Comparing Clinical Nurses' and Nurse Leaders' Perceptions of a Healthy Work Environment: An Integrative Review

Differences in perceptions of clinical nurses and nurse leaders have been observed and reported. Such differences can impact organizational outcomes and overall workplace environment.

The objective of this study was to provide an integrative global review and synthesis of published literature comparing perceptions of clinical nurses and nurse leaders of the work environment in acute care settings.

Five databases were searched for quantitative, qualitative, and mixed methods studies published in English within the last 10 years; publications were peer reviewed. An appraisal of articles meeting review criteria was conducted using the Johns Hopkins method. Selected studies were reviewed both independently and collaboratively by the authors.

The final sample consisted of 23 publications from five countries. The sample included 16 quantitative studies, five qualitative studies, and two mixed method studies. In articles, findings identified some similarities (22%) in perspectives of clinical nurses and nurse leaders of the work environment, but more differences were reported (78%). Areas identified were classified using the American Association of Critical Care Nurses standards established for a healthy workplace environment.

A global phenomenon of differences in perceptions between clinical nurses and nurse leaders was supported by this integrative review. Such differences impact nurse satisfaction, turnover, and patient outcomes. Interventions to shrink the gap in perceptual differences between clinical nurses and nurse leaders warrant further research exploration. The value of leadership education, highlighting authentic leadership traits, is prioritized for consideration. To be effective globally, cultural practices must be taken into consideration. Importantly, objective outcomes following structured education must be reported.