Kliinisen työn johtaminen, osastonhoitajien tasapainoilua sairaalaorganisaatioissa: Laadullinen pitkittäistutkimus

The purpose of this study was to describe the clinical leadership of nurse managers in healthcare and hospital organisations, related values and the nurse managers’ experiences of clinical leadership. This study aimed to produce a clinical leadership model in the nurse managers’ (NMs) work at the hospital organisation. The integrative review carried out in the first research phase examined how clinical leadership was described in healthcare. A literature search covering the years 2006 – 2021 was conducted in the Academic Search Ultimate, Cinahl Complete and Medline databases and manually. The obtained data included 11 articles which were analysed using inductive content analysis. Based on the results, clinical leadership was close to patients' day-to-day care, and played a key role in high-quality and safe care. Clinical leadership was described through the aims, means and professional knowledge of clinical leadership.

The second phase of this study aimed to study nurse managers’ perceptions of clinical leadership in hospitals. The data were collected in six group interviews of in total 21 nurse managers in three central hospitals in the years 2018–2019. The data were analysed by inductive content analysis and positioning analysis. Clinical leadership was divided into leading the nursing staff’s competence and leading the unit's multiprofessional network, interaction, and collaboration. Based on the results, the nurse manager’s role was key to ensuring that clinical work ran smoothly. Little attention was paid to aspects related to direct patient care.

The third phase included studying the values and tasks related to nurse managers’ clinical leadership in a hospital organisation and exploring how these values and tasks had possibly changed nurse managers’ leadership and management from 2000 to 2018–2019. The 2000 data were gathered in another leadership and management study through three group interviews with nine nurse managers. The 2018– 2019 data were gathered in six group interviews of 21 nurse managers. The data were analysed using thematic analysis. In the datasets for 2000 and 2018–2019, nurse man- agers’ main values revolved around a person-centred approach and responsibility. A person-centred approach was organised around patient-centred nursing and work with nursing staff. Responsibility was related to nurse managers’ leadership responsibility in the crossfire of expectations and leadership obligations. In the data from 2000 and 2018–2019, the nurse managers expected more self-direction from the nursing staff. In the years 2018–2019, the nurse managers’ work involved more balancing between the issues of the nursing staff and the work community.

The fourth phase of this study investigated nurse managers’ work in hospital wards before and during the COVID-19 pandemic and the experienced support during the pandemic. The first dataset was a purposeful sample of three group interviews of eight nurse managers collected in hospital wards in the period 2018–2019. The second dataset was collected in the year 2021 through an electronic survey conducted among nine nurse managers and deputy nurse managers. The data were analysed using inductive content analysis. The change in nurse managers’ work was described as an increase in workloads during the COVID-19 pandemic and wider collaboration with experts. Nurse managers’ communication turned into urgent communication and the priority was to ensure the sufficient availability of nursing staff and support them during the pandemic. The nurse managers received support from the hospital managers, experts, colleagues, and the sense of community at their ward but they also described having negative emotional experiences during the pandemic. Based on the studies, no systematic structure had been defined for the clinical leadership of the hospital organization. The foundation of the clinical leadership model for nurse managers was built on the values of a person-centred approach and responsibility, and they had remained unchanged from 2000 to 2018–2019. In organizations, it is necessary to define uniform principles of value-based leadership, as well as to commit multiprofessional personnel to these principles. In the work of nurse managers, clinical leadership related to patient care was occasionally left behind due to a focus on the management of the unit. In clinical leadership, there is a need to clarify the areas of responsibility of the nurse manager and, in particular, the responsible physician. A systematic operating model for clinical leadership could also consider the operating model for exceptional situations as a separate entity, which describes the clear responsibilities and tasks.

The foundation for promoting human well-being and health is built on people’s living environment, not just the hospital organization. For this reason, it is also necessary to strengthen the cooperation network in clinical leadership. The network will support the quality of care and patient safety in social welfare and healthcare while ensuring effectiveness. Network cooperation between different actors increases the opportunities to achieve the goals set for the healthcare and social welfare reform: equal, high-quality and cost-effective services.