Nuala Ryan

Background Burnout is highly prevalent among emergency department (ED) workers and is associated with adverse workforce, patient safety, and care outcomes. Although leadership is widely recognised as a protective factor, evidence in emergency medicine lacks specificity regarding which leadership behaviours and leadership-mediated organisational practices are most effective. This systematic review aimed to synthesise the evidence on how leadership characteristics and leadership-mediated organisational structures influence burnout and related outcomes among ED healthcare workers. Methods We conducted a systematic review following Cochrane methodology, and PRISMA 2020. We searched Web of Science, PubMed, and Scopus for peer-reviewed studies published in English between January 2000 and December 2025. Eligible studies examined leadership characteristics or leadership-mediated organisational practices among ED healthcare workers, compared with other leadership styles or standard practice, with burnout as the primary outcome. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Given heterogeneity in leadership constructs, study designs, and outcome measures, findings were synthesised using inductive thematic synthesis informed by Braun and Clarke's framework. Findings: 16 studies were included. Five overarching themes were identified: well-being infrastructure, leader support and interpersonal practices, leader communication, processes and structures, and individual factors. System-level leadership—particularly workload management, staffing adequacy, physical environment, and equity—emerged as the primary determinant of burnout. Interpersonal leadership behaviours, notably recognition, validation, mentorship, inclusion, and transparent communication, were strongly associated with psychological safety and engagement but could not compensate for persistent systemic deficits. Interpretation: Leadership mitigates burnout in EDs through two interdependent pathways: systemic leadership that shapes structural working conditions, and interpersonal leadership that fosters psychological safety. Sustainable burnout mitigation requires concurrent action across both domains, reframing leadership in emergency medicine as both an operational and relational responsibility. Registration PROSPERO, under the identifier CRD420251249431.

Background: With the domestic supply of nurses failing to meet healthcare demands, sourcing nurses globally has become a key strategy in healthcare. Taking an Ecosystem approach, our study is designed to advance and deepen our understanding of how recipient country systems at the macro, exo, meso and microsystems layers can affect talent management practices for internationally educated nurses (IENs). Objective: The objective of this study is to answer the following research question: How do the different layers of a host country’s ecosystem impact the talent management practices for internationally educated nurses?. Methods: Using face-to-face semi-structured focus groups, data were collected from 21 IENs in Ireland. The results were managed and organised using the NVivo™ version 14 software, while Braun and Clarke’s reflexive thematic analysis approach was used to analyse the qualitative data based on their six-phase framework. Results: The experiences of IENs moving to Ireland suggest that at the macrosystem, national policy and structures around housing, early childhood education and visa deployment are adversely affecting their ability to work and stay. At the exosystem layer, they highlight clear recruitment ‘reality gaps’ and role mismatch on their arrival, as well as systems and language uncertainty. Finally, IENs describe how issues with organisational leadership and meso and microsystems can create a difficult day-to-day work environment. Conclusion: Through the ecosystem approach, we consider the broader macro and exosystems, as well as the more commonly researched micro and mesosystems, and their impact on talent management for IENs. The research findings show how national environments provide the context in which the exo, meso and microsystems operate and suggest the important need for policymakers as well as healthcare organisations to understand and adopt a holistic, multisystem view of how IENs are managed from a talent perspective.

There is an increasing public, societal and policy imperative for effective integration of healthcare delivery systems. Central to integration in healthcare is a focus on people-centred health, access, patient empowerment, interprofessional teamwork and collaboration between all healthcare stakeholders – difficult to achieve in current silo-driven bureaucratic health organisations. Therefore, actor-network theory (ANT) offers a theoretical approach to understanding the complexities of healthcare delivery by unpacking the type of actor’s interplay between social elements and immaterial objects, their interactions, interdependencies and power dynamics. The first of its type, this systematic review aims to identify, synthesise, and appraise extant literature on the use and application of ANT in healthcare contexts. This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO. The authors generated a search strategy utilising 31 Boolean terms, conducting electronic searches of MEDLINE, CINAHL Complete, SCOPUS, PubMed, APA PsycINFO, Business Source Complete and Academic Search Complete. The studies obtained were evaluated for inclusion based on their alignment with the specified inclusion and exclusion criteria. Studies were independently evaluated by the authors, with all data synthesised using a thematic analysis. From an initial 2,533 studies, the systematic review included 103 studies which utilised ANT within a healthcare context. The analysis of the studies identified trends in the application of ANT across healthcare which we categorised into four themes: healthcare delivery systems, technology and data, integrated care, and innovation management. The findings demonstrated variability and fragmentation in the application of ANT, often diverging from its fundamental principles. Decluttering the literature suggests three dimensions for understanding the relationships of actors, unidimensional ANT – based on single actors, bi-dimensional ANT, the relationship between two actors and multi-dimensional ANT, where human and non-human actors interact to impact healthcare outcomes. The limited number of studies on the use of ANT for integrated healthcare research highlights both its importance to the topic and the considerable research gap that must be addressed.

