Viljan att göra skillnad : en utmaning i vårdenhetschefers ledarskap

Abstract

Aim: The overall aim of this thesis was to gain a deeper understanding of F-LNMs leadership. Another aim was to examine possible differences in self-rated health between F-LNMs and registered nurses (RNs) on various psychosocial factors.

Method: Study I and III are single case studies. Study I concerns a first-line nurse manager working in a unit for care of older people. Data collection comprised of two interviews, observations, and documents. A hermeneutic approach was used for the analysis. Study II was carried out in three units at three Swedish hospitals. Three F-LNMs and 14 RNs participated. Interviews were used to collect data. The interviews were analysed using qualitative content analysis. Study III was conducted at a palliative care unit. Data were collected using three separate instruments: a questionnaire, group interviews with nurses and leaders, and documents. Qualitative content analysis was used to analyse the material. Study IV was conducted at a university hospital. Seventy-eight F-LNMs and their 1,806 subordinated RNs participated in the study. Data were collected using a web-based questionnaire (Web-QPS) to assess the participant s psychosocial work environment and their self-rated health.

Result: The main finding in study I was that the F-LNM goal-profile consisted of three goals - the nurse goal, the administrator goal and the leadership goal. The administrator and leadership goal were in accordance to her job description, while the nurse goal was interpreted as a personally chosen and prioritised goal. In study II the result was illustrated in one main theme referred to as between being and doing. The RNs and F-LNMs described what it was to be a good professional (being), how they were engaged in creating a good work climate (doing) and personal outcomes of this project (gaining). In study III the result showed that the most important component at the palliative care unit was to accomplish the vision of good palliative care. Congruence in leadership, mature group functioning, adequate organisational structures and resources, and comprehensive and shared meaningfulness were all identified as essential components for fulfilling the vision. In study IV both F-LNMs and RNs found their work in general important, interesting and meaningful and reported self-rated health as good. However, about 10-15% shoved signs of being at risk for stress related ill health. The results showed statistically significant differences in the distribution between the F-LNMs and the RNs on three indices: job control, job demand and managerial support in a direction which would be favorable to the F-LNMs.

Conclusion: Nurses and F-LNMs seem to have high ideals and expectations of giving good care. The value- system of nursing, i.e. providing the best care for each patient, seems to be a point of departure for the F-LNMs leadership. Key factors for obtaining this are sufficient resources and adequate structures as well as good climate in the teams. One can therefore assume that the F-LNMs should be based on creating a healthy and sustainable work environment that promotes the quality of care and employee well-being. This is obtained by promoting development of ethical competence of the F-LNMs themselves as well as the employees. F-LNMs work conditions have a significant impact on how they can support and promote such a development.