Introduction
Nurse leaders act as guides for healthcare teams, ensuring quality patient care. These leaders leverage critical thinking, problem-solving, and decision-making skills, drawing on their knowledge in practical, theoretical, and emotional domains. Nurse managers optimize resources to ensure efficient healthcare delivery. They oversee team well-being, coordination, and activities, fostering a positive environment for staff and patients [1]. Leadership and management are crucial for effective patient care, influencing patient outcomes and team performance [2]. Good leadership and management in healthcare demonstrate the holistic understanding of optimizing team performance to meet patient needs with available resources [1]. Leading and managing in healthcare requires extensive experience across various patient, and clinical contexts [3]. While leadership skills traditionally prepare nurses for future leadership roles, integrating them throughout nursing education offers a broader impact. This equips student nurses with the ability to think critically, manage time effectively, and communicate clearly – all crucial for patient advocacy and efficient healthcare delivery. This well-rounded skillset fosters not only their personal career development but also strengthens teamwork, builds trust with patients and colleagues, and ultimately contributes to a more positive and efficient healthcare experience for everyone [4].
Student nurses benefit from early exposure to leadership and management skills such as task delegation, prioritization and resource management, enhancing their readiness to fulfil these roles upon becoming registered nurses [5]. However, many student nurses experience role confusion and struggle to utilize the necessary leadership and management skills, especially when addressing issues such as life-threatening emergencies, pandemics, or conflicts involving different staff members [6].
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Currently, nursing education tends to place less emphasis on leadership and management skills for student nurses. Traditionally, the focus has been on equipping students with strong clinical skills, such as patient assessment and medication administration. This emphasis, combined with potential limitations in faculty expertise, resource constraints, and the curriculum’s focus on passing licensing exams, may explain why leadership and management skills have not been fully integrated [7]. The absence of strong role models and effective mentorship experiences in clinical settings hinders student nurses’ ability to learn leadership and management skills. This can result from mentors’ unwillingness or inability to teach these skills or from miscommunication between mentor and student. Such factors lead to missed opportunities for developing essential skills, leaving students confused, stressed, and ill-prepared upon graduation [8]. The nursing education curriculum itself may also contribute to this gap. It may not adequately equip students with the knowledge and skills to demonstrate professionalism when faced with the inevitable leadership and management challenges of clinical settings [9]. Student nurses often enter clinical environments unprepared to navigate the complex interpersonal dynamics involving patients, staff members, and families [10]. The curriculum may not sufficiently prepare them to manage these interactions professionally in the context of foreseeable leadership and management challenges. Furthermore, the lack of emphasis on leadership and management training during their education results in a deficit in crucial skills such as communication, prioritization, and critical thinking — all essential for success in leadership roles [11].
Existing literatures also do not provide concrete and standardized means to improve leadership and management skills for the student nurses. The dynamic and diverse nature of leadership and management presents an additional challenge for student nurses, as they must adapt to constantly changing patient needs and environments without having a solid foundation, understanding of the skills that they need to have to prepare themselves in the clinical setting [12]. Besides the lack of preparedness strategies for leadership and management skills, there exists a gap in current literature regarding the specific leadership and management skills needed by student nurses in the clinical setting. This scoping review aims to explore existing literature that investigates the leadership and management skills necessary to prepare student nurses for their roles in clinical settings.
Objectives
The objective of the scoping review is to offer a comprehensive examination of published studies within the research topic area pertaining to leadership and management skills that are deemed important to prepare student nurses for their leadership and managerial role after their graduating and prior to their transition to becoming registered nurses in the clinical setting.
Review questions
What leadership and management skills do student nurses need to cultivate to prepare themselves to become effective nurse leaders in clinical settings?
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Which specific leadership and management skills do student nurses often find challenging to develop or require more focused improvement?
Methods
A scoping review was conducted to address broad research questions and to map existing evidence related to leadership and management surrounding student nurses from various sources. Synthesizing the papers in the review facilitates analysis of the research literature, helping researchers identify knowledge gaps and develop a deeper understanding of the issue [13]. The scoping review is reviewed using the framework PRISMA (2021). The SPIDER search strategy was employed to identify the most relevant literature for inclusion in the scoping review and to define key elements discussed within the research field, thereby enhancing its rigor and standardizing the search strategy.
The Sample, Phenomenon of Interest, Design, Evaluation, and Research type (SPIDER) [14] search strategy was utilized to guide the selection of studies as shown below.
Sample
student nurses, undertaking leadership and management training or program.
Phenomenon of interest
studies related to leadership and management skills for student nurses.
Design
published article originated from the globally acknowledged international organization which presents ideas on the leadership and management skills needed for student nurses.
Evaluation
narrative, explorative findings, which describe the leadership and management skills needed for student nurses.
Research type
qualitative, quantitative, or mixed method. Literature must be published within the most recent five years to the current year (2018 to 2023). Chosen articles must also be presented in the English language.
