OBJECTIVE To examine and report burnout, secondary trauma, and compassion satisfaction in acute care nurse leaders through a large mixed-methods research study. BACKGROUND Although nurse leaders are removed from daily patient care activities, the pervasive challenges in the work environment create conditions for professional burnout. Nurse leaders must garner compassion satisfaction from different sources, including peer and staff interactions. METHODS The Professional Quality of Life scale was given to nurse leaders at 29 hospitals in 1 health system. Sixteen leaders from 2 hospitals participated in qualitative interviews. RESULTS Six hundred seventy-two nurse leaders from 29 hospitals reported similar levels of burnout across frontline, midlevel, and director-level leadership. Directors demonstrated higher levels of compassion satisfaction and lower levels of work-life balance. Four themes emerged representing areas of professional life that potentiate and alleviate compassion fatigue. CONCLUSIONS All levels of nurse leaders must address the risk of burnout and can do so through individual and organizational resiliency strategies.

Transformational leadership in nursing has been associated with high-performing teams and improved patient care, but rarely has it been considered as a set of competencies that can be taught. Also, further research is warranted to strengthen empirical referents; this can be done by improving the operational definition, reducing ambiguity in key constructs and exploring the specific mechanisms by which transformational leadership influences healthcare outcomes to validate subscale measures.

Aim:To validate a framework of factors that influence the relationship of transformational leadership and safety climate, and to enable testing of safety chain factors by generating hypotheses regarding their mediating and moderating effects.Background: Understanding the patient safety chain and mechanisms by which leaders affect a strong climate of safety is essential to transformational leadership practice, education, and research. Methods:A systematic review of leadership and safety literature was used to develop an organising framework of factors proposed to influence the climate of safety. A panel of 25 international experts in leadership and safety engaged a three-round modified Delphi study with Likert-scored surveys.Results: Eighty per cent of participating experts from six countries were retained to the final survey round. Consensus (>66% agreement) was achieved on 40 factors believed to influence safety climate in the acute care setting. Conclusions:Consensus regarding specific factors that play important roles in an organisation's climate of safety can be reached. Generally, the demonstration of leadership commitment to safety is key to cultivating a culture of patient safety. Implications for Nursing Management:Transformational nurse leaders should consider and employ all three categories of factors in daily leadership activities and decision-making to drive a strong climate of patient safety. K E Y W O R D SDelphi survey, nursing, patient safety, safety climate, transformational leadership | INTRODUCTIONHuman suffering caused by preventable medical error has taken a significant toll on patients, families and the second victims, health care organisations and clinicians (James, 2013). As care providers and consumers have become increasingly aware of the high rates of preventable patient deaths worldwide, the global health care community has called for transformational improvement in patient care quality and safety. To achieve this goal, an understanding of specifically how nurse leaders improve patient safety is essential. According to Wong (2015: p. 276), "the development and testing of robust conceptualisations of leadership that clearly describe leadership behaviours and identify the | BACKGROUNDTransformational leadership has a salient role in the safety chain by developing cultures of safety in the patient care environment (Buckner et al., 2014). This leadership style is associated with im- Despite a growing body of evidence related to TFL and its influence on patient safety outcomes (Merrill, 2015;Ross, 2011;Weng et al., 2015), further research is needed to explain how, why, or when these factors affect the safety chain by testing mediating and moderating effects (McFadden et al., 2014;Wong, 2015). A mediator specifies how the relationship between TFL and SC occurs, while a moderator interacts with TFL to vary the strength of the relationship with SC (Baron & Kenny, 1986). The framework validated by this study serves as an organising tool for this testing.The review of current evidence and prop...

Barriers to implementation of nursing practice peer review in rural hospitals can be mitigated through a collaborative approach, resulting in efficient and effective processes for small, rural, and geographically distinct hospitals.

A sample of 1933 registered nurses working in 24 hospitals with shared leadership was surveyed to examine perceptions of nurse decisional involvement. Council participation was associated with higher decisional involvement scores (P = .03), and nurse experience was a statistically significant predictor of decisional involvement (P < .01). Nurse manager and staff registered nurse scores were significantly different (P < .01). Shared leadership may promote staff nurse perceptions of involvement in decision-making.

Healthcare is a complex area with significant potential for service improvement despite the effects of increasing economic and social pressures on the quality and safety of patient care. As the largest group of healthcare professionals in direct contact with patients, nurses are well positioned to contribute to improvements in healthcare services and to the development of new policies. To influence healthcare improvements and policies effectively, nurses require leadership skills. Historically, it was thought that only nurses in management roles required leadership skills; however, the ability to influence change is a requirement at all levels of clinical practice. Transformational leadership competencies provide nurses with the skills to contribute to improvements in the quality and safety of patient care, while enhancing their career satisfaction. This article examines how nurses can apply transformational leadership to their practice. It also informs nurses how to conduct an initial self-assessment of their leadership skills and to formulate a transformational leadership development plan.

Transformational leadership is a trending style and competency that has been embraced by many industries and nursing practice settings. Similar positive influence on follower engagement, teamwork, and solidarity might be experienced if transformational leadership is employed by administration and faculty as a guiding framework for nursing education. The impact of embedding a teamwork culture in basic nursing education could be significant on students and ultimately on the nursing profession. Further research is needed to develop and test application of the transformational leadership framework in nursing education.

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