50 Nursing Philosophy Examples + How To Write Your Own

nursing leadership philosophy paper

From the first semester of nursing school, aspiring nurses learn about the ethics and values associated with becoming a nurse. However, there comes a time when each nursing student or nurse must decide what they value most and how to incorporate those things into their roles as nurses. This important step is often referred to as establishing a personal philosophy of nursing. Perhaps you have heard of nursing philosophies but are unsure how to develop your personal philosophy. Have you wondered or asked, "What are some good personal philosophy of nursing examples?" If this sounds like you, keep reading! In this article, I will share some insight about nursing philosophies and provide you with information about 50 nursing philosophy examples + how to write your own.

What is a Personal Philosophy of Nursing?

Does every nurse have a personal nursing philosophy, what are the key components of a personal nursing philosophy, • knowledge:, 7 reasons why having a personal nursing philosophy is so important for your career, what are some good personal philosophy of nursing examples.

Nursing Philosophy Examples For Nursing Students
“I believe it is important for everyone to strive to demonstrate the characteristics of honesty, persistence, and compassion. My philosophy on nursing is that if I use those characteristics, coupled with a desire for lifelong learning and a willingness to represent others in need, I can make a difference in the life of my patients and their families and become a strong member of the profession."

“As an aspiring nurse, I feel like it is my responsibility to develop an attitude of life-long learning and take advantage of every opportunity to develop skills that will benefit my patients. If I were to articulate my own philosophy of nursing, I would say I believe nursing is one of the most selfless jobs a person can have, and I intend to put everything I have into this pursuit so I can make a difference in the lives of others.”

“My nursing philosophy is that nursing is more than a career. It is a privilege accepted by people who are passionate about using their skills and knowledge to help others who cannot help themselves. I vow to be the best nurse I can be and dedicate my professional life to making the lives of others better."
Nursing Philosophy Examples For New Grad Nurses
“My philosophy about nursing is that it takes diverse people with strong skills and dedication to help impact and improve the lives of patients. I intend to use the education and skills I've obtained in nursing school to establish myself in this profession. I believe if I dedicate myself to a lifelong pursuit of knowledge and personal growth, I can influence the profession of nursing and help improve outcomes for my patients and their loved ones."

"I believe in taking a holistic approach to nursing care, respecting my patients' cultural beliefs, ethnic background, and personal preferences. My philosophy of nursing is based on a desire to uphold the values and codes established by the American Nurses Association and to promote a sense of self-value in my patients as I help them reach their healthcare goals.”

“My personal philosophy of nursing is that all nurses, whether we are new graduates or nurses with years of experience, have something of value to offer to patients and nursing as a profession. My sincere desire is to develop strong clinical skills and be open to new opportunities to learn and grow so I may contribute to the well-being of my patients and the further development of this profession."
Nursing Philosophy Examples For Registered Nurses
“As a registered nurse, I believe the care I provide should involve more than giving medicines or changing bandages. I want to treat my patients with the best care, making them feel respected, comfortable, and confident about the care they receive from my service.”

“My philosophy as a registered nurse is quite simple. I want to serve everyone I can by giving my best as a nurse and decent human being. I believe all patients, families, and colleagues are unique individuals with unique needs, and I aim to offer my best to them in service as a registered nurse.”

“I believe it is important for all nurses to provide safe, high-quality, patient-centered care. My personal philosophy of nursing is driven by a desire to recognize my patients as more than a medical diagnosis or room number. Instead, I desire to be the nurse who promotes the well-being of patients and helps improve outcomes, which will help support and further our profession.”

“I chose to become a nurse because I have a deep-rooted desire to help people in need. My personal philosophy of nursing is that I will use my education and clinical experiences to care for my clients and act as an advocate for them, encouraging them to be actively involved in their own care, which increases their feelings of self-worth and results in improved outcomes."

“I believe nursing is the truest version of living art a person can demonstrate. As I consider what I feel about my nursing philosophy, I realize the important role I have in improving the lives of others. I want my practice to reflect a genuine concern for every person entrusted to my care and to be a source of hope and encouragement."

“For me, there was never any doubt I would become a nurse. I love people and feel most fulfilled when I can do something to help others. I believe nurses are in a unique position to make significant differences in the lives of others. I have made it my personal philosophy to embrace every opportunity to enrich my patients' lives and contribute to this wonderful profession."

“My philosophy of nursing is based on the belief that, as a registered nurse, I am an educator, patient advocate, and promoter of good health practices. I feel being a nurse is an honor and privilege, and I desire to fulfill my role with the highest level of integrity and best practices, with the hope that I can contribute positive things to the lives of my patients and their families.”

“It is my strong belief that my job involves much more than performing a nursing assessment or administering medications. I exercise my role within the personal nursing philosophy that all clients are unique in their own right and deserve to have care as unique as they are. By viewing each client as an individual and providing care with a holistic approach, I hope to positively impact their healthcare experiences and outcomes."
Nursing Philosophy Examples For Pediatric Nurses
“I always knew I wanted to become a nurse and had a strong desire to care for children, which is why I chose to specialize in pediatric nursing. I believe by combining compassionate and relational care that is centered around my patients and their family units, I can impact their lives and health outcomes.”

“To me, there is no greater joy than being involved in the care of pediatric patients and their families. My personal philosophy of nursing is based on the understanding that open communication, as well as respect and appreciation for the importance of family and each family member's role, can significantly improve my patients' outcomes and help me be a strong member of the pediatric nursing community."

“My philosophy of nursing may seem simple, but I truly believe it is possible to impact patient lives by using the power of human touch and emotional connections. I believe, as a pediatric nurse, it is especially important to develop trusting relationships with patients and their families so we can work together to reach positive patient outcomes.”
Nursing Philosophy Examples For Psychiatric Nurses
“I originally chose to pursue a career as a psychiatric nurse because of my personal experiences with major depression and anxiety. The more I learned, the more I realized how important it is to have competent nurses willing to be transparent enough that patients can relate and feel comfortable seeking help. My nursing philosophy stems from a strong belief that by being the type of nurse I needed when dealing with mental health issues, I can and will help my patients learn ways to manage and overcome obstacles that impact their well-being.”

“My philosophy of nursing centers around a sincere desire to help others realize and obtain their desired health goals. Psychiatric nursing is a specialty that is truly personal for me, as I have experienced the loss of a close loved one due to mental illness. I believe nursing should incorporate a holistic approach that honors patient values and promotes positive outcomes."

"I can't remember a time when I did not feel a longing to care for others in need, which I believe is what led me to choose nursing as a career. Psychiatric nursing is important to me because I feel as a society, we are just now beginning to realize the true impact mental health and wellness has on every other aspect of our lives. I feel happy when I serve others, and my personal philosophy of nursing is centered on the desire to serve and be compassionate toward others.”
Nursing Philosophy Examples For Neonatal Nurses
“I believe being trusted with the care of someone else’s child is a gift. As a neonatal nurse, I want to serve my patients and their families by using my skills to be actively involved in their journey of healing so they can recover and grow up to live healthy lives.”

“I feel like anyone would be hard-pressed to try and simplify nursing in just a phrase or two. Just like nursing is a complex system made up of many people, I believe our personal philosophies of nursing are often multi-faceted. For me, my nursing philosophy centers around a longing to care for others and help them realize their potential. As a neonatal nurse, that philosophy encompasses patients, families, and everyone involved in care.”

“I have a deep desire to care for neonatal patients and their families. My philosophy related to neonatal nursing is that it is my ethical duty to advocate for these patients who do not yet have a voice of their own. I intend to use every resource possible to learn and develop skills that will benefit my patients, comfort and educate their families, and be a strong partner in the neonatal nursing team.”
Nursing Philosophy Examples For ICU Nurses
"I chose to become an ICU nurse because I feel patients with intensive care needs should have the highest levels of quality care and compassion possible. My belief and personal philosophy of nursing is that all patients, regardless of their prognosis, should be cared for by nurses with a heart for healing. I desire to bring that type of care and compassion to my patients and their families."

"Loved ones and I have received care from extraordinary nurses, which solidified my belief in the goodness of others, leading me to choose to pursue this role. Although I chose to become a nurse, I believe nursing is more of a calling, one I am glad I headed. My philosophy related to nursing is that if I can help make the life of one patient better, I will have achieved more than most."

“I feel honored to be a nurse, and I have intentionally developed a personal nursing philosophy that reflects the privilege. My philosophy as an intensive care nurse is that I will offer the highest quality in nursing care to my patients and deliver it with compassion as if they were my own family. After all, we all want to feel wanted and cared for, especially when we are unable to care for ourselves."
Nursing Philosophy Examples For School Nurses
“I believe that school nurses can play a significant role in the lives of those we serve. My nursing philosophy is that I can positively influence those I meet and serve daily and that I will do everything I can to encourage their understanding of what it takes to be physically and mentally well. I feel strongly that when children learn the importance of health and wellness at an early age, they are more likely to make smart decisions about their health later. My personal goal in nursing is to have a positive impact on every client who crosses my path."

"I believe it is important for nurses to emphasize the value of every patient for whom we provide care. I understand a student's health can directly impact his ability to learn. My philosophy of nursing, especially as I practice as a school nurse, is to be a source of education and guidance to help students realize their physical and academic potential and to help them strive to achieve their attainable goals.”

“My personal nursing philosophy is built upon the belief that addressing the mental, physical, and social health needs of students is a responsibility that rests largely upon my shoulders. The job of a school nurse can be challenging but rewarding, and I am dedicated to always performing with the best interest of each student in mind.
Nursing Philosophy Examples For Labor And Delivery Nurses
“My philosophy is that nurses have an obligation to provide safe, patient-centered care in a manner that supports individual patient choices, values, and beliefs. I feel, as a labor and delivery nurse, it is crucial to understand the concept of holistic nursing care and to implement it with each patient and family."

“I believe nursing is much more than treating illness or disease. Instead, my philosophy of nursing is that it should be focused on providing high-quality patient care tailored to the patient's individual needs. Working in labor and delivery means offering the same care and compassion to the patient's spouse or other loved ones and ensuring everyone's needs are met."

"My nursing philosophy is based on my knowledge of what it feels like to need a competent nurse to coach and support me as I labored and delivered my children. I remind myself daily what it meant to have someone in my corner, and I intend to be the same professional, compassionate supporter for all my clients.”
Nursing Philosophy Examples For Home Health Nurses
“As a provider of nursing care with the privilege of serving in clients’ homes, I realize I am simply a guest who happens to have skills that could enrich my patients’ lives. Although some parts of my personal philosophy may change over time, the core of my personal philosophy on nursing is that I have a great responsibility to provide care for those unable to care for themselves. Knowing this, I am both grateful and extremely humbled."

"My beliefs about nursing and the philosophy I try to live by include acknowledging that all patient care should be based on respect for the value and dignity of the patient as an individual with rights. I desire to have a strong work ethic and demonstrate genuine compassion for those entrusted to my care."

“I believe effective nursing requires nurses to develop and adhere to strong personal and professional philosophies. My philosophy of nursing is that all patients, whether they are cared for in hospitals, nursing homes, another type of healthcare facility, or their own homes, deserve to feel respected and have their voices heard. I work hard to make sure my clients know their thoughts and feelings are important and promote an atmosphere of care conducive to positive outcomes."
Nursing Philosophy Examples For Charge Nurses
“As a nurse with several years of experience seeking to work as a charge nurse, my nursing philosophy is based on my duty to provide compassionate, competent nursing care and to lead others in doing the same. I am committed to providing exceptional nursing care and being a role model for other nurses to follow.”

“My philosophy of nursing is firmly rooted in beliefs instilled in me as a child. The values and beliefs taught to me by family and others include the need for respect, trustworthiness, and compassion. These beliefs led me to choose nursing as a profession and why I now desire to work as a charge nurse. It is my hope to pass these values onto other nurses for generations to come.”

“I feel strongly that all nurses have a responsibility to provide personalized care to patients, regardless of the patient's background or beliefs, and respect the patient's right to autonomy. My philosophy as a charge nurse is to demonstrate the work ethic and professional values I want to see in my team and to support them as they pursue professional goals and strive to provide exceptional patient care."
Nursing Philosophy Examples For Nurse Managers
"From the time I was in junior high school, I knew I would become a nurse. I love serving others and feel most successful when I help others succeed. My philosophy of nursing includes a belief that a few of the main factors in being a good nurse manager are the ability to effectively communicate with others and a desire to build solid teams, instead of promoting myself.”

“I have always believed nurses have a way of touching lives that others do not. As I embraced my career and began considering what is important to me, I began to develop a personal nursing philosophy based on the characteristics I value in others and how I can apply them to my life. To succeed as a nurse manager, I must treat every nurse with respect and appreciation and model the type of behavior I want for my patients, so my team has a strong leader to follow."

“I believe one of the most important jobs a nurse can do is be a strong support for patients and families. My nursing philosophy is grounded in the belief that by being a supportive advocate and giving clients a safe person to talk with and trust to provide their care, we can transform their healthcare experiences. I desire to become the kind of nurse manager who leads teams of nurses equipped to handle even the most delicate situations and who are viewed as assets to patient care."
Nursing Philosophy Examples For Directors Of Nursing
“I feel being a competent Director of Nursing requires active participation with the nurses on my team and the patients we provide care for. As a registered nurse serving as a nursing director, I believe in establishing an atmosphere of collaboration that fosters growth and a renewed commitment to our common goal of patient care"

"I sincerely believe nursing is the most rewarding career I could have chosen. I have a strong philosophy based on the idea that by exerting positive influence, promoting quality nursing care, and facilitating collaborative communication among the disciplinary team, we can be a strong nursing force. As a Director of Nursing, I intend to put those ideas into practice every day."

“My personal philosophy of nursing is that we all have the power to significantly impact and improve patient outcomes and promote the furtherance of our profession. I believe a solid education and continued learning are essential for the success of nurses. I also believe any nurse in a directorship position should promote the growth of every nurse on her team. That is something I vow to do."
Nursing Philosophy Examples For Nurse Practitioners
“As a nurse practitioner, my philosophy of nursing is to provide individualized care to my clients by acknowledging their unique situations, educating patients and their families, and providing unconditionally compassionate, high-quality care. I believe my success as a nurse practitioner requires me to accept accountability for being a strong advocate for my patients and their loved ones, as well as being a strong representative of advanced practice nursing."

“My personal nursing philosophy is grounded in a conviction that I am in a unique position to positively impact my patients and help improve their outcomes. I believe in the importance of creating an atmosphere that supports strong provider and patient relationships based on respect for my patient’s beliefs and desires for their health and their freedom of choice.”

"To me, being a nurse practitioner is more than prescribing medications or treating a specific illness. If I could describe my personal philosophy of nursing from the perspective of a nurse practitioner, I would say it is my duty to promote a healthcare environment that is respectful of and therapeutic for all patients and their families. I will take the role of being a nurse practitioner, representing my patients and the nursing profession to the best of my ability.”
Nursing Philosophy Examples For Nursing Educators
“As a nurse educator, I value the opportunity to pour into the lives of student nurses. I believe being a nurse educator is a true calling, and if I serve in my role to the best of my ability, I can help change the trajectory of my students' lives and the lives of every patient they ever encounter."

“I have based my personal philosophy of nursing on the belief that one of the greatest gifts I can give to my profession is a willingness to impart knowledge to, and encourage learning among, aspiring nurses. I have dedicated my life to improving the lives of others and will continue to do so as a nurse educator, with the hopes of impacting student nurses, the patients we care for, and this profession."

