What Do Nurses Need to Practice Effectively in the Hospital Environment? An Integrative Review With Implications for Nurse Leaders

Abstract

Background When staffing legislation was introduced, New Jersey nurse leaders recognized from the research and their years of clinical leadership experience that the work environment is a multidimensional concept and that staffing is not the only variable related to nurse and patient outcomes. Thus, an understanding of what nurses need in their hospital environment to practice nursing effectively was sought. Aims The aim of this study was to examine the evidence regarding clinical nurses’ perception of what they need to practice nursing effectively in the acute care hospital environment. Methods The following population, intervention, comparison, outcome question was used to search the literature databases PubMed, CINAHL, Johanna Briggs, and the Sigma Theta Tau Henderson Library: In the hospital environment what do nurses perceive as needed to practice nursing effectively? Specific search criteria and the Johns Hopkins nursing guidelines and tools were used to identify relative studies. Results The final review, which addressed what nurses in the hospital environment need to practice nursing effectively, included 25 articles: 20 were an evidence level III, and five were evidence level II. From this review, five key concepts were identified: Leadership, autonomy/decision making, respect/teamwork, resources/staffing, and organizational commitment to nursing. Linking Evidence to Action This integrative review, which explored nurses’ perceptions of what is needed to provide effective quality care, identified that providing quality care is multifactorial in nature. Resources, including but not limited to staffing, and leadership were identified as important by nurses as a key factor in supporting quality care. Nurses must be provided with resources and infrastructure to do their jobs, in an environment supported by authentic transformational leadership.

Leadership self‐perception of clinical nurses at the bedside: A qualitative descriptive study

“…Every healthcare system has its own culture with elements that serve to both facilitate and prevent leadership expression at the bedside. Kowalski et al, (2020) found that a culture that promotes a healthy work environment provides an atmosphere in which leadership, teamwork, and organisational commitment to nursing, among other characteristics, allows nurses to deliver high‐quality care. Many of these characteristics of a healthy work environment were identified by our focus group participants as facilitators of their leadership at the bedside.…”

The Relationship Between Transformational Leadership Practices of First‐Line Nurse Managers and Nurses’ Organizational Resilience and Job Involvement: A Structural Equation Model

“…Staff nurses are closely involved in providing care to their patients but are not constantly involved in decisions affecting the delivery of care. Kowalski et al (2020) identified that nurses value work environments with effective leadership that fosters decision-making, autonomy in nursing practice, respect, teamwork, and cohesive interactions.…”

“…Shared governance, participative decision-making, open communication, shared vision, self-reflection, and a fair and respectful working atmosphere that conveys appreciation and gratitude to nurses and their positions are popular strategies that enhance the efficacy of leadership, promote positive work attitudes among nurses, and achieve desired results (Abou Hashish, 2020;Abou Hashish & Fargally, 2018;Kowalski et al, 2020). Nurse managers should create opportunities for training and learning to inspire resilient and assertive nurses.…”

“…First-line nurse managers (FLNMs) are crucial in the healthcare delivery system, as are their leadership practices (Abou Hashish, 2017). Leadership was identified as having a major impact on practicing nurses and the perception of a supportive and healthy workplace environment (Kowalski et al, 2020). Behaviors of leaders directly influence their organization's aptitude to attract and maintain the talent of their nurses and are considered a crucial element in achieving competitive benefits in the marketplace (Kouzes & Posner, 2019).…”

Association of Nursing Work Environment, Relationship with the Head Nurse, and Resilience with Post-Traumatic Growth in Emergency Department Nurses

“…In addition, the nursing work environment in the emergency department is a busy and complex environment in which various professional staff members have both horizontal and vertical relationships [14]. Leadership, response/teamwork, and resourcing are especially important to provide high-quality care in this nursing environment [15], and in this organizational system, the head nurse is the most frequent contact in the vertical relationships of emergency department nurses. Although there has been no study on the relationship between posttraumatic growth and relationship with the head nurse, a previous study focusing on the relationship between leaders and members showed the perceived quality of exchange relations of staff nurses with head nurses is a more important factor influencing nurses' job satisfaction and organizational commitment than the quality of exchange relations of head nurses [16].…”