Leadership practices that enable healthful cultures in clinical practice: A realist evaluation

Caroline A. W. Dickson, Joy Merrell, Sonja Mcilfatrick, Liz Westcott, Nigel Gleeson, Brendan McCormack

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
14 Downloads (Pure)


Aim: To generate, test and refine programme theories that emerged from a rapid realist review investigating practising UK Nurses' and Midwives' experiences of effective leadership strategies during the COVID‐19 pandemic. Background: The realist review of literature generated six tentative theories of healthful leadership practices reflecting, working with people's beliefs and values; being facilitative; multiple means of communication and; practical support. The review yielded little insight into the actual impact of the leadership approaches advocated. Methods: A realist study, informed by person‐centredness using mixed‐methods. Online survey (n = 328) and semi‐structured interviews (n = 14) of nurses and midwives across the UK in different career positions/specialities. Quantitative data analysed using descriptive statistics and exploratory factor analysis. Framework analysis for qualitative data using context (C), mechanism (M), outcome (O) configurations of the tentative theories. Results: Three refined theories were identified concerning: Visibility and availability; embodying values and; knowing self. Healthful leadership practices are only achievable within organisational cultures that privilege well‐being. Conclusions: Leaders should intentionally adopt practices that promote well‐being. ‘Knowing self’ as a leader, coaching and mentoring practice development is important for leadership development. Implications for Clinical Practice: Nurses who feel valued, heard, cared for and safe are more likely to remain in clinical practice. Job satisfaction and being motivated to practice with confidence and competence will impact positively on patient outcomes. Impact: The study addresses the role of leadership in developing healthful workplace cultures. The main findings were six leadership practices that promote healthful cultures. The research will have an impact on strategic and clinical leaders, nurses and midwives. Reporting Method: This study used EQUATOR checklist, RAMASES II as reporting standards for realist evaluations. Patient or Public Contribution: No patient or public contribution.
Original languageEnglish
Pages (from-to)982-997
Number of pages16
JournalJournal of Clinical Nursing
Issue number3
Early online date6 Dec 2023
Publication statusPublished online - 6 Dec 2023

Bibliographical note

Funding Information:
This study received funding from RCN Foundation. We acknowledge the contributions of project advisor Elizabeth Rosser and research assistant Caitlin Davies. We also acknowledge Professor Jan Dewing, who designed the research and sought funding. Jan sadly died during the project and is sorely missed. We are forever thankful to her for her wisdom and energy.

Publisher Copyright:
© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.


  • leadership
  • realist evaluation
  • well‐being workplace cultures
  • nures and midwives


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