Journal of Nursing Management, 2017

A systematic review of factors influencing knowledge

management and the nurse leaders’ role
1 € 2
, TARJA KVIST P h D , R N 3
and
ANNE LUNDEN M N S , R N , MARIANNE TERAS P h D
€ 4
ARJA HAGGMAN-LAITILA P h D
1
PhD Student, Nursing Director, City of Helsinki, Department of Social Services and Health Care, Department of Nursing
Science, University of Eastern Finland, Helsinki, Finland, 2University Lecturer, Docent in Adult Education, Department of
Education, University of Stockholm, Stockholm, Sweden, 3Docent, University Researcher, Department of Nursing Science,
University of Eastern Finland, Kuopio, Finland and 4Professor, Nurse Director, City of Helsinki, Department of Social
Services and Health Care, Department of Nursing Science, University of Eastern Finland, Kuopio, Finland

., € ., ., & € - . (2017) Journal of Nursing

Correspondence LUNDEN A TERAS M KVIST T HAGGMAN LAITILA A
Anne Lunden Management
City of Helsinki, Department of A systematic review of factors influencing knowledge management and the nurse
Social Services and Health Care leaders’ role
University of Eastern Finland,
Department of Nursing Science
Aim To describe factors facilitating or inhibiting the development of registered nurses’
Kyl€akunnantie 70 b
competency and nurse leader’s role in knowledge management. Background Nurses’
FIN – 00660 Helsinki
competency directly influences patient safety and the quality and effectiveness of
Finland
patient care. Challenges of nurse leaders in knowledge management include acquiring,
E-mail: anne.lunden2@gmail.com
assessing and utilising current knowledge and assessing and enhancing competency.

Evaluation A systematic search was conducted in PubMed, CINAHL, SCOPUS and

ERIC databases in April 2015. The search identified 18 relevant research articles
published between 2009 and 2015. The quality of the studies was appraised in
accordance with study designs.
Key issue Knowledge management is facilitated by an organisation culture that
supports learning, sharing of information and learning together. Leader commitment
and competency were factors related to leadership facilitating knowledge
management.
Conclusion Nurse leaders need evidence-based interventions to support shared
learning and to create infrastructures that facilitate competence development. Future
research is especially needed to evaluate connections between knowledge management
and patient outcomes.
Implications for nursing management and leadership The results of this review can be
utilised in enhancing factors to facilitate knowledge management in clinical practice and
identifying nurse leaders’ role in strengthening nurses’ competency.
Keywords: competency, knowledge management, leadership, nurse leader

Accepted for publication: 12 January 2017

sharing and creating new knowledge. Factors facilitat-ing

Introduction
knowledge management include encouraging involvement
Knowledge management is a process in which the in decision-making, effective communica-tion and human
management of work tasks is enhanced by acquiring, resource management (Orzano et al.

DOI: 10.1111/jonm.12478
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A. Lunden et al.

2008). According to Sanches (2004), knowledge man- recognise the importance of the ability to take care of the
agement is supported by an organisation that is an open development of staff competency, nearly 50% of them
system in constant interaction with its environ-ment. perceive their readiness to manage competency as
Micro-level competencies are joined to the macro-level insufficient (Omoike et al. 2011). Nurses feel that they lack
strategic competency and leadership pro-cesses in the sufficient evidence-based knowledge and the ability to use
organisation. This enables simultaneous and systematic it in their work (Saunders & Veh-vil€ainen-Julkunen
emergence, utilisation and development of competency at 2015). In summary, leaders perceive their knowledge
different levels of the organisation. According to Sanches management capabilities as insuffi-cient, while nurses
(2004), knowledge management is dependent on the consider their ability to use evi-dence-based knowledge as
functional and cognitive flexibility of the organisation and inadequate. There is still little evidence on the
its resource utilisation. effectiveness of interventions promoting evidence-based
Competency means more than having skills or quali- practice, and interventions have not been sufficiently
fications required by a task. It also comprises atti-tudes, thoroughly reported to enable their repeatability and
motivation, insight, interpretation ability, receptiveness and comparability (Phillips et al. 2014). There is also little
maturity, and self-assessment. A competent professional research available on the significance of organisational
understands his or her per-sonal limitations and is able to infrastructures for the facilitation of evidence-based
provide safe care inde-pendently according to obligations, practice (Flodgren et al. 2014).
professional standards, education and qualifications.
Competency promotes collaboration between nurses and Previous research on knowledge management in nursing
other members of the nursing team, which expands and is sporadic. It is thus difficult to establish an overview
integrates new knowledge and skills in the working about factors facilitating and inhibiting knowledge
community (Axley 2008). management and the nurse leader’s role in knowledge
management to inform practice develop-ment and future
The development of nurses’ competency is an invest- studies. We chose to conduct a sys-tematic review to
ment facilitating safety, quality and effectiveness of patient identify, evaluate and summarise the currently available
care and nurse retention (Coventry et al. 2015). Nurses’ evidence on knowledge manage-ment in nursing and to
possibilities for continuous professional development and demonstrate gaps in research knowledge. We found no
participation in mandatory training at the organisation are previous systematic reviews on the topic.
limited by insufficient arrange-ments for substitutes
together with a demanding and growing workload
(Salmond et al. 2009). Assuming that nurses should use
The aim of the study and research questions
their personal time for addi-tional training cause
dissatisfaction among nurses and has negative impacts on The aim is to describe the factors facilitating or inhibiting
nurse retention and the qual-ity of nursing (Coventry et al. the development of registered nurses’ (RN) competency
2015). Knowledge man-agement is challenged by the and the nurse leader’s role in knowledge management
acquisition and assessment of up-to-date knowledge as (KM). The specific research questions are:
well as the utilisation of competency in a constantly
changing environment (Andreasson et al. 2016). What are the factors facilitating and inhibiting KM?

