Senior charge nurses’ leadership behaviours in relation to hospital ward safety: a mixed method study.

Background: High standards of quality and patient safety in hospital wards cannot be achieved without the active role of the nursing leaders that manage these units. Previous studies tended to focus on the leadership behaviours of nurses in relation to staff job satisfaction and other organizational outcomes. Less is known about the leadership skills of senior charge nurses that are effective for ensuring safety for patients and staff in their wards. Objectives: The aim of the two studies was to identify the leadership behaviours of senior charge nurses that are (a) typically used and, (b) that relate to safety outcomes. Methods: In study one, semi-structured interviews were conducted with 15 senior charge nurses at an acute NHS hospital. Transcribed interviews were coded using Yukl's Managerial Practices Survey (MPS) framework. In study two, self ratings of leadership (using the MPS) from 15 senior charge nurses (SCN) and upward ratings from 82 staff nurses reporting to them were used to investigate associations between SCNs’ leadership behaviours and worker and patient-related safety outcomes. Results: The interviews in study one demonstrated the relevance of the MPS leadership framework for nurses at hospital ward level. The SCNs mainly engaged in relations-oriented (n = 370, 49%), and task-oriented (n = 342, 45%) behaviours, with fewer change-oriented (n = 25, 3%), and lead by example behaviours (n = 26, 3%). In demanding situations, more task-oriented behaviours were reported. In study two, staff nurses’ ratings of their SCNs’ behaviours (Monitoring and Recognizing) were related to staff compliance with rules and patient injuries (medium severity), while the self ratings of SCNs indicated that Supporting behaviours were linked to lower infection rates and Envisioning change behaviours were linked to lower infection and other safety indicators for both patients and staff. Conclusion: This study provides preliminary data on the usability of a standard leadership taxonomy (Yukl et al., 2002), and the related MPS questionnaire, on a nursing sample. The findings indicate the relevance of several leadership behaviours of SCNs for ensuring a safer ward environment and contribute to the evidence base for their leadership skills training