Comparing nurse leader and manager perceptions of and strategies for nurse engagement using a positive deviance approach: A qualitative analysis

Aims To understand nurse leader and manager perspectives on employee engagement and their own role to foster engagement. To examine differences between managers of units with high versus low engagement. Background Health systems recognize the impact of employee engagement, yet alignment of leader and frontline-manager perspectives remains unclear. Methods A qualitative study at the Veteran Affairs New England Healthcare System. Leaders at five facilities (N = 13) and managers of units with high and low nurse engagement (N = 31) were interviewed. Results Nurse leaders almost universally conceptualized staff engagement as involvement in quality improvement service, while managers defined engagement as either commitment to excellence in direct patient care or involvement in quality improvement efforts. Intra- and interprofessional attitude contagion, and organisational factors of staffing-time-workload and senior leadership support were most common to support or detract from nurse engagement. A variety of strategies were identified, including protecting nurses as people and professionals. Differences in perceived roles and constraints to engaging nurse staff exist between managers of units with high versus low engagement. Conclusion Nurse managers and leaders perceive engagement differently; strategies exist to facilitate engagement. Implications for Nursing Management Leader and manager partnerships are needed to provide clarity on and resources for engagement.

Automated summary

Nurse leaders and managers have different perspectives on employee engagement, with factors such as attitude contagion, organizational factors, and leadership support influencing nurse engagement. There are differences in perceived roles and constraints to engaging nurse staff between managers of units with high versus low engagement. Collaborative partnerships between leaders and managers are essential for promoting employee engagement in nursing management.