{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T07:49:27Z","timestamp":1785829767460,"version":"3.56.0"},"reference-count":68,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study explored the experiences of 10 nurse managers when addressing staff underperformance in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A qualitative descriptive design was employed to answer the research question.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were collected through in\u2010depth, semi\u2010structured interviews with 10 nurse managers between March and August 2023. Data were analysed using Braun &amp; Clarke's six\u2010stage thematic analysis framework to identify the challenges and strategies nurse managers employed when managing staff underperformance in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four key themes were identified: Proactive Communication, Relational and Ethical leadership, learning on the job and adhering to policy and human resource processes. Collectively, these themes illustrate the complex interpersonal, organisational, and procedural factors that shape nurse managers' experiences when managing underperformance in practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings indicate that nurse managers integrate ethical and relational leadership approaches to address underperformance in clinical practice. This approach supports constructive performance management while preserving staff dignity and patient safety. Developing these capabilities among nurse managers may strengthen leadership effectiveness and enhance staff accountability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for the Profession and\/or Patient Care<\/jats:title>\n                    <jats:p>Empowering nurse managers through training, mentorship, and aligned human resource processes may strengthen performance management practices and ultimately enhance patient safety and care quality. This study contributes empirical evidence to an area where research remains limited, shedding light on the realities nurse managers face when addressing underperformance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>The findings from this research offer novel insight into the lived experiences and strategies of nurse managers as they navigate underperformance in clinical practice. The findings can inform the development of effective evidence\u2010based performance management approaches across healthcare settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Involvement<\/jats:title>\n                    <jats:p>This study did not include patient or public involvement in its design, conduct, or reporting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jan.70707","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T07:34:21Z","timestamp":1785828861000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ethical and Relational Leadership: How Nurse Managers Address Underperformance in Clinical Practice\u2014A Qualitative Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4020-4238","authenticated-orcid":false,"given":"Anita","family":"Duffy","sequence":"first","affiliation":[{"name":"Our Lady's Hospice &amp; Care Services  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6602-1803","authenticated-orcid":false,"given":"Michael","family":"Connolly","sequence":"additional","affiliation":[{"name":"School of Nursing, Midwifery &amp; Health Systems University College Dublin and Our Lady's Hospice &amp; Care Services  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nepr.2021.103259"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.16565"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.14744\/jern.2021.21221"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-295X.84.2.191"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733019858706"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/2333393617742282"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-69909-7_3470-2"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mpaic.2024.08.013"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.NUMA.0000834580.84896.55"},{"key":"e_1_2_11_12_1","unstructured":"Carroll M.1998.\u201cReport of the Commission on Nursing: A Blueprint for the Future.\u201dhttps:\/\/hdl.handle.net\/10147\/627027."},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1937586715614171"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2018.04.016"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.2147\/JHL.S93724"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733020935958"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.12968\/joan.2023.12.5.235"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1744987119880234"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.12841"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.colegn.2022.02.004"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912\u2010025\u201003043\u20107"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12571"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.13183"},{"key":"e_1_2_11_24_1","volume-title":"Managing Employment Relations","author":"Gennard J.","year":"2016"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1155\/jonm\/2575609"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.13380"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.70358"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.13117"},{"key":"e_1_2_11_29_1","volume-title":"Nurse Leadership