Emergency Nurses’ Perceptions of Leadership Strategies and Intention to Leave: A scoping review of the literature
DOI:
https://doi.org/10.29173/cjen138Abstract
Background
Retention of registered nurses in emergency departments (EDs) is as a critical issue, further exacerbated by the COVID pandemic. Leaders influence work life and working environment, but it is unclear what strategies leaders use to address nurse staffing issues in the ED. The purpose of this scoping review is to understand if leadership strategies used in EDs have links to nursing retention and turnover.
Methodology
This scoping review was completed with a comprehensive search within Cumulative Index to Nursing and Allied Health Literature, EMCARE, EMBASE. Two authors developed inclusion and exclusion criteria, did title and abstract screening, and full text screening using review software. Data extracted from included studies was analyzed to determine leadership strategies and relationships to intent to stay, retention, intent to leave, or turnover.
Results
Of the 553 records identified, nine met inclusion criteria. Leadership strategies identified in the studies included support from supervisor, engagement by the leader, organizational culture assessment, and a cultural change toolkit. No leadership strategy influenced nurse intention to stay, retention, intention to leave or turnover.
Conclusion
Emergency nurse retention and the prevention of turnover is a multidimensional issue stemming from various factors that may not be controllable due to the nature of the setting. However, leaders can implement strategies and provide support to staff to enhance quality of work life and the work environment. More information is needed to understand how leaders can influence the current and future supply of emergency nurses to produce quality patient care outcomes.
References
Adams, A., Hollingsworth, A., & Osman, A. (2019). The implementation of a cultural change toolkit to reduce nursing burnout and mitigate nurse turnover in the emergency department. Journal of Emergency Nursing, 45(4), 452–456. https://doi.org/https://dx.doi.org/10.1016/j.jen.2019.03.004
Adriaenssens, J., De Gucht, V., & Maes, S. (2015). Determinants and prevalence of burnout in emergency nurses: A systematic review of 25 years of research. International Journal of Nursing Studies, 52(2), 649–661. https://doi.org/https://dx.doi.org/10.1016/j.ijnurstu.2014.11.004
American College of Emergency Physicians. (2021). Policy statement: Definition of an emergency service. https://www.acep.org/globalassets/new-pdfs/policy-statements/definition-of-an-emergency-service.pdf
An, Y., Yang, Y., Wang, A., Li, Y. & Zhang, Q. (2020). Prevalence of depression and its impact on quality of life among frontline nurses in emergency departments during the COVID-19 outbreak. Journal of Affective Disorders, 276(1), p. 312–315. https://doi.org/10.1016/j.jad.2020.06.047
Arksey, H. & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32.
Baker, D. L. (2016). Exploring and describing the factors that influence emergency department nurse retention,1.1. http://libaccess.mcmaster.ca/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=123313975&site=ehost-live
Baldwin, K., Black, D. & Hammond, S. (2014). Developing a rural transitional care community case management program using clinical nurse specialists. Clinical Nurse Specialist, 28(3), 147–155. https://doi.org/10.1097/NUR.0000000000000044
Bass, B. M., Avoilio, B. J., Jung, D. I., & Berson, Y. (2003). Predicting unit performance by assessing transformational and transactional leadership. Journal of Applied Psychology, 88(2), 207–218.
Bass, B. M. & Avolio, B. J. (1990). Multifactor leadership questionnaire. Palo Alto, CA: Consulting Psychologists Press.
Boamah, S., Laschinger, H., Wong, C. & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing Outlook, 66(2), 180–189. https://doi.org/10.1016/j.outlook.2017.10.004.
Canadian Insititute for Health Information. (2021). NACRS Emergency department visits and lengths of stay by province/territory, 2021-2022 - Provisional data. Ottawa, ON: CIHI; 2021.
Canadian Nurses Association & Canadian Federation of Nurses Union. (2015). Evidence -based safe nurse staffing toolkit. https://www.cna-aiic.ca/en/nursing/regulated-nursing-in-canada/nurse-staffing/safe-staffing-toolkit
Centre for Creative Leadership. (2022). Leading effectively. https://www.ccl.org/articles/leading-effectively-articles/got-a-strong-leadership-strategy/
Choi, J., Bakken, S., Larson, E., Du, Y., & Stone, P. W. (2004). Perceived nursing work environment of critical care nurses. Nursing Research, 53(6), 370–378. https://doi.org/10.1097/00006199-200411000-00005
Collins, E., Owen, P., Digan, J. & Dunn, F. (2019). Applying transformational leadership in nursing practice. Nursing Standard. https://doi.org/10.7748/ns.2019.e11408
Colquhoun, H., Levac, D., O’Brien, K., Straus, S., Tricco, A., Perrier, L., Kastner, M. & Moher, D. (2014). Scoping reviews: Time for clarity in definition, methods, and reporting. Journal of Clinical Epidemiology, 67, 1291–1294.
Cornish, S., Klim, S. & Kelly, A. (2021). Is COVID-19 the straw that broke the back of the emergency nursing workforce? Emergency Medicine Australia (33), 6, p.1095–1099. https://doi.org/1111/1742-6723.13843.