“My philosophy of nursing is that we all have a role to play in the health and wellness of ourselves, our families, and our communities. I experienced some of the greatest influence in my life from nursing educators who prepared me for this career. I now intend to give back to the profession and society by demonstrating a strong work ethic and providing patient-centered care, with the hope of helping patients achieve wellness and students achieve professional goals."

How to Write Your Own Personal Philosophy of Nursing Statement?

1. define what nursing means in your perspective., 2. ask yourself what personal experience relates to your passion for nursing., 3. consider how you want to impact patients, families, and communities through your role as a nurse., 4. highlight your skills., 5. define your personal and professional values., 8 questions to ask yourself when developing your own personal philosophy of nursing, question #1: why did i choose to become a nurse, how to find an answer to this question:, question #2: what are my personal beliefs about nursing, question #3: what qualities make someone a great nurse, question #4: what skills should all nurses have, question #5: why is nursing important to me, question #6: what theories do i have about nursing, question #7: what values should nurses consider important, question #8: would i choose this career again, useful online resources to learn more about nursing philosophy, blogs/websites, youtube videos, bonus 5 important things to keep in mind when writing your personal philosophy of nursing statement, 1. keep it simple., 2. show you are prepared for action., 3. be yourself., 4. be open to change if needed., 5. make a copy for yourself and keep it visible., my final thoughts, frequently asked questions asked by our expert, 1. what was florence nightingale's philosophy of nursing, 2. is there a set format or right way to write a personal philosophy of nursing statement, 3. how do i start my nursing philosophy statement, 4. how can a nurse determine whether her nursing philosophy is good, 5. how long should a personal nursing philosophy statement be, 6. when should i write my nursing philosophy, 7. can i change my nursing philosophy from time to time, 8. how to write the introduction of my personal nursing philosophy, 9. should nursing students have a personal philosophy of nursing, 10. does an informatics nurse have a personal philosophy of nursing, 11. do nursing organizations have their own philosophy of nursing, 12. how does nursing philosophy influence nursing practice, 13. is it required for every nurse to have a personal nursing philosophy, 14. what happens if a nurse does not have a personal philosophy of nursing, 15. what are some famous personal philosophy of nursing quotes.

nursing leadership philosophy paper

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The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership

Affiliations.

  • 1 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada. Electronic address: [email protected].
  • 2 Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Level 1, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia.
  • 3 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada.
  • 4 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada; Technical High School of Campinas, State University of Campinas (UNICAMP), Barão Geraldo, Campinas - São Paulo 13083-970, Brazil.
  • PMID: 33383271
  • DOI: 10.1016/j.ijnurstu.2020.103842

Background: Nursing leadership plays a vital role in shaping outcomes for healthcare organizations, personnel and patients. With much of the leadership workforce set to retire in the near future, identifying factors that positively contribute to the development of leadership in nurses is of utmost importance.

Objectives: To identify determining factors of nursing leadership, and the effectiveness of interventions to enhance leadership in nurses.

Design: We conducted a systematic review, including a total of nine electronic databases.

Data sources: Databases included: Medline, Academic Search Premier, Embase, PsychInfo, Sociological Abstracts, ABI, CINAHL, ERIC, and Cochrane.

Review methods: Studies were included if they quantitatively examined factors contributing to nursing leadership or educational interventions implemented with the intention of developing leadership practices in nurses. Two research team members independently reviewed each article to determine inclusion. All included studies underwent quality assessment, data extraction and content analysis.

Results: 49,502 titles/abstracts were screened resulting in 100 included manuscripts reporting on 93 studies (n=44 correlational studies and n=49 intervention studies). One hundred and five factors examined in correlational studies were categorized into 5 groups experience and education, individuals' traits and characteristics, relationship with work, role in the practice setting, and organizational context. Correlational studies revealed mixed results with some studies finding positive correlations and other non-significant relationships with leadership. Participation in leadership interventions had a positive impact on the development of a variety of leadership styles in 44 of 49 intervention studies, with relational leadership styles being the most common target of interventions.

Conclusions: The findings of this review make it clear that targeted educational interventions are an effective method of leadership development in nurses. However, due to equivocal results reported in many included studies and heterogeneity of leadership measurement tools, few conclusions can be drawn regarding which specific nurse characteristics and organizational factors most effectively contribute to the development of nursing leadership. Contextual and confounding factors that may mediate the relationships between nursing characteristics, development of leadership and enhancement of leadership development programs also require further examination. Targeted development of nursing leadership will help ensure that nurses of the future are well equipped to tackle the challenges of a burdened health-care system.

Keywords: Interventions; Leadership; Nursing workforce; Systematic Review.

Copyright © 2020. Published by Elsevier Ltd.

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  • Targeting personalised leadership factors based on the organisational needs of nurses may cultivate and improve their nursing leadership. Singh S, Kapoor S. Singh S, et al. Evid Based Nurs. 2022 Apr;25(2):68. doi: 10.1136/ebnurs-2020-103385. Epub 2021 Aug 18. Evid Based Nurs. 2022. PMID: 34407986 No abstract available.

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Perceived Leadership Styles, Outcomes of Leadership, and Self-Efficacy Among Nurse Leaders:

In response to improving upon a leadership development program at a US regional medical center, coupled with the understanding that transformational leadership is linked with better outcomes, as a first step, we examined the perceived leadership styles, outcomes of leadership, and level of self-efficacy among nurse leaders, namely nurse managers, clinical supervisors, and nurse directors. Twenty-three hospital-based nurse leaders completed the surveys with a response rate of 57.5%. The majority of the leadership styles aligned with that of transformational. However, the items with the 3 lowest average frequency ratings within the transformational leadership style were in the areas of communication and showing confidence. Additionally, the perceived median self-efficacy score was low. Organizational support by way of providing continuous, sustainable professional leadership development, especially in the area of communication, and building self-efficacy is needed to ensure leader effectiveness, and improvement in staff and patient outcomes.

  • • This study identified the most prevalent leadership style among nurse leaders at a regional medical center in the United States.
  • • Although nurse leaders perceive to have a transformational leadership style, this study identified the need for professional development and interventions in the areas of self-efficacy and communication for nurse leaders in the hospital setting.

Nurse leadership in the unpredictable and often chaotic health care setting is critical to ensuring the delivery of safe, evidence-based care necessary to positively impact the overall patient experience. 1 Nurses make up the most significant number of health care professionals in the medical workforce, where daily, they are either directly or indirectly involved in patient care. 2 Nurse leaders in the clinical setting, therefore, have the critical and challenging task of influencing effective workplace performance and retention of hospital staff nurses by directing clinical practice and outcomes inclusive of compliance with regulations, human resource issues, fiscal accountability, patient satisfaction, and overall excellence in service. 3 The COVID-19 pandemic has undoubtedly reinforced the need for quality nurse leadership within health care. In troubling times, nurse leadership is paramount to safety and organizational outcomes.

Historically, nurse leaders have had a remarkable capacity to manage. However, becoming an exemplary leader requires transformational leadership, the personal capacity to inspire others through innovation to achieve optimal outcomes. 4 Inspired by James McGregor Burns’ theory of transformational leadership, 5 the American Nurses Association, the premier organization for nursing professionals, describes transformational leaders with having the ability to communicate effectively, inspire others, have enthusiasm, support positive change, and lead others in pursuit of shared goals. 6 , 7 In a systematic review conducted by Wong et al., 8 transformational nurse leadership was found to have resulted in staff work engagement, 9 nurses’ reluctance to quit, 10 medication safety, 11 , 12 , 13 workplace safety climate, 14 quality of care, 10 and decreases in inpatient falls, hospital infections, and patient mortality. 12 , 13 Additionally, self-efficacy, defined as the belief in one’s ability to accomplish specific tasks, has been found to mediate the relationship between transformational nurse leadership and staff engagement. 15 These studies, albeit limited, inform us that transformational leadership, which is the most optimal leadership style, with transactional and passive avoidant being suboptimal, can lead to overall staff well-being and improved patient outcomes.

In 2010, the Institute of Medicine (IOM), now known as the National Academy of Medicine, published The Future of Nursing: Leading Change, Advancing Health , 1 which provided a blueprint for nurse leadership development and mentorship within 3 core domains: transformational leadership, mentorship, and involvement in policy making. In response, efforts have been mobilized to equip clinical nurses with leadership competencies in their nursing programs and workplace that would enable to answer IOM’s call for effective nurse leadership in the hospital setting.

Survey on Leadership Styles, Outcomes of Leadership, and Self-Efficacy

In an effort to improve professional development for nurse leaders at a regional medical center located in the mid-Atlantic area of the United States, we conducted this hospital-based survey to examine the perceived leadership style, outcomes of leadership, and self-efficacy among nurse leaders at one of the third busiest hospitals in its state. The survey is the first stepping stone to inform the adaptation of an existing 9.5-day leadership development training program for nurse leaders focusing on fundamentals of performance coaching, leadership challenges, analyzing performance issues, and finance management facilitated by the human resources (HR) department. This survey for nurse leaders who held the position of clinical supervisor, nurse manager, or nurse director is a result of the medical center’s HR department's desire to strengthen the training focusing on transformational leadership and building self-efficacy for nurse leadership.

The survey and future development of a nurse leadership training program are inspired by the theory of structural empowerment, which posits that the work environment is accountable for providing access to resources to enable effective and influential leadership. 16 Structural empowerment is one of the core components of the American Nurses Credentialing Center’s Magnet Recognition Program® where it recognizes an institution that promotes shared decision-making, continual professional development, and organizational commitment and support that will ultimately lead to staff well-being, better patient outcomes, and institutional financial success. 16 , 17

We conducted the survey between June and July of 2019, utilizing a cross-sectional approach to examine the perceived leadership styles, outcomes of leadership, and level of self-efficacy among nurse leaders, inclusive of nurse managers, clinical supervisors, and nurse directors at a single-site regional medical center located in the mid-Atlantic area of the United States. Anonymous paper surveys without identifying information were stored via interdepartmental mail in a secure, locked file cabinet. Unique random numbers were assigned to each survey for participants to keep so that they may have access to their results. The results of the survey were disseminated to participants by placing them in a secure area, and participants used their identification number to identify their survey results. The sole collector of data was a clinical manager who did not observe who picked up the survey and who returned completed surveys. We collected information on participant’s gender, age, years of experience as a nurse and nurse manager/director/clinical supervisor, number of years in the workplace in current position, education, race/ethnicity, place of licensure, and type of unit (i.e., general surgical).

For the Perceived Leadership Style & Outcomes of Leadership , we used the 45-item Multifactor Leadership Questionnaire (MLQ) 5x Short Version. 18 The MLQ is an established and validated leadership instrument that evaluates self-perception of 3 different leadership styles: Transformational, Transactional, and Passive-Avoidant, and Perceived Outcomes of Leadership using a 5-point frequency behavioral scale (0 = not at all, 1 = once in a while, 2 = sometimes, 3 = fairly often, 4 = frequently, if not always). The specific components within each leadership style are as follows: Transformational (5 I’s): Idealized Attributes—ability to build trust; Idealized Behaviors—acting with integrity; Inspirational Motivation—ability to motivate; Intellectual Stimulation—ability to inspire innovation; Individual Consideration—focus on the individual development plan for personal achievement; Transactional : Contingent Reward—set goals; Management by Exception–Active—focus on compliance; Passive-Avoidant : Management by Exception–Passive—punitive; Laissez-Faire—uninvolved; Perceived Outcomes of Leadership– Extra Effort: can get followers to go above and beyond; Effectiveness—productive; Generates Satisfaction—staff satisfaction achieved. We measured level of self-efficacy using the general self-efficacy scale. It is a 17-item scale developed by Mark Sherer, which consists of 5-point Likert responses ranging from “strongly disagree” to “strongly agree.” Scores range from 17 to 85, where higher scores indicate greater self-efficacy. 19 Group frequency mean scores and standard deviations for each leadership style and outcomes of leadership scale and subscales were computed. Group standard deviations of the frequency ratings for the leadership scales and outcomes measured the variation in response to the MLQ. The smaller the standard deviation, the higher the agreement among group self-ratings. A value of 0.0 would mean complete agreement among ratings. Mean, and mode were calculated to measure the level of self-efficacy perceptions. We performed normality testing, using the Kolmogorov-Smirnov test and measures of central tendencies. The survey was reviewed and approved as exempt research by the institution’s clinical research committee.

Table 1 summarizes the demographic characteristics of the participants. There are a total of 40 nurse leaders at the regional medical center. Twenty-three deidentified surveys were completed and returned with index cards for a response rate of 57.5%. The majority of nurse leaders were above 41 years of age, self-identified as White, had at least a bachelor’s degree in nursing, and had a mean of 21 years of nursing experience and 5.2 years of nurse leadership experience in a clinical setting.

Table 1

Demographic Characteristics of Participants (N = 23)

Characteristics
  2 (8.7)
  3 (13.0)
  8 (34.8)
  6 (26.1)
  4 (17.4)
  19 (82.6)
  2 (8.7)
  1 (4.4)
  1 (4.4)
  1 (4.4)
  1 (4.4)
  11 (47.8)
  11 (47.8)
21 ± 8.6
5.2 ± 4.1

Perceived Leadership Styles and Outcomes of Leadership

The MLQ 5x mean frequency scores by Leadership Style, Outcomes of Leadership, and related subscales are summarized in Figure 1 . The majority of the leadership styles aligned with that of Transformational (Idealized Attributes mean ± SD: 3.1 ± 0.3; Idealized Behaviors mean ± SD: 3.1 ± 0.4); Inspirational Motivation mean ± SD: 3 ± 0.5); Intellectual Stimulation mean ± SD: 3.1 ± 0.5; Individual Consideration mean ± SD: 3.5 ± 0.4), followed by Transactional (Contingent Reward mean ± SD: 2.9 ± 0.6; Monitors Deviations and Mistakes mean ± SD: 1.5 ± 0.9) and Passive Avoidant mean ± SD: Management by Exception–Passive mean ± SD: 1 ± 0.5; Laissez-Faire mean ± SD: 0.7 ± 0.5). The items with the 3 highest average ratings within the Transformational leadership style scale were in the areas of coaching and developing people (mean: 3.6 treating others as individuals), acting with integrity (mean 3.5 considering consequences), and building trust (mean 3.5 building respect from others). The items with the 3 lowest average ratings for Transformational leadership style were in the areas of acting with integrity (mean 2.5 talking about personal values and beliefs), encouraging others (mean 2.5 vision casting), and building trust (mean 2.7 showing confidence).

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Multifactor Leadership Questionnaire (MLQ 5X) Mean Frequency Scores by Leadership Styles and Outcomes of Leadership Compared With Self-Norms (N = 23).

∗ The bar chart shows how the participants perceived the frequency of their behaviors for each leadership style compared to various norms for the MLQ. Self-norms represent data from 3375 self-ratings of leaders who previously completed the MLQ.

Regarding the perceived outcomes of leadership, the satisfaction of leadership had the highest mean frequency score (mean ± SD: 3.2 ± 0.4) followed by perceived leadership effectiveness (mean ± SD: 3.1 ± 0.5) and generating extra effort among staff (mean ± SD: 2.9 ± 0.5).

