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This article explores current evidence and practical strategies for nurse leaders to advance a healthy work environment. American Association of Critical Care Nurses's Standards for Establishing and Sustaining Healthy Work Environments should guide efforts to reconnect clinical teams with meaningful and satisfying work. Authors propose adding the domain of Wellbeing to guide leaders in holistically addressing the health of all care team members and the work environment.

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INTRODUCTION: Ageist attitudes negatively affect the quality of care for service users and the working conditions of older nursing staff. Clinical leaders' perceptions of older service users and nursing staff are unknown. AIM: To map research evidence on ageist attitudes in healthcare towards service users and older nursing staff, from the leadership perspective. MATERIAL AND METHODS: A systematic mapping review with database searches in March 2021 and May 2023). Nineteen articles (qualitative n = 13, quantitative n = 3, mixed methods n = 3) were analysed and mapped to the Nurse Executive Capability Framework. RESULTS: Future planning, team building, and self-awareness are leadership categories requiring consideration. Guidelines and policies addressing the holistic needs of older service users and older nursing staff are lacking. CONCLUSIONS: Organizational planning, team building, and self-awareness are crucial for the holistic care of older service users and for creating attractive workplaces for older nursing staff.

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BACKGROUND: Nurse leaders increasingly need effective tools that facilitate the prioritisation of ethics and help staff navigate ethical challenges and prevent moral distress. This study examined experiences with a new digital tool for ethical reflection, tailored to improve the capabilities of both leaders and employees in the context of municipal long-term care. AIM: The aim was to explore the experiences of nurse leaders and nurses in using Digital Ethical Reflection as a tool for ethics work in home nursing care. RESEARCH DESIGN: The study employed a qualitative design, incorporating individual and focus group interviews for data collection. Qualitative content analysis was used to analyse the data. PARTICIPANTS AND RESEARCH CONTEXT: The participants comprised six nurse leaders and 13 nurses, representing six home care zones across two Norwegian municipalities. ETHICAL CONSIDERATIONS: The study involved informed, voluntary participation and was approved by the Norwegian Agency for Shared Services in Education and Research. FINDINGS: Four themes were developed: a constant walk on the edge between engagement and discouragement and lost in translation describe the process, while tuning in to the ethical dimension and navigating ethical uncertainties illuminate the experienced significance of Digital Ethical Reflection. CONCLUSION: Success with Digital Ethical Reflection in home nursing care depends on clear leadership planning, nurses' understanding of the tool's purpose, and active use of digital registrations. Support from ethically interested nurses enhances overall engagement. Further research is needed to explore the potential of Digital Ethical Reflection as an additional tool in long-term care ethics work.

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BACKGROUND: Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL's experience. RESEARCH AIM: The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. RESEARCH DESIGN: A qualitative descriptive design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. PARTICIPANT AND RESEARCH CONTEXT: Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. ETHICAL CONSIDERATIONS: This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. FINDINGS: UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. CONCLUSIONS: The UBCCNL's experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed.

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BACKGROUND: Moral distress (MD) occurs when clinicians are constrained from taking what they believe to be ethically appropriate actions. When unattended, MD may result in moral injury and/or suffering. Literature surrounding how unit-based critical care nurse leaders address MD in practice is limited. AIM: The aim of this study was to explore how ICU nurse leaders recognize and address MD among their staff. STUDY DESIGN: Qualitative descriptive with inductive thematic analysis. RESULTS: Five ICU nurse leaders participated in a one-time individual interview. Interview results suggest that (1) ICU nurse leaders can recognize and address MD among their staff and (2) nurse leaders experience MD themselves, which may be exacerbated by their leadership role and responsibilities. CONCLUSIONS: Further research is needed to develop interventions aimed at addressing MD among nurse leaders and equipping nurse leaders with the skills to identify and address MD within their staff and themselves. RELEVANCE TO CLINICAL PRACTICE: MD is an unavoidable phenomenon ICU nurse leaders are challenged with addressing in their day-to-day practice. As leaders, recognizing and addressing MD is a necessary task relating to mitigating burnout and turnover and addressing well-being among staff within the ICU.

