Journal of Nursing Management, 2017, 25, 407–420

A systematic review of factors influencing knowledge

management and the nurse leaders’ role
ANNE LUNDEN M N S , R N 1, MARIANNE TERA€ S P h 2 , TARJA KVIST Ph D, R N
3
and
D
ARJA HA€ GGMAN-LAITILA
4
Ph D
1
PhD Student, Nursing Director, City of Helsinki, Department of Social
2
Services and Health Care, Department of
Nursing Science, University of Eastern Finland, Helsinki, Finland, University Lecturer,
3
Docent in Adult
Education, Department of Education, University of Stockholm, Stockholm, Sweden, Docent, University
4
Researcher, Department of Nursing Science, University of Eastern Finland, Kuopio, Finland and Professor, Nurse
Director, City of Helsinki, Department of Social Services and Health Care, Department of Nursing Science,
University of Eastern Finland, Kuopio, Finland

Correspondence
Anne Lunden
City of Helsinki, Department of
Social Services and Health Care
University of Eastern Finland,
Department of Nursing Science
Kylakunnantie 70 b
FIN – 00660 Helsinki
Finland
E-mail: anne.lunden2@gmail.com
LUNDEN A., TERA€ S M., KVIST T., & HA€ GGMAN-LAITILA A.
(2017) Journal of
Nursing
Management 25, 407–420.
A systematic review of factors influencing knowledge management and
the nurse leaders’ role
Aim To describe factors facilitating or inhibiting the development of registered
nurses’ competency and nurse leader’s role in knowledge management.
Background Nurses’ competency directly influences patient safety and the quality
and effectiveness of patient care. Challenges of nurse leaders in knowledge
management include acquiring, assessing and utilising current knowledge and
assessing and enhancing competency.
Evaluation A systematic search was conducted in PubMed, CINAHL, SCOPUS
and ERIC databases in April 2015. The search identified 18 relevant research
articles published between 2009 and 2015. The quality of the studies was
appraised in accordance with study designs.
Key issue Knowledge management is facilitated by an organisation culture that
supports learning, sharing of information and learning together. Leader
commitment and competency were factors related to leadership facilitating
knowledge management.
Conclusion Nurse leaders need evidence-based interventions to support shared
learning and to create infrastructures that facilitate competence development.
Future research is especially needed to evaluate connections between knowledge
management and patient outcomes.
Implications for nursing management and leadership The results of this review can
be utilised in enhancing factors to facilitate knowledge management in clinical
practice and identifying nurse leaders’ role in strengthening nurses’ competency.
Keywords: competency, knowledge management, leadership, nurse leader

Accepted for publication: 12 January 2017

sharing and creating new knowledge. Factors facilitat-

Introduction
ing knowledge management include encouraging
Knowledge management is a process in which the involvement in decision-making, effective communica-
management of work tasks is enhanced by acquiring, tion and human resource management (Orzano et al.