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Inclusion criteria
Inclusion criteria for the study encompass studies involving student nurses engaged in leadership and management training or programs at undergraduate and postgraduate level. Including student nurses in these selected studies ensures relevant sourcing for addressing the research topic. Additionally, studies related to the preparation of leadership and management skills involving student nurses within the sample population will be considered to address the specific research aim of investigating leadership and management in nursing care.
Scientific studies employing quantitative, qualitative, or mixed methods, including reviews, that discuss leadership and management needs for student nurses will also be included to enhance the diversity and deepen understanding of existing research. Chosen studies need to be published between 2018 and 2023 to ensure they are current and relevant, which is crucial in the dynamic and rapidly evolving field of nursing education. Changes in healthcare environments and leadership challenges can occur due to factors like technological advancements, policy shifts, pandemics, and societal transformations [15]. Therefore, including recent studies in the review enables better contextualization of the needed leadership and management skills for student nurses that align with and reflect the current healthcare landscape, policy frameworks, and organizational structures. Moreover, studies must be available in English to facilitate data extraction and analysis.
Search strategy
The research team began by clearly defining and discussing the research question and study objectives. This ensured a focused search strategy. Key concepts relevant to the research questions, such as leadership, management, skills, and student nurses, were identified. These concepts were then translated into search terms which was then formed in alignment with Medical Subject Headings (MeSH) terms, standardised terms used to index articles in PubMed and other databases, including synonyms and related terms (Table 1).
Multiple databases, including PubMed, Scopus, ScienceDirect, and Google Scholar, were considered for the search. To ensure access to the most relevant and reliable information, the study utilized databases known for their extensive collections of current, peer-reviewed literature. These databases also provide a valuable range of perspectives and allow for in-depth searching through their advanced functionalities.
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Boolean operators such as ‘AND’ and ‘OR’ were used, along with truncations (*), to combine search terms and identify articles potentially linking these themes. These operators were also employed to refine search results, ensuring the search was broad yet specific enough to capture all relevant literature. Additionally, filters were applied to refine the results and ensure their relevance. These filters included language (English), access type (free full text, full text, abstracts), and publication date (2018–2023).
The search process was iterative. An initial broad search was conducted by the primary researcher, HZAR to identify relevant articles. The search strategy was then refined based on the initial results to achieve a comprehensive overview of the topic. Throughout the process, meticulous documentation was maintained. This documentation included the databases searched, search terms employed, filters applied, and any adjustments made. This ensures transparency and replicability of the scoping review, facilitating discussions among the research team for further refinement or consultation.
Table 1
Search terms used in the scoping review data extraction step
Initial search terms | MeSH Term used | Related terms | Phrases searched (using combined terms) |
|---|---|---|---|
• Student nurse • Leadership skill • Management skill | Student nurse: MeSH Term: “Students, Nursing” Leadership skill: MeSH Term: “Leadership” Management skill: MeSH Term: “Management” | Student Nurse: • Pre-licensure nurse • Nursing student • Student in nursing • Undergraduate nursing student • Novice nurse (newly graduated nurse) Leadership Skill: • Delegation • Communication (verbal & written) • Conflict resolution • Critical thinking • Decision-making • Team building • Motivation • Mentorship • Advocacy • Time management • Interpersonal skills Management Skill: • Resource allocation • Prioritization • Task management • Budgeting • Scheduling • Quality improvement • Delegation • Risk management | • “Leadership development for student nurses,” • “Management training for student nurses” |
Selection of studies
The selection of studies was initially conducted by the primary researcher, involving a search for relevant articles based on their titles and abstracts via databases such as PubMed, ScienceDirect, Scopus, and Google Scholar. Inclusion criteria and filters were applied to enhance the researcher’s ability to scan and select appropriate studies for inclusion in the review. The selected articles were then presented to the co-authors for discussion regarding their relevance in addressing the research question and their inclusion in the review. The involvement of other authors in the article scanning and reviewing of the articles enhances the reliability and validity of the review findings, ensuring that the review process was rigorous and free from bias. The primary researcher alongside the co-authors further evaluated the filtered studies independently to assess whether the included student nurses had participated in any leadership and management training, seminars, or workshops. This evaluation involved scanning the abstracts, methodologies, keywords, and study designs of the articles. Discussions also centred on the content and focus of the studies, which aimed to investigate the leadership and management skills of student nurses. Once mutual consensus was reached on the included studies, further screening was conducted to minimize the risk of bias.
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Search outcome
Following an initial screening of 47 potentially relevant studies, a closer review revealed that 24 did not focus specifically on leadership and management skills for student nurses. Instead, they addressed general preparation for the clinical setting. Additionally, six studies targeted healthcare workers in general, potentially deviating from the review’s focus on nursing professionals. Finally, 17 studies were excluded because they explored leadership and management skills solely from the perspective of registered nurses or experienced nursing leaders. These exclusions resulted in a final selection of 15 studies that directly align with the review’s inclusion criteria and research objectives. The PRISMA framework guided the selection process throughout the scoping review, and each step has been documented (Fig. 1).
