title: An Integrative Review of the Structures and Processes Related to Nurse Supervisory Performance in Long-Term Care.
abstract: BACKGROUND
  Understanding the structures and processes related to the supervisor performance of regulated nurses (registered nurses [RN] and registered practical nurses [RPN]) is critical in order to discern how administrators of long-term care (LTC) homes can facilitate and better support nurses given their important contribution to nurse assistants' job satisfaction and resident outcomes.
  
  
  OBJECTIVE
  The aim of this integrative review is to identify the structures and processes related to supervisory performance of regulated nurses in LTC.
  
  
  METHODS
  An electronic search of six databases for studies published in English between 2000 and September 2015 was conducted by a librarian. The inclusion criteria were studies focused on RN or RPN supervisory performance in LTC, which included a structure or process related to supervisory performance of the nurse. Screening, quality assessment using the Mixed Methods Assessment Tool, and data extraction for the included studies were conducted independently by two reviewers.
  
  
  RESULTS
  A total of 22 studies were included in the review. Six nurse structures (e.g., nurses' "perceptions of their supervisory role and authority" as well as their "personal qualities"), and eight organizational structures (e.g., "organizational support (culture) for supervisory and management practices" and "staffing levels") were identified. Six processes of effective supervisory performance were identified, such as "being flexible, understanding, considerate listeners and encourage staff input" as well as "respect, value, recognize, acknowledge and motivate" nursing assistants they supervise.
  
  
  CONCLUSIONS
  The results highlight the nuanced and complex nature of nurses' supervisory performance and the multifaceted approach required to support effective nurse supervisors in LTC. Future research should examine how resident-related structures, as well as other moderators and mediators, may influence supervisory performance. Developing detailed models of effective supervision can inform future interventions targeting modifiable processes related to supervisory performance to thereby change practice and optimize supervisory performance in LTC.
authors.affiliation: Research Associate 2, Toronto Rehabilitation Institute, University Health Network and Doctoral Graduate, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Charlene H
authors.initials: CH
authors.lastname: Chu
authors.affiliation: Professor, School of Nursing and Scientific Director, Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: Research Coordinator, Division of Health Care and Outcomes Research and Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Toronto, Ontario, Canada.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Wong
authors.affiliation: Research Assistant, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Blain
authors.affiliation: Senior Scientist, Toronto Rehabilitation Institute, University Health Network and Associate Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: McGilton
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D007857:Leadership; D008134:Long-Term Care / Q000592:standards*; D009745:Nursing, Supervisory / Q000592:standards*; D015279:Organizational Culture; D017064:Process Assessment, Health Care
keywords: charge nurses; integrative review; long-term care; nurse supervision; nursing leadership; supervision; supervisory performance