DOI: 10.1111/jonm.12478
ª 2017 John Wiley & Sons Ltd 407
A. Lunden et al.
2008). According to Sanches (2004), knowledge man-
agement is supported by an organisation that is an
open system in constant interaction with its environ-
ment. Micro-level competencies are joined to the
macro-level strategic competency and leadership pro-
cesses in the organisation. This enables simultaneous
and systematic emergence, utilisation and development
of competency at different levels of the organisation.
According to Sanches (2004), knowledge management
is dependent on the functional and cognitive flexibility
of the organisation and its resource utilisation.
Competency means more than having skills or quali-
fications required by a task. It also comprises atti-
tudes, motivation, insight, interpretation ability,
receptiveness and maturity, and self-assessment. A
competent professional understands his or her per-
sonal limitations and is able to provide safe care inde-
pendently according to obligations, professional
standards, education and qualifications. Competency
promotes collaboration between nurses and other
members of the nursing team, which expands and
integrates new knowledge and skills in the working
community (Axley 2008).
The development of nurses’ competency is an invest-
ment facilitating safety, quality and effectiveness of
patient care and nurse retention (Coventry et al.
2015). Nurses’ possibilities for continuous professional
development and participation in mandatory training
at the organisation are limited by insufficient arrange-
ments for substitutes together with a demanding and
growing workload (Salmond et al. 2009). Assuming
that nurses should use their personal time for addi-
tional training cause dissatisfaction among nurses and
has negative impacts on nurse retention and the qual-
ity of nursing (Coventry et al. 2015). Knowledge man-
agement is challenged by the acquisition and
assessment of up-to-date knowledge as well as the
utilisation of competency in a constantly changing
environment (Andreasson et al. 2016).
In recent years, the development and knowledge
management of nursing has particularly been exam-
ined from the viewpoint of implementation of evi-
dence-based practice (EBP). In their systematic review,
Sandstro€ma et al. (2011) argued that leadership and
organisational culture bear a key significance in the
EBP implementation process. It is well known that
nurse leaders are aware of the importance of EBP and
have positive attitudes towards EBP and its leadership
(Kvist et al. 2014). In contrast, there are also observa-
tions indicating that leaders are passive and insuffi-
ciently committed to facilitating evidence-based
practice (Wilkinson et al. 2011). Although leaders
408
recognise the importance of the ability to take care of
the development of staff competency, nearly 50% of
them perceive their readiness to manage competency
as insufficient (Omoike et al. 2011). Nurses feel that
they lack sufficient evidence-based knowledge and the
ability to use it in their work (Saunders & Veh-
vilainen-Julkunen 2015). In summary, leaders perceive
their knowledge management capabilities as insuffi-
cient, while nurses consider their ability to use evi-
dence-based knowledge as inadequate. There is still
little evidence on the effectiveness of interventions
promoting evidence-based practice, and interventions
have not been sufficiently thoroughly reported to
enable their repeatability and comparability (Phillips
et al. 2014). There is also little research available on
the significance of organisational infrastructures for
the facilitation of evidence-based practice (Flodgren
et al. 2014).
Previous research on knowledge management in
nursing is sporadic. It is thus difficult to establish an
overview about factors facilitating and inhibiting
knowledge management and the nurse leader’s role in
knowledge management to inform practice develop-
ment and future studies. We chose to conduct a sys-
tematic review to identify, evaluate and summarise the
currently available evidence on knowledge manage-
ment in nursing and to demonstrate gaps in research
knowledge. We found no previous systematic reviews
on the topic.
The aim of the study and research questions
The aim is to describe the factors facilitating or
inhibiting the development of registered nurses’ (RN)
competency and the nurse leader’s role in knowledge
management (KM). The specific research questions
are:
What are the factors facilitating and inhibiting
KM?
What is the role of the nurse leader in KM?
Methods
Design
This systematic review was conducted in following
steps based on PRISMA Statement, which are (1) for-
mulating a research question, (2) selecting relevant
search terms and formulating search phrases by con-
sulting an information specialist in the field of health
sciences, (3) planning a search strategy, (4) agreeing
ª 2017 John Wiley & Sons Ltd
Journal of Nursing Management, 2017, 25, 407–420
 Knowledge management and nurse leaders

Table 1
Search terms

Skill Leader Management Inclusion or exclusion criteria

professional competenc* MeSH head nurse* MeSH knowledge management MeSH nurs*
clinical competenc* MeSH nurs* manage* MeSH leadership MeSH NOT student*MeSH
clinical skill* MeSH charge nurse* MeSH management MeSH
professional skill* nurs* director* personnel management MeSH
nurse leader human resources management
administ* nurs* improve*
develop*
model*

Identification
Records identified through database Additional records identified through
searching (n = 394 ) other sources (n = 1)

Records after duplicates removed (n = 284 )

Screening

Records screened (n =284) Records excluded based on

titles and abstracts (n =188)
Eligibility

Full-text articles assessed Full-text articles excluded,

for eligibility (n = 96 ) with reasons (n =77)

• Not research article

(n= 38)
• No answer to research
questions (n= 33)
Studies included in quality • Review (n= 6)
Included

assessment (n=19)

Figure 1 Studies included in the

PRISMA flow chart (Moher et al. 20- review (n = 18)
09).