In recent years, the development and knowledge What is the role of the nurse leader in KM?
management of nursing has particularly been exam-ined
from the viewpoint of implementation of evi-dence-based
practice (EBP). In their systematic review, Sandstroma€ et
al. (2011) argued that leadership and organisational culture
Methods
bear a key significance in the EBP implementation process. Design
It is well known that nurse leaders are aware of the
importance of EBP and have positive attitudes towards This systematic review was conducted in following steps
EBP and its leadership (Kvist et al. 2014). In contrast, there based on PRISMA Statement, which are (1) for-mulating a
are also observa-tions indicating that leaders are passive research question, (2) selecting relevant search terms and
and insuffi-ciently committed to facilitating evidence- formulating search phrases by con-sulting an information
based practice (Wilkinson et al. 2011). Although leaders specialist in the field of health sciences, (3) planning a
search strategy, (4) agreeing

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2 Journal of Nursing Management
 Knowledge management and nurse leaders

Table 1
Search terms

Skill Leader Management Inclusion or exclusion criteria

professional competenc* MeSH head nurse* MeSH knowledge management MeSH nurs*
clinical competenc* MeSH nurs* manage* MeSH leadership MeSH NOT student*MeSH
clinical skill* MeSH charge nurse* MeSH management MeSH
professional skill* nurs* director* personnel management MeSH
nurse leader human resources management
administ* nurs* improve*
develop*
model*

Identification
Records identified through database Additional records identified through
searching (n = 394 ) other sources (n = 1)

Records after duplicates removed (n = 284 )

Screening

Records screened (n =284) Records excluded based on

titles and abstracts (n =188)

Full-text articles assessed Full-text articles excluded,

Eligibility

for eligibility (n = 96 ) with reasons (n =77)

 Not research article

 (n= 38)
 No answer to research
questions (n= 33)
Studies included in quality  Review (n= 6)
assessment (n=19)
Included

Figure 1 Studies included in the

PRISMA flow chart (Moher et al. 20- review (n = 18)
09).

on inclusion and exclusion criteria, (5) conducting a NOT. Searches were limited to the English language. Only
systematic search in electronic databases, (6) selecting studies published between 2009 and 2015 were included.
eligible research articles and (7) performing a quality In order to be eligible for this study, reviews had to be
appraisal of the studies selected for the review (Moher et peer-reviewed, empirical studies with quan-titative or
al. 2009). qualitative research designs and answer the research
questions.
Search strategy and inclusion criteria
Search outcome and exclusion criteria
A systematic search was conducted in PubMed, CINAHL,
SCOPUS and ERIC databases in April 2015. Search The electronic database search yielded a total of 394
strategies and search terms (Table 1) were modified to suit abstracts and titles (Figure 1). The first author (AL)
the different databases. In order to obtain as comprehensive selected and evaluated all the articles. Three other authors
search results as possible, a number of different search (MT, TK, AH-L) selected and evaluated arti-cles of one
terms were used to find wide-ranging research on database each (CINAHL, Scopus, PubMed). The search in
knowledge management. Searches were performed by the ERIC database yielded no results. Titles and abstracts
employing combinations of terms using the Boolean terms were screened and those not meeting the inclusion criteria
AND, OR and were excluded. At

