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BACKGROUND: First-line nurse managers are central to quality improvement work when changing work practices into better patient outcomes. Quality improvement collaboratives have been adopted widely to support quality management in healthcare services and shared learning. We have little knowledge of the first-line nurse managers' own perspectives concerning their need for support and knowledge in quality improvement work. Therefore, the aim of this study was to gain understanding of first line nurse managers' experiences in leading quality improvement work in their own organization when participating in a quality improvement collaborative. METHODS: An interpretive approach was chosen following Graneheim and Lundman's qualitative content analysis. Data was collected through three focus group interviews with first-line nurse managers representing different workplaces: the local hospital, a nursing home, and a homecare service in a rural area of Norway. RESULTS: "Navigation to prioritizing the patient" emerged as an overarching metaphor to describe the first-line nurse managers experiences of leading quality improvement work, based on three themes: 1) fellowship for critical thinking and prioritizing the patient; 2) mastering the processes in quality improvement work; and 3) the everyday reality of leadership as a complex context. CONCLUSIONS: A quality improvement collaborative encompassing knowledge transfer and reflection may create an important fellowship for health care leaders, encouraging and enabling quality improvement work in their own organization. It is crucial to invite all leaders from an organization to be able to share the experience and continue their collaboration with their staff in the organization. Continuity over time, following up elements of the quality improvement work at joint meetings, involvement by users, and self-development of and voluntary involvement in the quality improvement collaborative seem to be important for knowledge development in quality improvement. The supportive elements of the quality improvement collaborative fellowship were crucial to critical thinking and to the first-line nurse managers' own development and security in mastering the quality improvement work processes. They preferred prioritizing the patients in quality improvement work, despite haste and obstructive situations in an everyday context.

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AIM: The aim was to explore first line nurse managers' experiences of opportunities and obstacles to support evidence-based nursing. DESIGN: A qualitative study with a phenomenographical approach. METHOD: Data were collected through focus group interviews with 15 first line nurse managers' in four settings. RESULTS: The results are presented in four categories of description headed: Manage the everyday work vs. evidence-based nursing; Uncertainties about evidence-based nursing and nursing research; Time as a reality, as an approach; and Shaping awareness-towards an active approach to evidence-based nursing. The overarching category of description has been formulated as follows: The internal relation-how active leadership influences evidence-based nursing. The outcome space is presented as: The individual path-how to make vision and reality become a working entity around evidence-based nursing.

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Aim: The aim of this study was to explore first-line nurse managers' perceptions of the challenges involved in decision-making concerning older patients who wish to die. Design: A descriptive qualitative design in three communities in Norway between January 2016 and June 2016. Methods: Qualitative focus group interviews with eight first-line nurse managers. Results: One main theme and two themes were identified: Struggling to make the right decision, The challenge of social isolation and loneliness and When life becomes too painful and problematic. The sub-themes revealed that: Arranging social meeting places where the older patients can talk to other older people is crucial. The participants explained that it was not an easy task to gain an overview of the older patients situation. The right decision could be encouraging the patients to talk about their problems by giving them more time, thereby showing that somebody cares about them.

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AIM: To examine first-line nurse managers' perceptions of safety culture and explore relationships between their safety attitudes and safety factors in Henan Province, China. BACKGROUND: Health providers' perceptions of patient safety culture have been studied widely, but little is known about first-line nurse managers' safety attitudes. METHODS: A cross-sectional survey was conducted with a convenience sample of 823 first-line nurse managers in 216 hospitals across Henan Province, China. The Safety Attitudes Questionnaire (Chinese version) was distributed to first-line nurse managers during training meetings; responses were returned in a sealed envelope in person or by mail. ANOVAs were used to analyse the differences in Safety Attitudes Questionnaire (Chinese version) scores between first-line nurse managers' attitudes and safety factors. RESULTS: The mean scores across the six domains of Safety Attitudes Questionnaire (Chinese version) ranged from 56.6 to 79.4 on a 100-point scale. First-line nurse managers: ≥45 years of age perceived better safety climate (p < .05); those with higher professional ranks and medical centre positions reported higher mean scores for teamwork climate (p < .01) and stress recognition (p < .01); and those with baccalaureate degrees or higher had significantly higher mean scores for stress recognition (p < .01). CONCLUSION: First-line nurse managers' safety attitudes were not satisfactory and there is great potential to improve patient safety culture. Age, hospital level, educational background and professional rank are positively related to first-line nurse managers' attitudes. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital administrators and nurse directors should focus on the safety factors identified in this study and enact a variety of strategies to create a strong patient safety culture in China.

