Perceptual differences in nursing implementation leadership and climate: a cross-sectional study

Abstract

Background: The literature on perceptual differences between managers and staff regarding social dynamic factors (e.g., leadership, climate) in nursing settings is sparse. Addressing this gap in knowledge is critical for informing implementation efforts and improving patient and organizational outcomes. The purpose of this study was to test the perceptual differences regarding implementation leadership and implementation climate between nursing staff and their managers.

Methods: This study was a secondary analysis of cross-sectional survey data collected in 2016-2017. The setting included 22 adult medical-surgical units nested in 7 acute care hospitals in the Eastern and Midwestern United States. Participants were registered nurses (N = 261) and nurse managers (N = 22) who completed an electronic survey consisting of the Implementation Leadership Scale (ILS), the Implementation Climate Scale (ICS), and demographic items. Differences in perception were analyzed at the unit level using structural equation modeling to develop latent difference score models (LDS). We assessed associations of the LDSs with manager ILS and ICS scores, years of nursing experience, and years of experience working on the current unit. The association of ILS LDS with the observed nursing staff ICS scores was also analyzed.

Results: Higher manager scores on the ILS and ICS were associated with greater perceptual differences in implementation leadership and implementation climate. Greater years of experience as a nurse were associated with greater perceptual differences in ILS and ICS scores. Greater tenure on the unit was associated with smaller differences on the ILS knowledge domain. Greater perceptual differences regarding implementation leadership were associated with worse staff ratings of implementation climate.

Conclusions: Although this study observed significant relationships among manager ILS and ICS scores, staff-manager perceptual differences, and staff ratings of implementation climate in nursing settings, it is still unclear why perceptual differences in implementation leadership and climate exist and how to address them. Future studies are warranted to test the effect of perceptual differences on implementation and patient outcomes.

Keywords: Climate; Evidence-based practice; Hospital; Implementation; Leadership; Nursing administration research; Nursing staff; Practice context.

Fig. 1

a Assessing nurse manager ILS scores on differences in staff-manager ILS scores. b Assessing nurse manager ICS scores on differences in staff-manager ICS scores. Note: ILS, Implementation Leadership Scale; ICS, Implementation Climate Scale; RN, registered staff nurse; NM, nurse manager; LDS, latent difference score (predicted)

Fig. 2

a Assessing the association with differences in staff-manager ILS scores with staff ICS scores. b Assessing the association with differences in staff-manager ILS scores with manager ICS scores. Note: ILS, Implementation Leadership Scale; ICS, Implementation Climate Scale; NM, nurse manager; RN, registered staff nurse; LDS, latent difference score (predicted)