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AIM: To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences. DESIGN: A scoping review. DATA SOURCES: The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched. REVIEW METHOD: The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data. RESULTS: A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC. CONCLUSION: There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.

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Nurse leaders face immense organizational pressures exacerbating their distress, which has not been prioritized as much as frontline nurses. This review synthesized the literature to examine theoretical models, measures, contributing factors, outcomes, and coping strategies related to moral distress in nurse leaders. PubMed, Embase, CINAHL, and PsycINFO were searched, and 15 articles-2 quantitative and 13 qualitative studies were extracted. The scoping review identified one study using a theoretical model and two measures-the ethical dilemmas questionnaire and the Brazilian moral distress scale. Contributing factors of moral distress include internal and organizational constraints, increased workload, and lack of support impacting physical and emotional well-being and intention to quit. This review did not yield any intervention studies emphasizing the need for research to identify specific predictors of moral distress and examine their relationship to nurse leader retention, so organizations can explore targeted interventions to promote coping and mitigate distress.

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INTRODUCTION: The Clinical Nurse Leader (CNL) care model is a different way of organizing frontline nursing care delivery in contrast to the traditional "staff nurse" model and is increasingly being adopted by health systems across the United States and abroad. However, variability in implementation and outcomes has been noted across health settings. AIM: A recently validated CNL Practice Model provides an explanatory pathway for CNL model integration into practice. The purpose of this study was to identify and compare patterns of empirical correspondence to the CNL Practice Model and predict their influence on implementation success. METHODS: We conducted a secondary analysis of a 2015 national-level study with clinicians and administrators involved with CNL initiatives in their health system. A psychometrically validated CNL Practice Survey was used to collect data measuring the presence (0%-100%) of the five domains of the CNL Practice Model (organizational readiness, CNL structuring, CNL practices, outcomes, and value) and one measure of CNL implementation success. We modeled the complex hierarchical structure of the data using a Bayesian multilevel regression mixed modeling approach. A zero-one-inflated beta distribution, a mixture of Bernoulli distributions for the minimum and maximum responses and a beta distribution for the responses between the minimum and maximum, was used to fit success ratings in the model. RESULTS: A total of 920 participants responded, 540 (59%) provided success scores. The model captured ratings skewed toward upper bound, while also adequately modeling data between the minimum and maximum values. The Bayesian model converged and gave estimates for all hierarchical parameters, which would likely have failed to converge in a pure maximum likelihood framework. The variability around success score across CNL Practice Model element ratings was greatest at the component level, 0.29 (0.18-0.48), compared to either the domain level, 0.16 (0.01-0.54), or the item level, 0.09 (0.01-0.17). The components most predictive of implementation success were (a) consensus CNL model can close gaps, (b) organization level implementation strategy, and (c) alignment of empirical CNL microsystem level structuring to the model's conceptualization. CONCLUSIONS: Findings provide further empirical evidence to support the explanatory pathway proposed by the CNL Practice Model and identified specific organizational readiness and CNL workflow structures that are critical antecedents predictive of CNL practice manifestation and production of expected outcomes. Findings indicate actionable implementation evidence that can be successfully adopted across real-world healthcare settings to achieve safer and higher quality patient care. CLINICAL RELEVANCE: CNL integrated care delivery is a frontline nursing care model that is being increasingly adopted by health systems across the United States and abroad. However, variability in CNL implementation and outcomes has been noted across health settings, limiting its evidence base. Findings of this study contribute a better understanding about the variability of CNL practice and outcomes found in the literature and contribute empirical and conceptual clarity about the relationships between modes of CNL implementation and successful adoption in healthcare settings.

