Outcomes of Unit Effectiveness In Relation to the Leadership Role of Nurse Managers in Critical Care Nursing

OBJECTIVE
To determine the leadership characteristics, behaviors and skills of critical care nurse managers that enhanced specific ICU unit outcomes.

METHODOLOGY
Participants were selected from hospitals meeting the following criteria: bed size greater than 250 and within 300 miles of UCLA. Seventy-seven hospitals formed the population, with 49 participating (64%). of which 35 were community, 8 teaching, 4 government, and 4 HMO hospitals. Stratifying by size (beds), a total of 645 subjects were selected for the study: 81 nurse managers, 454 staff nurses, and 110 physicians.

Respondents completed the ICU Nurse-Physician Questionnaire (Shortell, et al. 1991)--with scales measuring nursing leadership, communication, problem solving, quality of care, and meeting family member needs--the LEAD instrument (self and others), the LPI (self and observer)--with all internal scale reliabilities between .93 and .97--and provided demographic information.

KEY FINDINGS
LPI-Self scores (combined) for nurse managers were significantly correlated with meeting family needs, but not with staff nurse turnover, recruitment and retention, and quality of care. LPI-Observer scores (combined) for staff nurses and physicians were significantly correlated with recruitment and retention and quality of care but not with staff nurse turnover or meeting family needs.

"The study results also support the position that in a unit where the nurse manager role models leadership behaviors and practices (Kouzes and Posner, 1988) there will be a perception that the quality of care provided to the patients is at a high technical level. However, they failed to provide empirical evidence for situational leadership theory to influence outcomes of unit effectiveness" (p. 136).

"Leadership behaviors and practices were also positively associated with perceived effectiveness in recruiting and retaining critical care staff nurses, perceived effectiveness in the technical quality of care provided to the patients in the ICU as perceived by staff nurses and physicians. In the nurse manager group leadership behaviors and practices were positively associated with perceived effectiveness in meeting family member needs" (p. 143).