Fig. 1
PRISMA 2020 flow diagram for scoping review conducted which included searches of databases and registers only. Duplicate records were filtered by automation tools, however, filtered records were screened by the research team. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: https://doi.org/10.1136/bmj.n71
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Quality assessment of studies
Scoping reviews, unlike systematic reviews, typically don’t involve formal quality assessment tools for the included studies. The focus of a scoping review is to map the existing literature on a particular topic, not to assess the quality of individual studies. However, several frameworks and guidelines are implemented to ensure the methodological rigor of a scoping review. In addition to an iterative process and constant consultation with the research team, the PRISMA Extension for Scoping Reviews (PRISMA-ScR) is utilized to provide guidance on specific elements to be reported, enhancing the review’s transparency and replicability.
Appraisal tools adapted from systematic reviews can also be used in scoping reviews to assess the relevance of included studies to the research question using the ‘Critical Appraisal Skills Program’ (2018). The program offers a framework and set of guidelines to assist individuals in evaluating the quality, relevance, and trustworthiness of research studies, with a particular focus on healthcare and social sciences. It provides checklists comprising questions related to study design, methodology, results, and conclusions, enabling users to systematically assess various aspects of a research study.
This program facilitated the systematic evaluation of the trustworthiness, relevance, and results of published papers in addressing the purpose of the review. By employing this tool, the research team ensured that all essential factors and considerations were taken into account, promoting consistency in addressing the research question and providing a framework for data analysis [16].
After applying the CASP checklist, the review met the criteria outlined in the tool. The checklist addresses the validity of the included studies, the content of their results, and their relevance to identified gaps in knowledge. The successful completion of the CASP tool for systematic reviews indicates the robustness and quality of the review process. All selected articles were compiled and charted collectively using Microsoft Word software, enabling easier and categorized analysis. Frequent communication and discussions among the researcher team were conducted to provide opportunities for further evaluation of the papers. Agreement between both parties regarding the inclusion of studies in the review was sought until consensus was reached.
Data extraction
From the selected articles, data pertaining to the examination of leadership and management skills among student nurses at any level are extracted by the main researcher which took over the span of one month. Referring back to the research question as a guide, the methods used to assess or evaluate these skills are not restricted, allowing for a broader range of perspectives on the unique interactions and strategies observed in other studies. Additionally, qualitative data, including student nurses’ perspectives and input on skills they wish to improve or consider important, is deemed valuable and included in the scoping review. The data extracted from the selected articles are systematically organized according to themes and identified by the author, year of publication, samples chosen for each study, study design, and the skills identified within each study (Table 2). The selected studies were thematically analyzed to identify common or contrasting topics that can offer substantial insights into understanding the leadership and management skills necessary for student nurses. This organization allows for a systematic analysis and comparison of the findings and content of the articles, facilitating discussion based on similarities for further analysis and comparison.
Table 2
Characteristics of included studies
Author & Year | Objectives | Study Design | Sample | Skills Identified | CASP Score |
|---|---|---|---|---|---|
van Diggele et al., 2022 [32] | To explore participant perception and performance, and the contextual factors that influence student aspirations as clinical teachers. | The study employed semi-structured interviews with participants after they completed the Student Interprofessional Facilitator Training (SIFT) program. | Number of participants: 16 student nurses Academic Background: Undergraduate Country of Origin: Sydney, Australia | ● communication skills ● role awareness ● deep understanding of leadership ● time management skills ● creation of a supportive and friendly environment ● adaptability | 8: Represents a high-quality, robust study with solid evidence relevant to the review question. |
Jaworski et al., 2022 [13] | To determine whether perfectionism can be a mediator between self-efficacy, and authentic leadership skills in student nurses | In this cross-sectional study, student nurses completed the Authentic Leadership Questionnaire, Almost Perfect Scale-Revised (APS-R), and General Self-Efficacy Scale. | Number of participants: 615 student nurses Academic Background: Undergraduate Country of Origin: Warsaw, Poland | ● Reflection ● Self-Efficacy ● Adaptiveness ● Intrapersonal understanding of own skills ● Self- awareness ● Decision making | 9: The study demonstrates high methodological rigor, is reliable and trustworthy, with few or minor flaws, providing strong evidence relevant to the review question. |
Meneghesso et al., 2023 [20] | To verify the contributions of using the “blindfolded” technique on student nurses’ self-confidence and knowledge in critical patient care in simulated clinical scenarios. | This quasi-experimental study involved student nurses who attended a workshop and participated in simulated scenarios. The researchers used the “Self-confidence Scale” and the Checklist of CPR Knowledge, Skills and Attitudes to assess the students. | Number of participants: 25 student nurses Academic Background: Undergraduate Country of Origin: São Paulo, Brazil | ● communication ● self-confidence ● teamwork ● trust | 8: Represents a high-quality, robust study with solid evidence relevant to the review question. |