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Journal of Nursing Management 3
 Table 2
4

A. Lunden et al .
Overview of the included studies

Research design/ Quality

author/year/country Aim Sample size and study context Method Outcomes assessment

Quasi-experimental
Codier et al. The study explores the impact of 31 nurse managers Exploratory pilot study utilised an All participants who completed the Some limits
(2011), Hawaii peer coaching on the emotional A private tertiary care medical intervention and a pre-post-testing study perceived that the peer
intelligence abilities of nurse centre design. The Mayer-Salovey- coaching intervention improved
managers Caruso Emotional Intelligence their EI abilities and general
Test management skills
Questionnaire surveys
Akerjordet et al. The aim of the study is to 364 clinical nurses The Descriptive cross-sectional survey Positive attitude towards research Some limits
(2012), Norway determine clinical nurses’ interest response rate 61% emerged (40%), despite the fact
in and motivation for research. An University hospital that few were engaged in
additional aim was to identify research-based activities. Lack of
management and organisational designated time (60%), interest
resources in order to improve (31%), knowledge (31%) and lack
nurses’ research capacity in of research supervision and
practice support (25%) constituted
important research barriers.
Research supervision was one of
the most significant needs to
enhance clinical nurses’ research
skills, management and
organisation of research activities
(30%)
Chen (2012), The study deconstructs a 155 nurses The response rate 87% Quality function deployment. Leadership is identified as the Excellent
Taiwan knowledge management (KM) Health care institute Factory analysis and fuzzy set second most important enabler in
model for utilising nursing theory. Empirical survey. Case ensuring effective knowledge
knowledge assets in terms of KM study management at the case hospital
processes and KM enablers
Hsu et al. (2011), The objective of study is to gain an 15 new nurse managers, 101 staff A three-phased Multiple teaching resources, a Some limits
Taiwan understanding of the relationship nurses, 20 nurse administrators questionnaire survey supportive learning environment,
that exists between a nursing The response rate 100% (first and a positive preceptorship helps
preceptorship and a new nurse phase) improve an NNM’s competencies.
manager’s (NNM) competencies General hospital An NNM’s professional
competencies will be further
enhanced as a socialisation
facilitator and educator when
resources are directed more
toward teaching facilities,
Journal of Nursing Management

improving the education level of a

ª 2017 John Wiley & Sons Ltd

NNM, providing incentives,

effective support from the
organisation, and strengthening
the relationship among staff
nurses, nursing administrators,
and the NNMs
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Table 2
(Continued)

Research design/ Quality

author/year/country Aim Sample size and study context Method Outcomes assessment

Omoike et al. The aim of the study is to describe 43 nurse leaders The Leadership Survey was used Participants perceived themselves Excellent
(2011), USA how health care organisations can 3 Metropolitan hospitals to measure change in as more competent post
form strategic partnerships with respondents programme in 11 of the 12
academic institutions to improve perceived Importance versus subscales. The Leader subscales
nurse leader’s ability to apply and Competence in the 12 subscales includes among other concepts of
operationalise leadership pre– and 1-year post–program ‘attending to the training and
competency standards completion development needs of employees’
and ‘evaluating (in)formally
subordinates’ job performance’
Spicer et al. The aim of the study is to survey A random sample of 300 DONs. A descriptive research. The Chinese DONs and COOs Excellent
(2010), China directors of nursing (DONs) and The response rate 69% (n = 208) Two survey instruments, a rated the role competencies based
chief operating officers (COOs) of the DON and 64% (n = 192) of demographic survey and a on the Forces of Magnetism to be
perceived importance of DON role the COO surveys competency survey important for DONs to be
competencies based on the Hospitals effective.
Forces of Magnetism The DONs placed significantly
greater importance on
transformational leadership
Strickland and This study specifically examined 122 clinical nurse educators in A descriptive design. The The rank order for barrier Factor Excellent
O’Leary-Kelley the educators’ perceptions of California BARRIERS scale questionnaire means was (1) setting, (2) nurse,
(2009), USA barriers and facilitators to Nurse educator in acute care or (3) presentation, and (4)
research utilisation outpatient ambulatory care Research.
Educators with undergraduate
education perceived the setting to
be a greater barrier than did
educators with advanced degrees
Educators working in facilities with
Magnet designation perceived the

Knowledge management and nurse leaders

setting as less of a barrier than
did educators working in facilities
without Magnet status
Educators within smaller-bed-
capacity institutions perceived the
setting and presentation of
research to be greater barriers
than did the other identified
subgroups
5
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A. Lunden et al.
Table 2
(Continued)

