What does this research mean for the field?

Multilevel head nurse leadership in ICUs shapes the management of multidrug-resistant organisms by acting as system mediators and relational facilitators who transform individual knowledge into shared infection prevention and control practices. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to understand the role of head nurse leadership in managing multidrug-resistant organisms (MDROs) in intensive care units (ICUs).

May 29, 2026Open Access

Exploring Head Nurse Leadership at Multiple Levels to Prevent MDROs in ICUs: A Multicentre Grounded Theory Approach to create the BRIDGEIPC framework

ECE CappelliUniversity of Verona JFJacopo FioriniUniversity of Rome Tor Vergata LLLucilla LivigniUniversity of Rome Tor Vergata

Key Points

This research aims to understand the role of head nurse leadership in managing multidrug-resistant organisms (MDROs) in intensive care units (ICUs).
Grounded Theory approach applied to develop a framework from experiences of 34 healthcare professionals.
Data collected via non-participant observation and semi-structured interviews.
Analysis performed using constant comparative methods.
Head nurse leadership significantly influences MDRO management across various organizational levels.
Four themes identified: safe organization, flexible leadership strategies, relational dynamics, and modulation of professional behaviors.
The BRIDGE-IPC framework was created, linking policies, leadership, and team behaviors for effective IPC practices.

Abstract

SUMMARYBackground Managing Healthcare-Associated Infections due to Multidrug-Resistant Organisms (MDROs) in Intensive Care Units (ICUs) is a critical challenge. Although Infection Prevention and Control (IPC) practices are essential to reduce risk, differences in infrastructure and behavioural barriers often limit effectiveness. Head nurse leadership is crucial for overcoming these obstacles, fostering pathways and improving patient outcomes. Methods A Grounded Theory approach was used to develop a theoretical framework from the experiences of 34 professionals, including head nurses, nurses, nurse assistants, and physicians, from two hospitals. Participants were selected through theoretical sampling. Data were collected via non-participant observation and semi-structured interviews, then analysed using constant comparative methods. Results Effective MDRO management is significantly shaped by head nurse leadership operating across multiple organisational levels. Four themes emerged: creating a safe organisation, leading through flexible and contextual strategies, fostering belonging via relational dynamics, and modulating professional behaviours. These themes informed the BRIDGE-IPC framework, linking macro-level policies, meso-level leadership, and micro-level team and individual behaviours. The framework highlights how head nurses transform individual knowledge into shared, robust IPC practices within a "landscape of opportunities". Conclusion Multilevel head nurse leadership in ICUs shapes MDRO management by integrating professional competencies with individual attributes - nurturing, authoritative, resilient, reassuring or remissive. Acting as system mediators and relational facilitators, they create "virtual knowledge bridges" that foster tacit knowledge exchange, support adaptive practices, and maintain team motivation. Internalising IPC as a core value enables them to serve as credible role models, reinforcing staff engagement and adherence, improving patient safety, and shaping training and policy interventions.

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