Healthcare systems are confronted with constant challenges and new crisis waves necessitating a transformation of current approaches to healthcare delivery. Transformation calls for integration, partnerships, interprofessional teamwork and collaboration between all healthcare stakeholders to create improved access and more personalised healthcare outcomes for patients. However, healthcare organisations are complex systems, comprising multiple stakeholders, and the existence of professional silos and functions which have varying degrees of interaction hampering the delivery of effective integrated healthcare. Research investigating the underpinning operations of how the various healthcare stakeholders integrate is lacking. To address this gap, the use of actor-network theory (ANT) can provide insight into underlying dynamics, interactions, interdependencies, governance processes and power dynamics of stakeholders in healthcare. ANT represents a suitable theoretical lens as it helps to appreciate the dynamics and underpinning behaviours of complex organisations and explains how networks are developed and how actors join networks and form associations. Our systematic review will identify and evaluate available evidence to understand the interplay between stakeholders and all associated entities that impact collaboration and integration in healthcare delivery. Methods and analysis Using the Population-Intervention-Comparison-Outcome framework, the databases MEDLINE, CINAHL Complete, SCOPUS, PubMed, APA PsycINFO, Business Source Complete and Academic Search Complete will be searched using Boolean terms to identify peer-reviewed literature concerning ANT in healthcare. All relevant articles published between January 2013 and September 2023 will be eligible for inclusion. A thematic approach will be employed to appraise and analyse the extracted data to assess the various definitions of ANT and the use of ANT in healthcare settings, interactions and collaboration. Ethics and dissemination Given that no primary data will be captured, ethical approval will not be required for this study. Findings will be shared and ultimately published through open access peer-reviewed journals and reports. PROSPERO registration number 455283.

Purpose: The purpose of the study is an in-depth exploration of the processes through which a leader develops their leader identity in strength, meaning and integration, with resulting enrichment outcomes.Design/methodology/approach: Using multi-domain leader identity theory, this study provides an in-depth exploration of the processes through which a leader develops their leader identity. Set in a healthcare context, 26 participants took part in an 18-month multi-domain leadership development program.Findings: Findings indicate a typology of leader identities, capturing the dynamic nature of leader identity based on combinations of strength and meaning. Our research also suggests that as the leader develops, their leader identity can change from a differentiated identity as a leader to a more integrated leader identity, with resulting enrichment outcomes.Research limitations/implications: The results suggested value in inherently multi-domain focus using event-based reflection and, as such, are useful in leader identity development programs. We recommend future research generalize to other settings and a larger population.Practical implications: By taking a multi-domain approach to leader identity development, the leader has the opportunity to learn and develop in a more holistic way. They are encouraged to reflect on and learn from leadership experiences throughout their entire lives, adding breadth and depth that are often overlooked in development programs.Social implications: Developing leaders who understand who they are and are capable of critical self-reflection and learning is a fundamental requirement for the positive advancement of society.Originality/value: The value of the study lies in the first longitudinal, work-based empirical study taking an explicitly multi-domain approach to leader identity development.

Aim: To identify and systematically review current scholarship on talent management of international nurses in healthcare organizations.Background: As nurse shortages persistently pose challenges for healthcare organizations globally, one of the primary strategies employed to address these shortages is employment of international nurses. To date little has been done to systematically review and collate contemporary research on talent management of this strategically important cohort. Talent management is a holistic construct that can support healthcare organizations to attract, develop, motivate, and retain talented employees to drive organizational performance. This systematic review isolates, appraises and collates available evidence on talent management practices for international nurses.Study design: Systematic literature review.Data sources: Searches of PubMed, EBSCO and Scopus were made covering literature from 2012–2022.Review methods: This study followed Cochrane protocol for Systematic Reviews and key search terms were developed in consultation with University of Limerick library. As a key aim of the review was to provide evidence for the development of effective talent management practices, only peer-reviewed academic papers and empirical studies were included. Initial articles screening was conducted by two reviewers and full articles review was conducted by the entire research team. Findings were combined in a data extraction template for further analysis.Results: This review includes 62 articles thematically analysed under the headings recruitment and selection, retention and turnover, career progression, professional development, discrimination and racism, culture and communication.Conclusion: No articles were found that directly address talent management for international nurses. Although there are studies that address aspects of talent management independently, more research is required on talent management as a holistic process for international nurses to inform evidence-based practice.Impact: This research emphasizes the importance of talent management for retention of international nurses in healthcare settings. It provides a knowledge base for healthcare organisations to enhance employee retention and ensure quality care for patients, as well as setting the foundation for future studies in this area.

Aim: The aim of this study is to gather evidence on talent management practices for nurses and midwives in an Irish hospital group, to identify any shortcomings in the current practices and to develop an evidence‐based talent management framework for the hospital group.Design: This paper details a protocol for a mixed methods research study that will be used to (1) identify, critically evaluate and summarize academic scholarship on talent management strategies for both domestically and internationally trained nurses and midwives, leading to the development of a model of talent management for this study, (2) gather evidence from both domestic and internationally trained nurses and midwives, via questionnaires and focus groups within the hospital group on current talent management practices and (3) use the model previously developed to organize our findings and develop a talent management framework for the hospital group.Methods: The study will adapt a mixed methods approach. Quantitative data will be analysed using SPSS, and qualitative data will be analysed using NVivo.Results: Our findings will support a stakeholder approach to the development of talent management practices for both domestic and internationally trained nurses and midwives in healthcare organizations. Doing so should improve the pipeline of suitably qualified nurses and midwives for future roles, by assisting nurses and midwives to identify career paths and future educational opportunities. From an organizational perspective, this research will allow healthcare organizations to adapt their current workforce planning strategies, tailoring them to the needs of the current workforce, which should reduce turnover, ensuring a highly skilled workforce, with the appropriate numbers to provide the care required within that healthcare setting.No Patient of Public Contribution: Contributions will be sought from nursing and midwifery staff and management within the hospital group.