Led, unled, and unacknowledged: care staff’s experiences of registered nurses’ leadership close to older adults

Background Older adults in municipal home healthcare receive allocated care, including personal hygiene, nutritional aid, medication, and wound care. Care staff in this sector are a diverse group, comprising both educated and uneducated personnel. Registered nurses (RNs) lead the care close to older adults. Leadership is recognized as influencing a group towards a common goal and affects patient safety and the quality of care. However, little is known about how care staff experience RNs’ leadership close to older adults. Methods This study is explorative, with an inductive design. Three group interviews with care staff ( n = 13) were conducted in three municipalities in Norway from June to October 2025. The group size was four to five care staff. Data were analysed with qualitative content analysis. Findings The findings gave insights into care staff’s experiences of RNs’ leadership close to older adults. The experiences were categorized into three categories: led, unled, and unacknowledged, and 11 subcategories. Leadership was experienced as person-dependent, necessary, providing supportive quality assurance, entailing collaboration, and showing trust, as well as absent, unclear, and self-absorbed. RNs could underestimate care staff’s competence, overlook them or fail to notice their uncertainty in their leadership. The findings were that care staff’s experiences of RNs’ leadership close to older adults were diverse and nuanced, encompassing both supportive and conflicting aspects. Conclusions RNs’ leadership close to older adults could benefit from being clearly defined, which could reduce the person-dependent aspects of this leadership. In structural changes such as task shifting, leadership should be explicit. This study suggests that decision makers in home healthcare should allocate resources to ensure an organizational structure that provides RNs with the prerequisites to lead, to prevent care staff from experiencing being unled and unacknowledged.