the Commission on Collegiate Nursing Education (CCNE)
  • Prepares you for the National League for Nursing’s (NLN) Certification for Nurse Educators (CNE) exam

With an MSN degree, you may begin working in academia as a clinical instructor. If you are interested in a future role in academic faculty, an MSN degree is the next step to furthering your education toward a doctorate that will allow you to achieve professorial roles in colleges and universities. 

Cleveland State University’s Online MSN - Clinical Nurse Leader

The Online Master of Science in Nursing - Clinical Nurse Leader program at CSU prepares nurses for leadership roles in health care delivery by developing advanced clinical skills and interdisciplinary collaboration. Graduates of the CNL program are prepared to improve patient outcomes through evidence-based practice in complex health delivery situations. 

Program features include:

  • Completion in one year and seven months on a part-time schedule
  • Accredited by the Commission on Collegiate Education (CCNE)
  • Prepares you for the Commission on Nurse Certification’s (CNC) Clinical Nurse Leader (CNL) certification exam

Cleveland State University’s online MSN programs prepare you with the essential qualities of a nursing leader. For more information and details on how to apply, visit the Online MSN-NE and Online MSN-CNL program pages.

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What is Nurse Leadership?

A nurse leader with a stethoscope, leading a meeting with a group of other nurses

This article was updated on October 12, 2023 with additional contributions by Mars Girolimon.

Leaders are found everywhere, from government leaders to corporate leaders to leaders in local communities. You name the setting; we look toward leaders at the helm.

The nursing profession is no exception. Leaders in nursing are influencing healthcare organizations at all levels, and in every setting and discipline. “While nursing leadership is considered a relatively new role in the healthcare setting, the impact and influence of leadership [in the nursing profession] throughout history has been well-documented," said Mandy T. Bell, DNP, MSN, RN , clinical faculty of graduate nursing programs  at Southern New Hampshire University (SNHU). After all, the concept of leadership is “not confined to individuals who possess traditional positions of authority or scope of responsibility. Rather, anyone within an organization can be a leader,” she said.

So, what makes a nurse a leader and why is that important?

What is a Nurse Leader?

Nursing lends itself to attracting and developing strong natural leaders. There is no universally accepted definition, framework, or theory of nurse leadership. “However, most authorities in the profession agree on common leadership traits and skill sets that make a nurse leader,” Bell said.

As Bell defines it, nursing leadership is "the ability to inspire, influence and motivate nursing staff and other health care workers to work together to achieve their highest potential and collective organizational goals."

Why is Leadership Important in Nursing?

Dr. Mandy Bell with the text Dr. Mandy Bell

All of this change does have a silver lining. “The pandemic served as a catalyst for change and innovation as nurse leaders from all levels of nursing responded to the new challenges presented by COVID-19,” said Bell.

In order to accommodate the increased demands of managing patient care during the pandemic, nurse leaders across all levels of the profession "created new models of care and new workflows using technology such as video conferencing and telemedicine to communicate with patients and with other healthcare workers. They also identified ways to prevent shortages from the overuse of scarce resources such as personal protective equipment (PPE). ” Bell said.

As we move forward in healthcare, the innovations created by nurse leaders, like the role of telehealth in nursing , endure and will continue to help to advance the profession.

What is the Role of a Nurse Leader?

A primary role of the nurse leader is to serve as a role model to healthcare and team members. Being able to effectively communicate the goals and expectations of each team member is key. “Essentially, everyone needs to know their role and the roles of the other team members to be able to work together in attaining common organizational goals,” Bell said.

Leadership in nursing begins at the bedside. Then, “by developing and honing their fundamental leadership skills, bedside nurses can positively impact patient outcomes,” said Bell.

Clinical and bedside nurses use leadership skills to coordinate, direct and support patient care and other healthcare team members. They also possess effective communication skills  and serve as a patient advocate.

What Are Qualities of a Good Leader in Nursing?

To be effective in influencing and engaging others toward operationalizing goals, the emotionally intelligent nurse leaders  must be well-versed in both hard and soft skills.

“The hard skills for nurse leaders include advanced clinical knowledge and technical skills that the nurse leader needs to perform their job. Soft skills are the social skills that need to be consciously developed over time and help the nurse leader effectively communicate with peers and subordinates alike,” Bell said. “In other words, the soft skills are critical  for the nurse leader to get along with others in the workplace.”

Soft skills include:

  • Creating a culture that drives high reliability : over time and across the organization’s performance that positively impacts patient safety and quality outcomes
  • Creativity and innovation : by thinking mindfully and being open to new experiences and technologies to improve the status quo.
  • Dedication to excellence : by applying current and evidence-based practice, demonstrating consistency and passion for the profession, and engaging in lifelong learning
  • Excellent interpersonal skills : by using effective written and verbal communication skills, active listening, clarity, confidence, and empathy.
  • Sense of teamwork and collaboration : clearly defined roles and expectations, working toward common goals, and being accountable. As well as coaching and mentoring a culturally diversified workforce.

Additionally, a successful nurse leader must be knowledgeable about:

  • The health care system, advocacy, and policy
  • Conflict resolution and negotiation
  • Finance, business, and human resource management
  • Strategic management
  • Professional development
  • Self-care , such as practicing mindfulness  and developing resiliency

These combined skills promote increased productivity, higher staff satisfaction, and lower staff turnover. This leads to high quality of care plus excellent safety and desirable patient outcomes.

A blue infographic piece with the text Nurse leadership is "the ability to inspire, influence and motivate nursing staff and other health care workers to work together to achieve their highest potential and collective organizational goals." — Dr. Mandy Bell

What Are Examples of Nurse Leadership?

