BACKGROUND: Leadership plays a crucial role in the quality of care and patient safety, especially in the context of strained resources. Municipal home healthcare is facing challenges, for example, fewer care workers to meet increasing care needs. Registered nurses are key figures in municipal home healthcare, and they are leaders in the direct care of older adults. There is a lack of knowledge of how registered nurses lead close to older adults. The aim of this study was to explore how registered nurses lead close to older adults in municipal home healthcare. METHODS: Eight (n = 8) registered nurses participated in 50 h of participant observations. Meetings between registered nurses and older adults, and the time between these interactions, were observed to explore how the registered nurses lead close to older adults. Fieldnotes from observations and informal talks with the registered nurses were collected and analysed via reflexive thematic analysis. FINDINGS: The leadership of registered nurses close to older adults was portrayed into three themes: (1) 'starting from the older adults' implies viewing the older adults holistically and prioritising their needs over the needs of the organisational system; (2) 'adapting to the particular', which entails tailoring the environment and themselves to the unique in each situation: and (3) 'utilising professional knowledge' to both prepare their leadership and to lead. These three themes support an overarching theme showing how registered nurses lead close to older adults by 'leveraging situations' encountered in their work. CONCLUSION: This study provides insights into registered nurses' leadership close to older adults in home healthcare. The participant observations revealed that this leadership entails leveraging situations within the organisational framework, implying a need for registered nurses' flexibility and the ability to adapt to the prerequisites in this sector to provide good and safe care. These findings indicate it is time for organisations to align care for older adults and those who provide and lead the care. The findings illustrate how registered nurses enact leadership close to older adults through situated and adaptive practices in direct nursing care. The adaptive leadership practices of registered nurses might impact the quality of care. Providing registered nurses with the prerequisites to lead close to older adults, through means such as guidelines and educational efforts, might contribute to the long-term sustainability of municipal home healthcare. IMPLICATIONS FOR PRACTICE: Insights gained from this study indicate that RNs' leadership in HCC is performed by leveraging situations in their workday, which might be disguising potential consequences of a task-focused organization. This could affect the quality of care and RNs' work satisfaction. Subsequently, this study might affect the sustainability of HHC as a growing sector. Future research should explore how leadership contributes to sustainable development by balancing quality of care, health economic considerations and environmental impacts. RNs can apply the findings from this study to recognize and gain valuable insights in their own work. Decision-makers and educators should recognize how leadership is performed by RNs close to older adults. Facilitating educational efforts might advance RNs' leadership skills and competence, thereby enhancing the quality of care and contributing to the long-term sustainability of this growing sector in the future.
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Stien et al. (2026) studied this question.
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