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Viljan att göra skillnad: en utmaning i vårdenhetschefers ledarskap
Ersta Sköndal University College, Department of Health Care Sciences.
2010 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to gain a deeper understanding of F-LNMs’ leadership. Another aim was to examine possible differences in self-rated health between F-LNMs and registered nurses (RNs) on various psychosocial factors.

Method: Study I and III are single case studies. Study I concerns a first-line nurse manager working in a unit for care of older people. Data collection comprised of two interviews, observations, and documents. A hermeneutic approach was used for the analysis. Study II was carried out in three units at three Swedish hospitals. Three F-LNMs and 14 RNs participated. Interviews were used to collect data. The interviews were analysed using qualitative content analysis. Study III was conducted at a palliative care unit. Data were collected using three separate instruments: a questionnaire, group interviews with nurses and leaders, and documents. Qualitative content analysis was used to analyse the material. Study IV was conducted at a university hospital. Seventy-eight F-LNMs and their 1,806 subordinated RNs participated in the study. Data were collected using a web-based questionnaire (Web-QPS) to assess the participant’s psychosocial work environment and their self-rated health.

Result: The main finding in study I was that the F-LNM goal-profile consisted of three goals - the nurse goal, the administrator goal and the leadership goal. The administrator and leadership goal were in accordance to her job description, while the nurse goal was interpreted as a personally chosen and prioritised goal. In study II the result was illustrated in one main theme referred to as between being and doing. The RNs and F-LNMs described what it was to be a good professional (being), how they were engaged in creating a good work climate (doing) and personal outcomes of this project (gaining). In study III the result showed that the most important component at the palliative care unit was to accomplish the vision of good palliative care. Congruence in leadership, mature group functioning, adequate organisational structures and resources, and comprehensive and shared meaningfulness were all identified as essential components for fulfilling the vision. In study IV both F-LNMs and RNs found their work in general important, interesting and meaningful and reported self-rated health as good. However, about 10-15% shoved signs of being at risk for stress related ill health. The results showed statistically significant differences in the distribution between the F-LNMs and the RNs on three indices: job control, job demand and managerial support in a direction which would be favorable to the F-LNMs.

Conclusion: Nurses and F-LNMs seem to have high ideals and expectations of giving good care. The value- system of nursing, i.e. providing the best care for each patient, seems to be a point of departure for the F-LNMs leadership. Key factors for obtaining this are sufficient resources and adequate structures as well as good climate in the teams. One can therefore assume that the F-LNMs should be based on creating a healthy and sustainable work environment that promotes the quality of care and employee well-being. This is obtained by promoting development of ethical competence of the F-LNMs themselves as well as the employees. F-LNMs’ work conditions have a significant impact on how they can support and promote such a development.



Place, publisher, year, edition, pages
Stockholm: Karolinska institutet , 2010. , 61 p.
National Category
Nursing
Identifiers
URN: urn:nbn:se:esh:diva-698ISBN: 978-91-7409-895-2 (print)OAI: oai:DiVA.org:esh-698DiVA: diva2:357942
Public defence
2010-11-05, Föreläsningssalen CMB, Berzelius väg 21, Karolinska institutet, Solna, 11:00 (Swedish)
Opponent
Supervisors
Available from: 2010-11-05 Created: 2010-10-20 Last updated: 2011-05-16Bibliographically approved
List of papers
1. Between being and doing – the nature of leadership of first-line nurse managers and registered nurses
Open this publication in new window or tab >>Between being and doing – the nature of leadership of first-line nurse managers and registered nurses
2010 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 17/18, 2619-2628 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. The aim of this study was to describe first-line nurse managers’ (F-LNMs) and subordinate registered nurses’ (RNs) conceptions and experiences of their routine work and how leadership was exercised. Background. Extensive changes in health care organisations have had a powerful impact on leadership in nursing management. Nursing leadership, in turn, has an affect on both the quality of care and the subordinates’ work environment. Therefore, it is important to enhance our understanding of current leadership in nursing management. Design. This is a descriptive qualitative study carried out in three units at three Swedish hospitals. Methods. Three F-LNMs and 14 RNs participated. Interviews were used to collect data. The interviews were analysed using qualitative content analysis. Results. The result of this study was illustrated in one main theme referred to in this study as between being and doing. The RNs and F-LNMs described what it was to be a good professional (being), how they were engaged in creating a good work climate (doing) and personal outcomes of this project (gaining). Conclusion. The reciprocal relation between being and doing, which can be described as the development of virtues, was a central point in the professional work of the F-LNMs and RNs. The development of virtues is also a strategy to attain the goals of nursing and establish a work climate that motivates staff and improves performance. Relevance to clinical practices. The implication for nursing management is to create ample space to develop strategies and knowledge about how leadership in nursing management can stimulate the development of a common perspective of good care and professional virtues appropriate for health care praxis.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-610 (URN)10.1111/j.1365-2702.2010.03211.x (DOI)
Available from: 2010-09-09 Created: 2010-09-09 Last updated: 2011-04-04Bibliographically approved
2. Role stress among first-line nurse managers and registered nurses: a comparative study
Open this publication in new window or tab >>Role stress among first-line nurse managers and registered nurses: a comparative study
(English)Article in journal (Refereed) Submitted
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-697 (URN)
Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2011-05-16Bibliographically approved
3. A first-line nurse managers goal-profile
Open this publication in new window or tab >>A first-line nurse managers goal-profile
2007 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 1, 149-159 p.Article in journal (Refereed) Published
Abstract [en]

Aim. The aim of this case study was to acquire understanding concerning the first-line nurse manager's goal-profile, i.e. prioritization of goals in her work as a first-line nurse manager, through use of an action-theoretic and confirmatory theory. Background. The first-line nurse manager's pivotal role regarding quality of care and development in relation to on-going changes in the health care sector is stressed by many researchers and the transition from nurse to manager is described as a demanding challenge for the first-line nurse manager. Methods. The case study described in this paper concerns a first-line nurse manager in an actual working environment in care of older people. Data collection comprised interviews, observations, a job description and policy documents. A hermeneutic interpretation was used for data analysis. Results. The results showed that the first-line nurse manager had three goals in her goal-profile, in the following order of priority: (i) a nurse goal that she had strongly accepted and in which she had excellent control, (ii) an administrator goal that she had accepted and in which she had control, (iii) a leadership goal that she had not accepted and in which she did not have control. Both the administrator and leadership goals were based on her job description, but the nurse goal was a personally chosen goal based on her own self-relation/goal-fulfilment. Conclusion. The first-line nurse manager's prioritized self-identity, based on successful realization of goals in her goal-profile, was decisive in the manifestation of her work. Relevance to clinical practice. This study contributes to a new understanding of the first-line nurse manager's self-identity related to work in terms of goal acceptance and goal control of prioritized goals. This action-theoretic approach could be a valuable ‘key’ for understanding leadership (or lack of leadership) in clinical practice.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-609 (URN)10.1111/j.1365-2702.2006.01446.x (DOI)
Available from: 2010-09-09 Created: 2010-09-09 Last updated: 2011-05-16Bibliographically approved
4. Good care giving: the core of the work environment in palliative care
Open this publication in new window or tab >>Good care giving: the core of the work environment in palliative care
(English)In: Leadership in health services, ISSN 1751-1887Article in journal (Refereed) Submitted
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-696 (URN)
Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2011-05-16Bibliographically approved

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