Research design/ Quality

author/year/country Aim Sample size and study context Method Outcomes assessment

Qualitative studies
Anonson et al. Aim of the study was look at the 6 frontline nurses In-depth personal interviews with Common characteristics of Excellent
(2014), Canada characteristics of exemplary nurse The health care system in the open-ended questions exemplary nurse leaders are a
leaders in times of change from Province of Alberta passion for nursing; a sense of
the perspective of frontline nurses optimism, the ability to form
personal connections with their
staff; excellent role modelling and
mentorship; and the ability to
manage crisis while guided by a
set of moral principles
One of the categories of leadership
qualities was ‘Interest in facilitating
professional growth: mentoring
and modelling’
Brink et al. (2012), The aim of the study was to 6 nurses, 4 emergency medical Inductive qualitative approach, The principal findings are Some limits
Sweden evaluate the experience of group technicians focus group interview, content presented in the following four
supervision and to explore its Pre-hospital care analysis main themes: (a) model structure
impact on the participants’ creates security and participation,
personal and professional (b) the collegial exchange of
development experience leads to increased
self-awareness and positive
professional development, (c) the
group supervision affects
participants’ values and attitudes;
(d) the opportunity for group
supervision will be a means of
developing professional skills
Brinkert (2011), Evaluate the application of the 20 Nurse Managers and 20 Pre and post training semi- Conflict coaching was a practical Some limits
USA Comprehensive Conflict Coaching frontline nurses structured face-to-face interviews and effective means of developing
model in a hospital environment Magnet status 500-bed two-hospital and quantitative questionnaire. A the conflict communication
health system case study competencies of nurse managers
and supervisees
Carr and Clarke Explore the manager’s role in 36 the Health Action Zone Qualitative individual semi- The manager’s role is to be a Some limits
(2010), UK promoting and nurturing learning coordinators, performance structured interviews catalyst, which facilitate collective
manager and staff delivering learning at both individual and
services organisational levels
Journal of Nursing Management
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Guest et al. The aim of the project was to 21 child and family nurses The pre-test questionnaire and Participation in the pilot project was Some limits
(2013), Australia implement and evaluate Child and One health district in the New focus group interviews confidence building in that it
Family Health Nursing South Wales provided them with confirmation
Professional practice Framework and affirmation of clinical practice
Participation also provided CFHN
with an opportunity to reflect on
their clinical practice
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(Continued)
ohn
gof

Research design/ Quality

author/year/country Aim Sample size and study context Method Outcomes assessment

Hoare et al. The aim of the study was to 6 experienced nurses, 5 new A constructivist grounded theory Experienced practice nurses role Excellent
(2013), New investigate practice nurses’ use of graduate nurses design. Face-to-face interviews modelled clinical skills to new
Zealand information graduate nurses. New graduate
nurses were unconscious experts
at sourcing information and role
modelled this skill to experienced
practice nurses. Once this
attribute was acknowledged by the
experienced practice nurse,
mutual learning occurred that
enabled both groups of nurses to
become better practitioners
Leggat and The purpose of this paper is to A sample of 28 clinicians and Semi-structured focus groups The focus group participants Excellent
Balding (2013), gather opinions on the appropriate clinician managers from interviews. An inductive thematic identified seven organisational
Australia content of an educational initiative metropolitan, regional and rural analysis factors that contribute to clinical
being planned to improve clinical hospitals and community health leadership; role clarity and
leadership in quality and safety services accountability, role security and
sustainability for clinical leadership
positions, selective recruitment
into clinical leadership positions,
teamwork, transformational
leadership, training and
development, information sharing
Pepin et al. The aim of the study was to 32 student nurses, 10 new nurses An interpretative phenomenological The emerging cognitive learning Some limits
(2011), Canada develop a cognitive learning model and 10 expert nurses study design. Semi-structured model of clinical nursing
(CLM) of the clinical nursing individual interviews leadership. There are five learning
leadership competency, from the stages and in each stage, a
beginning of a nursing programme number of critical-learning turning

Knowledge management and nurse leaders

(students) to expertise (nurses) points. The five learning stages
are: (1) ‘I am aware of clinical
leadership in nursing’; (2) ‘I
integrate clinical leadership in my
actions’; (3) ‘I have active
leadership with patient/family, and
sometimes with colleagues’; (4) ‘I
have active leadership with the
team’; and (5) ‘I have embedded
clinical leadership that is extended
to organisational’
7
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A. Lunden et al.
Table 2
(Continued)