in a Changing World: Global Competency Framework","author":"International Council of Nurses","year":"2023"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.13273"},{"issue":"6","key":"e_1_2_11_31_1","article-title":"Impact of Ethical Leadership and Organizational Culture on Nursing Personnel's Organizational Commitment: A Cross\u2010Sectional Study","volume":"17","author":"Kourkouni V.","year":"2025","journal-title":"Cureus"},{"key":"e_1_2_11_32_1","volume-title":"The Leadership Challenge: How to Make Extraordinary Things Happen in Organizations","author":"Kouzes J. M.","year":"2017"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.14165"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1177\/01939459221114079"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzu010"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/0147-1767(85)90062-8"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.4102\/curationis.v43i1.2017"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2024-017682"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.3928\/00220124-20150518-01"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnr.2015.11.006"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102022\u2010067352"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-021-00680-6"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.4102\/hsag.v29i0.2595"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-020-00428-8"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010021\u201006288\u20105"},{"key":"e_1_2_11_47_1","unstructured":"Nursing and Midwifery Board of Ireland.2025a.\u201cGuidelines for the NMBI Professional Competence Scheme for Registered Nurses and Registered Midwives 2025 Pilot Scheme.\u201dhttps:\/\/www.nmbi.ie\/NMBI\/media\/NMBI\/NMBI\u2010Guidelines\u2010for\u2010the\u2010Professional\u2010Competence\u2010Scheme\u2010for\u2010Registered\u2010Nurses\u2010and\u2010Registered\u2010Midwives.pdf."},{"key":"e_1_2_11_48_1","unstructured":"Nursing and Midwifery Board of Ireland.2025b.\u201cCode of Professional Conduct and Ethics for Registered Nurses and Registered Midwives Incorporating the Scope of Practice and Professional Guidance.\u201dhttps:\/\/www.nmbi.ie\/NMBI\/media\/NMBI\/NMBICode\u2010of\u2010Professional\u2010Conduct\u2010and\u2010Ethics.pdf?ext=.pdf."},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.13658"},{"key":"e_1_2_11_51_1","first-page":"49","article-title":"Health\u2010Care Leaders' and Professionals' Experiences and Perceptions of Compassionate Leadership: A Mixed\u2010Methods Systematic Review","volume":"37","author":"\u00d6sterg\u00e5rd K.","year":"2023","journal-title":"International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs\u20102023\u2010016686"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1177\/20571585241238536"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2021.103906"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nepr.2020.102890"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098\u2010240X(200008)23:4<334::AID\u2010NUR9>3.0.CO;2\u2010G"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1002\/nur.20362"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.12961"},{"key":"e_1_2_11_59_1","unstructured":"Sigma Theta Tau International.2024.\u201cGlobal Nursing Leadership Competency Framework: Competency Development\u2014Nursing Levels and Definitions.\u201dhttps:\/\/plusmedia.sigmanursing.org\/public\/media\/2024\/03\/GNLCF\u2010Intro\u2010Comps\u2010Definition\u2010LevelDescV2\u2010Feb2024_b51748c0\u20101290\u2010469e\u20108531\u20101be0104fb7de.pdf."},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1590\/1980\u2010220X\u2010REEUSP\u20102021\u20100553en"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1177\/09697330211022415"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2025.102447"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leaqua.2006.10.007"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912\u2010024\u201001859\u20103"},{"key":"e_1_2_11_65_1","first-page":"33","article-title":"Nurse Leaders' Perceptions of Future Leadership in Hospital Settings in the Post\u2010Pandemic Era: A Qualitative Descriptive Study","volume":"37","author":"Vuorivirta\u2010Vuoti E.","year":"2023","journal-title":"International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1097\/NNA.0000000000000880"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.13315"},{"key":"e_1_2_11_68_1","volume-title":"Nursing Workforce Grows, but Inequities Threaten Global Health","author":"World Health Organization","year":"2025"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1071\/AH15022"}],"container-title":["Journal of Advanced Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jan.70707","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jan.70707","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jan.70707","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T07:34:26Z","timestamp":1785828866000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jan.70707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":68,"alternative-id":["10.1111\/jan.70707"],"URL":"https:\/\/doi.org\/10.1111\/jan.70707","archive":["Portico"],"relation":{},"ISSN":["0309-2402","1365-2648"],"issn-type":[{"value":"0309-2402","type":"print"},{"value":"1365-2648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]},"assertion":[{"value":"2026-01-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jan.70707"}}