Terkamo-Moisio et al., 2022 [29] | To apply and analyze an educational strategy to develop management skills in student nurses to work in hospital practice. | This exploratory qualitative study involved student nurses attending 13 workshops. After the workshops, the students participated in semi-structured interviews guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) instrument. | Number of participants: 44 student nurses Academic Background: Undergraduate Country of Origin: Finland | ● communication ● decision making ● interpersonal relationship ● Reflection ● Persuasion ● Strategic planning ● Negotiating ● Conflict resolution | 9: The study demonstrates high methodological rigor, is reliable and trustworthy, with few or minor flaws, providing strong evidence relevant to the review question. |
Unsworth et al., 2021 [31] | To identify the constructs that should be part of an assessment of student nurse competence in relation to clinical nursing leadership, and to evaluate the tool’s reliability. | Phase 1: The researchers built the assessment tool by reviewing existing literature (deductive approach) and consulting with experts. Phase 2: The tool was then evaluated among student nurses to assess its reliability and internal consistency. | Number of participants: 75 student nurses Academic Background: Postgraduate Country of Origin: Newcastle, United Kingdom | ● prioritisation, ● management of resources, ● communication ● management of risk | 9: The study demonstrates high methodological rigor, is reliable and trustworthy, with few or minor flaws, providing strong evidence relevant to the review question. |
Bryan & Vitello-Cicciu, 2022 [3] | Investigating the relationship between perceived preceptor authentic leadership and final year student nurses’ self-efficacy, job satisfaction and performance. | This correlational study employs a pre-test, post-test design to assess changes in student nurses’ knowledge or skills before and after their preceptorship. | Number of participants: 94 student nurses Academic Background: Undergraduate Country of Origin: Alberta, Canada | ● Create positive environment ● Great self-awareness ● Improve team morale ● Decision making ● Transparency | 9: The study demonstrates high methodological rigor, is reliable and trustworthy, with few or minor flaws, providing strong evidence relevant to the review question. |
Leal et al., 2022 [16] | To apply and analyze an educational strategy to develop management skills in student nurses to work in hospital practice. | The researchers used an intervention approach, holding 13 workshops where students discussed real-world management scenarios (management cases). Following the workshops, the researchers conducted in-depth interviews with the students (semi-structured interviews) to understand their experiences and perspectives. | Number of participants: 54 student nurses Academic Background: Undergraduate Country of Origin: São Paulo, Brazil | ● communication ● decision making ● leadership ● maintaining interpersonal relationships. | 8: Represents a high-quality, robust study with solid evidence relevant to the review question. |
Mrayyan et al., 2023 [24] | This study surveyed the attributes and skills of clinical nursing leadership and the actions that effective clinical nursing leaders can do. | This cross-sectional study involves disseminating online survey investigating clinical leadership. | Number of participants: 296 student nurses Academic Background: Undergraduate Country of Origin: Jordan | ● effective communication ● clinical competence ● approachability ● role model ● support | 8: Represents a high-quality, robust study with solid evidence relevant to the review question. |
Welch et al., 2019 [33] | This study designed a simulation which provides students with the opportunity to showcase the authenticity of the patient care experience using leadership skills. | The “Mock Hospital” capstone simulation was designed as a part of the Leadership in Professional Nursing Practice course in an undergraduate nursing program. Feedbacks were obtained upon completion of simulation. | Number of participants: 112 student nurses Academic Background: Postgraduate Country of Origin: Alabama, USA | ● critical thinking ● clinical judgment ● decision-making ● prioritization skills ● delegation | 8: Represents a high-quality, robust study with solid evidence relevant to the review question. |
Fuster Linares et al., 2020 [11] | To identify the dimensions of leadership present among nursing undergraduates in the original Self-Assessment Leadership Instrument (SALI). | This study focused on adapting an existing tool, the Self-Assessment Leadership Instrument (SALI), for use by Spanish student nurses. | Number of participants: 280 student nurses Academic Background: Undergraduate Country of Origin: Spain | ● Strategic thinking ● Emotional intelligence ● Impact and influence ● Teamwork | 8: Represents a high-quality, robust study with solid evidence relevant to the review question. |
Miles & Scott, 2019 [21] | To establish an integrated leadership development model for prelicensure student nurses | This study reviews trends, and synthesizes existing leadership theories through directed content analysis. | - | ● Envisioning goals ● Communication | 8: Represents a high-quality, robust study with solid evidence relevant to the review question. |
Karaman et al., 2023 [15] | To develop and examine the validity and reliability of the Education Leadership Scale for Student nurses. | The Educational Leadership Scale for Student nurses was developed in five stages (reviewing the literature, developing items, sending scale items to the experts for content validity index, piloting tests with students, performing the validity and reliability analysis of the tool). | Number of participants: 280 student nurses Academic Background: Undergraduate Country of Origin: Turkey | ● cognitive ● social-interpersonal (affective) ● psychomotor skills ● advocacy ● communication ● empowerment ● decision making ● rehabilitative | 9: The study demonstrates high methodological rigor, is reliable and trustworthy, with few or minor flaws, providing strong evidence relevant to the review question. |
Reime et al., 2022 [23] | Explore how second-year student nurses experience development of nursing leadership competence when participating in student-run teams (SRTs). | This study uses a qualitative approach with a descriptive, exploratory design to examine 37 reflective notes written while students were undertaking their leadership training in 14 medical and surgical wards. | Number of participants: 37 student nurses Academic Background: Undergraduate Country of Origin: Oslo, Norway | ● Communication ● collaboration ● prioritization ● delegation | 8: Represents a high-quality, robust study with solid evidence relevant to the review question. |
