Nursing and Midwifery Leadership in 2018 - Safety, Conflict Management and More


Published: 28 January 2018

It is essential that nurses and leaders engage in continuous development and quality improvement.

In this modern age, there is access to an enormous body of research at our fingertips via our phones or computers. Nurse managers can use this to their advantage, by keeping up-to-date with evidence-based practice.

What are some of this year’s findings?

Shared Learning

Lunden et al.’s (2017) systematic review concluded that nurse leaders/managers need to implement evidence-based strategies to assist with shared learning and competency development. It is therefore important that nurse managers help to establish an organisational culture that promotes continuous development. This means that the culture must ‘support learning, sharing of information and learning together’.

A Culture of Safety

Murray, Sundin and Cope (2017a) found that ‘The relationship between leadership and safety plays a pivotal role in creating positive safety outcomes for patient care. A safe culture is one nurtured by effective leadership.’ A safety culture can include nurse managers acting as leaders that support new graduate nurses. New graduate nurses are at risk of making errors which can impact client safety (Murray, Sundin & Cope 2017b). This is due to the theory-practice gap that occurs for new nurses as they embark on their learning journey that aims to transition them from a new professional, to an expert one (Murray et al, 2017b).

As per healthcare providers, a safety climate involves: senior managers creating a safe work environment; a shared perception of safety within the workplace; and, the successful distribution of safety information (Lin, Lin & Lou, 2017).

Dirik and Intepeler (2017) suggest in their study that authentic leadership can improve ‘positive perceptions of safety climate’. According to the University of Leicester (n. d.), authentic leadership involves: self-awareness, internalised moral perspective, balanced processing (objective analysis of the data prior to decision-making), and transparency regarding own values, thoughts and feelings.

Nurse managers should also consider the safety of their staff members in terms of wellbeing. For example, Sirilla et al. (2017) describe that nurses may experience moral distress when they ‘know the appropriate action’ but cannot act or fulfil this due to constraints. Moral distress may be influenced by the type of unit that the nurse works in (e.g. critical care), and their feelings/intentions regarding quitting their job (Sirilla et al. 2017).

Teamwork and Staffing Levels

Bae et al (2017) express that the quality and safety of nursing teams within hospital settings relies on teamwork components such as mutual support. Teamwork and adequate staffing levels are also essential to preventing missed nursing care (Bragadottir, Kalisch & Tryggvadottir, 2017). Staffing levels must be optimised in order to support the learning needs of new graduate nurses (Regan et al, 2017). Nurse managers and leaders need to have adequate resources to ensure that staff are not overworked, as this may prevent new graduate nurses from effectively practicing (Regan et al, 2017). Furthermore, new graduate nurses’ progress may also be impacted by negative workplace cultures (Regan et al, 2017). Thereby, it is essential that nurse managers and leaders promote psychological safety for new graduate nurses and experienced nurses, by developing a culture that allows individuals to ask questions or give/receive feedback without fearing judgment by their peers (Regan et al, 2017).

Nurse Fatigue

Current research, such as that by Steege et al (2017), indicated that ‘Most nurse leaders experience fatigue; nurse managers reported higher levels of chronic fatigue.’ Key contributors for fatigue involved having unending accountability, and demanding roles (Steege et al, 2017). Fatigue in nursing leaders can interfere with ‘decision-making, work-life balance, and turnover intent’ (Steege et al, 2017). Steege et al (2017) convey that nurse leader fatigue is a significant issue that can not only affect turnover rates, but also the quality of client care.

Conflict Management

Another way for nurse managers to support their staff nurses, is to provide them with conflict management training (Erdenk & Altuntas, 2017).

Many nurses reportedly experience conflict each month, and individual nurses’ personality traits can mean that they employ differing conflict-management techniques (Erdenk & Altuntas, 2017). Thereby, nurse managers may need to observe and gather information regarding personalities and conflict management approaches of their staff prior to training. Training and education needs may differ between individuals, and the nurse manager will need to tailor interventions accordingly.

This overview of current literature demonstrates that there are several ways for nurse managers and leaders to improve the experiences of clients, nursing staff, and oneself as a manager/leader.

  • Bae, SH, Farasat, A, Nikolaev, A, Seo, JY, Foltz-Ramos, K, Fabry, D & Castner, J 2017, ‘Nursing teams: behind the charts’, Journal of Nursing Management, vol. 25, no. 5, pp. 354–65, viewed 25 January 2018,
  • Bragadóttir, H, Kalisch, BJ & Tryggvadóttir, GB 2017, ‘Correlates and predictors of missed nursing care in hospitals’, Journal of Clinical Nursing, vol. 26, no. 11-2, pp. 1524–34, viewed 25 January 2018,
  • Dirik, HF & Seren Intepeler, S 2017, ‘The influence of authentic leadership on safety climate in nursing’, Journal of Nursing Management, vol. 25, no. 5, pp. 392–401, viewed 25 January 2018,
  • Erdenk, N & Altuntaş, S 2017, ‘Do personality traits of nurses have an effect on conflict management strategies’, Journal of Nursing Management, vol. 25, no. 5, pp.  366–74, viewed 25 January 2018,
  • Lin, YS, Lin, YC & Lou, MF 2017, ‘Concept analysis of safety climate in healthcare providers’, Journal of Clinical Nursing, vol. 26, no. 11-2, pp. 1737–47, viewed 25 January 2018,
  • Lunden, A, Teräs, M, Kvist, T & Häggman-Laitila, A 2017, ‘A systematic review of factors influencing knowledge management and the nurse leaders’ role’, Journal of Nursing Management, vol. 25, no. 6, pp. 405-88, viewed 25 January 2018,
  • Murray, M, Sundin, D & Cope, V 2017a, ‘The nexus of nursing leadership and a culture of safer patient care’, Journal of Clinical Nursing, viewed 25 January 2018,
  • Murray, M, Sundin, D & Cope, V 2017b, ‘New graduate registered nurses’ knowledge of patient safety and practice: A literature review’, Journal of Clinical Nursing, vol. 27, no. 1–2, viewed 31-47, viewed 25 January 2018,
  • Regan, S, Wong, C, Laschinger, HK, Cummings, G, Leiter, M, MacPhee, M, RhÉaume, A, Ritchie, JA, Wolff, AC, Jeffs, L, Young-Ritch, C, Grinspun, D, Gurnham, ME, Foster, B, Huckstep, S, Ruffolo, M, Shamian, J, Burkoski, V, Wood, K & Read, E 2017, ‘Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice’, International Journal of Nursing Studies, vol. 57, no. 82-95, viewed 25 January 2018,
  • Sirilla, J, Thompson, K, Yamokoski, T & Chipps, E 2017, ‘Moral Distress in Nurses Providing Direct Patient Care at an Academic Medical Center’, Worldviews on Evidence-Based Nursing, vol. 14, no. 2, pp. 128-35, viewed 25 January 2018,
  • Steege, LM, Pinekenstein, BJ, Arsenault Knudsen, É & Rainbow, JG 2017, ‘Exploring nurse leader fatigue: a mixed methods study’, Journal of Nursing Management, vol. 25, no. 4, pp. 276–86, viewed 25 January 2018,
  • University of Leicester n. d., ‘6.8.2. Authentic leadership’, in ORG Module Unit 6: Leadership, viewed 25 January 2018,