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To understand how Registered Nurses perceive the impact of nursing leadership on managing moral distress and mitigating burnout.
Moral distress and burnout are pervasive issues in nursing, compromising well-being, patient safety and workforce sustainability. Leadership is a critical factor in shaping workplace culture and mitigating these challenges, yet evidence remains limited.
Qualitative systematic review.
A qualitative systematic review was conducted following JBI methodology and PRISMA guidelines. Comprehensive searches across MEDLINE, PsycINFO, Embase, CINAHL and Scopus identified 5927 articles, with two studies meeting the inclusion criteria. Data were appraised using the JBI Critical Appraisal Checklist and synthesised via meta-aggregation. Confidence in findings was assessed using the ConQual approach.
Four major themes emerged: (1) Behind the barriers, (2) Breaking point, (3) Weathering the storm and (4) Leadership for lasting change. Leadership influenced nurses' psychological safety, ethical decision-making and resilience. Inadequate support amplified moral distress, and effective strategies included authentic communication, team solidarity and systemic interventions.
Leadership plays a pivotal role in mitigating moral distress and burnout. Evidence highlights the need for structural changes and support to sustain registered nurses' well-being and retention.
Findings offer direction for leadership strategies that promote ethical workplaces, shared decision-making and mental health supports to enhance resilience and patient care.
Strengthening leadership capability is vital for workforce sustainability, care quality and nurse retention.
Authors have adhered to relevant EQUATOR guidelines.
This study did not involve patients or the public in its design, conduct or reporting.
To examine the concept of midwifery agency when using Maternity Early Warning Tools.
Concept analysis using Rogers' evolutionary method.
Data were collected from interviews with midwives working in various Australian maternity settings. A subset of the dataset was collected and analysed (2021–2022) to examine how agency functions when midwives use Maternity Early Warning Tools.
Three conceptual attributes fundamental to agency were identified: considered judgement, reasoned clinical decision-making, and collaborative action. These attributes reveal how midwives navigate the interface between structured risk management tools and relational, woman-centred care.
Maternity Early Warning Tools can either limit or enhance professional agency. When used reflexively, they become artefacts that support learning, communication, and sound clinical judgement. Viewing these tools as enablers rather than enforcers sustains midwifery expertise and strengthens interdisciplinary collaboration.
Sustaining midwifery agency protects both professional integrity and the quality of woman-centred care.
What problem did the study address? How the use of Maternity Early Warning Tools influences midwives' agency.
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