Perceived Level of Self-Efficacy

The general self-efficacy mean and median scores were 2.4 ± 0.6 and 2.5, respectively, implying that the participants had low general self-efficacy.

We found that the nurse leaders perceived their leadership style to be transformational, followed by transactional and, lastly, passive avoidant. Nevertheless, we see opportunities for professional development in the areas of effective communication around personal values and beliefs, vision and mission, and showing a sense of power and confidence in the workplace. These potential areas for professional development align with the findings that the participants reported having a low-level of self-efficacy. In a recent integrative review of nurses’ needs to practice effectively in the hospital environment, quality leadership was identified as the highest need nurses have in the workplace setting. 20 Fine-tuning existing professional development training for nurse leaders to improve communication and confidence is necessary for quality leadership that so many nurses desire.

Nonetheless, leadership development should begin well before one becomes a leader in the health care setting. 21 Leading nursing organizations have provided resources to help. For example, the American Organization for Nursing Leadership (AONL), the professional organization for nurse leaders in health care, provides a comprehensive list of Nurse Executive Competencies, in which effective communication and relationship building is primary. 22 The AONL also provides 2 leadership credentialing certifications to become a Certified Nurse Manager and Leader or Certified in Executive Nursing Practice.

At the regional medical center, nurses should be encouraged and financially supported to pursue graduate programs such as the Doctor of Nursing Practice (DNP) Executive Leadership program, designed for experienced nurses seeking to be competent in the knowledge of various leadership theories, managing complex health care environments, applying evidence to practice, improving patient care through policy engagement and advocacy, and leading interprofessional collaboration. 23

This survey was intended to give us preliminary information on how to strategize professional development to support nurse leaders at a regional medical center. The first step is to examine their perceptions about their leadership style, outcomes of their leadership, and self-efficacy.

Despite the information gathered in this survey, there were limitations. We did not examine factors related to the transformational leadership style, outcomes of leadership, and self-efficacy. The survey is also prone to social desirability bias. Nurse leaders may provide responses that are desirable for their roles. To limit bias, we ensured that participation was not tracked because we did not observe who collected and returned surveys, and no identifiable information was collected. Despite the limitations, the results of this survey provide much-needed information on the areas of strength and for future projects focusing on professional development. Although the transformational style was the leading leadership style among the nurse leaders, content around effective communication around values and vision, and showing confidence is necessary to include in the hospital’s leadership development training. Finally, organizational support by way of providing continuous, sustainable professional leadership development is needed to ensure leader effectiveness and improvement in staff and patient outcomes. Hospital-based interventions and professional development focusing on leadership self-efficacy and effective communication are necessary to ensure leadership effectiveness and ultimately, clinical care outcomes.

Sharolyn Bush, MSN, RN, CMSRN, is a Clinical Nursing Director at Anne Arundel Medical Center in Annapolis, Maryland. Diane Michalek, DNP, RN, NE-BC, is the Director of Nursing Practice and Outcomes at the University of Maryland Baltimore in Glen Burnie, Maryland. Lucine Francis, PhD, RN, is an Assistant Professor at Johns Hopkins University School of Nursing in Baltimore, Maryland. She can be reached at [email protected] .

Note: The research received no funding. Funding to purchase the MLQ tools were provided by the regional medical center where the study was conducted. The regional medical center played no role in the design, collection, and dissemination of study or study results. There were no conflicts of interest to declare. We thank the nurse leaders who participated in this study. We also thank the leadership of the Nurse Leadership Institute (NLI) in Maryland for their support. The authors conducted this study as nurse leadership fellows at the NLI.

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How leadership matters

Clinical nurses' perceptions of leader behaviors affecting their work environment.

Raso, Rosanne DNP, RN, NEA-BC, FAAN, FAONL; Fitzpatrick, Joyce PhD, MBA, RN, FAAN, FNAP

Rosanne Raso is the editor-in-chief of Nursing Management and the vice president and CNO at NewYork-Presbyterian/Weill Cornell in New York, N.Y. Joyce Fitzpatrick is the director of the Marian K. Shaughnessy Nurse Leadership Academy and Elizabeth Brooks Ford professor of nursing at Case Western Reserve University Frances Payne Bolton School of Nursing in Cleveland, Ohio.

The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

For 131 additional nursing continuing professional development articles related to management topics, go to NursingCenter.com/CE .

What should nurse leaders do to ensure a healthy work environment? This article presents positive and negative leader attributes in the words of clinical nurses and actions you can take to boost your relational leadership competencies.

FU1-6

What should nurse managers and leaders do to ensure a healthy work environment for clinical nurses? What we know is that relational styles of leadership have been studied in nursing for years and are consistently associated with positive workforce outcomes. 1,2 Relational leadership is built on solid relationships with direct reports and individuals from other disciplines, as its name implies. This type of leadership is positive, particularly in nurturing employee engagement and healthy work environments. Mastering the skills of interpersonal engagement and creating trust and influence through connections are hallmarks of great nurse leaders. 3 Yet, even though there's considerable support for relational leadership, there are still gaps in the implementation of programs to develop nurse leaders. Developmental programs for nurse managers often focus on the management skills needed, such as finances, budgeting, and resource allocation and procurement, creating a significant gap in preparation related to the development of relational leadership competencies.

From a qualitative perspective, we were interested in determining what clinical nurses describe as positive and negative leadership behaviors that affect their work environment. In this article, we present our findings in the words of clinical nurses, along with implications for nurse leaders seeking to understand the impact of clinical nurses' perceptions of their supervisors' actions, especially their relational leadership competencies.

Relational leadership is based on positive psychology, which focuses on helping people find meaning and purpose, live meaningful lives, and search for personal strength and value. 4 Therefore, relational leadership is grounded in optimism, integrity, positive emotions, and employee growth and development. The link to nursing leadership is obvious—ethics, positive change, purpose, growth, and social connection are all part of who we are as nurses and nurse leaders.

The most common relational leadership styles are transformational, authentic, and servant. All three leadership styles have connections to healthy work environments and staff engagement, which, in turn, provide the foundation for positive workforce and patient outcomes. 5,6 (See Figure 1 .) To add empirical support to these connections, we previously conducted two research studies on authentic nurse leadership and its relationship with a healthy work environment, expecting a positive relationship. In both studies, we found a significant positive relationship, providing empirical evidence that authentic nurse leadership is a standard for a healthy work environment. 7,8

F1-6

We used Giordano-Mulligan and Eckhart's authentic nurse leadership model in our studies. This model has three main domains with five subcomponents or attributes: personal integrity to include moral-ethical courage and self-awareness, transparency to include relationship integrality and shared decision-making, and altruism to include caring. 9 These attributes were found to be important for nurse engagement. Caring was identified as an integral attribute that nurses seek in their leaders, which makes this one of the first nursing leadership models with caring science embedded in the practice. 10 (See Table 1 .)

Domains Attributes
Personal integrity Moral-ethical courage Self-awareness
Transparency Relational integrality Shared decision-making
Altruism Caring

We also used the American Association of Critical-Care Nurses' (AACN) healthy work environment model, which is evidence-based and relationship-centered and includes six standards: skilled communication, true collaboration, effective decision-making, authentic leadership, meaningful recognition, and appropriate staffing. All six elements are considered essential, meaning that missing any one of them won't result in a sustainable healthy work environment. 11 (See Figure 2 .)

F2-6

This study received Institutional Review Board approval. Participants were recruited at the 2019 American Nurses Credentialing Center National Magnet ® Conference. Two open-ended questions were asked after quantitative and demographic questions in an anonymous survey:

  • How does your manager positively affect your work environment?
  • How does your manager negatively affect your environment?

What did clinical nurses say?

Four-hundred and fifty-six open-ended comments were collected, split between positive (n = 245) and negative (n = 211) from a final sample of 254 clinical nurses. Eighty of the “negative” comments were either blank or positive rather than negative. Most respondents practiced in critical/progressive care (27%) and adult medical-surgical (26%) areas on the day shift (77%). The responses revealed behaviors that clinical nurses valued and criticized in their managers, which trended into several categories.

For positive comments, the top trends were related to relational skills, such as communication, positivity, and approachability (n = 87); caring and professional growth (n = 68); visibility (n = 57); and advocacy (n = 10), aligning with both authentic nurse leadership attributes and healthy work environment standards. There were 10 comments about flexible scheduling. (See Table 2 .)

Positive trend Authentic nurse leadership attribute Healthy work environment standard
Visibility and presence Self-awareness Authentic leadership
Flexible scheduling Appropriate staffing
Transparent communication Relational integrality Effective communication
Provides assistance Self-awareness True collaboration
Encourages involvement Shared decision-making Effective decision-making
Compassionate, kind, supportive Caring
Approachable, open minded, listens Shared decision-making Effective decision-making
Positive Relational integrality Authentic leadership
Advocacy Moral-ethical courage Authentic leadership
Encourages professional growth Caring Meaningful recognition
Recognizes staff Relational integrality Meaningful recognition

In the words of clinical nurses, positive leadership attributes included:

  • “By inspiring me to be my best.”
  • “When I see her, she's supportive and responsive to my concerns. She has asked me to be a part of various committees to further my career development.”
  • “She's very approachable and is an active listener.”
  • “She's concerned for my well-being as a person.”
  • “She's very involved in encouraging advancement and uplifting her staff.”
  • “Listens and takes suggestions/concerns seriously.”
  • “She uses open communication at all times in all situations.”
  • “Sends out a bulletin every Friday that's helpful for keeping up with nursing news and hospital updates.”
  • “She fights for us on a daily basis.”

For negative comments, the top trends were lack of presence and caring (n = 28), lack of follow-through and open-mindedness (n = 18), lack of visibility/unapproachable (n = 16), and inadequate communication (n = 11). There were seven negative comments about staffing and scheduling. (See Table 3 .)

Lack of visibility and presence
Unprofessional
Micromanager
Doesn't help
No follow-through
Judgmental, not open to suggestions
Unapproachable
Negative attitude
Plays favorites, biased
Makes emotional decisions
Inadequate communication

In the words of clinical nurses, negative leadership attributes included:

  • “The overall feeling on our unit is that our managers need to communicate more effectively.”
  • “She isn't always approachable and cares about budget more than staff wellness.”
  • “She doesn't always notice work I've done.”
  • “The manager focuses only on problems.”
  • “Night shift workers are unfortunately neglected.”
  • “She's judgmental. Has a hard time taking our opinion into consideration. She makes decisions without consulting us.”
  • “Doesn't have confidence in self and, therefore, doesn't instill confidence in staff.”
  • “Is too scattered, starts many things without finishing. Lacks follow-through and accountability.”

These qualitative results with a vast majority of positive comments aren't surprising considering our previous empirical findings that both authentic nurse leadership and healthy work environments were present in the national prepandemic sample of clinical nurses. In the second, midpandemic study in the summer of 2020, we also found that authentic nurse leadership was present in a much larger sample, signaling that nurse leaders throughout the country demonstrate authentic attributes as noted by their direct reports, even in a crisis. 8 Finding many more positive comments than negative points to the same conclusion about the overarching presence of sound nursing leadership.

Because the top positive trends were related to communication skills, caring, professional growth, and visibility, we understand what aspects of leadership are important to clinical nurses. It isn't their leaders' nursing acumen or clinical skills, although being able to help was mentioned several times. It isn't a perfect schedule or staffing, although flexible scheduling was brought up, albeit infrequently. Rather, it's about the alignment of relational competencies, authentic nurse leadership attributes, and healthy work environment standards. Clinical nurses want to be heard, receive honest information, be supported by a visible leader, grow, and be recognized. Values-driven leadership, shown in the comments on advocacy and “fighting” for staff, is integral for the authentic nurse leadership attribute of moral-ethical courage. We believe that nurse managers aspire to be this type of leader.

The negative behavior trends were consistently the opposite of the positive ones. Lack of presence, communication, recognition, follow-through, and collaborative decision-making are noticed and can contribute to disengagement. Staffing and scheduling were only occasionally mentioned, which was surprising considering there wasn't agreement that appropriate staffing was present in the rating of healthy work environment standards. Perhaps clinical nurses consider staffing to be out of the scope of the frontline manager and more of an organizational issue.

The attribute of caring in the authentic nurse leadership model, with its concomitant depiction as nurturing, compassionate, kind, and personally interested, was frequently mentioned and important to clinical nurses, further supporting this relatively new framework for nursing leadership. This attribute isn't specifically included in the healthy work environment standards, although the standard of meaningful recognition certainly includes professional growth and feeling valued for your contributions.

Implications for nurse managers

The link between relational leadership and nursing values, such as ethical practice, positive change, purpose, growth, and interpersonal connections, was evident in our findings, as was the association with healthy work environments and staff engagement—the foundation for positive patient outcomes. Nurse leaders must remove the barriers to relational, authentic, and visible leadership. Covering two geographically separate units, being inundated with meetings and tasks, or not having a frontline leader at all impacts clinical nurses' perceptions of leadership support. Making this case to senior leaders is imperative when decisions are being made about frontline leaders' scope and responsibilities.

Effective communication and meaningful recognition are practices we can all do, and structures are needed to support them. Regarding communication, you must get information first, which may be challenging, and share it in as many formal and informal ways as you can (verbal, written, posted, emailed, cascaded), with night supervisors on the same page. Shared governance structures can be effective not only for decision-making, but also communication. 12 If you think you've communicated enough, do it again. As a human resource colleague often implores, get the message out seven times in seven different ways.

Recognition is the same—there's never enough. Do you get tired of being recognized for your value? Of course not. Structured mechanisms include daily shout-outs, bulletin boards, “random acts of kindness” programs, DAISY awards, employee of the week/month, Nurses Week activities, thank-you cards, leader rounds, and numerous other ideas. Leaders must make recognition as important as any other responsibility in the job description. 13

Our obligation to teach and learn relational behaviors, authentic nurse leadership attributes, and healthy work environment standards and how to build and demonstrate them is another implication. Effective leadership development occurs through experiential learning, as well as didactic mechanisms. 14 This applies to aspiring leaders, clinical leaders, and formal leaders.

Leadership matters

Our clinical nurses have spoken. The importance of relational competencies, caring behaviors, and visibility is evident. Relational leadership is even more critical as we continue to be challenged through our second year of the pandemic. This type of leadership alone isn't enough to create a healthy work environment for clinical nurses; nevertheless, it's required. We're all obligated to be present and lead with integrity, caring, and transparency. Leadership matters.

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nursing leadership philosophy paper

How to Write a Great Nursing Personal Philosophy Paper

nursing leadership philosophy paper

Are you finding it difficult to write a brilliant nursing philosophy paper? If yes, you are in the right corner of the internet. In this post, you will discover everything you need to know to write a brilliant personal nursing philosophy. Let's jump right in!

What is a personal nursing philosophy statement?

A personal nursing philosophy statement is a statement that shows a nurse's values, ethics, and beliefs about patient care and nursing in general. In other words, it is a statement that clarifies a nurse's thoughts, ideas, and principles regarding patient care and nursing.

The statement is often between four to five sentences long. When you write it, you are supposed to put it somewhere where you can read it from time to time to remember your goals and objectives and to motivate yourself.

An extended personal nursing philosophy statement is called a personal nursing philosophy paper . The paper is usually between five to six paragraphs long. It is longer than a typical nursing philosophy statement because it is more detailed.

How does one create a personal nursing philosophy statement?