on inclusion and exclusion criteria, (5) conducting a
systematic search in electronic databases, (6) selecting
eligible research articles and (7) performing a quality
appraisal of the studies selected for the review (Moher
et al. 2009).
Search strategy and inclusion criteria
A systematic search was conducted in PubMed,
CINAHL, SCOPUS and ERIC databases in April
2015. Search strategies and search terms (Table 1)
were modified to suit the different databases. In order
to obtain as comprehensive search results as possible,
a number of different search terms were used to find
wide-ranging research on knowledge management.
Searches were performed by employing combinations
of terms using the Boolean terms AND, OR and
ª 2017 John Wiley & Sons Ltd
Journal of Nursing Management, 2017, 25, 407–420
NOT. Searches were limited to the English language.
Only studies published between 2009 and 2015 were
included. In order to be eligible for this study, reviews
had to be peer-reviewed, empirical studies with quan-
titative or qualitative research designs and answer the
research questions.
Search outcome and exclusion criteria
The electronic database search yielded a total of 394
abstracts and titles (Figure 1). The first author (AL)
selected and evaluated all the articles. Three other
authors (MT, TK, AH-L) selected and evaluated arti-
cles of one database each (CINAHL, Scopus,
PubMed). The search in the ERIC database yielded no
results. Titles and abstracts were screened and those
not meeting the inclusion criteria were excluded. At
409
41 Table 2 A.
0 Overview of the included studies Lu
nd
Research design/ Quality en
author/year/country Aim Sample size and study context Method Outcomes assessment et
al.
Quasi-experimental
Codier et al. The study explores the impact of 31 nurse managers Exploratory pilot study utilised an All participants who completed the Some limits
(2011), Hawaii peer coaching on the emotional A private tertiary care medical intervention and a pre-post-testing study perceived that the peer
intelligence abilities of nurse centre design. The Mayer-Salovey- coaching intervention improved
managers Caruso Emotional Intelligence their EI abilities and general
Test management skills
Questionnaire surveys
Akerjordet et al. The aim of the study is to 364 clinical nurses Descriptive cross-sectional survey Positive attitude towards research Some limits
(2012), Norway determine clinical nurses’ interest The response rate 61% emerged (40%), despite the fact
in and motivation for research. An University hospital that few were engaged in
additional aim was to identify research-based activities. Lack of
management and organisational designated time (60%), interest
resources in order to improve (31%), knowledge (31%) and lack
nurses’ research capacity in of research supervision and
practice support (25%) constituted
important research barriers.
Research supervision was one of
the most significant needs to
enhance clinical nurses’ research
skills, management and
organisation of research activities
(30%)
Chen (2012), The study deconstructs a 155 nurses The response rate 87% Quality function deployment. Leadership is identified as the Excellent
Taiwan knowledge management (KM) Health care institute Factory analysis and fuzzy set second most important enabler in
model for utilising nursing theory. Empirical survey. Case ensuring effective knowledge
knowledge assets in terms of KM study management at the case hospital
processes and KM enablers
Hsu et al. (2011), The objective of study is to gain an 15 new nurse managers, 101 staff A three-phased questionnaire Multiple teaching resources, a Some limits
Taiwan understanding of the relationship nurses, 20 nurse administrators survey supportive learning environment,
that exists between a nursing The response rate 100% (first and a positive preceptorship helps
ª preceptorship and a new nurse phase) improve an NNM’s competencies.
Wiley manager’s (NNM) competencies General hospital An NNM’s professional
Ltd
competencies will be further
Journ enhanced as a socialisation
al of
Nursi facilitator and educator when
ng resources are directed more
Mana toward teaching facilities,
geme improving the education level of a
nt, NNM, providing incentives,
2017,
effective support from the
25,
407– organisation, and strengthening
420 the relationship among staff
nurses, nursing administrators,
and the NNMs
ª
2017
John
Wiley
&
Sons
Ltd
Table 2
Journa
(Continued)
l of
Nursin
g Research design/ Quality
Mana author/year/country Aim Sample size and study context Method Outcomes assessment
geme
nt, Omoike et al. The aim of the study is to describe 43 nurse leaders The Leadership Survey was used Participants perceived themselves Excellent
2017, (2011), USA how health care organisations can 3 Metropolitan hospitals to measure change in as more competent post
25, form strategic partnerships with respondents programme in 11 of the 12
407–
academic institutions to improve perceived Importance versus subscales. The Leader subscales
420
nurse leader’s ability to apply and Competence in the 12 subscales includes among other concepts of
operationalise leadership pre– and 1-year post–program ‘attending to the training and
competency standards completion development needs of employees’
and ‘evaluating (in)formally
subordinates’ job performance’
Spicer et al. The aim of the study is to survey A random sample of 300 DONs. A descriptive research. The Chinese DONs and COOs Excellent
(2010), China directors of nursing (DONs) and The response rate 69% (n = 208) Two survey instruments, a rated the role competencies based
chief operating officers (COOs) of the DON and 64% (n = 192) of demographic survey and a on the Forces of Magnetism to be
perceived importance of DON role the COO surveys competency survey important for DONs to be
competencies based on the Hospitals effective.
Forces of Magnetism The DONs placed significantly
greater importance on
transformational leadership
Strickland and This study specifically examined 122 clinical nurse educators in A descriptive design. The The rank order for barrier Factor Excellent
O’Leary-Kelley the educators’ perceptions of California BARRIERS scale questionnaire means was (1) setting, (2) nurse,
(2009), USA barriers and facilitators to Nurse educator in acute care or (3) presentation, and (4)
research utilisation outpatient ambulatory care Research.
Educators with undergraduate
education perceived the setting to
be a greater barrier than did
educators with advanced degrees
Educators working in facilities with
Magnet designation perceived the Kn
setting as less of a barrier than ow
did educators working in facilities led
without Magnet status ge
Educators within smaller-bed- m
an
capacity institutions perceived the ag
setting and presentation of e
research to be greater barriers m
than did the other identified en
subgroups t
an
d
nu
rs
e
le
41 ad
er
1 s
41 A.
2 Lu
Table 2 nd
(Continued) en
et
Research design/ Quality al.
author/year/country Aim Sample size and study context Method Outcomes assessment