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AIM: To describe nurse leaders' experiences of how culturally and linguistically diverse registered nurses integrate into healthcare settings. DESIGN: A qualitative descriptive study design. PARTICIPANTS: A total of 13 nurse leaders were recruited from four primary and specialized healthcare organizations in Finland. METHODS: Data were collected through individual semi-structured interviews and analyzed using inductive content analysis. RESULTS: Nurse leaders' experiences were categorized into seven main categories as follows: leadership, which concerns a leader's roles, style, and experience; organizational strategy and culture, which includes structure, policies, and intra-organizational culture; support strategies, including workplace and outside-of-work integration strategies; relationships and interactions, which considers interpersonal relationships and interactions; nurse competence requirements and development, which concerns both organizational and ward level competence demands, and support for competence development; language competence, which concerns challenges relating to language proficiency and development of language competence; and cultural diversity, which considers the importance of competence development brought about through experiences of being in a multicultural workplace. CONCLUSIONS: Culturally and linguistically diverse nurses are important within healthcare systems. These nurses constitute additional human resources, bring diverse experiences and expertise, and add to organizational cultural capital. Nurse leaders require competencies that are suitable for leading a diverse workforce, utilizing its competencies, establishing staff members' needs, and ensuring their continuous development. Resourcing, planning, and structuring the integration process affects nurses' experiences of the organizational socialization process. IMPACT: The findings of our study can offer guidance to healthcare organizations with regard to structural integration strategies at an institutional level. Leadership and management educators can benefit from the findings towards developing a curriculum that supports leaders' diversity, equity and inclusion, knowledge management and formal leadership competencies. Finally, nurse leaders may benefit from this study through being more aware towards supporting a multicultural, cohesive, and competent workforce through strong social capital.

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BACKGROUND: The profession of nursing has recognized the lack of diversity in nursing leadership. Nurses of color represent fewer than 20% of leadership roles in nursing administration, education, and professional organizations. Efforts are needed to identify and implement strategies to increase the representation of nurses of color in positions of high influence. PURPOSE: To review the literature to uncover the factors that may impact Black nurses in their pursuit of leadership roles in nursing administration, education, and professional organizations. METHODS: The authors conducted a scoping review, searching CINAHL and PubMed databases in November 2022 for peer-reviewed English-language studies of leadership among U.S. nurses. They excluded studies that did not include a research method, did not have participants, a minimum of baccalaureate preparation as an inclusion criterion for participants, or were published before January 1, 2012. DISCUSSION: Of 331 articles identified, a total of 12 met the inclusion criteria. Evaluation of the studies revealed three concepts related to mentorship, racism, and hiring practices. Of the 12 studies, 9 addressed issues related to mentorship, 5 addressed issues related to racism, and 2 addressed issues related to hiring practices. Some studies address more than one of the concepts. Ten were qualitative studies, and two were quantitative studies. CONCLUSION: Findings suggest that Black nurse leaders are faced with obstacles and challenges when considering entering and/or staying in leadership roles. The limited amount of research on Black nurses in leadership roles remains inadequate.

