Priority Setting in Nursing Administration Research: A Rapid Review of the Literature

Background: Strong, effective nursing administration is necessary to positively influence healthcare delivery. Administration amidst highly demanding, complex healthcare organizations is a considerable challenge for today’s leader. The importance of nursing administrators in achieving desired organizational and patient outcomes is not disputed (Aiken et al 2012; Higgins, 2015). These individuals play an ‘essential’ role in promoting and sustaining evidence-based practice (Fleiszer et al., 2016; Van der Zijpp et al., 2016), ensuring a positive work environment (Higgins, 2015), and managing rapid and frequent change (Antwi & Kale, 2014) while upholding the vision, mission and goals of their organization. Over one decade ago, the rapid nature of organizational change was recognized as a significant challenge for those in leadership (Berwick & Leape, 2004). In 2018, increasing complexity in healthcare organizations and increasing expectations placed on administrators (amidst fiscal constraints) may lead to the ‘perfect storm’ resulting in a multitude of negative patient and organization outcomes. Unless action is taken to better support nursing administrators to manage expectations and navigate changes negative outcomes can be expected. However, opportunities for a multi-dimensional approach to support and, where necessary, improve nursing leadership (Hurley & Hutchinson, 2013) abound. But determining ‘where’ to begin and ‘what’ to examine to best support these leaders poses a significant challenge.

To shed light on current knowledge gaps in nursing administration research and to inform a new program of research, a rapid review of the literature on this topic was conducted. Findings from this review were then organized and compared to the results of a 3-staged Delphi study conducted by Scott et al. in 2016 which sought to determine the priorities for nursing administration research. Scott et al. identified eight research priorities (in order of priority); 1) Economic Value of Nursing; 2) Design of Future Nursing Practice and Care Delivery Systems; 3) Healthy Practice Environments; 4) Patient Safety and Outcomes Research; 5) Leadership Education; 6) Effective Leadership; 7) Information Technology to Transform Care; 8) Innovative Research Design and Frameworks. The purpose of triangulating the results provided by Scott et al. with a rapid review was to ensure that accurate research priorities were identified. Thus, a strategy to generate the most valuable research outcomes for healthcare organizations and policy makers is an imperative.

Aim: The purpose of this rapid review was to answer the question, ‘Do the nursing administration research priorities identified by Scott et al. (2016) reflect gaps in the current health administration literature?’.

Method: To answer this question, the following databases were searched: CINAHL, Business Premier, PsychINFO, PubMed and Embase. Search terms included: ((MM "Nursing Leaders") OR (MM "Nurse Administrators+") OR (MM "Nurse Managers+") OR ((MM”Leaders”) AND nurs*) OR (TI "nurs* leader*" OR AB "nurs* leader*")). These terms were then combined with the following MESH terms: 1) systematic or scoping reviews; 2) indigenous; 3) gender/sex; 4) development or capacity building or transition; 5) health care system or services improvement, reform, or redesign; 6) work environment; 7) professional role or role stress; and 8) priorities or agenda or trends or issues. Limits included English language, published in the last 5 years, full text, journal articles. Grey literature was not scoped for this review. A matrix was developed for the 182 articles. The matrix included the study/publication year, study/article purpose, study method (where applicable) and key findings. A template organizing style was then employed to analyze the literature (Miller & Crabtree, 1999). A template was then created using the categories and sub-categories of the nursing administration research priorities described by Scott et al. (2016). This template was then applied to the matrix by two independent reviewers. A comparison was drawn between the priorities indicated by Scott et al. and the representation of these priorities in the current literature.

Results: Findings reveal a limited body of current literature related to nurse administrators/leaders (n= 182). The most explored areas are: 1) Effective Leadership (n=80); 2) Health Practice Environments (n=58) and, 3) Leadership Education (n=19). The least explored areas are: 1) Economic Value of Nursing (n=0), 2) Using Information Technology to Transform Care (n=2); 3) Innovative Research Design and Frameworks (n=7); 4) Design of Future Nursing Practice and Care Delivery Systems (n=8), 5) Patient Safety and Outcomes Research (n=8).

Conclusion: This literature reveals that the least explored area in the healthcare and leadership literature is consistent with the top research priority identified by Scott et al. (2016), ‘Economic Value of Nursing’. According to Scott et al. This category contains several sub-categories including- “the quantification of nursing’s value across the healthcare system” (p. 242), “measures for evaluating leadership and administration” (p. 242) and “cost-benefit analyses of various nursing delivery models” (p. 242). The dearth of current literature in this area is concerning as the economic value of nursing is currently challenged by various health policy makers and professional organizations driven by the need to increase efficiencies and cost-savings. A program of research is needed to examine the topic of the value of nursing to healthcare delivery and to the attainment of organizational goals. Research is also needed to evaluate the role of the administrator and to measure leadership related outcomes. Based on this rapid review and the finding from Scott et al., a program of research related to the 'economic value of nursing' is warranted.