Williamson et al., 2021 [34] | To investigate whether or not the team working and leadership module has an impact on students’ self-reported leadership skills. | This study employed a quantitative approach using a pre- and post-module survey using the Student Leadership Inventory – Self, and followed by a qualitative approach through conducting a virtual focus group with the students. | Number of participants: 52 student nurses Academic Background: Undergraduate Country of Origin: Plymouth, United Kingdom | ● Team dynamics ● Situation awareness ● ability to lead unconsciously ● development of new skills in practice ● interpersonal awareness of others skills. | 9: The study demonstrates high methodological rigor, is reliable and trustworthy, with few or minor flaws, providing strong evidence relevant to the review question. |
Jo & Hwang, 2022 [14] | identify the relationship between self-leadership, goal commitment, critical thinking, and problem-solving abilities in nursing undergraduates who experienced simulation training on practice and the impact of these variables on problem-solving processes. | A self-reporting survey assessed self-leadership, goal commitment, critical thinking, and problem-solving skills in 260 student nurses who had participated in simulation practice. | Number of participants: 260 student nurses Academic Background: Undergraduate and Postgraduate Country of Origin: South Korea | ● critical thinking ● goal commitment ● explanatory powers | 8: Represents a high-quality, robust study with solid evidence relevant to the review question. |
Data synthesis
For this review, the narrative synthesis approach was employed by the main researcher to compile, summarize, and explain the findings of each selected article. This approach emphasizes narrative and descriptive accounts from participants rather than relying solely on statistical results, thus offering a deeper understanding of the interactions and relationships relevant to the research question [17]. The results were then shared with the rest of the research team, who would discuss, verify, and validate their relevance for inclusion in the scoping review. This process was also undertaken to minimize potential bias and errors made by the primary researcher. The research team had full access to the documentation of the data synthesis process to ensure transparency and replicability, thereby enhancing the objectivity of the review. The synthesized results (Table 2) provides an overview and summary of the selected articles included in this review.
Characteristic of studies - study designs
The chosen studies were conducted in various healthcare institutions and nursing schools across multiple countries, including Australia, the United States, and Poland. All the articles were published between 2019 and 2023 and utilized either qualitative, quantitative, or mixed-method approaches in their design. The quantitative aspect involves the use of scales, questionnaires, and assessment tools to collect data on the leadership and management skills deemed relevant by participants. Meanwhile, the qualitative aspect entails the utilization of semi-structured interviews, focus groups, and individual interviews. This combined approach allows for a comprehensive exploration of leadership and management skills among participants, capturing both quantitative data for statistical analysis and qualitative insights through in-depth interviews and discussions.
Study participants
The selected review articles predominantly consist of undergraduate student nurses, which aligns with the research question for this literature review. Although one study included postgraduate students in a separate group, this review will focus solely on the perspective of undergraduate student nurses to maintain consistency and focus.
In addition to nurses, students from various majors such as medicine, radiography, dentistry, and midwifery, as well as managers, were also involved in one of the studies. The selected studies encompass participants ranging from 16 to 615 individuals, reflecting a diverse range of perspectives and experiences within the scope of leadership and management skills among healthcare professionals and students.
Result of review
After conducting thematic analysis of the selected studies, several themes emerged regarding leadership and management in nursing. These themes include students’ perspectives on essential skills for becoming effective leaders in clinical settings, based on their experiences in undergraduate or postgraduate studies. Mentorship was highlighted as a crucial learning process for student nurses, aiding in the identification of relevant leadership and management skills. Additionally, workshops, training sessions, and simulations were frequently cited in the studies as facilitating students’ preparation for their leadership and managerial roles. Through these activities, student nurses were able to actively engage and identify the necessary skills they need to master before assuming leadership or managerial positions in clinical settings.
Learning through experience: exploring student views on identified skills
The various approaches presented in each of the studies showcased in the review reveal similar themes regarding student nurses’ perceptions and experiences with leadership roles upon transitioning to registered nurses. Students consistently express feeling ill-prepared for leadership responsibilities and recognize the importance of developing competency, which necessitates more time and opportunities to learn and practice their leadership and managerial skills especially task delegation, critical thinking, and resource management [18]. Students identified these skills as the most crucial for leadership preparation, as they strengthen self-efficacy and adaptability upon graduation, which are essential to mitigate culture shock.
Additionally, students emphasize the importance of management competencies such as communication, decision-making, and interpersonal relationships. These skills were identified as the most challenging because they require building close rapport and familiarity with the clinical environment [19]. Nevertheless, mastering these skills is essential for students.