What drives you as a nurse? What makes you wake up daily to go to your nursing duty station? Is it your belief that every patient should receive holistic care? Is it your belief that patients deserve the highest level of care? Whatever drives or motivates you as a nurse is your nursing philosophy . Thus, to create a personal nursing philosophy, all you need to do is write down what motivates you as a nurse.

In a few moments, you will discover how to create a personal nursing philosophy statement in a step-by-step guide.

Personal nursing philosophy vs. personal leadership philosophy

A personal nursing philosophy is a statement that shows a nurse's beliefs, values, and ethics regarding the nursing profession. It is specific to the nursing profession because it is only written by nurses or those training to be nurses.

In contrast, a personal leadership philosophy is a statement that shows a leader's values, principles, and beliefs regarding leadership (influencing or leading people). It can be written by just about anybody in a serious leadership position.

The two definitions above reveal significant differences between the two types of personal philosophies. The first difference is in the definition. The two philosophies are two different things by definition.

The second difference is in the author. Personal nursing philosophy can only be written by a nurse. In contrast, anyone in a serious leadership position can write a personal leadership philosophy.

Who writes a nursing philosophy statement?

A nursing student or a practicing nurse can write a nursing philosophy statement.

A personal nursing philosophy statement written by a nursing student is typically written for motivation. Nursing courses and practice can be challenging, which is an accepted fact worldwide. Because of this, instructors usually encourage students to write a nursing philosophy statement that they can refer to from time to time to motivate themselves and to remind themselves why they are pursuing a nursing profession.

A personal nursing philosophy statement written by a practicing nurse is typically written for motivation and as a career guide. Nursing is a challenging profession that is both physically and mentally demanding. Therefore, practicing nurses are encouraged to write and have a personal nursing philosophy for motivation. They are also encouraged to do so to clarify their career goals.

Why it is essential to have a personal nursing philosophy statement

There are 5 key reasons why having a personal nursing philosophy as a nursing student or nurse is crucial.

  • It helps you to set standards for your nursing practice. This is good, especially if your nursing job involves handling serious or challenging situations.
  • It helps you to set a standard for interacting with patients and colleagues regardless of the situation.
  • It helps you adopt a mindset that can improve your service delivery or how you work in your current posting.
  • It helps you to stay motivated even when facing enormous challenges by showing you the bigger picture (why you are in nursing).
  • It assists you in capturing your goals and beliefs and actualizing them in your day-to-day nursing work.

What goes into my nursing philosophy paper?

A personal nursing philosophy paper is an extended version of a personal philosophy statement. It is more detailed. To write one, you first must create an outline. You cannot write an excellent logical nursing philosophy paper without first creating a nursing philosophy paper outline .

While it is ideal for creating an outline for your nursing personal philosophy paper , it is essential to remember that a personal philosophy is personal (based on your thoughts, principles, and beliefs). Therefore, there is always a freehand element when writing a personal philosophy paper.

Even if there is a freehand element when writing a personal philosophy paper, following an outline must ensure your paper has excellent structure and organization.

Personal nursing philosophy paper outline

1. Introduction

  • Attention-grabbing statement
  • Background information
  • Thesis statement

2. Body Paragraph 1

  • Opening statement
  • Supporting information
  • Closing statement

3. Body Paragraph 2

4. Body Paragraph 3

5. Conclusion

  • Thesis restatement
  • Restatement of main points
  • Show that research supports the thesis statement

Steps for writing a brilliant personal nursing philosophy

In this section, you will discover the steps you must follow to create a brilliant personal nursing philosophy for motivation or to prepare yourself for nursing job interviews.

You must take a significant pre-writing step before you start writing your nursing philosophy . The step involves answering a set of questions related to the nursing profession. By answering the questions, you will make it easier for yourself to define your philosophy.

The questions are:

  • What exactly is nursing?
  • Why is nursing important to you?
  • Why is nursing important to society?
  • What are the attributes of a good nurse?
  • What skills and qualities are vital for nurses?
  • What values do you think every nurse should have?
  • What errors should you never make as a nurse?

By thinking about these questions and answering them as honestly as you can, you will find it relatively easy to define your personal nursing philosophy .

Your answers to the questions above will help reveal your personal nursing philosophy . And it is by expanding these answers that you can write a detailed personal nursing philosophy. You can expand the answers by following the steps below.

1. Define what exactly nursing means to you

The first thing you should put in your nursing personal philosophy statement after your introduction is your personal definition of nursing. Use your answers to questions 1, 2, and 3 above to offer your own definition of nursing. This will help the reader quickly determine how you conceptualize and understand nursing and how you approach it.

2. Describe how you embody the attributes of a good nurse

After describing what nursing means to you in the first body paragraph, you should use the second body paragraph to describe how you embody a good nurse's attributes (skills, traits, & values). If you do not want to describe how you embody the attributes of a good nurse, you should share a story or an incident that shows how you embody them (or some of them). Writing this section in your nursing philosophy paper will tell the reader what nursing qualities you value the most.

3. Discuss how you want to impact your community or society through nursing

In the third body paragraph of your nursing philosophy paper, you should discuss how you intend to impact your community or society through nursing. This will help you to set your goals nicely for your nursing profession. Reading this part of your nursing philosophy will also help to motivate you, especially when you face challenges at your workplace.

4. Discuss the nursing qualities and traits that mean a lot to you

This is the fourth and last paragraph of your personal nursing philosophy . You should use it to reiterate the critical nursing skills, traits, principles, and values you believe define you the best. Ensure you have comprehensively yet briefly described your nursing experience, principles, and beliefs.

Using the steps above plus the outline shared earlier, you should be able to write a brilliant and well-structured personal philosophy of nursing paper.

Nursing Philosophy Example Paper

The nursing philosophy example below shows a detailed version of a personal nursing philosophy:

My personal nursing philosophy is all about trying to see art and beauty in the nursing profession. One of the pioneer nurses in the modern-day world, Florence Nightingale , once likened the nursing profession to art and argued that there is a need to ensure nurses, just like artists, are well-prepared and given the time and space to do their work. I agree with her, which is why I sometimes consider myself an artist. Like every experienced artist, I know I must pay attention to every little detail in my work to ensure I deliver exemplary services. Every little detail means the patient's emotional, psychological, and physical conditions. And I know that the only way I can stay at the top of my game is through preparation and constant training and learning. I believe the most important aspect of nursing is that we, as nurses, are at the core of patient treatment. They are given the training and the tools to help deliver treatment to patients. As a nurse who believes nursing is an art, I think of the training and tools we have been given as the tools of an artist. And I strive to use these tools effectively to help improve the patient's environment and condition. I use them to help deliver comfort and healing. Nursing, like most science-based professions, is a constantly changing profession. New information, new studies, and new ways of doing things are constantly being published in credible publications. Therefore, I believe that I must continually improve myself to continue delivering top-notch evidence-based nursing services. And this can only be done by continually reading new research, participating in training, and getting new certifications in the field. Only then can I continue administering medication and keeping conditions sterile according to the latest industry standards. I love the fact that ethics are an integral part of nursing education and nursing work. When dealing with patients, I always remember that while they are under my care, they need to feel that they are protected and that all their rights are observed. They need to access to the right to nutrition, oxygenation, safety, acceptance, and rest. They also need to be listened to and to have their thoughts and opinions considered. In closing, I believe nursing is one of the best professions in the world! It might not be the highest-paying profession, but to me, it is engaging, intricate, exciting, and highly satisfying work. Of course, it has its challenges, but I believe that by approaching it as an artist, I know everything is within my hands. I can use my training and tools to keep calm and continue delivering exemplary nursing services.

Five things to keep in mind when writing a personal nursing philosophy

You now know the steps to follow to write a personal nursing philosophy. You have also seen a personal nursing philosophy example paper above. It is almost certain that you feel confident about your ability to write a brilliant nursing philosophy paper. However, you need to know a few more things before you start writing your personal philosophy of nursing . These things will help you to write a brilliant personal nursing philosophy.

  • Keep your paper short and precise. Your personal nursing philosophy is something that can be expressed in four to five sentences. It is called a personal nursing philosophy statement when it is short. It is called a personal nursing philosophy paper when it is long and detailed. And even when it is long and detailed, it is never too long; it usually does not exceed 500 words.
  • Show you are ready for action. It is essential to ensure your personal nursing philosophy has action verbs that show you are ready to work. You should never say anything to the effect that you are a laidback person in your philosophy. This could be interpreted negatively and cause you to miss the opportunity.
  • Be original. When you write your own personal philosophy of nursing , you should try to be yourself. Do not try to impress anyone or to express thoughts that are not your own. You should be genuine as possible. If you are, you will find yourself drawn to your philosophy, and it will have a natural motivating effect on you. If you are not, you really will not believe in the philosophy, and it will have no motivating or inspiring effect on you.
  • Be ready for change. The nursing profession is a constantly changing profession. Thousands of new research studies are published annually, revealing new information on how to treat patients, care for patients, administer medicine, sterilize environments, and so on. Therefore, what you believe or hold true in your philosophy might hold true in a few months or years. Thus, you must be ready for change. You must be prepared to adjust your philosophy if you feel there is a need to.
  • Keep a copy of your philosophy close to you. This is important to ensure that you have something to remind you of why you are in nursing, especially when the going gets tough. Many practicing nurses print and stick their personal philosophies somewhere in their work station to help them to keep going, especially when they want to give up.

Final thoughts

The personal philosophy of nursing is an important thing to have as a nursing student or as a practicing nurse. It is an important thing to have as a nursing student because it will remind you why you wanted to become a nurse. This will motivate you to keep going, especially if you constantly face academic challenges. A personal nursing philosophy is important for a practicing nurse for motivation and career direction.

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  • Inspirational nursing topics for nursing papers.
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  • List of borrowed or non-nursing theories
  • Nursing theories to inspire your nursing philosophy statement

You can write your nursing philosophy as a statement or an essay/paper. Writing a personal nursing philosophy statement is easy because it is usually just about five sentences long. In contrast, it is much harder to write a personal nursing philosophy paper because it is much longer and must be very detailed. However, using the information we have provided in this post, you should be able to write a decent nursing philosophy paper.

If you do not have the time to write one or are not confident you can write a good one, you should order it from us. We have dozens of experienced writers ready to help you quickly complete any academic assignment. You can pay the nursing writers to write your papers and assignments from scratch. All you must do is to put an order, and one of them will soon be working on your paper.

Personal Nursing Philosophy FAQs

What is a good example of a personal philosophy statement.

My personal nursing philosophy is that the e must use their training and their experience to ensure every patient gets the highest level of care regardless of their social status. I strongly believe nursing is about gaining knowledge, caring, and persistence. I use this philosophy to guide my day day-to-day decisions.

What was Florence Nightingale�s personal nursing philosophy?

Nightingale believed that the nursing profession was a spiritual calling. She also believed that every patient had a spiritual dimension that needed to be comforted and healed in the same way the physical dimension needs to be comforted and healed.

How long should my personal nursing philosophy statement be?

It should be no more than five sentences long. The shorter it is, the better. This is because a personal philosophy statement should simply be a short statement that states your motivations and helps you stay on track.

How long should my personal nursing philosophy paper be?

It should be no more than 500 words long. A personal nursing philosophy paper is a longer and more detailed version of a personal philosophy statement. It is unnecessary to be longer than 500 words unless you have been specifically instructed to make it longer than 500 words.

Do nursing organizations have nursing philosophies?

Yes, they do. However, most of them do not call them nursing philosophies. They call them a statement of purpose.

What was Florence Nightingale's nursing theory?

Florence Nightingale's nursing theory emphasizes that a nurse must use their brain, hands, and heart to create a healing environment for the patient's body, mind, and spirit. It is one of the most famous nursing theories .

How to start a nursing philosophy paper?

You should start the paper with a robust and attention-grabbing sentence. This will hook the reader and make them want to read your philosophy paper.

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Leadership in Nursing: Qualities & Why It Matters

4 min read • May, 19 2023

Strong leaders in nursing are vital to help navigate the constant evolution of health care. Nurse leaders do more than balance costs, monitor productivity, and maintain patient and staff satisfaction. They serve as role models and influence health care organizations at all levels. A strong nurse leader motivates their colleagues, setting the tone for a safe, civil workplace with a culture of high morale and job retention.

What Is a Nurse Leader?

A nurse leader is defined by their actions, and not always by a position of authority. Leaders in nursing inspire and influence others to achieve their maximum potential. They use applied leadership in nursing by drawing upon critical thinking skills to manage a team.

Nurse leaders take a broad view of how daily tasks impact the overall goals of the health care organization. They communicate expectations to their team and motivate them to achieve predetermined goals. Nurses can lead from various organizational areas if they project the necessary leadership qualities to influence others.

Leadership Qualities in Nursing

A  nurse leader role combines essential nursing, business, and leadership skills developed through ongoing learning . They must be flexible enough to adapt to technological changes, fluctuating payment methods, new treatment modalities, and regulatory and legislative environments. Critical skills for effective nursing leadership include:

  • Communication and Collaboration : These skills can reduce miscommunication, encourage shared decision making, and provide a sense of working together toward common goals.
  • Education and Quality of Practice :  Continued professional development  allows leaders in nursing to keep pace with the ever-changing health care environment while striving for excellence by supporting quality, evidence-based practice.
  • Environmental Health and Resource Utilization : Leadership in nursing ensures that patient care can be provided effectively in a  safe and healthy environment  while promoting wellness among all health care staff.
  • Ethics and Professional Practice Evaluation : Influential nurse leaders model ethical practices to guide decisions, display honesty by being accountable for their actions, and evaluate their adherence to professional practice standards.  Learn more about the Code of Ethics for Nurses .
  • Professionalism and Leadership : Leaders in nursing build vital relationships and collaborate with various health care teams on sensitive topics. Using critical thinking skills allows those in nursing leadership roles to analyze decisions impacting the organization. They then clearly explain the rationale in a manner that encourages staff support.

Other nursing leadership skills, such as displaying compassion and empathy, can assist the nurse leader in developing interpersonal relationships and gaining respect in their role.

7 Leadership Styles in Nursing

Nursing  leadership styles can impact job satisfaction ,  nurse retention rates , quality of care, and  patient outcomes . The nurse’s educational background, personality, and work environment may influence their nursing leadership style. Each type of nurse leader role can be valuable when utilized in the right setting.

  • The Transformational  nurse leader works to inspire nurses to achieve a greater vision by helping with strength development. This nursing leadership style works well with mentoring.
  • The Autocratic  nurse leader makes quick decisions with little input from employees and excels at task delegation. This nursing leadership style may be most effective in an emergency.
  • A Laissez-faire  leadership style puts faith in every facet of a well-oiled machine. This method may work well with experienced teams or self-directed nurses.
  • The Democratic  nurse leader is collaborative and focuses on team success. This nurse leader might excel in quality improvement roles but may not be effective in situations requiring independent decisions.
  • The Servant  nurse leadership style focuses on employee development and individual needs. This method works well with goal-driven environments or as a nurse educator.
  • The Situational  leadership style is the most adaptable since it analyzes the situation and determines the appropriate approach. This nurse leader is flexible enough to modify their approach based on the organization or individual’s needs. This style works well with nursing students but may divert from the organization’s long-term goals.
  • The Transactional  nurse leader does well with short-term goals by focusing on efficiency and performance. This task-oriented style reduces errors and works well with tight deadlines.