Being a leader in the field of nursing can come in many forms, but Nurse Journal notes three major types of positions for nurse leaders:

  • Nurse administrators : Nurse administrators oversee nursing staff, perform human resources tasks  and represent their department, area or practice to external stakeholders, according to Nurse Journal.
  • Nurse managers : Nurse Journal said nurse managers "are leaders in their units and oversee patient care and daily operations, making sure that the workflow and procedures align with the facility's overall strategic plan and goals."
  • Nurse executives : The most senior nurses may become nurse executives, administrators with additional financial responsibilities who collaborate with partners both inside and outside their organization, Nurse Journal reports.

According to the U.S. Bureau of Labor Statistics ( BLS ), medical and health service managers made a median of $104,830 in 2022, and BLS projects a 28% growth rate by 2032 — much faster than average.*

How Does One Become a Nurse Leader?

While leading comes naturally for many people, nurses, by definition of their challenging and multi-faceted roles, develop more leadership skills while on the job. All nurses within the healthcare organization can assume a role as a leader through embracing the various leadership styles in nursing . They do not need to be in a defined role of authority to exhibit these skills and traits. Leadership in nursing can be accomplished “through experience, pursuing certification and an advanced degree,” said Bell.

Before you earn an advanced degree, you'll need to complete your undergraduate education. According to BLS, medical and health service manager roles typically require a bachelor's degree and up to five years of experience in the field. A Bachelor of Science in Nursing (BSN) is  the preferred choice for many nursing professionals.

Find Your Program

When Danielle Jernigan '23 decided to earn her BS in Nursing  from SNHU, she was working as a nurse in New York City. "Initially, I wanted to get my BSN so that I could apply for better jobs. As a nurse, most employers prefer to hire BSNs, especially the city hospitals," Jernigan said.

Once she started her program, Jernigan became more motivated to seek leadership and management positions in nursing. "With this degree, I am able to advance in my career, and I have already applied for a supervisory role within my current department," she said. "I am more confident in my abilities because the knowledge is there to back it up."

Jernigan said she's eager to learn more and is currently in the process of applying for an MSN Nurse Practitioner  program.

Some universities, like SNHU, also offer MSN Nurse Leadership programs that can help you earn the credentials and preparation you need to advance to the next level.

Above all, a nurse leader must “be agile and flexible in adapting to a rapidly changing environment,” Bell said. Nurse leaders must be prepared to respond swiftly to:

  • Changes in regulatory and legislative requirements
  • New treatment modalities
  • New and ever-changing technologies, including computer use, artificial intelligence (AI), telemedicine, and electronic patient care documentation
  • Evidence-based practices, which includes staying current on the latest best practices, conducting research, and sharing research findings

Keep in mind that the necessary skills to be a nurse leader will change as the profession changes. With each new demand on the world of health care, the need for nurses to be agile grows.

Why is Nurse Leadership Development Important?

Nurses are the cornerstone for any healthcare organization. Effective nurse leadership “is critical for strengthening integration of safe, effective and high-quality care,” Bell said. “This, in turn, creates a positive work environment and promotes positive patient outcomes and experiences,” for patients and staff alike.

The ability to transform business practices as well as patient care is profound. Strong leaders manage staff effectively. Confident and capable staff members who trust in their ability to lead result in “increased staff productivity, morale and job satisfaction,” Bell said. That’s good for everyone.

What’s the Bottom Line?

It’s no secret that nursing is a challenging profession. On a good day, nurses can work up to 12 hours in a shift, on their feet, managing multiple patients with competing needs and demands. Nurses work nights, weekends and holidays. They must have laser-sharp attention to detail, be business-minded and show an exceptional amount of compassion and empathy to those around them.

To be effective, “a key responsibility for a nurse leader is to engage in self-awareness,” said Bell. Nurses who continuously develop their own advanced skill set are investing in themselves and their career. “It is important for the nurse leader to continuously reflect on their leadership strengths and identify opportunities for continued professional growth.” This will help nurse leaders continue to proactively drive positive change in healthcare.

As we move into the future, advances in technology, treatment regimens and the rapidly changing healthcare landscape, and global demographics, there will be even more demands for nurses at all levels to assume a leadership role. Nurses and other healthcare professionals will also continue to look within the nursing profession for leadership. According to Bell: “It will be more important than ever for nurses to assume leadership roles to proactively respond and adapt to each new challenge and continue to advance the profession.”

Discover more about SNHU’s online MSN program : Find out what courses you'll take, skills you’ll learn and how to request information about the program.

*Cited job growth projections may not reflect local and/or short-term economic or job conditions and do not guarantee actual job growth. Actual salaries and/or earning potential may be the result of a combination of factors including, but not limited to: years of experience, industry of employment, geographic location, and worker skill.

Marie Morganelli, PhD, is an educator, writer and editor.

Mars Girolimon '21 '23G is a staff writer at Southern New Hampshire University where they earned their bachelor's and master's, both in English and creative writing. In addition to their work in higher education, Girolimon's short fiction is published in the North American Review, So It Goes by The Kurt Vonnegut Museum & Library, X-R-A-Y and more. They're currently writing their debut novel, which was Longlisted for The First Pages Prize. Connect with them on LinkedIn and X, formerly known as Twitter .

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About southern new hampshire university.

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SNHU is a nonprofit, accredited university with a mission to make high-quality education more accessible and affordable for everyone.

Founded in 1932, and online since 1995, we’ve helped countless students reach their goals with flexible, career-focused programs . Our 300-acre campus in Manchester, NH is home to over 3,000 students, and we serve over 135,000 students online. Visit our about SNHU  page to learn more about our mission, accreditations, leadership team, national recognitions and awards.

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Stories of nurse leaders

nurse leader essay

In tandem with our series of case studies on the Nursing Now ‘Young Nurses’, we are also sharing the stories of some of our nurse leaders.

“We will not be able to achieve UHC unless nurses are involved in decision-making […], in all aspects of health as leaders.”

nurse leader essay

“I could have taken an easier path to a different location or given up altogether – but I didn’t want to as it just felt right to become a member of this profession.” 

