Nursing leadership and patient outcomes

For the past decade, considerable research has shown the relationship between various leadership styles of healthcare nursing leaders and outcomes for nurses, work environments, and patients. Through a series of systematic reviews of the nursing research literature, the relationships between nursing leadership practices of those in healthcare management roles and outcomes for nurses including job satisfaction, health and wellbeing (Cummings et al. 2010), motivation to perform (Brady-Germain and Cummings 2010), intent to remain (Cowden et al. 2011) and for their work environments (Cummings et al. 2010) have been clearly shown. Outcomes for nurses are highly important, as nurses are the largest group of healthcare professionals in the health system, and thereby a substantial investment, cost and quality driver into achieving patient outcomes. Ultimately the primary concern of all nurses and the nursing profession as a whole is the achievement of optimum patient outcomes. The influence that nurses in leadership and management roles can have on health system and nurse outcomes can be profound, both positively and negatively (Cummings et al. 2010), yet we know less about these relationships to patient outcomes; the mechanism of action by which nursing leaders influence patient outcomes has been a ‘black box’. In 2011, I called for research into the relationships between leadership styles of health services research and outcomes for patient in the healthcare system (Cummings 2011). In this issue, we explore this black box further to advance knowledge and understanding about ways that nursing leaders in formal management roles can increase their effectiveness in improving outcomes for patients. In 2007, to identify the state of knowledge on the relationship between nursing leadership and patient outcomes, Wong and Cummings published a systematic review of the research literature to address this question (Wong & Cummings 2007). We found seven studies that examined whether transformational leadership styles of nurses in management roles were related to better patient outcomes. While evidence was not conclusive given the small number of studies and the primarily correlational study designs, it did show a beginning trend toward higher patient satisfaction and lower adverse events and complications (Wong & Cummings 2007). In this issue, Wong et al. have updated their systematic review and found 13 new studies since 2007, indicative of significantly more research interest in this field. Additionally, the trend in findings (greater patient satisfaction, and lower mortality, adverse events and complications) is strengthening (Wong et al., pp. 709–724). However, the strength of the research designs used in the included studies is still of concern with an over-reliance on correlational designs. Additional studies in this issue report on the relationship between nurse manager turnover and higher patient fall and pressure ulcer rates (Warshawsky et al., pp. 725–732), the positive relationship between authentic leadership practices, nurses' satisfaction as well as reduced adverse patient events (Wong & Giallonardo, pp. 740–752) and nurses' and nursing managers' attitudes towards patient advocacy in the community care of older patients (Eklund et al., pp. 753–761). Two studies reported on interventions: Clinical Nurse Leaders' discharge phone calls to patients to reduce readmission rates (Eggenberger et al., pp. 733–739), and reporting of barriers to implementing nine clinical practice guidelines following a workshop with home healthcare managers and leaders (Gifford et al., pp. 762–770). Hofmeyer (pp. 782–789) has provided a very thoughtful and reasoned argument for the development of social capital as a mechanism by which nursing managers can develop positive relationships with nurses and thereby influence outcomes for patients. Scheingold and Scheingold (pp. 790–801) report on the development and psychometric testing of a measure of Social Capital that can be used in practice and research to advance our knowledge of the impact of social capital relationships in the healthcare workplace. The research in this issue was conducted in a variety of settings – communities, longterm care facilities, home care, hospitals etc., so will have a broad range of interest for readers. The knowledge in this issue also adds to our understanding of the important relationships between relational leadership practices and how they can influence health outcomes for our patients.

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