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A variety of terms are used interchangeably to define managerial competence of first-line nurse managers. This has resulted in a degree of ambiguity in the way managerial competence is described. The aim of this concept analysis is to clarify what is meant by managerial competence of first-line nurse managers internationally, what attributes signify it, and what its antecedents and consequences are. The Walker and Avant concept analysis approach was applied. The attributes of managerial competence include developing self, planning, organizing, leading, managing legal and ethical issues, and delivering health care. Antecedents to managerial competence include internal and external factors. Consequences include nurse performances, nurse and patient outcomes, intention to stay of nurses, and nurse and patient satisfaction. This analysis helps first-line nurse managers to understand the concept and determine where the responsibility lies in establishing a definition of managerial competence. It is recommended that middle and top managers should be aware of the internal and external factors as antecedents of the concept. Further research is needed to illuminate the attributes of managerial competence in relation to antecedents and the potential effect upon the consequences, and the need to establish managerial competence evaluation.

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BACKGROUND: Nursing is acknowledged as being the art and science of caring. According to the theory of nursing as caring, all persons are caring but not every behaviour of a person is caring. Caring behaviours in the relationship between first-line nurse managers and Registered Nurses have been studied to a lesser extent than those that exist between patients and nurses. Caring behaviour of first-line nurse managers from the perspective of Registered Nurses is as of yet unknown. Identifying caring behaviours may be useful as a reference for first-line nurse managers caring for nurses in a way that nurses prefer. AIMS: To explore first-line nurse managers' caring behaviours from the perspective of Registered Nurses in mainland China. DESIGN: Qualitative study, using descriptive phenomenological approach. METHODS: Fifteen Registered Nurses recruited by purposive sampling method took part in in-depth interviews. Data were analysed according to Colaizzi's technique. RESULTS: Three themes of first-line nurse managers' caring behaviours emerged: promoting professional growth, exhibiting democratic leadership and supporting work-life balance. CONCLUSIONS: A better understanding of the first-line nurse managers' caring behaviours is recognised. The three kinds of behaviours have significant meaning to nurse managers. Future research is needed to describe what first-line nurse managers can do to promote nurses' professional growth, increase the influence of democratic leadership, as well as support their work-life balance.

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AIM: To determine the factors that attract and retain Registered Nurses in the first-line nurse manager role. BACKGROUND: The first-line nurse manger role is pivotal in health-care organisations. National demographics suggest that Canada will face a first-line nurse manager shortage because of retirement in the next decade. Determination of factors that attract and retain Registered Nurses will assist organisations and policy makers to employ strategies to address this shortage. METHODS: The study used an exploratory, descriptive qualitative approach, consisting of semi-structured individual interviews with 11 Registered Nurses in first-line nurse manager roles. RESULTS: The findings revealed a discrepancy between the factors that attract and retain Registered Nurses in the first-line nurse manager role, underscored the importance of the mentor role and confirmed the challenges encountered by first-line nurse managers practicing in the current health-care environment. CONCLUSIONS: The first-line nurse manager role has been under studied. Further research is warranted to understand which strategies are most effective in supporting first-line nurse managers. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies to support nurses in the first-line nurse manager role are discussed for the individual, programme, organisation and health-care system/policy levels.

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PURPOSE: The purpose of this study was to examine the effects of Self-Development training on the Human Relationship and Intrinsic Motivation for first-line nurse managers. METHOD: This was an empirical study on the Human Relationship and Intrinsic Motivation of Self Development Training. The researcher developed a new Self-Development Training Program, and the two-hour long training session was performed twice a week for each group. The program was performed for 4 session in two weeks. The subjects consisted with 24 nurse managers from C University Hospital in Seoul, Korea. The subjects were divided into two groups for the training. Two weeks before and 4 weeks after the training, subjects completed questionnaires that measured Human Relationship and Intrinsic Motivation. Analysis was completed by using SPSS PC 10.0 for percentile, mean, standard deviation and paired t-test. RESULT: The results of this study showed that Self-Development Training Program resulted in a significant effects on the Human Relationship. But the Intrinsic Motivation was not significantly affected by the program. CONCLUSION: This Self-Development training program had a positive effect on the Human Relationship and Intrinsic Motivation.