The impact of mentorship on developing student leadership skills
Concerns are raised about the influence of role models on their learning experiences and perspectives, highlighting the subjective nature of mentorship and its impact on students’ ability to practice leadership and management skills such as task delegation, problem solving and critical thinking in clinical settings [20]. Mentorship programs are viewed positively by students, providing valuable support for their professional growth and leadership development, including emotional support and a sense of belonging [18]. Based on the majority of studies extracted, student nurses find it difficult to maximize their mentorship experience to identify and develop the necessary leadership and management skills in the clinical setting [21]. Students have expressed that their mentorship experiences do not sufficiently provide learning opportunities to practice advanced leadership skills due to lack of clinical time, understaffing, mentor’s capability to teach and unmatched expectation among many more [19]. These skills, which students have identified as more physically and mentally demanding, include conflict resolution, critical thinking during emergencies, and problem-solving.
Workshop in leadership skill identification and development
Similarly, in a study involving healthcare students from various academic majors, participants expressed satisfaction with a leadership and management training program. They reported improvements in interprofessional communication skills, increased awareness of other health professions’ roles, and enhanced understanding of leadership concepts [22]. Workshops involving simulation also yielded positive outcomes, with students reporting increased knowledge of the needed leadership and management skills and self-confidence when facing critical scenarios. During these workshops, student nurses were able to identify key leadership and management skills that they deem important and believe should receive more focus during their training. These skills include delegation, task prioritization, and resource management [19].
Overall, these findings underscore the importance of comprehensive training programs, mentorship opportunities, and simulation-based learning in preparing student nurses and healthcare professionals for leadership roles in clinical settings.
Enhancing preparation: perspectives of student nurses
The majority of participants across various studies have shared insights that could enhance their preparation in leadership and management skill development. Strategies identified in these studies include the use of assessment tools and various scales. These tools can help identify the essential leadership and management skills required by student nurses for their roles in leadership and management. These skills include task delegation, critical thinking, prioritization and resource management [23]. However, participants have expressed a lack of confidence due to insufficient opportunities to practice during workshops, seminars, and simulation programs. It was noted that only students actively participating in leadership roles gain the most experience and benefits, while those observing or not placed in leadership roles gain less experience in practicing their leadership skills such as task delegation, critical thinking, and resource management [19].
Equal opportunities should be provided to all students to ensure a fair learning experience, which would enhance their confidence and competency in leading and managing nursing team [24]. A thorough understanding of nursing skills is necessary to develop standardized tools and guidelines applicable across different student majors. Studies should not only focus on specific leadership styles but also acknowledge various classical and modern styles applicable to different individuals based on their work environment, style, and patient needs [6].
Participants in some studies expressed a lack of role clarity due to diverse experiences gained from clinical placements and role models [25]. Further investigation is needed to provide clarity on students’ roles and scope of practice. Participants also suggested incorporating reflection and feedback sessions to allow them to express concerns, communicate experiences, and develop intrapersonal skills [18]. Such sessions can aid in identifying strengths and weaknesses, guiding students in choosing the most suitable leadership and management styles based on their skills and learning experiences.
Discussion
With the purpose of the research being to identify the leadership and management skills necessary for student nurses to develop in preparation for becoming leaders and managers in clinical settings, it is important to explore various aspects of preparation and approaches taken in different studies. These include mentorship, workshops, and simulations, in order to identify the specific leadership and management skills that student nurses need to prepare themselves holistically.
Mentorship influence in students’ learning experiences
From the findings of the themes in the reviewed articles, it is evident that mentors serve as role models for student nurses, guiding them in identifying the necessary skills and developing them in clinical settings, aligning with the study’s aim to pinpoint essential leadership skills. During clinical placements, students have the greatest opportunity to practice and learn leadership skills such as prioritization, interpersonal communication and critical thinking through hands-on interaction with nursing teams and patients [26]. Mentors serve as positive role models by demonstrating effective leadership and management practices in real-world clinical settings. They showcase effective communication, problem-solving, decision-making, and team collaboration skills [26]. Observing these skills in action allows student nurses to learn by example and aspire to similar leadership qualities. Mentors can guide student nurses through real-world clinical challenges, requiring them to analyze situations, make decisions, and solve problems independently. This fosters critical thinking skills necessary for effective leadership and management [27].
Hence, it is crucial to carefully select mentors who can effectively serve as role models and guides for students during their transition to becoming registered nurses [21].
Creating a conducive learning environment allows both mentors and mentees to benefit from interactive and two-way learning experiences, thereby mitigating culture shock as students transition into independent registered nurses expected to lead and manage teams without supervision [9]. Mentorship fosters open communication between students and experienced nurses. This allows students to ask questions, discuss challenges, and receive feedback on their leadership and management approaches. This communication helps students refine their communication skills, which are crucial for effective leadership [27]. Participants in one of the reviewed studies highlighted the benefits of frequent feedback sessions and mentor advice in developing confidence, awareness, and a sense of belonging which are also integral leadership skills which student nurses can adopt [20]. Mentors can share their own experiences and knowledge of leadership and management within the healthcare system. This includes navigating complex situations, delegating tasks effectively, and advocating for patients. This knowledge transfer provides students with valuable insights beyond what they may learn solely in the classroom [9].
