The experience of being a shift-leader in a hospital ward

Aim. This paper is a report of a study to explore the experience of being a shift-leader, and how these nurses view the management of their shift. Background. Professional demands on skilled and capable shift-leaders, who competently handle multi-disciplinary staff and patients, as well as operations and information, call for the development of efficient nursing leadership roles. Nevertheless, knowledge of shift-leaders' perspectives concerning their task management and leadership styles is relatively limited. Method. Twenty-eight Registered Nurses working in an Israeli medical centre participated in this qualitative study. Data were gathered through in-depth interviews conducted in two phases between February and October 2005: three focus group interviews (phase 1) followed by seven individual interviews (phase 2). Findings. Content analysis revealed two major themes which constitute the essence of being a shift-leader: (1) a burden of responsibility, where the shift-leader moves between positions of maximum control and delegating some responsibility to other nurses; (2) the role's temporal dimension, expressed as a strong desire to reach the end of the shift safely, and taking managerial perspectives beyond the boundaries of the specific shift. The core of the shift-leader's position is an immense sense of responsibility. However, this managerial role is transient and therefore lacks an established authority. Conclusion. A two-dimensional taxonomy of these themes reveals four types of potential and actual coping among shift-leaders, indicating the need to train them in leadership skills and systemic thinking. Interventions to limit the potential stress hazards should be focused simultaneously on shift-leaders themselves and on job restructuring.