Some nurses are responding rebelliously to the changing healthcare landscape by challenging the status quo and deviating from suboptimal practices, professional norms, and organizational rules. While some view rebel nurse leadership as challenging traditional structures to improve patient care, others see it as disruptive and harmful. These diverging opinions create dilemmas for nurses and nurse managers in daily practice. To understand the context, dilemmas, and interactions in rebel nurse leadership, we conducted a multiple case study in two Dutch hospitals. We delved into the mundane practices to expand the concept of leadership-as-practice. By shadowing rebel nurse practices, we identified three typical leadership practices which present the most common “lived” experiences and dilemmas of nurses and nurse managers. Overall, we noticed that deviating acts were more often quick fixes rather than sustainable changes. Our research points to what is needed to change the status quo in a sustainable manner. To change unworkable practices, nurses need to share their experienced dilemmas with their managers. In addition, nurse managers must build relationships with other nurses, value different perspectives, and support experimenting to promote collective learning.
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Most nurse leadership studies have concentrated on a classical, heroic, and hierarchical view of leadership. However, critical leadership studies have argued the need for more insight into leadership in daily nursing practices. Nurses must align their professional standards and opinions on quality of care with those of other professionals, management, and patients. They want to achieve better outcomes for their patients but also feel disciplined and controlled. To deal with this, nurses challenge the status quo by showing rebel nurse leadership. In this paper, we describe 47 nurses’ experiences with rebel nurse leadership from a leadership-as-practice perspective. In eight focus groups, nurses from two hospitals and one long-term care organization shared their experiences of rebel nurse leadership practices. They illustrated the differences between “bad” and “good” rebels. Knowledge, work experience, and patient-driven motivation were considered necessary for “good” rebel leadership. The participants also explained that continuous social influencing is important while exploring and challenging the boundaries set by colleagues and management. Credibility, trust, autonomy, freedom, and preserving relationships determined whether rebel nurses acted visibly or invisibly. Ultimately, this study refines the concept of rebel nurse leadership, gives a better understanding of how this occurs in nursing practice, and give insights into the challenges faced when studying nursing leadership practices.
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In the Netherlands, there is an increasing need for collective forms of housing for older people. Such housing bridges the gap between the extremes of living in an institutionalised setting and remaining in their own house. The demand is related to the closure of many residential care homes and the need for social engagement with other residents. This study focuses on housing initiatives that offer innovative and alternative forms of independent living, which deviate from mainstream housing arrangements. It draws on recent literature on healthcare ‘rebels’ and further develops the concept of ‘rebellion’ in the context of housing. The main research question is how founders dealt with challenges of establishing and governing ‘rebellious’ innovative living arrangements for older people in the highly regulated context of housing and care in the Netherlands. Qualitative in-depth interviews with 17 founders (social entrepreneurs, directors and supervisory board members) were conducted. Founders encountered various obstacles that are often related to governmental and sectoral rules and regulations. Their stories demonstrate the opportunities and constraints of innovative entrepreneurship at the intersection of housing and care. The study concludes with the notion of ‘responsible rebellion’ and practical lessons about dealing with rules and regulations and creating supportive contexts. Original article at MDPI; DOI: https://doi.org/10.3390/ijerph17176235 And atachment "Supplementary Materials" (This article belongs to the Special Issue Feature Papers "Age-Friendly Cities & Communities: State of the Art and Future Perspectives")
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Veel ouderen willen zelfstandig blijven wonen. Het liefst doen ze dit in nabijheid van gelijkgestemden in een woning en omgeving die past bij hun levensfase en behoeften. Nieuwe woonvormen ontwikkelen die voorzien in deze wensen is makkelijker gezegd dan gedaan. Initiatiefnemers lopen vaak aan tegen niet-passende regels, stroperige procedures en doorgeslagen hokjesdenken. Die tegenwerking zorgt voor frustratie en moedeloosheid, maar wakkert ook het vuur aan bij initiatiefnemers. Ze willen laten zien dat het anders moet en anders kán. Ze doen dit door de gebaande paden te verlaten, door rebels hun eigen weg te kiezen. Deze uitgave is tot stand gekomen door een bijdrage van het Regieorgaan SIA in het kader van het project Naar Verantwoorde Rebellie: Governance en Inspraak bij Collectieve Woonvormen voor Ouderen (SIA-project nummer RAAK.MKB09.002).
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Aims To (1) give an overview of rebel nurse leadership by summarising descriptions of positive deviance, tempered radicals and healthcare rebels; (2) examine the competences of nurse rebel leadership; and (3) describe factors that stimulate or hinder the development of rebel nurse leadership. Background Research shows nurses have lower intention to leave their jobs when they can control their work practices, show leadership and provide the best care. However, organisational rules and regulations do not always fit the provision of good care, which challenges nurses to show leadership and deviate from the rules and regulations to benefit the patient. Three concepts describe this practice: positive deviance, healthcare rebels and tempered radicals. Design Scoping review using the Joanna Briggs Institute methodology and PRISMA-ScR checklist. Methods Papers describing positive deviance, healthcare rebels and tempered radicals in nursing were identified by searching Scopus, CINAHL, PubMed and PsycINFO. After data extraction, these three concepts were analysed to study the content of descriptions and definitions, competences and stimulating and hindering factors. Results Of 2705 identified papers, 25 were included. The concept descriptions yielded three aspects: (1) positive deviance approach, (2) unconventional and non-confirmative behaviour and (3) relevance of networks and relationships. The competences were the ability to: (1) collaborate in/outside the organisation, (2) gain and share expert (evidence-based) knowledge, (3) critically reflect on working habits/problems in daily care and dare to challenge the status quo and (4) generate ideas to improve care. The factors that stimulate or hinder the development of rebel nurse leadership are as follows: (1) dialogue and reflection, (2) networking conditions and (3) the managers’ role. Conclusions Based on our analysis, we summarise the descriptions given of rebel nurse leadership, the mentioned competences and provide an overview of the factors that stimulate or hinder rebel nurse leadership. Relevance to clinical practice The descriptions produced in this review of rebel nurse leadership and the stimulating or hindering factors listed should help nurses and managers encourage rebel leadership.
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In dit artikel bestuderen we rebelse initiatieven in onderwijs en ouderenhuisvesting. We verstaan hieronder de initiatieven van individuen of teams die weloverwogen anders te werk gaan dan anderen en daarbij soms bepaalde regels overtreden ten behoeve van een betere kwaliteit van dienstverlening. Uitgeversversie: https://doi.org/10.5553/BenM/138900692021048002005
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Er is in ons land een toenemende vraag naar ouderenhuisvesting, maar het proces van initiatief tot oplevering gaat niet zonder slag of stoot. Het blijkt lastig om in het gereguleerde Nederlandse woonzorglandschap een initiatief te starten dat niet in de bestaande hokjes past. Hoe gaan ‘rebelse’ initiatiefnemers om met de bestaande wet-en regelgeving?
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Introductie bij het themanummer van 'Beleid en Maatschappij': Rebelse initiatieven in wonen, zorg en onderwijs – het op verantwoorde wijze nét even anders doen. Uitgeversversie: https://doi.org/10.5553/BenM/138900692021048002002
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