Qualitative studies
Anonson et al. Aim of the study was look at the 6 frontline nurses In-depth personal interviews with Common characteristics of Excellent
(2014), Canada characteristics of exemplary nurse The health care system in the open-ended questions exemplary nurse leaders are a
leaders in times of change from Province of Alberta passion for nursing; a sense of
the perspective of frontline nurses optimism, the ability to form
personal connections with their
staff; excellent role modelling and
mentorship; and the ability to
manage crisis while guided by a
set of moral principles
One of the categories of leadership
qualities was ‘Interest in facilitating
professional growth: mentoring
and modelling’
Brink et al. (2012), The aim of the study was to 6 nurses, 4 emergency medical Inductive qualitative approach, The principal findings are Some limits
Sweden evaluate the experience of group technicians focus group interview, content presented in the following four
supervision and to explore its Pre-hospital care analysis main themes: (a) model structure
impact on the participants’ creates security and participation,
personal and professional (b) the collegial exchange of
development experience leads to increased
self-awareness and positive
professional development, (c) the
group supervision affects
participants’ values and attitudes;
(d) the opportunity for group
supervision will be a means of
developing professional skills
Brinkert (2011), Evaluate the application of the 20 Nurse Managers and 20 Pre and post training semi- Conflict coaching was a practical Some limits
USA Comprehensive Conflict Coaching frontline nurses structured face-to-face interviews and effective means of developing
ª model in a hospital environment Magnet status 500-bed two-hospital and quantitative questionnaire. A the conflict communication
Wiley
Ltd health system case study competencies of nurse managers
Journ and supervisees
al of Carr and Clarke Explore the manager’s role in 36 the Health Action Zone Qualitative individual semi- The manager’s role is to be a Some limits
Nursi (2010), UK promoting and nurturing learning coordinators, performance structured interviews catalyst, which facilitate collective
ng manager and staff delivering learning at both individual and
Mana
services organisational levels
geme
nt, Guest et al. The aim of the project was to 21 child and family nurses The pre-test questionnaire and Participation in the pilot project was Some limits
2017, (2013), Australia implement and evaluate Child and One health district in the New focus group interviews confidence building in that it
25, Family Health Nursing South Wales provided them with confirmation
407– Professional practice Framework and affirmation of clinical practice
420 Participation also provided CFHN
with an opportunity to reflect on
their clinical practice
ª
2017
John
Wiley
&
Sons Table 2
Ltd (Continued)
Journa
l of Research design/ Quality
Nursin author/year/country Aim Sample size and study context Method Outcomes assessment
g
Mana Hoare et al. The aim of the study was to 6 experienced nurses, 5 new A constructivist grounded theory Experienced practice nurses role Excellent
geme
(2013), New investigate practice nurses’ use of graduate nurses design. Face-to-face interviews modelled clinical skills to new
nt,
2017, Zealand information graduate nurses. New graduate
25, nurses were unconscious experts
407– at sourcing information and role
420 modelled this skill to experienced
practice nurses. Once this
attribute was acknowledged by the
experienced practice nurse,
mutual learning occurred that
enabled both groups of nurses to
become better practitioners
Leggat and The purpose of this paper is to A sample of 28 clinicians and Semi-structured focus groups The focus group participants Excellent
Balding (2013), gather opinions on the appropriate clinician managers from interviews. An inductive thematic identified seven organisational
Australia content of an educational initiative metropolitan, regional and rural analysis factors that contribute to clinical
being planned to improve clinical hospitals and community health leadership; role clarity and
leadership in quality and safety services accountability, role security and
sustainability for clinical leadership
positions, selective recruitment
into clinical leadership positions,
teamwork, transformational
leadership, training and
development, information sharing
Pepin et al. The aim of the study was to 32 student nurses, 10 new nurses An interpretative phenomenological The emerging cognitive learning Some limits
(2011), Canada develop a cognitive learning model and 10 expert nurses study design. Semi-structured model of clinical nursing
(CLM) of the clinical nursing individual interviews leadership. There are five learning
leadership competency, from the stages and in each stage, a
beginning of a nursing programme number of critical-learning turning
(students) to expertise (nurses) points. The five learning stages Kn
ow
are: (1) ‘I am aware of clinical led
leadership in nursing’; (2) ‘I ge
integrate clinical leadership in my m
actions’; (3) ‘I have active an
leadership with patient/family, and ag
sometimes with colleagues’; (4) ‘I e
m
have active leadership with the en
team’; and (5) ‘I have embedded t
clinical leadership that is extended an
to organisational’ d
nu
rs
e
le
41 ad
er
3 s
 Knowledge management and nurse leaders