Research design/ Quality

author/year/country Aim Sample size and study context Method Outcomes assessment

Data from the students’ interviews

raised the question of the support
available to develop clinical
leadership, because certain
students noted that their
preceptors did not encourage
them to try or to continue
influencing others for better care.
Also provide basic and continuing
education about clinical leadership
Romain-Glassey The central objective of the study 10 discussion groups A case study methodology. If the VMU nurses’ roles were to be Excellent
et al. (2014), was to describe forensic nursing Forensic nursing in the violence Thematic content analysis completely compatible with
Switzerland practice in the VMU, and through medical unit advanced nursing practice, this
a critical analysis, compare it with would entail increasing their level
the seven core competencies of of competencies in the fields of
advanced nursing practice consultation, ethics, leadership
and research. This evolution
would need to be linked to the
strategic planning of the university
institution and cannot be limited to
a specific unit. Such a trend is
under way at the CHUV, and it
requires strong leadership, both at
the level of the institution and of
the nursing discipline
Severinsson et al. The aim of this study was to One focus group discussion A qualitative thematic analysis was The outcome of the midwives Excellent
(2010), Norway evaluate midwives experiences of Experienced midwives used to analyse the content of the group supervision was increased
group supervision and the notes from the supervision professional competence
influence of the continuity of care sessions and focus group
model, with particular focus on discussion. There was only one
childbearing women’s need for group discussion
emotional support. An additional
aim was to evaluate the
development of the midwives
professional competence
Tregunno et al. To explore nursing leadership for 31 focus groups with 188 Focus groups Executives are called upon to Some limits
Journal of Nursing Management
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(2009), Canada patient safety in critical care and participants develop and sustain evidence-
identify opportunities to improve Multidisciplinary frontline informed safety cultures where the
leadership that promotes patient providers and managers in the knowledge of safety science is
safety context of critical care nursing mobilised and valued, and
evidence is used by nurse leaders
at all levels to deliver safer care
 Knowledge management and nurse leaders

this stage, 96 full-text articles were obtained, each of which the process of combining themes and sub-themes. The
was reviewed in detail to identify whether they met the description of the process of developing themes and sub-
inclusion criteria. Reviews, discussion papers, editorials themes was used to answer the research questions
and empirical studies concerning nursing students were (Vaismoradi et al. 2013).
excluded. One article was found for this study based on
references in the information searches. Altogether 19
studies were included in the quality assessment process. Results
Characteristics of the included studies

Quality assessment The research articles were published between 2009 and
2014 in several countries (Table 3). The median number of
The studies were assessed according to criteria pre-sented research participants was 21 in surveys in interviews and
by Gifford et al. (2007). The criteria included eight items 137 in questionnaires. In the pre-tests and post-tests, the
for quasi-experimental studies, six for questionnaire minimum study population had 31 and the maximum 40
surveys and 11 for qualitative studies. Each item was participants. Ten studies were rated excellent, and eight as
scored 2 (excellent), 1 (some limita-tions) or 0 (several having some limitations.
limitations). Quasi-experimental studies were excluded if
they scored 0–6 points, ques-tionnaire surveys if they
Factors facilitating knowledge management
scored 0–4 points and quali-tative studies if they scored 0–
8 points in total. Two authors evaluated all the eligible Organisation culture and leadership were determined as the
articles individually and discussed any differences in main themes for factors facilitating knowledge
quality assessment to make a decision on the quality of the management (Table 4). Knowledge management is
study. One arti-cle was excluded due to poor quality. The facilitated by an organisation culture that supports learning,
quality appraisal of each study is reported in a Supporting sharing of information, learning together and reciprocal
information (Table S1). feedback (Chen 2012, Hoare et al. 2013, Leggat & Balding
2013). Effective support from envi-ronment and
strengthening the relationship between supervisors and
nurses facilitates both leaders’ and nurses’ learning (Hsu et
Data extraction
al. 2011). Supervision enabling reflection and self-
The following characteristics of each study were extracted; assessment (Guest et al. 2013) and especially group
authors, publication year, country of origin, aim of the supervision have been found to posi-tively influence the
study, sample size and study context, method, outcomes personal and professional growth of participants
and quality assessment (Table 2). (Severinsson et al. 2010). Positive precep-torship (Hsu et
al. 2011), continuous mentoring (Guest et al. 2013) and
support for nurses’ leadership in nurs-ing practice
Data analysis
promotes the development of nurses’ com-petency (Pepin
In total, 18 articles were analysed by two researchers et al. 2011). Clinical and academic collaborative networks
identifying common themes. At the initialisation phase, the expedite and sustain nurses’ research capacity (Akerjordet
selected articles were read through once to form an et al. 2012).
overview of the data. The articles were read several times Knowledge management is facilitated by an organisa-
to internalise their contents and to detect preliminary tion culture that rewards employees based on compe-tency
themes. At the construction phase of the analysis, data (Hsu et al. 2011); in return, employees also have an
were classified into categories. The cate-gories begin to opportunity to give feedback to their superiors (Chen
articulate the core element of the theme. At the rectification 2012). In order to sustain a satisfactory level of
phase, nearly complete themes had been formed. At this competency, it is important that supervisors are pro-vided
phase, the research-ers distanced themselves from the data with up-to-date information based on feedback on the level
by taking a break from the analysis process. Subsequently, of competency and needs for further train-ing among staff
the theme development process was revised, assessed and (Guest et al. 2013). Information tech-nology solutions
verified by revisiting the data and making sure that both enable online studies and feedback, networking and
researchers could accept the categorisation. At the communal learning as well as facilitate knowledge
finalisation phase, a clear story line was created in management (Pepin et al. 2011, Chen 2012). There have
been attempts to ensure and increase
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A. Lunden et al.