Matt daley, rn, john burdett fellow, health education england, when did you first realise you were interested in health and healthcare.

Growing up, I was very squeamish and hated the thought of injury and the sight of blood, but I realised I was interested in health and healthcare whilst serving in the Royal Navy on-board HMS Ark Royal and HMS Illustrious during the Balkans War. During this time. I learnt about the need for humanitarian healthcare due to the conditions ashore. I had some experience in first aid, but wanted to be more involved in helping people directly by providing personal care and intervention.  I had an aunt who was a nurse (still is!) and that was the role I aspired to, however, it took some time to achieve this academically and professionally.

How did your career in health begin?

Once I had made a decision to work in health, I was able to transfer my role to the Royal Navy Medical Branch and became a Medical Assistant in the wider general service.  This allowed me to gain broad knowledge and experience in emergency, primary and secondary healthcare role settings. After this, I worked as a First Aid Instructor whilst I prepared to enter adult nursing. 

I became a Registered Nurse (Adult) in Queen Alexandra’s Royal Naval Nursing Service in 2006, and since then I have worked on wards and intensive care units, with opportunities to work with the Ministry of Defence on innovation and research projects.  I completed my military service in December 2013 after 23 years, and have mainly worked in Practice Development since then.

Who inspired you to become a nursing leader?

I have had the good fortune to be surrounded by many inspirational leaders who were compassionate, firm, principled and forgiving. During my time as a military intensive care nurse I liaised often with relatives, staff and wider organisations in very sensitive, highly emotional circumstances.  During this time I was personally supported by my Chief Nursing Officer. This experience, and the support I received taught me about the value and impact of compassionate leadership. One particularly poignant time was when she accompanied a new member of the team through the final journey of a patient’s organ donation.  Her example has stayed with me and continues to inspire me.

What obstacles did you encounter and how did you overcome them?

I have navigated my way through several career changes and sought new opportunities while striving to maintain family relationships, current role and deployments. I have also had to work on my confidence and willpower. Determination, persistence and self-belief have helped me to get thus far. I could have taken an easier path to a different location or given up altogether – but I didn’t want to as it just felt right to become a member of this profession.

What would you tell your younger self/ a nurse at the beginning of their career?

  • Find an inspirational role model, if not from your close peers then look further afield. 
  • Remember, you are representative of the nursing profession and every nurse from the past, present and future.  You have the power to make the profession in the image you want it to be.
  • Have aspirations, follow them and believe in your abilities – nurses are bright, clever professionals that make a difference every day.
  • Vision is everything, share it and make it a reality, whatever it is.  Remember that you may be driving it by yourself for a while.

What are the qualities required to be a nurse leader?

From my experience of observing and interacting with different levels of nurse leadership, I think the qualities of compassion and kindness, combined with staying true to values and principles have demonstrated what I believe are the qualities to be a nurse leader – kind, firm and fair.  To this I would add – having the will to drive these outwards into the workplace and influence the wider culture of organisations and the social culture of the communities where we live and work.

If you could change one thing about the health system in the UK, what would it be?

The one thing I would change would be the consistency of access to educational and career opportunities for promising young nurses and midwives.  I would change the “system” so that newly qualified nurses and midwives with talent and ambition could be fast tracked into advanced leadership or clinical roles. This would ensure that we recognise and reward talented individuals who are the future of the nursing profession.

Why is it important, in your opinion, for young nurses to be involved in policy and decision making? 

In my opinion, young nurses must be involved in policy and decision making in order to make their relevance known and build their influence as a body, alongside medical colleagues. Other professionals have a voice and influence, I think that young nurses should be prepared to establish themselves and bring their own profession forward into this arena.   Nurses are at the very heart of healthcare and are present in every area – they understand the fundamental concerns of the patient, family and carers, so should be involved at the highest level to ensure that what is being decided meets the requirements now and later. I was taught to be the patients’ advocate in my profession, and I would expect my younger nurses to speak for me, my generation and future generations when I am no longer able.

How do you think that Nursing Now will make its mark on the future of nursing?

I want Nursing Now to make its mark on the future of Nursing by being the point when things changed for the profession. The global passion for involvement is so encouraging, and this I think is because there is a hunger for connection amongst nurses. I work in a Trust consisting of many nationalities and we are all passionate about delivering the same high-quality of care to our patients. Healthcare systems may be different but the reason the nurses are there is the same in any country, and it is this connection that makes us a very strong force for change globally. Conversation and collaboration are key to this change and growing out of this I would want to see the cross pollination of ideas that means countries work closer together to bring benefits to the profession and populace.

Why is it important for governments around the world to invest in nurses/ the nursing profession?  

Investment in nursing ensures the profession has the skills, tools and knowledge to meet the needs of the community at home, as well as in GP practices and hospitals.  Nurses are fundamental to a functioning health system in society, a lack of investment would be to the detriment of nursing skill and preventative health measures. It would also make nurses feel under-valued.

“My patients and students challenge, motivate and inspire me to live up to my commitment to nursing excellence everyday.”

Bongi sibanda, dnpc msc-anp fhea rn, advanced practice nurse consultant/educator, apn africa founder .

I always had a keen interest in health as a child. Growing up with many relatives who were in the healthcare industry, especially different nursing roles, was instrumental in my nursing choice. One relative, a community nursing sister used to drive around the city in a company Madza 323 seeing patients in their homes in the 90s, and by then l knew l just wanted to do that too!

I did my pre-registration nurse training in Zimbabwe and by the age of 20, l was already a Registered Nurse. It was one of the great foundations to healthcare practice and one l hold dear to where l am now. Post qualification l worked in a number of roles including mental health, casualty, critical care and clinical research; before practising in the UK from 2004.

Who inspired you along the way to become a nursing leader?

I have worked with a number of incredible leaders within healthcare and beyond and I am privileged to have family members who have held senior nursing roles too; they have all inspired me and held my hand along the way. However, my patients and students challenge, motivate and inspire me to live up to my commitment to nursing excellence everyday. I am truly grateful for this challenge that keeps me curious and looking for ways to serve better daily.