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Examples of Leadership in Nursing

Projecting leadership skills in nursing that influences others can allow a nurse to lead without being assigned a specific leadership position. The aspiring nurse leader might:

  • Seek out a mentor or become one
  • Volunteer for committee roles
  • Become involved in the community
  • Take educational courses
  • Stay current on the latest health care trends
  • Get involved with public policy

A nurse aspiring for a nursing leadership role can get a certification or obtain additional degrees specific to nursing leadership to increase their knowledge base and expand upon professional development. But a title and the education aren’t enough to create an effective leader. Nurses and other health care staff need to believe their contributions make a difference in the organization.

Why Is Nurse Leadership Important?

Nurse leaders make a difference in workplace culture and drive positive changes in health care legislation. When a team admires the qualities of their leader, it boosts morale and promotes a psychologically safe workplace, which leads to higher job satisfaction and retention rates. Influential leaders in nursing ensure that the organization's vision is communicated to the nursing staff while  mentoring the nursing leadership of tomorrow .

Explore courses, webinars, and  other nursing leadership and excellence resources offered by ANA .

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NURS 4321: Health Systems Leadership: Nursing Philosophy Paper

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The impact of evidence-based nursing leadership in healthcare settings: a mixed methods systematic review

  • Maritta Välimäki 1 , 2 ,
  • Shuang Hu 3 ,
  • Tella Lantta 1 ,
  • Kirsi Hipp 1 , 4 ,
  • Jaakko Varpula 1 ,
  • Jiarui Chen 3 ,
  • Gaoming Liu 5 ,
  • Yao Tang 3 ,
  • Wenjun Chen 3 &
  • Xianhong Li 3  

BMC Nursing volume  23 , Article number:  452 ( 2024 ) Cite this article

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Metrics details

The central component in impactful healthcare decisions is evidence. Understanding how nurse leaders use evidence in their own managerial decision making is still limited. This mixed methods systematic review aimed to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurse leaders and their performance, organizational, and clinical outcomes.

We included articles using any type of research design. We referred nurses, nurse managers or other nursing staff working in a healthcare context when they attempt to influence the behavior of individuals or a group in an organization using an evidence-based approach. Seven databases were searched until 11 November 2021. JBI Critical Appraisal Checklist for Quasi-experimental studies, JBI Critical Appraisal Checklist for Case Series, Mixed Methods Appraisal Tool were used to evaluate the Risk of bias in quasi-experimental studies, case series, mixed methods studies, respectively. The JBI approach to mixed methods systematic reviews was followed, and a parallel-results convergent approach to synthesis and integration was adopted.

Thirty-one publications were eligible for the analysis: case series ( n  = 27), mixed methods studies ( n  = 3) and quasi-experimental studies ( n  = 1). All studies were included regardless of methodological quality. Leadership problems were related to the implementation of knowledge into practice, the quality of nursing care and the resource availability. Organizational data was used in 27 studies to understand leadership problems, scientific evidence from literature was sought in 26 studies, and stakeholders’ views were explored in 24 studies. Perceived and measured effects of evidence-based leadership focused on nurses’ performance, organizational outcomes, and clinical outcomes. Economic data were not available.

Conclusions

This is the first systematic review to examine how evidence is used to solve leadership problems and to describe its measured and perceived effects from different sites. Although a variety of perceptions and effects were identified on nurses’ performance as well as on organizational and clinical outcomes, available knowledge concerning evidence-based leadership is currently insufficient. Therefore, more high-quality research and clinical trial designs are still needed.

Trail registration

The study was registered (PROSPERO CRD42021259624).

Peer Review reports

Global health demands have set new roles for nurse leaders [ 1 ].Nurse leaders are referred to as nurses, nurse managers, or other nursing staff working in a healthcare context who attempt to influence the behavior of individuals or a group based on goals that are congruent with organizational goals [ 2 ]. They are seen as professionals “armed with data and evidence, and a commitment to mentorship and education”, and as a group in which “leaders innovate, transform, and achieve quality outcomes for patients, health care professionals, organizations, and communities” [ 3 ]. Effective leadership occurs when team members critically follow leaders and are motivated by a leader’s decisions based on the organization’s requests and targets [ 4 ]. On the other hand, problems caused by poor leadership may also occur, regarding staff relations, stress, sickness, or retention [ 5 ]. Therefore, leadership requires an understanding of different problems to be solved using synthesizing evidence from research, clinical expertise, and stakeholders’ preferences [ 6 , 7 ]. If based on evidence, leadership decisions, also referred as leadership decision making [ 8 ], could ensure adequate staffing [ 7 , 9 ] and to produce sufficient and cost-effective care [ 10 ]. However, nurse leaders still rely on their decision making on their personal [ 11 ] and professional experience [ 10 ] over research evidence, which can lead to deficiencies in the quality and safety of care delivery [ 12 , 13 , 14 ]. As all nurses should demonstrate leadership in their profession, their leadership competencies should be strengthened [ 15 ].

Evidence-informed decision-making, referred to as evidence appraisal and application, and evaluation of decisions [ 16 ], has been recognized as one of the core competencies for leaders [ 17 , 18 ]. The role of evidence in nurse leaders’ managerial decision making has been promoted by public authorities [ 19 , 20 , 21 ]. Evidence-based management, another concept related to evidence-based leadership, has been used as the potential to improve healthcare services [ 22 ]. It can guide nursing leaders, in developing working conditions, staff retention, implementation practices, strategic planning, patient care, and success of leadership [ 13 ]. Collins and Holton [ 23 ] in their systematic review and meta-analysis examined 83 studies regarding leadership development interventions. They found that leadership training can result in significant improvement in participants’ skills, especially in knowledge level, although the training effects varied across studies. Cummings et al. [ 24 ] reviewed 100 papers (93 studies) and concluded that participation in leadership interventions had a positive impact on the development of a variety of leadership styles. Clavijo-Chamorro et al. [ 25 ] in their review of 11 studies focused on leadership-related factors that facilitate evidence implementation: teamwork, organizational structures, and transformational leadership. The role of nurse managers was to facilitate evidence-based practices by transforming contexts to motivate the staff and move toward a shared vision of change.

As far as we are aware, however, only a few systematic reviews have focused on evidence-based leadership or related concepts in the healthcare context aiming to analyse how nurse leaders themselves uses evidence in the decision-making process. Young [ 26 ] targeted definitions and acceptance of evidence-based management (EBMgt) in healthcare while Hasanpoor et al. [ 22 ] identified facilitators and barriers, sources of evidence used, and the role of evidence in the process of decision making. Both these reviews concluded that EBMgt was of great importance but used limitedly in healthcare settings due to a lack of time, a lack of research management activities, and policy constraints. A review by Williams [ 27 ] showed that the usage of evidence to support management in decision making is marginal due to a shortage of relevant evidence. Fraser [ 28 ] in their review further indicated that the potential evidence-based knowledge is not used in decision making by leaders as effectively as it could be. Non-use of evidence occurs and leaders base their decisions mainly on single studies, real-world evidence, and experts’ opinions [ 29 ]. Systematic reviews and meta-analyses rarely provide evidence of management-related interventions [ 30 ]. Tate et al. [ 31 ] concluded based on their systematic review and meta-analysis that the ability of nurse leaders to use and critically appraise research evidence may influence the way policy is enacted and how resources and staff are used to meet certain objectives set by policy. This can further influence staff and workforce outcomes. It is therefore important that nurse leaders have the capacity and motivation to use the strongest evidence available to effect change and guide their decision making [ 27 ].

Despite of a growing body of evidence, we found only one review focusing on the impact of evidence-based knowledge. Geert et al. [ 32 ] reviewed literature from 2007 to 2016 to understand the elements of design, delivery, and evaluation of leadership development interventions that are the most reliably linked to outcomes at the level of the individual and the organization, and that are of most benefit to patients. The authors concluded that it is possible to improve individual-level outcomes among leaders, such as knowledge, motivation, skills, and behavior change using evidence-based approaches. Some of the most effective interventions included, for example, interactive workshops, coaching, action learning, and mentoring. However, these authors found limited research evidence describing how nurse leaders themselves use evidence to support their managerial decisions in nursing and what the outcomes are.

To fill the knowledge gap and compliment to existing knowledgebase, in this mixed methods review we aimed to (1) examine what leadership problems nurse leaders solve using an evidence-based approach and (2) how they use evidence to solve these problems. We also explored (3) the measured and (4) perceived effects of the evidence-based leadership approach in healthcare settings. Both qualitative and quantitative components of the effects of evidence-based leadership were examined to provide greater insights into the available literature [ 33 ]. Together with the evidence-based leadership approach, and its impact on nursing [ 34 , 35 ], this knowledge gained in this review can be used to inform clinical policy or organizational decisions [ 33 ]. The study is registered (PROSPERO CRD42021259624). The methods used in this review were specified in advance and documented in a priori in a published protocol [ 36 ]. Key terms of the review and the search terms are defined in Table  1 (population, intervention, comparison, outcomes, context, other).

In this review, we used a mixed methods approach [ 37 ]. A mixed methods systematic review was selected as this approach has the potential to produce direct relevance to policy makers and practitioners [ 38 ]. Johnson and Onwuegbuzie [ 39 ] have defined mixed methods research as “the class of research in which the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, concepts or language into a single study.” Therefore, we combined quantitative and narrative analysis to appraise and synthesize empirical evidence, and we held them as equally important in informing clinical policy or organizational decisions [ 34 ]. In this review, a comprehensive synthesis of quantitative and qualitative data was performed first and then discussed in discussion part (parallel-results convergent design) [ 40 ]. We hoped that different type of analysis approaches could complement each other and deeper picture of the topic in line with our research questions could be gained [ 34 ].

Inclusion and exclusion criteria

Inclusion and exclusion criteria of the study are described in Table  1 .

Search strategy

A three-step search strategy was utilized. First, an initial limited search with #MEDLINE was undertaken, followed by analysis of the words used in the title, abstract, and the article’s key index terms. Second, the search strategy, including identified keywords and index terms, was adapted for each included data base and a second search was undertaken on 11 November 2021. The full search strategy for each database is described in Additional file 1 . Third, the reference list of all studies included in the review were screened for additional studies. No year limits or language restrictions were used.

Information sources

The database search included the following: CINAHL (EBSCO), Cochrane Library (academic database for medicine and health science and nursing), Embase (Elsevier), PsycINFO (EBSCO), PubMed (MEDLINE), Scopus (Elsevier) and Web of Science (academic database across all scientific and technical disciplines, ranging from medicine and social sciences to arts and humanities). These databases were selected as they represent typical databases in health care context. Subject headings from each of the databases were included in the search strategies. Boolean operators ‘AND’ and ‘OR’ were used to combine the search terms. An information specialist from the University of Turku Library was consulted in the formation of the search strategies.

Study selection

All identified citations were collated and uploaded into Covidence software (Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia www.covidence.org ), and duplicates were removed by the software. Titles and abstracts were screened and assessed against the inclusion criteria independently by two reviewers out of four, and any discrepancies were resolved by the third reviewer (MV, KH, TL, WC). Studies meeting the inclusion criteria were retrieved in full and archived in Covidence. Access to one full-text article was lacking: the authors for one study were contacted about the missing full text, but no full text was received. All remaining hits of the included studies were retrieved and assessed independently against the inclusion criteria by two independent reviewers of four (MV, KH, TL, WC). Studies that did not meet the inclusion criteria were excluded, and the reasons for exclusion were recorded in Covidence. Any disagreements that arose between the reviewers were resolved through discussions with XL.

Assessment of methodological quality

Eligible studies were critically appraised by two independent reviewers (YT, SH). Standardized critical appraisal instruments based on the study design were used. First, quasi-experimental studies were assessed using the JBI Critical Appraisal Checklist for Quasi-experimental studies [ 44 ]. Second, case series were assessed using the JBI Critical Appraisal Checklist for Case Series [ 45 ]. Third, mixed methods studies were appraised using the Mixed Methods Appraisal Tool [ 46 ].

To increase inter-reviewer reliability, the review agreement was calculated (SH) [ 47 ]. A kappa greater than 0.8 was considered to represent a high level of agreement (0–0.1). In our data, the agreement was 0.75. Discrepancies raised between two reviewers were resolved through discussion and modifications and confirmed by XL. As an outcome, studies that met the inclusion criteria were proceeded to critical appraisal and assessed as suitable for inclusion in the review. The scores for each item and overall critical appraisal scores were presented.

Data extraction

For data extraction, specific tables were created. First, study characteristics (author(s), year, country, design, number of participants, setting) were extracted by two authors independently (JC, MV) and reviewed by TL. Second, descriptions of the interventions were extracted by two reviewers (JV, JC) using the structure of the TIDIeR (Template for Intervention Description and Replication) checklist (brief name, the goal of the intervention, material and procedure, models of delivery and location, dose, modification, adherence and fidelity) [ 48 ]. The extractions were confirmed (MV).

Third, due to a lack of effectiveness data and a wide heterogeneity between study designs and presentation of outcomes, no attempt was made to pool the quantitative data statistically; the findings of the quantitative data were presented in narrative form only [ 44 ]. The separate data extraction tables for each research question were designed specifically for this study. For both qualitative (and a qualitative component of mixed-method studies) and quantitative studies, the data were extracted and tabulated into text format according to preplanned research questions [ 36 ]. To test the quality of the tables and the data extraction process, three authors independently extracted the data from the first five studies (in alphabetical order). After that, the authors came together to share and determine whether their approaches of the data extraction were consistent with each other’s output and whether the content of each table was in line with research question. No reason was found to modify the data extraction tables or planned process. After a consensus of the data extraction process was reached, the data were extracted in pairs by independent reviewers (WC, TY, SH, GL). Any disagreements that arose between the reviewers were resolved through discussion and with a third reviewer (MV).

Data analysis

We were not able to conduct a meta-analysis due to a lack of effectiveness data based on clinical trials. Instead, we used inductive thematic analysis with constant comparison to answer the research question [ 46 , 49 ] using tabulated primary data from qualitative and quantitative studies as reported by the original authors in narrative form only [ 47 ]. In addition, the qualitizing process was used to transform quantitative data to qualitative data; this helped us to convert the whole data into themes and categories. After that we used the thematic analysis for the narrative data as follows. First, the text was carefully read, line by line, to reveal topics answering each specific review question (MV). Second, the data coding was conducted, and the themes in the data were formed by data categorization. The process of deriving the themes was inductive based on constant comparison [ 49 ]. The results of thematic analysis and data categorization was first described in narrative format and then the total number of studies was calculated where the specific category was identified (%).

Stakeholder involvement

The method of reporting stakeholders’ involvement follows the key components by [ 50 ]: (1) people involved, (2) geographical location, (3) how people were recruited, (4) format of involvement, (5) amount of involvement, (6) ethical approval, (7) financial compensation, and (8) methods for reporting involvement.

In our review, stakeholder involvement targeted nurses and nurse leader in China. Nurse Directors of two hospitals recommended potential participants who received a personal invitation letter from researchers to participate in a discussion meeting. Stakeholders’ participation was based on their own free will. Due to COVID-19, one online meeting (1 h) was organized (25 May 2022). Eleven participants joined the meeting. Ethical approval was not applied and no financial compensation was offered. At the end of the meeting, experiences of stakeholders’ involvement were explored.