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AIM(S): To describe nurse leaders' perceptions of culturally and linguistically diverse (CALD) nurses' competence-based management. DESIGN: A descriptive qualitative study of the competence-based management of CALD nurses, from the perspectives of nurse leaders in three primary and specialised medical care organisations. This study followed the COREQ guidelines. METHODS: Qualitative semi-structured individual interviews were conducted with 13 nurse leaders. Eligible interviewees were required to have management experience, and experience of working with or recruiting CALD nurses. Data were collected during November 2021-March 2022. The data were analysed using inductive content analysis. RESULTS: Competence-based management was explored in terms of competence identification and assessment of CALD nurses, aspects which constrain and enable competence sharing with them, and aspects which support their continuous competence development. Competencies are identified during the recruitment process, and assessment is based primarily on feedback. Organisations' openness to external collaboration and work rotation supports competence sharing, as does mentoring. Nurse leaders have a key role in continuous competence development as they organise tailored induction and training, and can indirectly reinforce nurses' work commitment and wellbeing. CONCLUSION(S): Strategic competence-based management would enable all organisational competencies potential to be utilised more productively. Competence sharing is a key process for the successful integration of CALD nurses. RELEVANCE TO CLINICAL PRACTICE: The results of this study can be utilised to develop and standardise competence-based management in healthcare organisations. For nursing management, it is important to recognise and value nurses' competence. IMPACT: The role of CALD nurses in the healthcare workforce is growing, and there is little research into the competence-based management of such nurses. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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AIM: To summarize the evidence available on Nurse Manager Intentional Rounding (NMIR) describing the main characteristics and methodological quality of studies available, the features of rounding and the outcomes as measured to date. DESIGN: A systematic review. DATA SOURCES: Electronic databases, including MEDLINE-EBSCHOST, PubMed, CINAHL, Scopus, Cochrane, Clinicalkey, ScienceDirect, OVID, Sage Journals and Web of Science, were searched up to June 2021. REVIEW METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline was used to summarize methods and report findings. The Joanna Briggs Institute Critical Appraisal tools were used to evaluate the methodology quality of the studies included. RESULTS: Seven studies were included with pre-post-test (n = 3), longitudinal, two-group post-tests, quasi-experimental, and retrospective study designs (n = 1, respectively). In five studies, the nurse managers were trained to conduct the rounding, which was shaped according to three main features: a structured (n = 4), a semi-structured (n = 1) and an unstructured rounding (n = 2) delivered from high (twice a day 7/7) to low intensity (once a day, 5/7). Two main outcomes have been measured to date, the patient satisfaction and some aspects related to the care quality. Five studies reported that the satisfaction scores of patients who received rounding were significantly higher than that perceived by patients not receiving rounding. About the other aspects of the quality of care, two studies documented significant improvements as a consequence of the NMIR (e.g. information accessibility, discharge instructions, coordination of care after discharge). CONCLUSION: Studies available report in general a low methodological quality, mainly due to their pragmatic nature as quality improvement projects. Therefore, transforming this field of research by establishing a methodological rigour and a theoretical foundation in both interventions and outcomes and by designing experimental approaches, might expand the evidence available on the effects of nurse managers intentional rounding.

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OBJECTIVES: The engagement of nursing leaders is critical for the future of the cancer nursing profession, quality cancer care, and the overall health care system. The field of cancer care is facing enormous challenges, requiring strong nursing leadership. Cancer nursing leadership is needed to overcome the challenges caused by workforce shortages, restricted resources, historic and ongoing under-recognition of nursing, unsafe working conditions, and unequal access to education. The aim of this article is to contribute to the discussion about how cancer nursing leaders can act as visionaries and support transformation of cancer nursing for the future. DATA SOURCES: Author experience, journal articles and organizational position papers were used. CONCLUSION: To improve the state of cancer nursing and the working conditions of the cancer nursing workforce, nursing leadership practices need to be embraced on all governance levels in clinical practice and academia. When effective and high-quality nursing leadership is enacted, positive outcomes for people affected by cancer, nursing, and health care systems can be achieved. Cancer nursing leadership needs to be supported through nursing scholarship, influencing national and global policies and strategies and by active involvement in national and international health care management. IMPLICATIONS FOR NURSING PRACTICE: Nursing leadership and governance is critical to strengthening the cancer nursing workforce. Strong nursing leadership is required to realize the vision for transforming the health care systems and cancer care. Therefore, collaboration among multidisciplinary leadership, health care organizations, academic institutions, professional organizations, and policy-making structures is warranted.

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AIMS: To describe how nurse leaders' work-related well-being is related to a superior's transformational leadership style and structural empowerment. BACKGROUND: The demanding role of nurse leader means that these professionals experience emotional exhaustion and challenges with work-life balance. They can also be influenced by the leadership style of their own superiors. METHODS: A cross-sectional questionnaire using two internationally validated scales, namely, the Transformational Leadership Scale and Conditions For Work Effectiveness Questionnaire-II, was used. Statistical methods were applied during data analysis. RESULTS: A total of 155 nurse leaders participated completed the questionnaire. The participants' work-related well-being scores ranged from 8 to 10. The participants felt that their superiors employ transformational leadership. The dimension of feedback and rewards received the lowest scores, whereas the nurse leaders reported moderate overall empowerment levels. A nurse leader's work-related well-being was positively correlated with structural empowerment and their superior's leadership style. CONCLUSIONS: Despite the fact that nurse leaders reported relatively high levels of work-related well-being, more attention should be paid on the feedback and rewards and on the support of superiors as they positively influence the work-related well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Transformational leadership should be supported in organisations and through education as it strengthens work-related well-being and structural empowerment of nurse leaders.