Given the importance of mentorship, nursing education should put more emphasis on utilizing the mentorship experience as an integral part of the nursing education to develop the student nurses’ leadership and management skills. Mentors can provide opportunities for student nurses to practice leadership and management skills in a safe and supportive environment. This could involve delegating tasks during clinical rotations, participating in team meetings, or taking on small leadership roles under the mentor’s guidance [16]. This practical experience allows students to develop their skills while receiving feedback and support.
Students are expected to maximize their experience by establishing professional trust and rapport with their mentors to ensure an optimal learning experience to help them identify and develop the necessary leadership and management skills for them to utilize in the clinical setting [8]. Therefore, nursing educators should liaise with the clinical mentor on proper briefing and establishment of learning goals and expectations to maximise the learning experience for the students. Policy maker on the other hand should have greater recognition on the importance of mentorship for the student nurses’ leadership and management skill development as part of their nursing education.
Challenges in standardizing guideline
The reviewed articles demonstrate the use of various assessment tools and methods to identify necessary leadership and management skills for student nurses. While these approaches have been effective within their respective studies, there is a challenge in ensuring the replicability and validity of such tools across different cultural settings and countries. This highlights the need for the development of standardized guidelines that can be easily replicated and are valid across different nursing education contexts [15]. However, creating a standardized guideline poses challenges, particularly in recognizing the differences in educational preparation across institutions and healthcare systems. Variations in resources, facilities, and program durations can lead to differences in students’ experiences and outcomes. As a result, it may be challenging for students to adapt or relate to standardized guidelines across different regions.
Addressing these challenges requires careful consideration of the unique characteristics and contexts of nursing education programs in different settings. Collaboration among educators, practitioners, and policymakers is essential to develop guidelines that are adaptable and relevant across diverse cultural and institutional contexts [28]. Additionally, ongoing evaluation and refinement of standardized guidelines are necessary to ensure their effectiveness and applicability in promoting the identification and development of leadership and management skills among student nurses worldwide.
Culture, race, and ethnicity also have a significant impact as they influence patient care, team dynamics, interactions within the team, and day-to-day activities in clinical settings. These factors affect how leadership and management skills are utilized, as Western leadership and management approaches may not be applicable in different regions of the world [29]. Therefore, a broader demographic of participants, including student nurses from diverse backgrounds and qualifications, is needed to gain a more comprehensive perspective. The input of registered nurses is invaluable in developing standardized guidelines, as they have first-hand experience of the clinical setting’s daily operations. Registered nurses possess a deeper understanding of workflow and team dynamics compared to students, who may have limited clinical placement opportunities, particularly in busy ward settings with multiple students [10].
Another challenge in creating standardized guidelines is considering individual differences in skills, confidence levels, attitudes, expectations, and backgrounds [30]. These factors influence how individuals perceive necessary skills and the approaches they take to lead and manage teams effectively. Therefore, assessing each unique approach is crucial to ensure effectiveness in the clinical setting [15]. In addition to developing standardized guidelines, clear communication is essential to prevent confusion between academic and clinical settings. This clarity helps students avoid difficulties in translating and applying skills learned in educational institutes and simulations to real clinical scenarios [4].
Impact of interactive learning
From the reviewed articles, various approaches to developing and discovering leadership and management skills have been highlighted. These include workshops, simulations, and leadership programs, which differ from traditional lecture-based learning. Group learning is emphasized in these approaches, positively enhancing teamwork and teambuilding skills among students [31]. Through group learning, students engage in peer teaching and learning, facilitating shared experiences and reducing the burden of individual learning, while identifying the necessary leadership and management skills [32]. Diverse teaching approaches are beneficial, as they cater to different learning preferences, with some participants preferring group learning for a less stressful and pressured environment [5].
Given the clear benefits, nursing education should integrate group learning and interactive activities earlier in the curriculum. However, educators must be innovative while remaining mindful of individual student learning styles and preferences. By actively soliciting student feedback, educators can optimize learning by tailoring the frequency and intensity of group activities to maximize skill development [24]. This is particularly important for leadership and management skills, which require in-depth understanding and practice.
Simulation is highlighted as a safe method for students to practice and learn under supervision, improving readiness and adaptability while mitigating culture shock by allowing students to simulate leadership and management scenarios [32]. Nursing education can leverage simulations to develop leadership and management skills like critical thinking, task delegation, and communication. However, effective simulations require careful design. Educators must be aware of the need for both realistic scenarios, developed in collaboration with clinical mentors or representatives, and a focus on learning objectives to ensure the simulation effectively targets the specific skills being taught [33]. By combining these elements, nursing educators can create impactful simulations that enhance student learning and prepare them for real-world clinical experiences.