The meeting started with an introductory presentation with power points. The rationale, methods, and preliminary review results were shared with the participants [ 51 ].The meeting continued with general questions for the participants: (1) Are you aware of the concepts of evidence-based practice or evidence-based leadership?; (2) How important is it to use evidence to support decisions among nurse leaders?; (3) How is the evidence-based approach used in hospital settings?; and (4) What type of evidence is currently used to support nurse leaders’ decision making (e.g. scientific literature, organizational data, stakeholder views)?

Two people took notes on the course and content of the conversation. The notes were later transcripted in verbatim, and the key points of the discussions were summarised. Although answers offered by the stakeholders were very short, the information was useful to validate the preliminary content of the results, add the rigorousness of the review, and obtain additional perspectives. A recommendation of the stakeholders was combined in the Discussion part of this review increasing the applicability of the review in the real world [ 50 ]. At the end of the discussion, the value of stakeholders’ involvement was asked. Participants shared that the experience of participating was unique and the topic of discussion was challenging. Two authors of the review group further represented stakeholders by working together with the research team throughout the review study.

Search results

From seven different electronic databases, 6053 citations were identified as being potentially relevant to the review. Then, 3133 duplicates were removed by an automation tool (Covidence: www.covidence.org ), and one was removed manually. The titles and abstracts of 3040 of citations were reviewed, and a total of 110 full texts were included (one extra citation was found on the reference list but later excluded). Based on the eligibility criteria, 31 studies (32 hits) were critically appraised and deemed suitable for inclusion in the review. The search results and selection process are presented in the PRISMA [ 52 ] flow diagram Fig.  1 . The full list of references for included studies can be find in Additional file 2 . To avoid confusion between articles of the reference list and studies included in the analysis, the studies included in the review are referred inside the article using the reference number of each study (e.g. ref 1, ref 2).

figure 1

Search results and study selection and inclusion process [ 52 ]

Characteristics of included studies

The studies had multiple purposes, aiming to develop practice, implement a new approach, improve quality, or to develop a model. The 31 studies (across 32 hits) were case series studies ( n  = 27), mixed methods studies ( n  = 3) and a quasi-experimental study ( n  = 1). All studies were published between the years 2004 and 2021. The highest number of papers was published in year 2020.

Table  2 describes the characteristics of included studies and Additional file 3 offers a narrative description of the studies.

Methodological quality assessment

Quasi-experimental studies.

We had one quasi-experimental study (ref 31). All questions in the critical appraisal tool were applicable. The total score of the study was 8 (out of a possible 9). Only one response of the tool was ‘no’ because no control group was used in the study (see Additional file 4 for the critical appraisal of included studies).

Case series studies . A case series study is typically defined as a collection of subjects with common characteristics. The studies do not include a comparison group and are often based on prevalent cases and on a sample of convenience [ 53 ]. Munn et al. [ 45 ] further claim that case series are best described as observational studies, lacking experimental and randomized characteristics, being descriptive studies, without a control or comparator group. Out of 27 case series studies included in our review, the critical appraisal scores varied from 1 to 9. Five references were conference abstracts with empirical study results, which were scored from 1 to 3. Full reports of these studies were searched in electronic databases but not found. Critical appraisal scores for the remaining 22 studies ranged from 1 to 9 out of a possible score of 10. One question (Q3) was not applicable to 13 studies: “Were valid methods used for identification of the condition for all participants included in the case series?” Only two studies had clearly reported the demographic of the participants in the study (Q6). Twenty studies met Criteria 8 (“Were the outcomes or follow-up results of cases clearly reported?”) and 18 studies met Criteria 7 (“Q7: Was there clear reporting of clinical information of the participants?”) (see Additional file 4 for the critical appraisal of included studies).

Mixed-methods studies

Mixed-methods studies involve a combination of qualitative and quantitative methods. This is a common design and includes convergent design, sequential explanatory design, and sequential exploratory design [ 46 ]. There were three mixed-methods studies. The critical appraisal scores for the three studies ranged from 60 to 100% out of a possible 100%. Two studies met all the criteria, while one study fulfilled 60% of the scored criteria due to a lack of information to understand the relevance of the sampling strategy well enough to address the research question (Q4.1) or to determine whether the risk of nonresponse bias was low (Q4.4) (see Additional file 4 for the critical appraisal of included studies).

Intervention or program components

The intervention of program components were categorized and described using the TiDier checklist: name and goal, theory or background, material, procedure, provider, models of delivery, location, dose, modification, and adherence and fidelity [ 48 ]. A description of intervention in each study is described in Additional file 5 and a narrative description in Additional file 6 .

Leadership problems

In line with the inclusion criteria, data for the leadership problems were categorized in all 31 included studies (see Additional file 7 for leadership problems). Three types of leadership problems were identified: implementation of knowledge into practice, the quality of clinical care, and resources in nursing care. A narrative summary of the results is reported below.

Implementing knowledge into practice

Eleven studies (35%) aimed to solve leadership problems related to implementation of knowledge into practice. Studies showed how to support nurses in evidence-based implementation (EBP) (ref 3, ref 5), how to engage nurses in using evidence in practice (ref 4), how to convey the importance of EBP (ref 22) or how to change practice (ref 4). Other problems were how to facilitate nurses to use guideline recommendations (ref 7) and how nurses can make evidence-informed decisions (ref 8). General concerns also included the linkage between theory and practice (ref 1) as well as how to implement the EBP model in practice (ref 6). In addition, studies were motivated by the need for revisions or updates of protocols to improve clinical practice (ref 10) as well as the need to standardize nursing activities (ref 11, ref 14).

The quality of the care

Thirteen (42%) focused on solving problems related to the quality of clinical care. In these studies, a high number of catheter infections led a lack of achievement of organizational goals (ref 2, ref 9). A need to reduce patient symptoms in stem cell transplant patients undergoing high-dose chemotherapy (ref 24) was also one of the problems to be solved. In addition, the projects focused on how to prevent pressure ulcers (ref 26, ref 29), how to enhance the quality of cancer treatment (ref 25) and how to reduce the need for invasive constipation treatment (ref 30). Concerns about patient safety (ref 15), high fall rates (ref 16, ref 19), dissatisfaction of patients (ref 16, ref 18) and nurses (ref 16, ref 30) were also problems that had initiated the projects. Studies addressed concerns about how to promote good contingency care in residential aged care homes (ref 20) and about how to increase recognition of human trafficking problems in healthcare (ref 21).

Resources in nursing care

Nurse leaders identified problems in their resources, especially in staffing problems. These problems were identified in seven studies (23%), which involved concerns about how to prevent nurses from leaving the job (ref 31), how to ensure appropriate recruitment, staffing and retaining of nurses (ref 13) and how to decrease nurses’ burden and time spent on nursing activities (ref 12). Leadership turnover was also reported as a source of dissatisfaction (ref 17); studies addressed a lack of structured transition and training programs, which led to turnover (ref 23), as well as how to improve intershift handoff among nurses (ref 28). Optimal design for new hospitals was also examined (ref 27).

Main features of evidence-based leadership

Out of 31 studies, 17 (55%) included all four domains of an evidence-based leadership approach, and four studies (13%) included evidence of critical appraisal of the results (see Additional file 8 for the main features of evidence-based Leadership) (ref 11, ref 14, ref 23, ref 27).

Organizational evidence

Twenty-seven studies (87%) reported how organizational evidence was collected and used to solve leadership problems (ref 2). Retrospective chart reviews (ref 5), a review of the extent of specific incidents (ref 19), and chart auditing (ref 7, ref 25) were conducted. A gap between guideline recommendations and actual care was identified using organizational data (ref 7) while the percentage of nurses’ working time spent on patient care was analyzed using an electronic charting system (ref 12). Internal data (ref 22), institutional data, and programming metrics were also analyzed to understand the development of the nurse workforce (ref 13).

Surveys (ref 3, ref 25), interviews (ref 3, ref 25) and group reviews (ref 18) were used to better understand the leadership problem to be solved. Employee opinion surveys on leadership (ref 17), a nurse satisfaction survey (ref 30) and a variety of reporting templates were used for the data collection (ref 28) reported. Sometimes, leadership problems were identified by evidence facilitators or a PI’s team who worked with staff members (ref 15, ref 17). Problems in clinical practice were also identified by the Nursing Professional Council (ref 14), managers (ref 26) or nurses themselves (ref 24). Current practices were reviewed (ref 29) and a gap analysis was conducted (ref 4, ref 16, ref 23) together with SWOT analysis (ref 16). In addition, hospital mission and vision statements, research culture established and the proportion of nursing alumni with formal EBP training were analyzed (ref 5). On the other hand, it was stated that no systematic hospital-specific sources of data regarding job satisfaction or organizational commitment were used (ref 31). In addition, statements of organizational analysis were used on a general level only (ref 1).

Scientific evidence identified

Twenty-six studies (84%) reported the use of scientific evidence in their evidence-based leadership processes. A literature search was conducted (ref 21) and questions, PICO, and keywords were identified (ref 4) in collaboration with a librarian. Electronic databases, including PubMed (ref 14, ref 31), Cochrane, and EMBASE (ref 31) were searched. Galiano (ref 6) used Wiley Online Library, Elsevier, CINAHL, Health Source: Nursing/Academic Edition, PubMed, and the Cochrane Library while Hoke (ref 11) conducted an electronic search using CINAHL and PubMed to retrieve articles.

Identified journals were reviewed manually (ref 31). The findings were summarized using ‘elevator speech’ (ref 4). In a study by Gifford et al. (ref 9) evidence facilitators worked with participants to access, appraise, and adapt the research evidence to the organizational context. Ostaszkiewicz (ref 20) conducted a scoping review of literature and identified and reviewed frameworks and policy documents about the topic and the quality standards. Further, a team of nursing administrators, directors, staff nurses, and a patient representative reviewed the literature and made recommendations for practice changes.

Clinical practice guidelines were also used to offer scientific evidence (ref 7, ref 19). Evidence was further retrieved from a combination of nursing policies, guidelines, journal articles, and textbooks (ref 12) as well as from published guidelines and literature (ref 13). Internal evidence, professional practice knowledge, relevant theories and models were synthesized (ref 24) while other study (ref 25) reviewed individual studies, synthesized with systematic reviews or clinical practice guidelines. The team reviewed the research evidence (ref 3, ref 15) or conducted a literature review (ref 22, ref 28, ref 29), a literature search (ref 27), a systematic review (ref 23), a review of the literature (ref 30) or ‘the scholarly literature was reviewed’ (ref 18). In addition, ‘an extensive literature review of evidence-based best practices was carried out’ (ref 10). However, detailed description how the review was conducted was lacking.

Views of stakeholders

A total of 24 studies (77%) reported methods for how the views of stakeholders, i.e., professionals or experts, were considered. Support to run this study was received from nursing leadership and multidisciplinary teams (ref 29). Experts and stakeholders joined the study team in some cases (ref 25, ref 30), and in other studies, their opinions were sought to facilitate project success (ref 3). Sometimes a steering committee was formed by a Chief Nursing Officer and Clinical Practice Specialists (ref 2). More specifically, stakeholders’ views were considered using interviews, workshops and follow-up teleconferences (ref 7). The literature review was discussed with colleagues (ref 11), and feedback and support from physicians as well as the consensus of staff were sought (ref 16).

A summary of the project findings and suggestions for the studies were discussed at 90-minute weekly meetings by 11 charge nurses. Nurse executive directors were consulted over a 10-week period (ref 31). An implementation team (nurse, dietician, physiotherapist, occupational therapist) was formed to support the implementation of evidence-based prevention measures (ref 26). Stakeholders volunteered to join in the pilot implementation (ref 28) or a stakeholder team met to determine the best strategy for change management, shortcomings in evidence-based criteria were discussed, and strategies to address those areas were planned (ref 5). Nursing leaders, staff members (ref 22), ‘process owners (ref 18) and program team members (ref 18, ref 19, ref 24) met regularly to discuss the problems. Critical input was sought from clinical educators, physicians, nutritionists, pharmacists, and nurse managers (ref 24). The unit director and senior nursing staff reviewed the contents of the product, and the final version of clinical pathways were reviewed and approved by the Quality Control Commission of the Nursing Department (ref 12). In addition, two co-design workshops with 18 residential aged care stakeholders were organized to explore their perspectives about factors to include in a model prototype (ref 20). Further, an agreement of stakeholders in implementing continuous quality services within an open relationship was conducted (ref 1).

Critical appraisal

In five studies (16%), a critical appraisal targeting the literature search was carried out. The appraisals were conducted by interns and teams who critiqued the evidence (ref 4). In Hoke’s study, four areas that had emerged in the literature were critically reviewed (ref 11). Other methods were to ‘critically appraise the search results’ (ref 14). Journal club team meetings (ref 23) were organized to grade the level and quality of evidence and the team ‘critically appraised relevant evidence’ (ref 27). On the other hand, the studies lacked details of how the appraisals were done in each study.

The perceived effects of evidence-based leadership

Perceived effects of evidence-based leadership on nurses’ performance.

Eleven studies (35%) described perceived effects of evidence-based leadership on nurses’ performance (see Additional file 9 for perceived effects of evidence-based leadership), which were categorized in four groups: awareness and knowledge, competence, ability to understand patients’ needs, and engagement. First, regarding ‘awareness and knowledge’, different projects provided nurses with new learning opportunities (ref 3). Staff’s knowledge (ref 20, ref 28), skills, and education levels improved (ref 20), as did nurses’ knowledge comprehension (ref 21). Second, interventions and approaches focusing on management and leadership positively influenced participants’ competence level to improve the quality of services. Their confidence level (ref 1) and motivation to change practice increased, self-esteem improved, and they were more positive and enthusiastic in their work (ref 22). Third, some nurses were relieved that they had learned to better handle patients’ needs (ref 25). For example, a systematic work approach increased nurses’ awareness of the patients who were at risk of developing health problems (ref 26). And last, nurse leaders were more engaged with staff, encouraging them to adopt the new practices and recognizing their efforts to change (ref 8).

Perceived effects on organizational outcomes

Nine studies (29%) described the perceived effects of evidence-based leadership on organizational outcomes (see Additional file 9 for perceived effects of evidence-based leadership). These were categorized into three groups: use of resources, staff commitment, and team effort. First, more appropriate use of resources was reported (ref 15, ref 20), and working time was more efficiently used (ref 16). In generally, a structured approach made implementing change more manageable (ref 1). On the other hand, in the beginning of the change process, the feedback from nurses was unfavorable, and they experienced discomfort in the new work style (ref 29). New approaches were also perceived as time consuming (ref 3). Second, nurse leaders believed that fewer nursing staff than expected left the organization over the course of the study (ref 31). Third, the project helped staff in their efforts to make changes, and it validated the importance of working as a team (ref 7). Collaboration and support between the nurses increased (ref 26). On the other hand, new work style caused challenges in teamwork (ref 3).

Perceived effects on clinical outcomes

Five studies (16%) reported the perceived effects of evidence-based leadership on clinical outcomes (see Additional file 9 for perceived effects of evidence-based leadership), which were categorized in two groups: general patient outcomes and specific clinical outcomes. First, in general, the project assisted in connecting the guideline recommendations and patient outcomes (ref 7). The project was good for the patients in general, and especially to improve patient safety (ref 16). On the other hand, some nurses thought that the new working style did not work at all for patients (ref 28). Second, the new approach used assisted in optimizing patients’ clinical problems and person-centered care (ref 20). Bowel management, for example, received very good feedback (ref 30).