What difficulties did you encounter and how did you overcome them?

Being a nurse leader/academic from a BME background, especially in the area of advanced clinical practice is a challenge in itself in the UK and evidence tells us so. My experience has not been that different; I have had to work twice as hard as my colleagues, navigate prejudice and prove my worth in many clinical/academic roles. Fortunately, I am privileged to have many global leaders who have given me opportunities and supported my work along the way; as a result, l have been able to persevere and stay committed to excellence in nursing practice.

What would you tell your younger self/ a nurse at the beginning of his/her career?

It’s the best career choice young lady; relax and see how it all works out later!

Among other critical qualities of authenticity, commitment to excellence and emotional intelligence; nurse leaders must be well-versed with healthcare business and policy to achieve organisational goals and population outcomes. Therefore, the ability to grasp the bigger picture beyond healthcare industry and remaining curious on business strategy, policy and global issues cannot be underestimated.

If you could change one thing about the health system in your country, what would it be?

Well, l have a number of countries! 

First in England and within my area of expertise – Unscheduled Care (Urgent Care and GP Out of hours services), I would like to see more integration of services and single commissioning. This would address a number of issues around commitment to workforce development, especially in advanced clinical practice by all stakeholders, reduce high expenditure on agency/locum staff and improve patient experience/journey in the system. 

In Africa, the current reliance on donors and NGOs for the provision of core primary care services in some countries is unsustainable, not congruent with the Astana Declaration and needs to change. Therefore, in collaboration with colleagues, we are working across disciplines and with a number of regional organisations to strengthen primary health care systems and help governments towards achieving Universal Health Coverage (UHC). This includes advocating for the development of Family Nurse Practitioners who are well placed to provide high quality care to under-served /rural populations.

Why is it important, in your opinion, for young nurses to be involved in policy and decision making?

Not only is the future young with over 50% of the world population under the age of 30 years; young nurses are future healthcare leaders who will inherit the legacy of UHC 2030. Therefore we need them at the policy and decision making table now to help them carry this work forward. In my experience of working and mentoring young nurses, l have found them to be innovative with great minds. I have learnt a lot from them too. We must harness this opportunity for the future of our profession and positive patient outcomes.

The current Nursing Now work speaks volumes. The collaboration with WHO, ICN, and Nursing Now has already proved a success in a number of projects; facilitating nursing leaders to be more visible in policy and decision making tables. There is certainly more awareness on the complexity of nursing practice and the need for this to be recognised. The Nightingale Challenge will be one critical area that will make governments commit to investing in nursing and realise the need to do so.

Why is it important for governments around the world to invest in nurses/ the nursing profession?  

Nurses are by far the largest workforce across the globe, providing more than 80% of primary care services in many countries. For UHC and health-related Sustainable Development Goals (SDGs) to be achieved; nursing education, scope of practice and leadership must be enhanced and this includes scaling up the number of nurses highly trained in clinical practice (Advanced Practice Nurses). The ageing population of current nursing workforce and the WHO projected shortfall of 18 million health workers means that governments around the world must commit to nursing investment if health services are to be delivered to populations.

Nursing Now

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Nurse leadership: Sustaining a culture of safety

Helena e.m. haskins.

1 Department of Health Studies, University of South Africa, Pretoria, South Africa

Lizeth Roets

Associated data.

Full data are available in the researcher’s custodian university.

Nurse leaders are essential to manage nursing practices that affect patient safety; therefore, they must create and sustain a sound safety culture in a diverse cultural environment.

To describe the specific actions required by nurse leadership to enhance the sustainability of a safety culture in hospitals and among a diverse nursing team, ultimately improving patient outcomes.

Two hospitals in the United Arab Emirates (UAE) were selected purposively, based on the diversity of the nursing team.

A quantitative design, using Reason’s safety culture framework and Ekenedo’s behavioural safety model, formed the theoretical background of this study to identify the safety culture and positive work environment that exist among culturally diverse nurses. Thirty-four nurse managers and 417 nurses were conveniently selected to participate. Various instruments were used to gather hospital outcomes and other data from respondents pertaining to their demographics, patient safety, positive work environments and safety culture.

Findings received from the nursing team describe the correlation between patient safety, a diverse nursing workforce and positive work environment affecting a safety culture and promoting positive patient outcomes.

Nurse leaders’ integration of specific actions to address the system, as well as diverse nursing teams’ behavioural practices, create a patient care environment that adequately contributes to safety culture practices and enhances positive patient outcomes, which are essential for a culture of safety.

Contribution

The study contributes by providing a structured integration of specific actions for nurse leaders to sustain practices ensuring positive patient outcomes.

Nurse leaders are essential to manage nursing practices that affects patient safety; therefore, they must create and sustain a sound safety culture in a diverse cultural environment such as the United Arab Emirates (UAE).

With healthcare evolving, there is growing attention and focus on patient safety, ultimately requiring nurse leadership practices that follow through on patient safety events and manage nursing actions that affect patient safety.

A diverse healthcare workforce further complicates matters, and nurse leaders (also referred to as nurse managers) face increased challenges in sustaining patient safety (Padgett et al. 2017 ).

The behavioural safety culture model of Ekenedo defines the specific skills and decisions that nurse leaders must apply in their departments to sustain a sound safety culture (Besnard et al. 2018 ; Golda 2013 ).

A nurse leader has many responsibilities, such as instilling a culture of safety; assessing, reducing, mitigating and managing safety risks in a caring environment; maintaining a safe patient allocation based on the acuity and skill mix of the nurses; evaluating team performances; sharing and educating patient safety measures; and managing risky behaviours among nursing staff (Bronkhorst, Tummers & Steijn 2018 ; Edgar 2017 ).

