UK Nurses' and Midwives' experiences of healthful leadership practices during the COVID-19 pandemic: A Rapid Realist Review

Caroline Dickson, Caitlin Davies, Brendan McCormack, Liz Westcott, Joy Merrell, Sonja J McIlfatrick, Jan Dewing

Research output: Contribution to journalReview articlepeer-review


Aim: To explore healthful leadership practices in nursing and midwifery evident within the Covid-19 pandemic in the UK, the contextual facilitators, barriers, and outcomes.

Background: Globally, the health and care sector are under pressure and despite nurses and other professionals demonstrating resilience and resourcefulness in the COVID-19 pandemic, this has negatively impacted on their health and wellbeing and on patient care.

Evaluation: Two searches were conducted in July 2021 and December 2021. Inclusion/exclusion criteria were identified to refine the search, including papers written since the beginning of the pandemic in 2020. A total of 38 papers were included principally from the USA and UK. 10 were research papers, the others were commentaries, opinion pieces and editorials. MS Teams literature repository was created. A unique critical appraisal tool was devised to capture contexts, mechanisms and outcomes whilst reflecting more standardised tools i.e., the Critical Appraisal Skills Programme and the Authority, Accuracy, Coverage, Objectivity and Date tool (AACOD) tool for reviewing grey literature to refine the search further.

Key Issues: Six tentative theories of healthful leadership emerged from the literature around leadership strategies which are relational, being visible and present; being open and engaging; caring for self and others; embodying values; being prepared and preparing others and using available information and support. Contextual factors that enable healthful leadership practices are in the main, created by leaders’ values, attributes, and style, as well as the culture within which they lead. The literature suggests leaders who embody values of compassion, empathy, courage, and authenticity create conditions for positive and healthful relations between leaders and others. Nurse and midwives’ voices are however absent from the literature in this review.

Conclusion: Current available literature would suggest healthful leadership practices are not prioritized by nurse leaders but the perspectives of nurses’ and midwives’ about the impact of such practices on their well-being is missing. Tentative theories are offered as a means of identifying healthful leadership strategies, the context that enable these and potential outcomes for nurses an midwives. These will be explored in phase two of this study.
Original languageEnglish
JournalJournal of Nursing Management
Early online date5 Sep 2022
Publication statusE-pub ahead of print - 5 Sep 2022

Bibliographical note

This work has been possible due to funding from the RCN Foundation


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