The measured effects of evidence-based leadership

The measured effects on nurses’ performance.

Data were obtained from 20 studies (65%) (see Additional file 10 for measured effects of evidence-based leadership) and categorized nurse performance outcomes for three groups: awareness and knowledge, engagement, and satisfaction. First, six studies (19%) measured the awareness and knowledge levels of participants. Internship for staff nurses was beneficial to help participants to understand the process for using evidence-based practice and to grow professionally, to stimulate for innovative thinking, to give knowledge needed to use evidence-based practice to answer clinical questions, and to make possible to complete an evidence-based practice project (ref 3). Regarding implementation program of evidence-based practice, those with formal EBP training showed an improvement in knowledge, attitude, confidence, awareness and application after intervention (ref 3, ref 11, ref 20, ref 23, ref 25). On the contrary, in other study, attitude towards EBP remained stable ( p  = 0.543). and those who applied EBP decreased although no significant differences over the years ( p  = 0.879) (ref 6).

Second, 10 studies (35%) described nurses’ engagement to new practices (ref 5, ref 6, ref 7, ref 10, ref 16, ref 17, ref 18, ref 21, ref 25, ref 27). 9 studies (29%) studies reported that there was an improvement of compliance level of participants (ref 6, ref 7, ref 10, ref 16, ref 17, ref 18, ref 21, ref 25, ref 27). On the contrary, in DeLeskey’s (ref 5) study, although improvement was found in post-operative nausea and vomiting’s (PONV) risk factors documented’ (2.5–63%), and ’risk factors communicated among anaesthesia and surgical staff’ (0–62%), the improvement did not achieve the goal. The reason was a limited improvement was analysed. It was noted that only those patients who had been seen by the pre-admission testing nurse had risk assessments completed. Appropriate treatment/prophylaxis increased from 69 to 77%, and from 30 to 49%; routine assessment for PONV/rescue treatment 97% and 100% was both at 100% following the project. The results were discussed with staff but further reasons for a lack of engagement in nursing care was not reported.

And third, six studies (19%) reported nurses’ satisfaction with project outcomes. The study results showed that using evidence in managerial decisions improved nurses’ satisfaction and attitudes toward their organization ( P  < 0.05) (ref 31). Nurses’ overall job satisfaction improved as well (ref 17). Nurses’ satisfaction with usability of the electronic charting system significantly improved after introduction of the intervention (ref 12). In handoff project in seven hospitals, improvement was reported in all satisfaction indicators used in the study although improvement level varied in different units (ref 28). In addition, positive changes were reported in nurses’ ability to autonomously perform their job (“How satisfied are you with the tools and resources available for you treat and prevent patient constipation?” (54%, n  = 17 vs. 92%, n  = 35, p  < 0.001) (ref 30).

The measured effects on organizational outcomes

Thirteen studies (42%) described the effects of a project on organizational outcomes (see Additional file 10 for measured effects of evidence-based leadership), which were categorized in two groups: staff compliance, and changes in practices. First, studies reported improved organizational outcomes due to staff better compliance in care (ref 4, ref 13, ref 17, ref 23, ref 27, ref 31). Second, changes in organization practices were also described (ref 11) like changes in patient documentation (ref 12, ref 21). Van Orne (ref 30) found a statistically significant reduction in the average rate of invasive medication administration between pre-intervention and post-intervention ( p  = 0.01). Salvador (ref 24) also reported an improvement in a proactive approach to mucositis prevention with an evidence-based oral care guide. On the contrary, concerns were also raised such as not enough time for new bedside report (ref 16) or a lack of improvement of assessment of diabetic ulcer (ref 8).

The measured effects on clinical outcomes

A variety of improvements in clinical outcomes were reported (see Additional file 10 for measured effects of evidence-based leadership): improvement in patient clinical status and satisfaction level. First, a variety of improvement in patient clinical status was reported. improvement in Incidence of CAUTI decreased 27.8% between 2015 and 2019 (ref 2) while a patient-centered quality improvement project reduced CAUTI rates to 0 (ref 10). A significant decrease in transmission rate of MRSA transmission was also reported (ref 27) and in other study incidences of CLABSIs dropped following of CHG bathing (ref 14). Further, it was possible to decrease patient nausea from 18 to 5% and vomiting to 0% (ref 5) while the percentage of patients who left the hospital without being seen was below 2% after the project (ref 17). In addition, a significant reduction in the prevalence of pressure ulcers was found (ref 26, ref 29) and a significant reduction of mucositis severity/distress was achieved (ref 24). Patient falls rate decreased (ref 15, ref 16, ref 19, ref 27).

Second, patient satisfaction level after project implementation improved (ref 28). The scale assessing healthcare providers by consumers showed improvement, but the changes were not statistically significant. Improvement in an emergency department leadership model and in methods of communication with patients improved patient satisfaction scores by 600% (ref 17). In addition, new evidence-based unit improved patient experiences about the unit although not all items improved significantly (ref 18).

Stakeholder involvement in the mixed-method review

To ensure stakeholders’ involvement in the review, the real-world relevance of our research [ 53 ], achieve a higher level of meaning in our review results, and gain new perspectives on our preliminary findings [ 50 ], a meeting with 11 stakeholders was organized. First, we asked if participants were aware of the concepts of evidence-based practice or evidence-based leadership. Responses revealed that participants were familiar with the concept of evidence-based practice, but the topic of evidence-based leadership was totally new. Examples of nurses and nurse leaders’ responses are as follows: “I have heard a concept of evidence-based practice but never a concept of evidence-based leadership.” Another participant described: “I have heard it [evidence-based leadership] but I do not understand what it means.”

Second, as stakeholder involvement is beneficial to the relevance and impact of health research [ 54 ], we asked how important evidence is to them in supporting decisions in health care services. One participant described as follows: “Using evidence in decisions is crucial to the wards and also to the entire hospital.” Third, we asked how the evidence-based approach is used in hospital settings. Participants expressed that literature is commonly used to solve clinical problems in patient care but not to solve leadership problems. “In [patient] medication and care, clinical guidelines are regularly used. However, I am aware only a few cases where evidence has been sought to solve leadership problems.”

And last, we asked what type of evidence is currently used to support nurse leaders’ decision making (e.g. scientific literature, organizational data, stakeholder views)? The participants were aware that different types of information were collected in their organization on a daily basis (e.g. patient satisfaction surveys). However, the information was seldom used to support decision making because nurse leaders did not know how to access this information. Even so, the participants agreed that the use of evidence from different sources was important in approaching any leadership or managerial problems in the organization. Participants also suggested that all nurse leaders should receive systematic training related to the topic; this could support the daily use of the evidence-based approach.

To our knowledge, this article represents the first mixed-methods systematic review to examine leadership problems, how evidence is used to solve these problems and what the perceived and measured effects of evidence-based leadership are on nurse leaders and their performance, organizational, and clinical outcomes. This review has two key findings. First, the available research data suggests that evidence-based leadership has potential in the healthcare context, not only to improve knowledge and skills among nurses, but also to improve organizational outcomes and the quality of patient care. Second, remarkably little published research was found to explore the effects of evidence-based leadership with an efficient trial design. We validated the preliminary results with nurse stakeholders, and confirmed that nursing staff, especially nurse leaders, were not familiar with the concept of evidence-based leadership, nor were they used to implementing evidence into their leadership decisions. Our data was based on many databases, and we screened a large number of studies. We also checked existing registers and databases and found no registered or ongoing similar reviews being conducted. Therefore, our results may not change in the near future.

We found that after identifying the leadership problems, 26 (84%) studies out of 31 used organizational data, 25 (81%) studies used scientific evidence from the literature, and 21 (68%) studies considered the views of stakeholders in attempting to understand specific leadership problems more deeply. However, only four studies critically appraised any of these findings. Considering previous critical statements of nurse leaders’ use of evidence in their decision making [ 14 , 30 , 31 , 34 , 55 ], our results are still quite promising.

Our results support a previous systematic review by Geert et al. [ 32 ], which concluded that it is possible to improve leaders’ individual-level outcomes, such as knowledge, motivation, skills, and behavior change using evidence-based approaches. Collins and Holton [ 23 ] particularly found that leadership training resulted in significant knowledge and skill improvements, although the effects varied widely across studies. In our study, evidence-based leadership was seen to enable changes in clinical practice, especially in patient care. On the other hand, we understand that not all efforts to changes were successful [ 56 , 57 , 58 ]. An evidence-based approach causes negative attitudes and feelings. Negative emotions in participants have also been reported due to changes, such as discomfort with a new working style [ 59 ]. Another study reported inconvenience in using a new intervention and its potential risks for patient confidentiality. Sometimes making changes is more time consuming than continuing with current practice [ 60 ]. These findings may partially explain why new interventions or program do not always fully achieve their goals. On the other hand, Dubose et al. [ 61 ] state that, if prepared with knowledge of resistance, nurse leaders could minimize the potential negative consequences and capitalize on a powerful impact of change adaptation.

We found that only six studies used a specific model or theory to understand the mechanism of change that could guide leadership practices. Participants’ reactions to new approaches may be an important factor in predicting how a new intervention will be implemented into clinical practice. Therefore, stronger effort should be put to better understanding the use of evidence, how participants’ reactions and emotions or practice changes could be predicted or supported using appropriate models or theories, and how using these models are linked with leadership outcomes. In this task, nurse leaders have an important role. At the same time, more responsibilities in developing health services have been put on the shoulders of nurse leaders who may already be suffering under pressure and increased burden at work. Working in a leadership position may also lead to role conflict. A study by Lalleman et al. [ 62 ] found that nurses were used to helping other people, often in ad hoc situations. The helping attitude of nurses combined with structured managerial role may cause dilemmas, which may lead to stress. Many nurse leaders opt to leave their positions less than 5 years [ 63 ].To better fulfill the requirements of health services in the future, the role of nurse leaders in evidence-based leadership needs to be developed further to avoid ethical and practical dilemmas in their leadership practices.

It is worth noting that the perceived and measured effects did not offer strong support to each other but rather opened a new venue to understand the evidence-based leadership. Specifically, the perceived effects did not support to measured effects (competence, ability to understand patients’ needs, use of resources, team effort, and specific clinical outcomes) while the measured effects could not support to perceived effects (nurse’s performance satisfaction, changes in practices, and clinical outcomes satisfaction). These findings may indicate that different outcomes appear if the effects of evidence-based leadership are looked at using different methodological approach. Future study is encouraged using well-designed study method including mixed-method study to examine the consistency between perceived and measured effects of evidence-based leadership in health care.

There is a potential in nursing to support change by demonstrating conceptual and operational commitment to research-based practices [ 64 ]. Nurse leaders are well positioned to influence and lead professional governance, quality improvement, service transformation, change and shared governance [ 65 ]. In this task, evidence-based leadership could be a key in solving deficiencies in the quality, safety of care [ 14 ] and inefficiencies in healthcare delivery [ 12 , 13 ]. As WHO has revealed, there are about 28 million nurses worldwide, and the demand of nurses will put nurse resources into the specific spotlight [ 1 ]. Indeed, evidence could be used to find solutions for how to solve economic deficits or other problems using leadership skills. This is important as, when nurses are able to show leadership and control in their own work, they are less likely to leave their jobs [ 66 ]. On the other hand, based on our discussions with stakeholders, nurse leaders are not used to using evidence in their own work. Further, evidence-based leadership is not possible if nurse leaders do not have access to a relevant, robust body of evidence, adequate funding, resources, and organizational support, and evidence-informed decision making may only offer short-term solutions [ 55 ]. We still believe that implementing evidence-based strategies into the work of nurse leaders may create opportunities to protect this critical workforce from burnout or leaving the field [ 67 ]. However, the role of the evidence-based approach for nurse leaders in solving these problems is still a key question.

Limitations

This study aimed to use a broad search strategy to ensure a comprehensive review but, nevertheless, limitations exist: we may have missed studies not included in the major international databases. To keep search results manageable, we did not use specific databases to systematically search grey literature although it is a rich source of evidence used in systematic reviews and meta-analysis [ 68 ]. We still included published conference abstract/proceedings, which appeared in our scientific databases. It has been stated that conference abstracts and proceedings with empirical study results make up a great part of studies cited in systematic reviews [ 69 ]. At the same time, a limited space reserved for published conference publications can lead to methodological issues reducing the validity of the review results [ 68 ]. We also found that the great number of studies were carried out in western countries, restricting the generalizability of the results outside of English language countries. The study interventions and outcomes were too different across studies to be meaningfully pooled using statistical methods. Thus, our narrative synthesis could hypothetically be biased. To increase transparency of the data and all decisions made, the data, its categorization and conclusions are based on original studies and presented in separate tables and can be found in Additional files. Regarding a methodological approach [ 34 ], we used a mixed methods systematic review, with the core intention of combining quantitative and qualitative data from primary studies. The aim was to create a breadth and depth of understanding that could confirm to or dispute evidence and ultimately answer the review question posed [ 34 , 70 ]. Although the method is gaining traction due to its usefulness and practicality, guidance in combining quantitative and qualitative data in mixed methods systematic reviews is still limited at the theoretical stage [ 40 ]. As an outcome, it could be argued that other methodologies, for example, an integrative review, could have been used in our review to combine diverse methodologies [ 71 ]. We still believe that the results of this mixed method review may have an added value when compared with previous systematic reviews concerning leadership and an evidence-based approach.

Our mixed methods review fills the gap regarding how nurse leaders themselves use evidence to guide their leadership role and what the measured and perceived impact of evidence-based leadership is in nursing. Although the scarcity of controlled studies on this topic is concerning, the available research data suggest that evidence-based leadership intervention can improve nurse performance, organizational outcomes, and patient outcomes. Leadership problems are also well recognized in healthcare settings. More knowledge and a deeper understanding of the role of nurse leaders, and how they can use evidence in their own managerial leadership decisions, is still needed. Despite the limited number of studies, we assume that this narrative synthesis can provide a good foundation for how to develop evidence-based leadership in the future.

Implications

Based on our review results, several implications can be recommended. First, the future of nursing success depends on knowledgeable, capable, and strong leaders. Therefore, nurse leaders worldwide need to be educated about the best ways to manage challenging situations in healthcare contexts using an evidence-based approach in their decisions. This recommendation was also proposed by nurses and nurse leaders during our discussion meeting with stakeholders.

Second, curriculums in educational organizations and on-the-job training for nurse leaders should be updated to support general understanding how to use evidence in leadership decisions. And third, patients and family members should be more involved in the evidence-based approach. It is therefore important that nurse leaders learn how patients’ and family members’ views as stakeholders are better considered as part of the evidence-based leadership approach.

Future studies should be prioritized as follows: establishment of clear parameters for what constitutes and measures evidence-based leadership; use of theories or models in research to inform mechanisms how to effectively change the practice; conducting robust effectiveness studies using trial designs to evaluate the impact of evidence-based leadership; studying the role of patient and family members in improving the quality of clinical care; and investigating the financial impact of the use of evidence-based leadership approach within respective healthcare systems.

Data availability

The authors obtained all data for this review from published manuscripts.

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Acknowledgements

We want to thank the funding bodies, the Finnish National Agency of Education, Asia Programme, the Department of Nursing Science at the University of Turku, and Xiangya School of Nursing at the Central South University. We also would like to thank the nurses and nurse leaders for their valuable opinions on the topic.