The hospital climate (or ‘positive work environment’, used interchangeably) can be described as the ‘perceived and recurring patterns of behaviour, attitudes and feelings that characterise life in the organization’ (Gea-Caballero et al. 2021 ). Because nurses spend most of their time in the work environment, facilitating a safe, positive work environment is essential to ensure the safety of patients and staff.

Evidence shows that nurse leaders have a direct impact on the perceived climate based on their commitment to a culture of safety, communication, fostering teamwork, productivity, scheduling and recognition of nurses’ achievements that support patient safety (Farokhzadian, Nayeri & Borhani 2018 ). It is essential for nurse leaders to understand how their nursing team perceives the hospital climate to proactively address patient safety events in order to promote positive patient outcomes

There are numerous positive work environment tools that the nurse leader can use to determine how their nursing team perceives their work environment, and in the UAE many healthcare organisations apply the National Database of Nursing Quality Indicators nurse surveys annually (Alsalam et al. 2018 ). Ultimately, this information may provide the nurse leader with supporting information to establish how these factors affect the culture of safety in the unit.

A culture of safety was established as the result of a number of events that occurred in the aviation and nuclear industries (Al-Lawati et al. 2018 ). However, a culture of safety specifically related to healthcare can be defined in terms of measuring the different dimensions appropriate to clinical settings (Hogden et al. 2017).

Creating an institutional safety culture is not based on a new set of rules but rather on a philosophy that should be embraced by the healthcare team to prevent harm in the workplace (Hogden et al. 2017). Healthcare organisations with a positive safety culture are characterised by communications founded on mutual trust, shared perceptions of the importance of safety and confidence in the efficacy of preventive measures (Hodgen et al. 2017 ).

Jilcha and Kitaw ( 2016 ) and Ma and Rankin ([sa]) list five components required for a sound culture of safety to be applied in healthcare, namely (1) an informed culture, (2) a flexible culture, (3) a reporting culture, (4) a learning culture and (5) a just culture. Applying them in practice allows the nurse leader to address all components in a clinical care setting.

According to Reason’s Culture of Safety Framework (Jilcha & Kitaw 2016 ; Ma & Rankin [sa]), a learning culture is vital to enable nurses to practise safely; thus, nurses’ orientation, regular in-service training programmes and unit-specific competency training should be offered. In creating an environment of learning, nurses are empowered to assess their own learning needs and practise safely (Oliveira et al. 2017 ).

As technology advances, so does the complexity of systems within healthcare; therefore, various subjective safety indicators are required to determine the nursing teams’ safety performance (Mirrah et al. 2020 ).

Currently, there is no benchmarking among the UAE hospitals; thus, quality and services are measured against international hospitals, which do not have the same cultural backgrounds and issues. Healthcare facilities should ultimately benchmark against other facilities in the same country in order to constantly work towards enhanced practices and processes for improved patient safety and patient outcomes.

Patient safety is the reduction of risks associated with injury or harm to a patient to a minimal acceptable level (World Health Organization 2018 ). Pelzang and Hutchinson ( 2018 ) claim many patients are affected by adverse events such as poor documentation practices, falls, insufficient hand hygiene (HH) and hospital-acquired pressure injury (HAPI). Some experience lasting damage, while others could potentially die.

Safety culture practices are not always sustained in hospitals (Alsalam, Bowie & Morrison 2018 ), despite nurses being exposed to various development, planning and education projects on standards of care and safety practices. Although hospitals use nursing-sensitive performance indicators, the variances reported have had a negative impact on patient outcomes (Alsalam et al. 2018 ).

On average, in the two hospitals investigated, patient fall rates have increased from 0.1% to 0.4%, HAPI incidences increased from six to eight cases per month, HH compliance was at 85% and the Nursing Admission Assessment (NAA) completed within the specified 24 h was at 90%.

Nurse leaders must understand the synergy between the factors in the hospital climate and safety culture on patient safety to identify the impact it has on positive patient outcomes (Churruca et al. 2021 ; Willmott & Mould 2018 ).

Therefore, describing the specific actions required by nurse leaders to facilitate a safety culture and improve patient outcomes may be advantageous to address cultural diversity among the nursing team, as well as promoting a positive work environment and managing safety factors affecting the safety culture.

The purpose of this study is to describe specific actions required by nurse leaders to enhance the sustainability of a safety culture in hospitals and among a diverse nursing team, ultimately improving patient outcomes.

Reason’s safety culture framework and Ekenedo’s behavioural safety model (Golda 2013 ; Jilcha & Kitaw 2016 ; Ma & Rankin [sa]) formed the theoretical background of this study. Utilising these two theoretical frameworks provided insight into how the study hospitals compared to Reason’s safety culture and the Ekenedo behavioural safety model to clarify reasons for the nursing team not sustaining safe practices.

Research design

A quantitative design was utilised (Creamer 2018 ) to identify and describe the hospitals’ safety culture and describe the specific actions that may facilitate a sustainable safety culture among the nursing team that contributes to improved patient outcomes.

Population and sample

Six hospitals in Abu Dhabi fall under the umbrella of the Department of Health, of which two were purposively selected to gather data, because these hospitals are known to have a diverse nursing workforce. Forty-six nurse managers and 1597 nurses work in these hospitals, of which 34 nurse managers and 417 nurses were conveniently selected to participate. Based on a 95% confidence interval (CI), only 310 nurse respondents were required for a satisfactory sample size.

Data collection tools

Checklists were used to gather hospital outcome data, and different questionnaires were used to collect data from nurses and nurse managers pertaining to demographics, patient safety, a positive work environment and safety culture.

Reliability and validity

Reliability.