Table 3
Summary of the articles

Publishing year n Country n Design n Sample size min med max Quality assessment n

2009 2 US 3 Qualitative 11 Interviews 6 21 52 Excellent 10

2010 3 Canada 3 Survey 6 Questionnaires 43 137 364 Some limits 8
2011 5 Norway 2 Quasi-experimental design 1 Pre- and post tests 31 40
2012 3 Taiwan 2
2013 3 Australia 2
2014 2 UK 1
2015 0 Hawaii 1
China 1
New Zealand 1
Switzerland 1
Sweden 1

Table 4 2013). Leaders’ competency in emotional intelligence and

Factors facilitating and inhibiting knowledge management
general leadership skills has increased, for exam-ple by
Facilitating factor Inhibiting factors introducing peer coaching (Codier et al. 2011) and conflict
Themes Subthemes Subthemes
coaching (Brinkert 2011). The Adminis-trative Leadership
Organisation Support of learning Lack of motivation to learn programme, which was conducted in the United States, has
culture Sharing knowledge Lack of support for learning increased leaders’ networking with colleagues and
and learning together Lack of knowledge
Feedback Organisational traits information sharing. This pro-gramme has also improved
(non-Magnet status, their ability to form part-nerships between stakeholders in
small bed capacity, education and working life (Omoike et al. 2011).
task-oriented discipline)
Leadership Leadership model Lack of time resources
Leader’s traits Lack of human resources
Leader’s competency
Factors inhibiting knowledge management
Two main themes emerged out of factors inhibiting
competency at work unit by hiring nurses with solid knowledge management (Table 4): organisation cul-ture
educational foundations or who have completed spe- and management of human resources. Inhibiting factors
cialisation training (Hsu et al. 2011, Pepin et al. 2011). related to the organisation culture include a lack of
Leadership models, leader’s traits and leader’s com- motivation, support and knowledge. Factors related to lack
petence are sub-themes related to leadership. In rela-tion to of motivation include unspecified per-sonnel roles and
leadership models, transformational leadership and Magnet responsibilities, poor rewarding sys-tems and
hospital status have been found to facili-tate competency unwillingness to learn from errors (Carr & Clarke 2010,
among employees (Strickland & O’Leary-Kelley 2009, Leggat & Balding 2013). Motivation might also be
Spicer et al. 2010, Leggat & Balding 2013). The term negatively affected by excessive pres-sures to succeed and,
‘Magnet hospital status’ denotes an institution that has in contrast, lack of interest in development work (Carr &
successfully attracted and retained nurses. Magnet Clarke 2010, Akerjordet et al. 2012).
hospitals value high qual-ity competency at all
organisational levels and continu-ing improvement of A lack of organisational support for training and
competency (Salmond et al. 2009). developing in the profession and as a leader also inhi-bits
Knowledge management-facilitating leadership includes knowledge management (Pepin et al. 2011, Leg-gat &
the leader’s commitment in his or her task and the clarity, Balding 2013). Other inhibiting factors include the lack of
responsibility, reliability and stability of the leader’s role financing and technology as well as insuffi-cient support
(Chen 2012, Leggat & Balding 2013). Other related factors for research activities in the organisation (Strickland &
include strategic plan-ning, strong leadership and team O’Leary-Kelley 2009, Akerjordet et al. 2012). Insufficient
work (Leggat & Balding 2013, Romain-Glassey et al. provision of information and edu-cation in the organisation
2014). Compe-tency in leadership can be ascertained by are also inhibiting factors. Lack of distributing existing
the leaders’ solid educational foundation and maintained knowledge widely at the different organisational levels also
and pro-moted with continuous training and guidance (Hsu has similar effects. An organisation where knowledge is
et al. 2011, Omoike et al. 2011, Leggat & Balding only available for few people and units is vulnerable (Carr
& Clarke
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 Knowledge management and nurse leaders

