Factors contributing to nursing leadership: a systematic review

J Health Serv Res Policy 2008;13:240-248
© 2008 Royal Society of Medicine Press


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Greta Cummings ,
How Lee,
Tara MacGregor,
Mandy Davey 1,
Carol Wong 2,
Linda Paul,
Erin Stafford

Faculty of Nursing, University of Alberta, Alberta;
1 Bonnyville Health Centre;
2 School of Nursing, University of Western Ontario, Canada

Correspondence to: gretac{at}ualberta.ca

Objectives: Leadership practices of health care managers can positively or negatively influence outcomes for organizations, providers and, ultimately, patients. Understanding the factors that contribute to nursing leadership is fundamental to ensuring a future supply of nursing leaders who can positively influence outcomes for health care providers and patients. The purpose of this study was to systematically review the multidisciplinary literature to examine the factors that contribute to nursing leadership and the effectiveness of educational interventions in developing leadership behaviours among nurses.

Methods: The search strategy began with 10 electronic databases (e.g.CINAHL, Medline). Published quantitative studies were includedthat examined the factors that contribute to leadership or thedevelopment of leadership behaviours in nurse leaders. Qualityassessments, data extraction and analysis were completed onall included studies.

Results: A total of 27,717 titles/abstracts were screened resulting in 26 included manuscripts reporting on 24 studies. Twenty leadership factors were examined and categorized into four groups – behaviours and practices of individual leaders, traits and characteristics of individual leaders, influences of context and practice settings, and leader participation in educational activities. Specificbehaviours and practices of individual leaders, such as takingon or practising leadership styles, skills and roles, were reportedas significantly influencing leadership in eight studies. Traitsand characteristics of individual leaders were examined in sixstudies with previous leadership experience (three studies)and education levels (two of three studies) having positiveeffects on observed leadership. Context and practice settingshad a moderate influence on leadership effectiveness (threeof five studies). Nine studies that examined participation inleadership development programs all reported significant positiveinfluences on observed leadership.

Conclusion: These findings suggest that leadership can be developed throughspecific educational activities, and by modelling and practisingleadership competencies. However, the relatively weak studydesigns provide limited evidence for specific factors that couldincrease the effectiveness of current nursing leadership orguide the identification of future nurse leaders. Robust theoryand research on interventions to develop and promote viablenursing leadership for the future are needed to achieve thegoal of developing healthy work environments for health careproviders and optimizing care for patients.

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