Demerouti, E., Bakker, A.B., Vardakou, I., & Kantas, A. (2002). The convergent validity of two burnout instruments: A multitrait-multimethod analysis. European Journal of Psychological Assessment, 18, 296–307.
Dunham-Taylor, J. (2000). Nurse executive transformational leadership found in participative organizations. The Journal of Nursing Administration, 30(5), 241–250. https://doi.org/10.1097/00005110-200005000-00005
Enns, C. L., & Sawatzky, J.-A. V. (2016). Emergency nurses’ perspectives: Factors affecting caring. Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association, 42(3), 240–245. https://doi.org/http://dx.doi.org/10.1016/j.jen.2015.12.003
Evans, C., Hughes, C., & Ward, K. (2017). Improving staff recruitment and retention in the emergency department. Nursing Times, 77–77. http://libaccess.mcmaster.ca/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=127102008&site=ehost-live
Gelsema, T. (2007, June 13). Job stress in the nursing profession. https://hdl.handle.net/1887/12080
Gardner, W., Avolio, B., Luthans, F., May, D. & Walumbwa, F. (2005). “Can you see the real me?” A self-based model of authentic leader and follower development. The Leadership Quarterly, 16(3), 343–372. https://doi.org/10.1016/j.leaqua.2005.03.003
Gorman, V. L.-A. (2019). Future emergency nursing workforce: What the evidence is telling us. JEN: Journal of Emergency Nursing, 45(2), 132–136. https://doi.org/10.1016/j.jen.2018.09.009
Kilpatrick, K., Kaasalainen, S., Donald, F., Reid, K., Carter, N., Bryant-Lukosius, D., Martin-Misener, R., Harbman, P., Marshall, D., Charbonneaut-Smith, R. & DiCenso, A. (2014). The effectiveness and cost-effectiveness of clinical nurse specialists in outpatient roles: A systematic review. Journal of Evaluation in Clinical Practice, 20(6), 1106–1123. https://doi.org/10.1111/jep.12219. Epub 2014 Jul 5.
Kiwanuka, F., R.C. Nanyonga, N. Sak‐Dankosky, P.A. Muwanguzi and T. Kvist. (2021). Nursing leadership styles and their impact on intensive care unit quality measures: An integrative review. Journal of Nursing Management 29(2), 133–142. https://doi.org/10.1111/jonm.13151
Kleinman, C. (2004). Leadership: A key strategy in staff nurse retention. The Journal of Continuing Education in Nursing, 35(3), 128–132. http://libaccess.mcmaster.ca/login?url=https://www.proquest.com/scholarly-journals/leadership-key-strategy-staff-nurse-retention/docview/223313391/se-2?accountid=12347
Lake, E. (2002). Development of the practice environment scale of the nursing work index. Research in Nursing & Health, 25(3). https://doi.org/10.1002/nur.10032
LaRock-McMahon, C. (2018). Factors influencing emergency registered nurse satisfaction and engagement, 1-1. http://libaccess.mcmaster.ca/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=136077261&site=ehost-live
Laschinger, H., Wilk, P., Cho, J. & Greco, P. (2009). Empowerment, engagement and perceived effectiveness in nursing work environments: Does experience matter? Journal of Nursing Management, 17(5), 636–646. https://doi.org/10.1111/j.1365-2834.2008.00907.x
Lavoie-Tremblay, M., Chevrier, A., Emed, J., Clausen, C., Biron, A., Oliver, C., & Aube, T. (2019). Global shortage of nurses. https://www.mcgill.ca/nursing/files/nursing/nurse_shortages.pdf
Leary, A. & Baxter, J. (2014). Impact of lung cancer clinical nurse specialists on emergency admissions.British Journal of Nursing, 23(17), 935–938. https://doi.org/10.12968/bjon.2014.23.17.935.
Lee, H., Chiang, H. & Kuo, H. (2018). Relationship between authentic leadership and nurse’s intent to leave: The mediating role of work environment and burnout. Journal of Nursing Management, 27, 52–65. https://doi.org/10.1111/jonm.12648
Levac, D., Colquohoun, H., O’Brien, K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5,(1), 69. https://doi.org/10.1186/1748-5908-5-69
Li, J., Westbrook, J., Callen, J., Georgiou, A. & Braithwaite, J. (2013). The impact of nurse practitioners on care delivery in the emergency department: A multiple perspectives qualitative study. BMC Health Services Research, 13, 356. http://www.biomedcentral.com/1472-6963/13/356
Maziero, V., Bernardes, A., Righetti, E., Spiri, W. & Gabriel, C. (2020). Positive aspects of authentic leadership in nursing work: Integrative review. Rev Bras Enferm, 73(6). http://dx.doi.org/10.1590/0034-7167-2019-0118
Monsen, K. (2018). Intervention effectiveness research: Quality improvement and program evaluation. https://doi.org/10.1007/978-3-319-61246-1_2
Mobley, W., Horner, S. & Hollingsworth, A. (1978). An evaluation of precursors of employee turnover. Jounal of Applied Psychology, 63, 408-414.
