“To lead close to is invisible work”: registered nurses’ experiences of leadership close to older adults in municipal home healthcare

Background Norwegian municipal home healthcare (HHC) provides publicly funded healthcare for people across all age groups; however, the majority are older adults aged 65 and more. Older adults in HHC are assigned care based on their needs, including assistance with personal hygiene, wound care, nutrition and medication. Norway prioritizes HHC through political measures to support older people living at home. Registered nurses (RNs) are key figures in municipal HHC, ensuring quality and continuity of care. Links between quality of care and patient safety, and leadership in general are well established. Leadership can be defined as the process of influencing a group of people towards a common goal. RNs’ leadership close to older adults in HHC is defined as leading close to older adults, where the next of kin and care staff. This leadership, a multi-actor endeavour, which is enacted at the microlevel of HHC organizations, is complex and remains underexplored in research. The present study aims to explore how leadership close to older adults is experienced by RNs in municipal HHC. Methods This study has an exploratory inductive qualitative design using individual interviews and is analysed through qualitative content analysis. Results The study explored how RNs experience their leadership close to older adults in municipal HCC. The results are organized into one theme, To lead close to is invisible work , with four categories: person-orientation, responsibility, support, and variety. This entailed experiencing leadership close to older adults as invisible leadership enabling HHC function. The RNs focused on older adults and their needs, took responsibility for acting when appropriate and for maintaining coherence. The RNs also described supporting their fellow workers and leading with variety. Conclusion The results show that the RNs experienced their leadership as an invisible part of their work in HHC. RNs’ leadership was experienced as entailing a person-oriented approach, implying having responsibility for older adults and supporting both care staff and other RNs. This aligns RNs’ leadership close to with value-based leadership practices. There is a need to make leadership close to older adults more explicit and visible, thereby avoiding a potential overreliance on individual RNs to assume responsibility for holistic care and supporting the delivery of high-quality care.