Toxic absence: why leader presence matters in times of crisis

Aim(s) – This study examines the importance of senior-leader presence on the ‘front-line’ in times of crisis.

Background – The COVID-19 pandemic placed unprecedented demands on nurses charged with delivering critical care. Extant research suggests that the active presence of ward level leaders has an important role to play in supporting front-line staff and mediating the negative impacts of stress and burnout. There is little evidence on the impact of senior leader presence or absence on the experience of frontline critical care nurses, particularly at times of crisis.

Method(s) – A three-phase qualitative interview study of critical care nurses in the UK and Ireland. A total of 107 semi-structured interviews with 54 nurses representing 38 different healthcare units.

Results – Senior-leader presence at time of crisis serves as an important symbol of organisational support. Where senior leaders are not meaningfully present, they risk allowing the necessary pain of difficult work situations becoming toxic. Toxicity is manifest in increased staff stress, emotional ills, absence and turnover.

Conclusion(s) – Senior-leaders must balance their responsibilities for strategy and structures with the frontline presence required to shape a positive emotional climate.

Implications for Nursing Management – Senior managers should consider supplementing their strategic focus with punctuated returns to the floor. Symbolically, leaders who get their hands dirty embody a sense of mutual struggle and practical support. Managerially, time on the floor increases the opportunities for collecting primary data to improve decision-making and support.