The work was supported by the Finnish National Agency of Education, Asia Programme (grant number 26/270/2020) and the University of Turku (internal fund 26003424). The funders had no role in the study design and will not have any role during its execution, analysis, interpretation of the data, decision to publish, or preparation of the manuscript.

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Department of Nursing Science, University of Turku, Turku, FI-20014, Finland

Maritta Välimäki, Tella Lantta, Kirsi Hipp & Jaakko Varpula

School of Public Health, University of Helsinki, Helsinki, FI-00014, Finland

Maritta Välimäki

Xiangya Nursing, School of Central South University, Changsha, 410013, China

Shuang Hu, Jiarui Chen, Yao Tang, Wenjun Chen & Xianhong Li

School of Health and Social Services, Häme University of Applied Sciences, Hämeenlinna, Finland

Hunan Cancer Hospital, Changsha, 410008, China

Gaoming Liu

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Contributions

Study design: MV, XL. Literature search and study selection: MV, KH, TL, WC, XL. Quality assessment: YT, SH, XL. Data extraction: JC, MV, JV, WC, YT, SH, GL. Analysis and interpretation: MV, SH. Manuscript writing: MV. Critical revisions for important intellectual content: MV, XL. All authors read and approved the final manuscript.

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Correspondence to Xianhong Li .

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Differences between the original protocol

We modified criteria for the included studies: we included published conference abstracts/proceedings, which form a relatively broad knowledge base in scientific knowledge. We originally planned to conduct a survey with open-ended questions followed by a face-to-face meeting to discuss the preliminary results of the review. However, to avoid extra burden in nurses due to COVID-19, we decided to limit the validation process to the online discussion only.

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Välimäki, M., Hu, S., Lantta, T. et al. The impact of evidence-based nursing leadership in healthcare settings: a mixed methods systematic review. BMC Nurs 23 , 452 (2024). https://doi.org/10.1186/s12912-024-02096-4

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Personal Leadership Philosophy in Nursing

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Nursing leadership is the most important factor in day-to-day medical care. A nursing leader within a healthcare organization is necessary to inspire and motivate nurses to heal and comfort people in need (Stanley, D. & Stanley, K., 2018). To me, leadership means respect and loyalty to my job, my clients, and co-workers. Being responsible for patient care and safety should be the leader’s top priority. However, a nursing leader should never forget the importance of teamwork and communication. As such, bearing the weight of leadership, a nurse must work diligently to provide care and support other nurses.

Being a successful nursing leader primarily requires agility and adaptability. At the time of new technologies and challenges, the leader must be able to learn new skills. Unpredictable changes within different situations would be impossible to overcome without the ability to adjust. Flexibility and thinking ahead help a nursing leader prepare for any possible difficulties and opportunities. Whether it is a severe injury or force majeure at the workplace, nursing leadership must be ready to act and assist the team.

Such a leader should always strive to excel and serve as a role model to others. Knowledgeable and experienced team leader cares not only for patients but also for other nurses. Being understanding is necessary, yet a leader needs to be able to empower and inspire the team as well. Through this work, nursing leaders have the potential to change the future of the healthcare for the better. Influencing the medical field can be done through both initiatives and the transformations within the team. My ultimate goal as a nursing leader is to improve the quality of care and the lives of those I lead.

Stanley, D., & Stanley, K. (2018). Clinical leadership and nursing explored: A literature search. Journal of Clinical Nursing, 27 (9-10), 1730-1743.

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Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example

Cummings et al. (2021) highlight that effective leadership is essential in building great organizational cultures and a healthy working environment. While leaders can reinforce values and simultaneously hold people accountable, their influence can be positive or negative based on their execution strategy and leadership style. In this regard, competent nurse leaders can help improve the workplace environment by providing a better work-life balance and opportunities for growth that translates to greater retention rates and overall employee satisfaction.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example

According to Murray et al. (2018), a healthy work environment is the foundation of an organization and involves meaningful work, well-being, appreciation, and connection. First, while employees spend most of their time at work, a healthy work environment allows them to have a deep and personal connection to the job while having opportunities and motivation to deliver the best outcomes.  In this regard, the environment will enable them to stay engaged and contribute in an impactful way, contributing to improved health outcomes.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

Second, effective leaders appreciate their employees by celebrating their achievements and career milestones. As a result, these employees feel more valued, which increases their retention rates. Third, effective leaders influence a healthy working environment by promoting nurses’ emotional and social wellness, creating a sense of community (Murray et al., 2018). So forth, these leaders foster a sense of connection through collaboration where employees can feel connected to the organization and share their experiences while working together to achieve the organization’s objectives. The connection has effectively produced a solution and burnout at work, promoting a sense of belonging and purpose at work (Murray et al., 2018).(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

My philosophy on leadership is that a good leader cares about others and brings the best out of them through listening, coaching, and mentoring. In this case, effective leaders coach their subordinates on how they can become better rather than micromanage them. Additionally, these leaders are dynamic in that they adjust based on what is required in a given situation. They also advocate for other individuals and allow them to share their ideas which help in decision-making rather than imposing their own decisions. Nonetheless, these leaders provide growth opportunities, appreciate the employees, and build connections with them to make them feel more included in the organization (Cummings et al., 2021). Also, these leaders should have a sense of purpose to guide their subordinates on what is needed to be achieved and the strategies they should adopt to realize these goals.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

Core Values 

My core values are connectedness and individualism. I believe that every achievement is a result of an action taken. In this case, to realize the goals of an organization, there is a need to adopt the right strategies aimed at achieving these goals. From another perspective, I believe that there is a need to integrate the different perceptions and values among nurses, which can help in developing more inclusive decisions, achieving better healthcare outcomes. In this regard, rather than seeing the differences as a potential source of conflict or separation, as a leader, I believe there is a need for collaboration because we all influence and impact each other in different ways. As a result, we are a better place to learn from each other, building on our knowledge and skills and developing better strategies to help achieve the organization’s objectives. Specifically, connectedness enhances inclusiveness and collaboration, which are essential in creating a healthy working environment.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

            On the other hand, individualization is based on the fact that everyone is unique and has different capabilities that can be of the essence to the organization. In this case, there is a need to identify each health provider’s strengths and maximize the strength to realize the organization’s vision. Understanding the strength of each nurse in the organization allows the leaders to delegate tasks more effectively to achieve better outcomes (Persaud, 2019). Nonetheless, understanding that everyone has their strengths and weaknesses creates space for collaboration, where everyone’s input is considered important to realize the organization’s objectives.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

I would also apply this in patient care delivery, where I understand that every patient has their values and beliefs that should be respected. In this case, I would integrate these values into health care delivery by offering patient-centered care to improve health outcomes. Prezerakos (2018) highlights that patient-centered care is essential in improving patient outcomes and experience, which are some of the main primary goals of healthcare. Ideally, individualization is more of identifying an individual’s needs and working towards fulfilling these needs rather than taking a generalized approach.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

Mission and Vision Statement

Mission- To provide compassionate and quality care to the community through effective practice, leadership, and innovation.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

Vision- To provide quality patient care while creating a positive work environment that fosters employee growth and development.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

Clifton Strengths Assessment

Based on Gallup’s strengthsfinder assessment, my top five teams were connectedness, individualization, futuristic, learner, and strategic. First, connectedness is based on the idea that human beings are one regardless of their backgrounds. In this case, I believe that these differences are essential in realizing the most significant results in an organization rather than creating separation. Additionally, I believe that there’s a reason behind every event and link together incidences, facts, and conversations to understand how a specific goal was achieved, which can help me identify better approaches to achieving my future goals. Second, individualization involves understanding that everyone is unique, and it is by working together that people can become more productive. Nonetheless, there is a need to identify everyone’s values and beliefs and implement policies that respect these differences.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

Third, the futuristic theme indicates that I am more inspired by having a vision of what I want to achieve in the future. I find what is present less appealing and like working with visionaries to learn more innovative approaches to address problems. Fourth, I am curious to learn new ideas and acquire new knowledge that can help me improve the current processes to realize more effective health outcomes. Lastly, I am strategic in that I assess the different alternatives to a problem before adopting the most suitable solution that will help to solve the problem at hand.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

Key behaviors to Strengthen

I need to strengthen my individualization and futuristic behaviors. In this case, I tend to consider opinions from people who have the same vision as mine. However, I believe considering opinions from people with different perspectives will help me gain a different approach to a problem that provides alternative solutions. Second, I tend to be more future-oriented and less appreciative of what I have accomplished in the present. As a leader, it is vital to take note of the small wins and motivate other employees to achieve bigger goals. Through appreciating the milestones taken, one feels motivated to pursue long-term objectives. Therefore, improving on this behavior will help me have a clearer picture of the milestones I have made while looking forward to achieving my vision.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

Development Plan

I plan to improve individualization by listening to other people’s opinions with an open mind, even if I disagree. I also plan to appreciate diversity and find common ground to help me understand their approach to the problem (Rosser et al., 2020). As a result, I will assess the different opinions given and adopt the most effective strategy to help achieve the goal. Additionally, I plan on appreciating small wins by breaking down larger goals into smaller, manageable goals. In this case, I will focus less on the bigger picture and more on the short-term goals, which will help to achieve the long-term objectives. Nonetheless, I will track progress on how far I am with achieving my vision and reward myself and others for each step taken.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)

Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example

Cummings, G. G., Lee, S., Tate, K., Penconek, T., Micaroni, S. P., Paananen, T., & Chatterjee, G. E. (2021). The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership.  International Journal of Nursing Studies ,  115 , 103842.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)  https://doi.org/10.1016/j.ijnurstu.2020.103842

Murray, M., Sundin, D., & Cope, V. (2018). The nexus of nursing leadership and a culture of safer patient care.  Journal of Clinical Nursing ,  27 (5-6), 1287-1293.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)  https://doi.org/10.1111/jocn.13980

Persaud, S. (2019). Addressing unconscious bias.  Nursing Administration Quarterly ,  43 (2), 130-137.(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example)  https://doi.org/10.1097/naq.0000000000000348

Prezerakos, P. E. (2018). Nurse managers’ emotional intelligence and effective leadership: A review of the current evidence.  The Open Nursing Journal ,  12 (1), 86-92. (Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example) https://doi.org/10.2174/1874434601812010086

Rosser, E., Westcott, L., Ali, P. A., Bosanquet, J., Castro‐Sanchez, E., Dewing, J., McCormack, B., Merrell, J., & Witham, G. (2020). The need for visible nursing leadership during COVID‐19.  Journal of Nursing Scholarship ,  52 (5), 459-461.  https://doi.org/10.1111/jnu.12587

Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example

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    The link to nursing leadership is obvious—ethics, positive change, purpose, growth, and social connection are all part of who we are as nurses and nurse leaders. The most common relational leadership styles are transformational, authentic, and servant. All three leadership styles have connections to healthy work environments and staff ...

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    Articulating a philosophy statement is an intellectual activity that requires careful thought, because values need to be identified, clarified, and prioritized. Once these values are identified, putting them together into a short, cohesive statement is a challenging process ( Chitty, 2001 ). The first part of the process is identifying general ...

  11. Nursing Leadership Philosophy Essay

    Nursing Leadership Philosophy Paper. My nursing leadership philosophy is based on transformational leadership to which I ascribe. Transformational nurse leaders have a vested interest in the success of those they lead and their organization's vision. They are visionaries in the pursuit of cutting-edge ways of completing the tasks and goals of ...

  12. Personal Nursing Philosophy: Guide, Example, & Tips

    Personal nursing philosophy vs. personal leadership philosophy. A personal nursing philosophy is a statement that shows a nurse's beliefs, values, and ethics regarding the nursing profession. ... It should be no more than 500 words long. A personal nursing philosophy paper is a longer and more detailed version of a personal philosophy statement ...

  13. Leadership in Nursing: Qualities & Why It Matters

    7 Leadership Styles in Nursing. Nursing leadership styles can impact job satisfaction, nurse retention rates, quality of care, and patient outcomes. The nurse's educational background, personality, and work environment may influence their nursing leadership style. Each type of nurse leader role can be valuable when utilized in the right setting.

  14. NURS 4321: Health Systems Leadership: Nursing Philosophy Paper

    Margaret Newman is one of the most influential forces in nursing theor y and practice today. Here is the definitive collection of her article s, papers, and lectures. This remarkable resource showcases the progre ssion of her ideas, capturing her revolutionary impact on nursing and health care.

  15. The impact of evidence-based nursing leadership in healthcare settings

    The central component in impactful healthcare decisions is evidence. Understanding how nurse leaders use evidence in their own managerial decision making is still limited. This mixed methods systematic review aimed to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurse leaders and their performance ...

  16. The Personal Leadership Philosophy in Nursing Essay

    Get a custom essay on The Personal Leadership Philosophy in Nursing. Core values reflect the innate motivational drivers that underpin one's decisions and actions. They indicate the deep aspects of a person's motives for whatever work that they do and what fulfills and satisfies them about it.

  17. Developing a Philosophy of Leadership

    Developing a Philosophy of Leadership Essay developing philosophy of leadership lisandra hernandez galen college of nursing ldr 4400 chelsea hansen jan 17th. Skip to document. University; ... In nursing leadership, being team- oriented is crucial to developing essential patient care and ensuring safety. Having multiple patients increases the ...

  18. Leadership Philosophy in Nursing

    A strategic leadership philosophy is crucial for my effective and productive leadership skills. Therefore, my belief that a leader must be strategic, will become essential in my nursing profession. Get a custom essay on Leadership Philosophy in Nursing

  19. Personal Leadership Philosophy in Nursing

    Personal Leadership Philosophy in Nursing. Nursing leadership is the most important factor in day-to-day medical care. A nursing leader within a healthcare organization is necessary to inspire and motivate nurses to heal and comfort people in need (Stanley, D. & Stanley, K., 2018). To me, leadership means respect and loyalty to my job, my ...

  20. Nursing Leadership Philosophy Essay

    Nursing Leadership Philosophy Essay. Leadership is all about having the right amount of heart and determination to help make a difference in someone's life. It takes certain qualities to be considered a good leader. A leader should want to help inspire others to make a change and to be the best that they can be.

  21. Leadership QEP Paper

    This is the QEP paper for the course of leadership. nursing philosophy ayana mcgill benjamin leon school of nursing, miami dade college nur 2811c: professional. Skip to document. University; High School ... Nursing Philosophy A metaparadigm is 'a set of concepts and propositions that set forth the phenomena with which a discipline is ...

  22. Nursing Leadership Philosophy Paper

    nursing leadership philosophy paper - Free download as Word Doc (.doc / .docx), PDF File (.pdf), Text File (.txt) or read online for free. This document discusses transformational nursing leadership. It begins by defining transformational leadership as a process that motivates followers by appealing to higher moral values and persuading them to act for the greater good.

  23. Personal Leadership Philosophy Comprehensive Solved Nursing Essay

    The connection has effectively produced a solution and burnout at work, promoting a sense of belonging and purpose at work (Murray et al., 2018).(Personal Leadership Philosophy Comprehensive Solved Nursing Essay Example) My philosophy on leadership is that a good leader cares about others and brings the best out of them through listening ...

  24. nursing leadership and philosophy paper.docx

    2 Personal Leadership Styles and Nursing Philosophy Nursing is made up of a diverse group of individuals with different philosophies and leadership styles. These individuals and their differences are what make nursing one of the most trusted professions for patient care. In this paper, I will focus on my own leadership style and nursing philosophy and will give evidence-based support on the ...