41 A.
4 Lu
Table 2 nd
(Continued) en
et
Research design/ Quality al.
author/year/country Aim Sample size and study context Method Outcomes assessment

Data from the students’ interviews

raised the question of the support
available to develop clinical
leadership, because certain
students noted that their
preceptors did not encourage
them to try or to continue
influencing others for better care.
Also provide basic and continuing
education about clinical leadership
Romain-Glassey The central objective of the study 10 discussion groups A case study methodology. If the VMU nurses’ roles were to be Excellent
et al. (2014), was to describe forensic nursing Forensic nursing in the violence Thematic content analysis completely compatible with
Switzerland practice in the VMU, and through medical unit advanced nursing practice, this
a critical analysis, compare it with would entail increasing their level
the seven core competencies of of competencies in the fields of
advanced nursing practice consultation, ethics, leadership
and research. This evolution
would need to be linked to the
strategic planning of the university
institution and cannot be limited to
a specific unit. Such a trend is
under way at the CHUV, and it
requires strong leadership, both at
the level of the institution and of
the nursing discipline
Severinsson et al. The aim of this study was to One focus group discussion A qualitative thematic analysis was The outcome of the midwives Excellent
(2010), Norway evaluate midwives experiences of Experienced midwives used to analyse the content of the group supervision was increased
group supervision and the notes from the supervision professional competence
influence of the continuity of care sessions and focus group
ª model, with particular focus on discussion. There was only one
Wiley
Ltd childbearing women’s need for group discussion
Journ emotional support. An additional
al of aim was to evaluate the
Nursi development of the midwives
ng professional competence
Mana
Tregunno et al. To explore nursing leadership for 31 focus groups with 188 Focus groups Executives are called upon to Some limits
geme
nt, (2009), Canada patient safety in critical care and participants develop and sustain evidence-
2017, identify opportunities to improve Multidisciplinary frontline providers informed safety cultures where the
25, leadership that promotes patient and managers in the context of knowledge of safety science is
407– safety critical care nursing mobilised and valued, and
420 evidence is used by nurse leaders
at all levels to deliver safer care
A. Lunden et al.
this stage, 96 full-text articles were obtained, each of
which was reviewed in detail to identify whether they
met the inclusion criteria. Reviews, discussion papers,
editorials and empirical studies concerning nursing
students were excluded. One article was found for this
study based on references in the information searches.
Altogether 19 studies were included in the quality
assessment process.
Quality assessment
The studies were assessed according to criteria pre-
sented by Gifford et al. (2007). The criteria included
eight items for quasi-experimental studies, six for
questionnaire surveys and 11 for qualitative studies.
Each item was scored 2 (excellent), 1 (some limita-
tions) or 0 (several limitations). Quasi-experimental
studies were excluded if they scored 0–6 points, ques-
tionnaire surveys if they scored 0–4 points and quali-
tative studies if they scored 0–8 points in total. Two
authors evaluated all the eligible articles individually
and discussed any differences in quality assessment to
make a decision on the quality of the study. One arti-
cle was excluded due to poor quality. The quality
appraisal of each study is reported in a Supporting
information (Table S1).
Data extraction
The following characteristics of each study were
extracted; authors, publication year, country of origin,