Reliability was achieved by adapting an already validated checklist developed by the Abu Dhabi Health Services Company (SEHA) to obtain hospital outcomes data. The self-developed questionnaire, based on a thorough literature review, was pretested after being assessed by a scientific committee of experts and a statistician. The response rate for the nursing respondents’ questionnaires during the pretest was 100%, which is exceptional considering an acceptable response of 80% is described in the literature (Creamer 2018 ). The descriptive results from Statistical Package for Social Sciences (SPSS; IBM Corporation, Armonk, New York, United States) on all ‘culture of safety questions’ demonstrated a mean of above 3, the standard deviation for all questions ranged between 0.59 and 1.0 and Cronbach’s alpha was 0.877. These results are indicative of the high reliability of the data.

Criterion-related validity was ensured as the researcher sought to establish a relationship between the scores on an instrument and some external construct by comparing the hospital outcome data with the data obtained from nurses and nurse leaders regarding patient safety questions.

Face validity was applicable as the different questionnaires for the nurses and nurse leaders were pretested to determine nurses’ and nurse leaders’ culture of safety and positive work environment practices, and the influence of cultural diversity on the safety culture was compared with the hospital data.

Data collection methods

The chief nursing officers in each of the study hospitals were recruited to provide patient outcome data recorded on the checklist pertaining to the following aspects: completion of the NAA within 24 h, fall rates, HAPI incidence rates and HH compliance rates.

Research coordinators were appointed in both study hospitals to distribute the information leaflets, questionnaires and consent forms to the participants. Various sessions were scheduled to allow participants to attend the sessions based on their convenience. In total, 900 nurses (600 from hospital A and 300 from hospital B) and 34 ( n = 46) nurse leaders attended the various information sessions, A 4-week period was provided to return questionnaires in the sealed boxes available on each unit. These boxes were then sealed and collected for data analysis.

Ethical considerations

Ethical clearance to conduct this study was obtained from the Health Studies Higher Degrees Committee of the University of South Africa (reference number: REC – 012714-039) and the two hospitals’ institutional ethics review boards (reference numbers: REC – 26.02.2015 [RS-357]; REC – AAH/EC-03-15-002). Individual respondents provided written informed consent. The ethical principles of beneficence, nonmaleficence, justice, human dignity, privacy and confidentiality of information, as described by Creamer ( 2018 ), were adhered to.

Statistical Package for Social Sciences 2010 was used to analyse the data received from 417 (46.3% response rate) nurses and 34 nurse leaders (73.91% response rate).

Biographical data of nurses and nurse leaders

Attum et al. ( 2020 ) state that privacy and gender are very important in Islam, and gender was thus an important aspect in this context, where the majority of the nursing team were female ( n = 345, f = 81.03%; n = 26, f = 76.45%).

As the majority ( n = 257; f = 61.33% nurses and n = 33; f = 97% nurse leaders) of respondents fell in the 35–64 age group, it was indicative of a sound competence and skills mix ( Table 1 ). The literature describes older nurses as more experienced and skilled because of exposure to clinical settings (Bridges et al. 2019 ).

Gender and age of nurses and nurse leaders.

Source: Haskins, H.E.M., 2019, An action plan to sustaining a culture of safety for positive patient outcomes, doctoral thesis, University of South Africa, Pretoria, viewed n.d., from http://hdl.handle.net/10500/26185

The data in Table 2 indicates the nurse respondents were from diverse cultural backgrounds; the majority ( n = 164) were from the Philippines, followed by India ( n = 155). However, nurse leaders were predominantly from Jordan ( n = 7; f = 21.21 %), South Africa ( n = 7; f = 21.21 %), the Philippines ( n = 5; f = 21.21%) and India ( n = 5; f = 21.21%). The least represented were nurse leaders from Egypt, Finland, New Zealand and Romania ( n = 1; f = 3.03%). Patient admissions data revealed that 75% of patients treated in both study hospitals A and B to be Emirati and 25% non-Emirati (from 19 different nationalities encountered in hospitals). As a result of this diversity, language barriers may have existed because of the majority of nurses and nurse leaders not being able to converse in the Arabic language ( n = 338 nurses and n = 22 nurse leaders). Only 70 nurses and 10 nurse leaders spoke an Arabic dialect – Emirati, Jordanian, Syrian, Sudanese and Palestinian. This illustrates that important patient information may not be retrieved and shared because of language deficits, and because competent translators may not be readily available (Basu, Costa & Jain 2017 ).

Nationalities of nurses and nurse leaders.

Source : Haskins, H.E.M., 2019, An action plan to sustaining a culture of safety for positive patient outcomes , doctoral thesis, University of South Africa, Pretoria, viewed n.d., from http://hdl.handle.net/10500/26185

Communicating across cultural boundaries increases the risk of misunderstanding, and it is further compounded when dealing with complex scientific and medical information (Brooks et al. 2019 ). Patient information is in English, but only 5.8% of the nurses’ home language is English, which could have an impact on effective communication and how the nurses apply safety best practices. This finding reflects that nurse leaders should facilitate strategies to assist nurses to improve their English proficiency, to use specific tools to communicate with patients with limited English proficiency and to ensure translators are available in the units (Basu et al. 2017 ; Brooks et al. 2019 ).

Cultural perceptions of nurses and nurse leaders

Nurses ( n = 339; f = 81.5%) and nurse leaders ( n = 28; f = 82.5%) indicated that the cultures of the nursing team and patients directly affect patient safety. The reasons mentioned by the nursing team as to why their own and patient cultures affect patient safety included differences in education, language barriers and cultural values among the nurse and the patient.

The UAE has more than 200 different nationalities residing in the country; thus, healthcare professionals should become aware of the cultural influences and health behaviours related to illness and recovery and translate that awareness into culturally congruent care (Brooks et al. 2019 ).

The UAE cultural structure consists of each family, traditionally bound by obligations of mutual assistance to their immediate relatives and the tribe as a whole. The culture and traditions of the UAE are grounded in the Islamic heritage of the Arab region, and they seek the Qur’an as a healing source in times of psychological and spiritual distress (UAE webpage).