Leadership workshops provide students with opportunities for self-reflection, helping them understand their strengths and limitations, identify the needed leadership and management skills and clarifying their scope of practice as leaders or managers. However, ensuring equal opportunities for all participants in interactive learning approaches is crucial to ensure equitable learning experiences [6]. Nursing educators should actively seek out workshops and seminars on leadership and management skills to supplement classroom learning for student nurses. This exposure to diverse learning opportunities broadens student understanding of these crucial skills and fosters their development [34]. Furthermore, policymakers on both the academic and clinical side should prioritize the creation of more workshops, training seminars, and forums focused on leadership and management. By emphasizing the importance of these skills, such programs can contribute to the development of well-rounded leaders and managers, benefiting both student nurses and practicing nurses alike [22].
Furthermore, the components of these programs should be carefully considered by the nursing educators and policy makers, as effective components can be implemented as standard practices if they demonstrate effectiveness across diverse demographics [30]. Overall, a diverse range of interactive learning approaches facilitates the development of leadership and management skills among student nurses, catering to different learning preferences and promoting shared experiences and skill development.
Role clarity amongst student nurses
One of the reviewed articles highlighted that student nurses often face confusion regarding their leadership roles and scope of practice in clinical settings. Role clarity is essential for student nurses to understand their responsibilities, expectations, and needed leadership and management skills as leaders [25]. Clear role definition prevents students from being overwhelmed with unnecessary tasks or responsibilities, allowing them to use their time and energy more effectively [11].
Confusion may arise due to differing expectations of leadership and management among student nurses, hindering their ability to translate learned skills into clinical practice and adapt to the dynamic clinical environment [35]. Therefore, effective communication with supervisors, mentors, and role models is crucial during students’ learning experiences. Seeking frequent feedback and having supportive role models help correct misconceptions and address confusion [20]. Therefore, nursing education should place greater emphasis on clear communication. This can be achieved through proper briefings that establish student roles, learning goals, and expectations for clinical rotations. Facilitating open communication channels between faculty, clinical staff, and students fosters mutual understanding and allows issues impacting student learning to be addressed collaboratively [23]. Policymakers in clinical settings should prioritize training for mentors, ensuring they are well-equipped to impart knowledge, provide guidance, and serve as role models for leadership and management skills development [36]. Careful selection of mentors with strong leadership qualities further enhances the impact. Finally, regularly soliciting feedback from students allows policymakers to identify and address limitations and challenges encountered in the clinical environment. This feedback loop is crucial for shaping effective learning experiences.
Role clarity should be established early in students’ education, before they transition into independent registered nurses expected to lead and manage autonomously. The sooner students understand their roles and scope of practice, the sooner they can effectively lead and manage nursing teams to achieve optimal patient outcomes in clinical settings [3]. Nursing educators should prioritize developing students’ critical thinking, self-reflection, and communication skills. These skills are essential for students, mentors, and educators to collaboratively curate personalized lesson plans that address individual learning needs and foster leadership and management development [36].
Implications for future research
From the review of available articles on the research topic, it is evident that leadership and management skills are essential yet dynamic and multifaceted components of nursing practice. Future research should delve deeper into how student nurses can be adequately prepared and exposed to develop these skills throughout their educational journey as they transition into registered nurses. Additionally, there is a need for further studies to explore effective methods for assessing and evaluating student nurses’ competency levels in these skills. This would facilitate the development of standardized guidelines and learning approaches that can be expanded and refined to better equip student nurses as holistic and proficient leaders and managers in the healthcare field.
Overall, continued research in these areas is crucial for advancing nursing education and ensuring that future nurses are well-prepared to meet the complex challenges of healthcare delivery and provide optimal patient care.
Limitations
The scoping review’s restriction to literature available only in English presents a limitation as it excludes perspectives and information from non-English sources. This exclusion could potentially overlook valuable insights that might be offered by the excluded literature. Additionally, focusing primarily on student nurses as the target population may limit the breadth of perspectives, given their varying levels of clinical experience and expectations of leadership and management. While the research question centers on student nurses, insights from registered nurses could provide new perspectives on the required preparation for leadership and management skills within nursing practice. Incorporating these perspectives could enrich the understanding of leadership and management skill development across different stages of nursing education and practice.
Conclusions
In conclusion, this review has examined fifteen selected articles discussing the nature of leadership and management skills essential for student nurses transitioning into registered nurses. Leadership skills such as delegation, critical thinking, prioritization, and resource management have been identified as crucial for student nurses aiming to enhance their preparation for leadership and managerial roles. Various methods for identifying and developing these skills, including workshops, mentorship, and simulations, have shown positive outcomes in supporting student nurses’ skill development and improving their transition into leadership and management roles. However, further research is needed to explore additional approaches that can help students better understand their leadership roles, develop these skills, and improve their overall preparation, considering their individual learning needs and preferences. Overall, this review underscores the importance of ongoing research and innovation in nursing education to ensure that students are adequately prepared to assume leadership and management roles in clinical practice.
Acknowledgements
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