2010, Akerjordet et al. 2012, Leggat & Balding 2013). viewpoint of knowledge management and the factors
Inhibiting factors related to organisational traits include the facilitating and inhibiting the development of compe-tency.
small capacity of an organisation, its non-Magnet status According to this review, knowledge manage-ment is
(Strickland & O’Leary-Kelley 2009) and an individualistic facilitated by an organisation culture that appreciates
and task-oriented organi-sation culture (Leggat & Balding learning and emphasises the nurse leader’s role (also
2013). Garneau & Pepin 2015). The interpretation of culture
Lack of time and human resources are factors inhibit-ing varies between leaders and nursing staff. Furthermore,
knowledge management in relation to the theme of better understanding of the workplace culture and its
leadership. Lack of time resources is a result of short-term connection with patient, nurse and organisational factors
goals and insufficiency of human resources reserved for the would equip nurse leaders with ideas on how to develop
development of competencies (Strick-land & O’Leary- strategies for improving nurs-ing-sensitive patient
Kelley 2009, Carr & Clarke 2010, Akerjordet et al. 2012). outcomes (Hahtela 2015).
Development of competencies without time specially Factors related to organisation culture and leader-ship
allocated for the process causes time-pressure-related stress have a dual nature as they contain both facilitat-ing and
in employees (Guest et al. 2013). Factors related to lack of inhibiting factors. Non-Magnet hospital status and lack of
human resources include failed recruitments, low number time and human resources is related to factors inhibiting
of employees related to workload, and uncertainty and knowledge management. Carlson and Plonczynski’s (2008)
temporariness of the role of supervisors (Guest et al. 2013, systematic review of 45 stud-ies indicated that factors
Leggat & Balding 2013). related to the organisation were most frequently identified
as obstacles; for instance, insufficient time resources for
reading studies and implementing new ideas and lack of
authority by nurses inhibited realising changes.
Role of the nurse leader in nursing
knowledge management
Despite the dual nature of the factors facilitating and
The role of the nurse leader in knowledge manage-ment inhibiting knowledge management, time and employee
contains two main themes; the facilitator and the organiser. resources only emerged as inhibiting factors. The results of
As a facilitator, the leader acts as a pro-moter of collective this review support the idea that increasing time and
learning in both units and the organisation (Carr & Clarke employee resources will not alone facilitate knowledge
2010). The leader’s com-mitment and assertiveness are management (also Coventry et al. 2015). Instead,
facilitator traits (Chen 2012). The leader is interested in facilitating knowledge management would require leaders
facilitating nursing and professional growth. Additionally, to actively support nurse commitment, encourage, take into
he or she is capable of forming personal relationships with account and enable reciprocal feedback, and offer enough
staff and providing them with role modelling and mentor- training opportunities (Bahtsevani et al. 2010, Gifford et al.
ing (Anonson et al. 2014). 2011). According to our results, nurse leaders can support
infrastructures that facilitate learning and the development
In the role of the organiser, the leaders coordinates and of nurses’ competencies by providing tools and spaces for
visualises knowledge management and acts as a situational shared knowledge creation and reward systems that
leader and team coordinator. As a coordi-nator, the leader acknowl-edge competence development (also Flodgren et
is well acquainted with the substance of nursing, aware of al. 2014, Saunders & Vehvil€ainen-Julkunen 2015).
everything going on at the unit, and capable of managing
the different situations that may emerge. Leaders also have According to Sandstroma€ et al. (2011) the charac-
an extensive perspec-tive of the operations of their units teristics of the role of leaders is a sum of personal qualities,
(Tregunno et al. 2009). Leaders determine a mission, formal education and the context and organ-isation in
vision, strategy and aims for knowledge management which leadership is practised. Leaders influ-ence
(Chen 2012). They must also recognise development areas knowledge management by their personal characteristics,
in employee competencies (Leggat & Balding 2013). the organisation and culture. Nurse leaders influence the
learning culture of the organisa-tion as mentors and role
models. Their role is pivotal in implementing evidence-
based procedures to avoid unnecessary, ineffective or even
Discussion
harmful treatments (Wallen et al. 2010). Leaders have
This is the first systematic review concerned with reported risks and anxiety associated with adopting an
examining the role of nurse leaders from the additional
ª 2017 John Wiley & Sons Ltd
Journal of Nursing Management 11
A. Lunden et al.