Cultural aspects can impede patient care plans; therefore, healthcare professionals must understand what drives the patient and family towards healing. Although the Crescent of Care model was developed to guide the care of Arab Muslim patients and describes the holistic care nurses should practise in a daily plan of care, it is not evident in practice in the UAE (Lovering 2012 ).

Privacy and gender separation are important aspects of Islam, and nurse leaders need to ensure the environment is appropriate and include nurses of the correct gender according to patients’ genders (Attum et al. 2020 ; Hassan et al. 2020 ). Appropriate signs need to be displayed, indicating the allowed gender to use a specific room or enter that room to provide care. Knocking on the door before entering to ensure female Muslim patients are appropriately covered is another important cultural principle (Attum et al. 2020 ).

To ensure that nurses are able to apply transcultural nursing care in practice, senior nurse leadership must confirm that the orientation programmes and ongoing education address cultural differences and expectations (Kaihlanen, Hietapakka & Heponiemi 2019; Uman, Edfors & Jakobsson 2020 ).

Culture of safety and nurse leadership

Organisations with a positive safety culture are characterised by communications founded on mutual trust, shared perceptions of the importance of safety and confidence in the efficacy of preventive measures (Hodgen et al. 2017 ). Jilcha and Kitaw ( 2016 ) and Ma and Rankin [sa] list five components required for a culture of safety, namely (1) an informed culture, (2) a flexible culture, (3) a reporting culture, (4) a learning culture and (5) a just culture.

Authors indicate a definite association between a safety culture, a positive work environment and patient safety outcomes in healthcare facilities (Khoshakhlagh et al. 2019 ; Kumbi et al. 2018 ).

A five-point Likert scale was used for nurses to grade their perception of the impact a positive work environment, cultural aspects and patient safety have on the sustainment of a culture of safety in the clinical setting.

Nurse leaders must establish an environment of transparency and engage the nursing team in patient safety and safety improvement activities, regularly share patient performance outcome data, ensure open communication, enforce teamwork and provide a supportive environment to speak freely about safety concerns on units, to ensure mutual respect and recognition of nurses’ safety efforts (Khoshakhlagh et al. 2019 ; Kumbi et al. 2018 ).

The web diagram in Figure 1 shows nurses did not perceive their work environment as positively supporting patient safety, which is a significant safety concern for nurse leaders to consider (Murray, Sundin & Cope 2017 ). Moreover, safety culture forms part of larger organisational processes, and nurse leaders must review these in terms of the nurses’ perceptions of the hospital’s environmental safety features that may influence their overall safety performance (Murray et al. 2017 ).

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Nurses’ perception of a positive work environment affecting patient safety.

As illustrated in Figure 2 , approximately 57% of nurses confirmed that a punitive environment does not exist within the facility. However, 43% of nurses reported nurse leaders follow a punitive approach if an incident occurred, and 33% disagreed that nurse leaders proactively address system concerns affecting patient safety. This is of concern because a culture of safety is unsustainable if nurse leaders do not address systems and processes.

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Relation between nurses’ perception of nurse leaders’ proactive system review versus punitive approach.

Based on the nurses’ perception, nurse leaders have a primary responsibility to identify process changes to sustain a sound safety culture in the clinical areas. Nurse leaders must proactively identify system gaps and ensure a safe care environment that could influence patient safety; thus, they need to be visible in the units and have sound decision-making concern for patient safety events (Golda 2013 ).

As illustrated in Table 3 , the majority of nurse respondents agreed ( n = 279) that nurse leaders are visible and supportive in the units to enable them to address patient safety concerns. However, 134 nurses disagreed ( n = 64; f = 15.4%) and remained neutral ( n = 70; f = 16.8%), which indicates nurse leaders are not always visible and supportive in addressing a safe care environment; such behaviour could have a potential negative impact on patient safety.

Nurse leader’s visibility and support to ensure a safe care environment.

Source: Haskins, H.E.M., 2019, An action plan to sustaining a culture of safety for positive patient outcomes , doctoral thesis, University of South Africa, Pretoria, viewed n.d., from http://hdl.handle.net/10500/26185

It is essential for nurse leaders to apply ‘just culture’ principles in practice to eliminate patient safety concerns, address system issues and manage unsafe practices among the nurses (Haskins 2019 ; Paradiso & Sweeney 2019 ). Nurse leaders must (1) follow clear disciplinary processes, (2) frequently review system issues, (3) manage system defects through frequent processes review, (4) use structured performance reviews to manage nurses’ behaviour affecting patient safety, (5) obtain data from the incident reporting system allowing them to manage patient safety issues, (6) support hospital management in addressing system issues and (7) manage incidents through appropriate quality methodologies.

It is evident in Figure 3 that most nurse leaders ( n = 26 of n = 33) applied the basics of ‘just culture’ in managing nurses’ behavioural practice gaps. However, a third of the respondents disagreed, indicating that nurse leaders did not utilise ‘just culture’ practices within the context of patient care.

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Object name is HSAG-27-2009-g003.jpg

Nurse leaders’ just culture practices.

Nurse leaders have a significant role and responsibility for ensuring the sustainment of a culture of safety despite a diverse nursing workforce responsible for nursing care. An analysis of the data within this research study revealed that nurse leaders must take specific actions to sustain a culture of safety, thereby improving patient outcomes.

English proficiency testing of nurses prior to employment must be assessed, and remedial opportunities to provide basic Arabic or any other relevant language proficiency training when joining a hospital or any other healthcare facility where diversity exists must available. This will allow for communicating among a diverse nursing team (Al-Harasis 2012 ; Oducado et al. 2020 ).

Specific tools to communicate with patients with limited English proficiency or availing competent translators to assist with the communication are required. Translators might be a feasible solution to the challenges experienced; however, availability and cost implications might be challenging in resource-poor healthcare environments (Blay et al. 2018 ).