Mullennix, S., Iseler, J., Kwiatkowski, G., McCann-Spry, L., Skinner, J., Kuhl, N., VanDePol, E. & Poland, C. (2020). A clinical nurse specialist-led emergency department naloxone distribution program. Clinical Nurse Specialist, 34(3), 116–123. https://doi.org/10.1097/NUR.0000000000000515
National Emergency Nurses’ Assocation. (2018). Emergency nursing scope and standards of Canadian practice (sixth ed.). https://nena.ca/w/wp-content/uploads/2018/11/Standards-of-ED-Nursing-Practice-2018.pdf
O’Brien-Pallas, L., Murphy, G. T., Shamian, J., Li, X., & Hayes, L. J. (2010). Impact and determinants of nurse turnover: A pan-Canadian study. J Nurs Manag, 18(8), 1073–1086. https://doi.org/10.1111/j.1365-2834.2010.01167.x
Ouzzani, M., Hammady, H., Fedorowicz, Z. & Elmagarmid, A. (2016). Rayyan: Intelligent systematic reviews. 5, 210. https://doi.org/10.1186/s13643-016-0384-4.
Registered Nurses Association of Ontario. (2013). Developing and sustaining nursing leadership best practice guideline (2nd edition). https://rnao.ca/sites/rnao-ca/files/LeadershipBPG_Booklet_Web_1.pdf
Registered Nurses Association of Ontario. (2017). Best-practice guideline: Developing and sustaining safe, effective staffing and workload practices (2nd ed). https://rnao.ca/sites/rnao-ca/files/bpg/Staffing_and_Workload_Practices_2017.pdf
Ribeiro do Valle, R., Balsanelli, A., Taminato, M., Saconato, H. & Gasparino, R. (2020). The relationship between the authentic leadership of nurses and structural empowerment: A systematic review. Rev Esc Enferm USP. doi: https://doi.org/10.1590/S1980-220X2019029003667
Sawatzky, J.-A. V., & Enns, C. L. (2012). Exploring the key predictors of retention in emergency nurses. Journal of Nursing Management, 20(5), 696–707. https://doi.org/10.1111/j.1365-2834.2012.01355.x
Schauefeli, W. & Bakker, A. (2004). Job demands, job resources, and their relationship with burnout and engagement: A multi-sample study. Journal of Organizational Behaviour, 25, 293–315. https://doi.org/10.1002/job.248
Silas, L. (2012). The research to action project: Applied workplace solutions for nurses. Nursing Leadership, 25(Sp), 9–20. https://doi.org/10.12927/cjnl.2012.22815
Straka, K., Ambrose, H., Burkett, M., Capan, M., Flook, D., Evangelista, T., Houck, P., Lukansi, A., Schenkel, K., Thornton, M. (2014). The impact and perception of nursing certification in pediatric nursing. Journal of Pediatric Nursing, 29(3), p. 205–211. https://doi.org/10.1016/j.pedn.2013.10.010. Epub 2013 Oct 31.
Valdez, A. (2008). Transitioning from novice to competent: What can we learn from the literature about graduate nurses in the emergency setting? Journal of Emergency Nursing, 34(5), 435–440. https://doi.org/10.1016/j.jen.2007.07.008
Van Osch, M., Scarborough, K., Crowe, S., Wolff, A. C., & Reimer‐Kirkham, S. (2018). Understanding the factors which promote registered nurses’ intent to stay in emergency and critical care areas. Journal of Clinical Nursing, 27(5–6), 1209–1215. https://doi.org/10.1111/jocn.14167
Veritas Heath Innovation. (2021). Covidence systematic review software. Melbourne, Australia. www.covidence.org
Virkstis, K. Boston-Fleischhauer, C., Rewers, L., Critchley, N., Whitemarsh, K., Paiewonsky, A. & Gerstenfeld, R. (2022). 7 Executive strategies to stabilize the nursing workforce. JONA: The Journal of Nursing Administration, 52(4), 194–196. https://doi.org/10.1097/NNA. 0000000000001129.
Volk, M. C. & Lucas, M. D. (1991). Relationship of management style and anticipated turnover. Dimensions of Critical Care Nursing, 10(1), 35–40. https://doi.org/10.1097/00003465-199101000-00008
Wong, C., Cummings, G. & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709–724. https://doi.org/10.1111/jonm.12116
World Health Organization. (2022). Emergency care. https://www.who.int/health-topics/emergency-care#tab=tab_1
Yasinki, L. (2014). Authentic leadership: Develop the leader within. ORNAC Journal, 36–38.
Zaheer, S., Ginsburg, L., Wong, H. J., Thomson, K., Bain, L., & Wulffhart, Z. (2019). Turnover intention of hospital staff in Ontario, Canada: Exploring the role of frontline supervisors, teamwork, and mindful organizing. Human Resources for Health, 17(1). https://doi.org/10.1186/s12960-019-0404-2
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