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BACKGROUND: Nurse leaders are vital for improving nursing efficiencies and the quality of care that they provide during a crisis and its aftermath. The value of positive leadership characteristics has never been more critical than during the COVID-19 pandemic. Functioning in a crisis mode required nurse leaders to demonstrate the necessary skills for clear communication and solid leadership. Therefore, nursing leadership, especially in emergencies such as the COVID-19 pandemic, needs to be transformative in the sense that leaders are informational, motivating, and able to advance the organization, notwithstanding a global pandemic. Timely leadership research during and after COVID-19 is crucial for filling the literature gap resulting from the unique changes in the nursing profession in the post-pandemic period. OBJECTIVE: This study aimed to investigate leadership characteristics shown by nurse leaders during the COVID-19 pandemic, and investigate nurses' perceptions of nurse leader effectiveness based on leaders' work roles. METHODS: An exploratory, quantitative study was conducted 18 months after the declaration of the COVID-19 pandemic (June-August 2021). The Multifactor Leadership Questionnaire (MLQ 5X) was sent to registered nurses (RNs) in Texas using the State Board's listing of active RNs. In total, 70 practicing RNs participated in the study. Data were analyzed using descriptive statistics and multivariate correlational analysis. RESULTS: Perceived leadership characteristics remained primarily transformational. Nurse directors and executives reported positive leadership characteristics more frequently than did staff and charge nurses. LINKING EVIDENCE TO ACTION: Specific tactics and strategies must be adopted to support nurses and nursing leadership during ongoing healthcare challenges. Close monitoring of leadership characteristics will enable organizations to support and provide educational opportunities for ongoing organizational success.

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AIM: To elicit oncology nurse leaders' perceptions and experiences of accessing, using and interpreting report data at the unit level, and their suggestions for future reports. BACKGROUND: Nurse leaders are expected to use data reports for decisions about unit-level operations, yet data may be inaccessible, unavailable and lack relevance for improving patient care and unit-level outcomes. METHODS: A purposeful sampling was used to recruit 12 unit-level nurse leaders. Qualitative data were collected through semi-structured interviews and analysed using thematic content analysis. RESULTS: Consistent themes included the lack of accurate, useful and meaningful data specifically related to patient care. Accessibility Challenges, Limits to Applicability and Suggestions for Improvement were the main themes. CONCLUSION: Nurse leaders require real-time data to effectively implement clinical interventions and practice changes for improving unit-level patient care. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders emphasized that their insight into the development of customizable reports is crucial for obtaining meaningful data relevant to the varied unit-level health care setting. Reports targeting unit-level outcomes would provide meaningful data to facilitate clinical improvement where patient care is provided. Improved reports increase the likelihood of their use and the potential for enhancing the quality and safe care outcomes.

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PURPOSE: This study aims to describe nurse leaders' experiences of work-related well-being and its association with background variables, working conditions, work engagement, sense of coherence and burnout. DESIGN/METHODOLOGY/APPROACH: An electronic survey design was used. Data was collected between December 2015 and May 2016 with an instrument that included demographic questions and four internationally validated scales: the Utrecht Work Engagement Scale, QPS Nordic 34+, the shortened Sense of Coherence scale and the Maslach Burnout Inventory. Data was analysed using statistical methods. FINDINGS: A total of 155 nurse leaders completed the questionnaire, giving a 44% response rate. Most of them worked as nurse managers (89%). Participants' work-related well-being scores ranged from 8 to 10. Statistically significant relationships were found between participants' work-related well-being and their leadership skills, current position, sense of coherence and levels of burnout. In addition, there were statistically significant relationships between work-related well-being and all dimensions of working conditions. ORIGINALITY/VALUE: This study underlines the fact that work-related well-being should not be evaluated based on a single factor. The participants' perceived work-related well-being was high, although almost half of them reported always or often experiencing stress. The results suggest that nurse leaders may have resources such as good leadership and problem-solving skills, supportive working conditions and a high sense of coherence that prevent the experienced stress from adversely affecting their work-related well-being.