Nurse leaders must ensure that induction programmes include cultural training to enable the diverse team to provide culturally congruent care. Induction programmes and continuous professional development opportunities focusing on basic healthcare education and communication in more than one language will be useful to allow patients and professionals to understand one another, contributing to a safety culture (Noonea et al. 2020 ; NSW Report [sa]).

It is important that nurse leaders should create and facilitate a positive work environment (hospital climate) that promotes leadership support and visibility, reward and recognition, effective communication, teamwork, safe staffing and patient allocation for staff to ensure patient safety. This will facilitate a work environment where nurses feel free to engage, speak up and participate in safety events that might affect patient safety (Debika, Kumar & Kumari 2020 ).

Nurse leaders must practise a culture of safety through sharing information related to patient safety. They must be flexible in managing patient safety and report incidents or concerns that could have an impact on patient safety. They have to apply a ‘just culture’ to manage behavioural choices and system safety as well as providing opportunities for a continuous learning culture among their diverse nursing team. This will lead to nursing team being proactive, engaged, empowered and educated on safety event prevention that will facilitate sustainability of a safety culture (Churruca et al. 2021 ).

Nurse leaders must furthermore create a ‘just’ culture by following a clear disciplinary process. They must continuously review system concerns affecting safety, manage system defects through frequent process reviews, use structured performance reviews to manage nurses’ behaviour affecting patient safety and obtain data from the incident reporting system to manage patient safety issues. They also have to support hospital management in addressing system issues and manage incidents through appropriate quality methodologies. It is therefore essential for nurse leaders to practise ‘just’ culture to allow the nursing team to feel engaged, educated and empowered to manage their own practice and speak up if safety concerns are present in the care environment and thus model optimal clinical outcomes (Fend, Willoughby & Jackson 2021 ; Paradiso & Sweeney 2019 ).

The strengths of the study describe the importance that nurse leaders have to play to sustain a culture of safety, thereby ensuring positive patient outcomes. It is of value to do further research to determine the direct correlation that the diverse culture might have on sustaining a culture of safety.

This study described the structured integration of specific actions for nurse leaders.

Conclusions

Nurse leaders must understand the influence that the hospital climate factors, cultural diversity, patient safety risk and ‘just’ culture practices have on positive patient outcomes and sustaining a culture of safety.

It is therefore important for nurse leaders to ensure that patient care environments adequately contribute to safety culture practices that enhance positive patient outcomes through the application of specific actions in operational activities. It is possible to sustain a culture of safety if very specific actions are implemented and facilitated in practice to allow patients and professionals from diverse cultures to enhance a culture of safety, ultimately improving patient outcomes and providing a positive patient experience.

Acknowledgements

This article is derived from the first author’s thesis, entitled ‘An action plan to enhance a sustainable culture of safety to improve patient outcomes’ submitted in partial fulfilment of the requirements for the degree of DLitt et PHIL in Health Studies at the University of South Africa, 2019. Supervisor: Prof. L. Roets. Available at : http://hdl.handle.net/10500/26185 .

Competing interests

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Authors’ contributions

H.E.M.H. contributed to the conceptualisation, methodology and writing of the original draft. L.R. was the supervisor.

Funding information

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data availability

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.

How to cite this article: Haskins, H.E.M. & Roets, L., 2022, ‘Nurse leadership: Sustaining a culture of safety’, Health SA Gesondheid 27(0), a2009. https://doi.org/10.4102/hsag.v27i0.2009

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Home — Essay Samples — Business — Leadership — The Importance of Effective Nursing Leadership

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The Importance of Effective Nursing Leadership

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Published: Jan 30, 2024

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Definition and importance of nursing leadership, qualities and skills of effective nursing leaders, roles and responsibilities of nursing leaders, impact of nursing leadership on patient care, challenges and strategies in nursing leadership.

  • Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: a systematic review. Journal of Nursing Management, 21(1), 30-40.

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nurse leader essay

Organizational Barriers’ Experienced by Nurse Leaders Essay

Introduction.

While healthcare organizations strive to cultivate high standards, regulations, and values in their settings to achieve better patient outcomes via nursing work improvement, often, such aspirations are characterized by barriers. In particular, nurse leaders might be unable to resolve issues related to organizational culture due to the lack of authority or capability to overcome them, which might make them feel powerless. It is essential to acknowledge such issues to ensure that a larger scope of actions is implemented to adjust the nursing workplace setting to a level unimpacted by significant barriers.

Indeed, organizational culture implies a scope of factors that reach beyond the expertise of a nurse leader. An example of such a barrier might be the difficulty in obtaining required resources or their scarcity (McCauley et al., 2020, p. 1770). When a nurse manager needs particular equipment or human resources to accomplish an organizational goal, they might feel powerless because the resources are limited or unavailable due to organizational circumstances. Moreover, as managers, nurse leaders “plan staffing and skill mix for optimum care, while maintaining focus on the strategic goals of the organization” (McCauley et al., 2020, p. 1770). However, a barrier that might be implied in the accomplishment of such duties is the lack of clarity in higher management’s directions related to strategy, which leaves a nurse leader hesitant and powerless.

In conclusion, organizational culture-related implications of workplace interactions, communication, and perception of nursing roles might serve as barriers to nursing leaders’ performance. For example, as stated by researchers, moral disengagement and knowledge hiding in nurse staff’s behavior in the workplace might be a significant challenge for leadership (Zhao & Xia, 2019, p. 357). These issues are harmful due to the disruption of normal work processes and limited results in patient care. Thus, the identification of these barriers might be used as a premise for implementing initiatives aimed at facilitating organizational culture’s impact on nursing.

McCauley, L., Kirwan, M., Riklikiene, O., & Hinno, S. (2020). A scoping review: The role of the nurse manager as represented in the missed care literature. Journal of Nursing Management, 28( 8), 1770-1782.

Zhao, H., & Xia, Q. (2019). Nurses’ negative affective states, moral disengagement, and knowledge hiding: The moderating role of ethical leadership . Journal of Nursing Management, 27 (2), 357-370. Web.

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