leadership role. Nurse leaders need support and educa-tion

Study validity, reliability and limitations
on knowledge management and EBP to be appro-priate
competent and courage to fill the role of a knowledge Several test searches were made with numerous differ-ent
management innovator and change man-ager (Kitson et al. search terms before the information search reported in this
2011). Some previous studies have presented positive review. The final search terms and phrases were selected
results regarding enhancing nurse leaders’ capabilities in with the help of an information specialist and MeSH terms
knowledge management through training programmes were used. Searches were conducted in four databases. The
(Gifford et al. 2011) and mentorship programmes (Wallen number of databases can be considered a limitation of this
et al. 2010). review. How-ever, the databases are commonly used, cover
The findings from this review indicate, leaders play a many scientific fields and are deemed the most comprehen-
multifaceted role in knowledge management, acting as sive in health sciences (Centre for Reviews and Dis-
facilitators at the individual and organisational levels, and semination 2009). The fact that all of the articles were
organisers creating favourable conditions for developing published in English might have caused some publica-tion
competency. The findings of Grealish et al. (2014) and bias. In contrast, the studies originated from 12 different
Everett and Sitterding (2011) were similar. Nurse leaders countries, which decreases possible bias to some extent.
are expected to support nurses at all organisational levels in Grey sources were not examined, but all reference lists in
questioning practices, thinking critically and basing their the selected publications were exam-ined to find additional
decisions on the best available evidence. Leaders should publications.
respect nurses’ autonomy, authority and accountability.
They provide possibilities for shared leadership in Two researchers selected the publications. All selec-tions
knowledge man-agement and give constant feedback on were discussed at every stage of the selection pro-cess. A
competence development (also Bahtsevani et al. 2010). senior researcher served as one of the researchers in the
Everett and Sitterding (2011) indicate that, through nursing selection process. Clear inclusion and exclusion criteria
staff, transformative nurse leaders can influence patient were applied. The selection process was carefully
care and support producing remarkable outcomes. In documented, making it easy to follow. Details of the
knowledge management, nurse leaders should have original articles were included in a table. Criteria by
abilities to enhance interdisciplinary relationships and Gifford et al. (2007) were used in assessing the articles.
partnerships with universities and act as change agents. The criteria are suitable for the assessment of both
According to Melnyk et al. (2012) nurses in Magnet qualitative and quantitative articles.
institutions report higher levels of more con-sistent Factors limiting forming a synthesis included the small
implementation of evidence-based practice, availability of scale of data in the selected studies; many stud-ies had
evidence-based practice experts, organi-sational culture been conducted at a local level and in different work
supporting evidence-based practice, routine educational communities. The small number of the articles limited
offerings in evidence-based prac-tice and routine forming a synthesis of the role of nurse leaders in
recognition of evidence-based practice efforts than nurses knowledge management.
in non-Magnet institutions.
Conclusion
The results of this review were limited regarding the
identification of the role of leaders in knowledge man- The results of this review indicated that there continues to
agement. Previous studies on evidence-based practice have be little research available on knowledge manage-ment
also pointed out that the nature of nurse leader’s role has despite the long tradition of nursing leadership research. It
not been fully identified (Andreasson et al. 2016). can be argued that there is need for research on how
Wilkinson et al. (2011) found in their case studies that the knowledge management in nursing can be used to
nurse leader’s role is under-articulated, largely passive and influence organisation-related obstacles on imple-
limited by competing demands. Knowledge of mentation of evidence-based practice. Research should be
measurements for competency identifi-cation and tracking focused on factors related to nurse leader and change agent
and interventions that nurse lead-ers can use in knowledge roles influence the effectiveness of the develop-ment of
management is also limited. Identifying nurse leaders’ role, competency, and how nurses’ professional development
measurements for com-petency identification and tracking can be supported.
and interventions in knowledge management are therefore In the future, it is important to study the cultural factors
important future research challenges. with influence on knowledge management. Further studies
are also needed on the role of nurse
ª 2017 John Wiley & Sons Ltd
12 Journal of Nursing Management
 Knowledge management and nurse leaders

leaders’ knowledge of measurements for competency

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14 Journal of Nursing Management