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AIM: To explore nurse leaders' resilience and their role in supporting nurses' resilience during the COVID-19 pandemic. BACKGROUND: The COVID-19 pandemic has challenged health care systems on a global level. Nurse leaders are tasked with ensuring high-quality care, even during crises, which requires active problem-solving and confidence in the future-resilience from leaders. METHOD: A scoping review was conducted using inductive thematic analysis and the PCC (Participants, Concept, Context) framework. The PubMed, Scopus, CINAHL, and PsycINFO databases, as well additional studies and grey literature, were searched from December 2019 to June 2021. RESULTS: The review included 12 studies. Nurse leaders' self-awareness, self-reflection, and coping strategies described their resilience during the pandemic. A relational leadership style, supportive and safe work environment, and adequate communication were found to support nurses' resilience. CONCLUSIONS: There is scarce research concerning nurse leaders' resilience during the COVID-19 pandemic. Future research needs to address nurse leaders' personal resilience due to the link with nurses' resilience. IMPLICATIONS FOR NURSING MANAGEMENT: A healthy work environment is essential for nurses' resilience. During crises, nurse leaders should adopt relational leadership styles and actively interact with nursing staff.

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AIM: This systematic review aimed to summarize current research knowledge about the relationships between nurse leaders' leadership styles and nurses' work-related well-being. BACKGROUND: Due to the global shortage of nurses, it is essential for nurse leaders to maximize staff retention and work-related well-being. METHODS: Following Cochrane Collaboration procedures, the PRISMA statement and PRISMA checklist, relevant quantitative studies published between 1 January 2012 and 31 December 2020 were retrieved from the CINAHL, Scopus, PubMed and Medic databases and then systematically reviewed. Seventeen cross-sectional and follow-up studies with surveys were retained for inclusion and evaluated with the Critical Appraisal of a Survey instrument. The data were summarized narratively. RESULTS: Three core themes of leadership styles: destructive, supportive and relationally focused, were identified, with statistically significant direct and indirect connections between nurses' work-related well-being. Well-being was mainly assessed in terms of burnout. Effects of leadership styles on work-related well-being were reportedly mediated by trust in leader, trust in organization, empowerment, work-life conflict, relational social capital, emotional exhaustion, affectivity, job satisfaction and motivation. CONCLUSION: Nurse leaders' leadership styles affect nurses' work-related well-being. In developing intervention studies and providing training on work-related well-being, the impact of the indirect effects and the mediating factors of the leadership styles should be acknowledged.

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AIM: To gather and synthesize current empirical evidence on remote leadership and to provide knowledge that can be used to develop successful remote leadership in health care. DESIGN: A integrative literature review with an integrated mixed methods design. DATA SOURCES: The literature search was carried out between February and March 2019 in the CINAHL, Medline (Ovid), PsycInfo, Scopus, SocIndex, Web of Science and Business Source Elite (EBSCO) databases. REVIEW METHODS: An integrative review was conducted to identify relevant studies published from 2010 to 2019. Of the 88 eligible studies, 21 studies met the inclusion criteria and were selected for the final review. The included studies were analysed using mixed methods synthesis, more specifically, data-based convergent synthesis. RESULTS: The performed analysis identified three main themes: characteristics of successful remote leadership; enhancing the leader-member relationship; and challenges in remote leadership. The first theme included the following sub-themes: remote leader characteristics; trust; communication; and leading the team culture. The second theme covered the importance of organizing regular face-to-face meetings, clear communication policies and the connection between positive team spirit and good remote leader-member relationship, while the third theme emphasized leader- and member-related challenges for remote work. CONCLUSIONS: As none of the identified studies had been conducted in a health care setting, future remote leadership research must also specifically consider the health care context. This will be pivotal to exploring how remote work can foster a safe workplace culture, empower health care workers, increase job satisfaction and improve patient outcomes. IMPACT: Remote leadership has rarely been studied in the health care context. Trust, communication, team spirit and a leader's characteristics are central to remote leadership, a finding which is useful for re-evaluating and improving the current culture at health care organizations.

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