aim of the study, sample size and study context,
method, outcomes and quality assessment (Table 2).
Data analysis
In total, 18 articles were analysed by two researchers
identifying common themes. At the initialisation
phase, the selected articles were read through once to
form an overview of the data. The articles were read
several times to internalise their contents and to detect
preliminary themes. At the construction phase of the
analysis, data were classified into categories. The cate-
gories begin to articulate the core element of the
theme. At the rectification phase, nearly complete
themes had been formed. At this phase, the research-
ers distanced themselves from the data by taking a
break from the analysis process. Subsequently, the
theme development process was revised, assessed and
verified by revisiting the data and making sure that
both researchers could accept the categorisation. At
the finalisation phase, a clear story line was created in
ª 2017 John Wiley & Sons Ltd
415
Journal of Nursing Management, 2017, 25, 407–420
Knowledge management and nurse leaders
the process of combining themes and sub-themes. The
description of the process of developing themes and
sub-themes was used to answer the research questions
(Vaismoradi et al. 2013).
Results
Characteristics of the included studies
The research articles were published between 2009
and 2014 in several countries (Table 3). The median
number of research participants was 21 in surveys in
interviews and 137 in questionnaires. In the pre-tests
and post-tests, the minimum study population had 31
and the maximum 40 participants. Ten studies were
rated excellent, and eight as having some limitations.
Factors facilitating knowledge management
Organisation culture and leadership were determined
as the main themes for factors facilitating knowledge
management (Table 4). Knowledge management is
facilitated by an organisation culture that supports
learning, sharing of information, learning together and
reciprocal feedback (Chen 2012, Hoare et al. 2013,
Leggat & Balding 2013). Effective support from envi-
ronment and strengthening the relationship between
supervisors and nurses facilitates both leaders’ and
nurses’ learning (Hsu et al. 2011). Supervision enabling
reflection and self-assessment (Guest et al. 2013) and
especially group supervision have been found to posi-
tively influence the personal and professional growth of
participants (Severinsson et al. 2010). Positive precep-
torship (Hsu et al. 2011), continuous mentoring (Guest
et al. 2013) and support for nurses’ leadership in nurs-
ing practice promotes the development of nurses’ com-
petency (Pepin et al. 2011). Clinical and academic
collaborative networks expedite and sustain nurses’
research capacity (Akerjordet et al. 2012).
Knowledge management is facilitated by an organisa-
tion culture that rewards employees based on compe-
tency (Hsu et al. 2011); in return, employees also have
an opportunity to give feedback to their superiors
(Chen 2012). In order to sustain a satisfactory level of
competency, it is important that supervisors are pro-
vided with up-to-date information based on feedback
on the level of competency and needs for further train-
ing among staff (Guest et al. 2013). Information tech-
nology solutions enable online studies and feedback,
networking and communal learning as well as facilitate
knowledge management (Pepin et al. 2011, Chen
2012). There have been attempts to ensure and increase
ª 2017 John Wiley & Sons
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Journal of Nursing Management, 2017, 25, 407–420
Table 3
Summary of the articles

Publishing year n Country n Design n Sample size min med max Quality assessment n

2009 2 US 3 Qualitative 11 Interviews 6 21 52 Excellent 10

2010 3 Canada 3 Survey 6 Questionnaires 43 137 364 Some limits 8
2011 5 Norway 2 Quasi-experimental design 1 Pre- and post tests 31 40
2012 3 Taiwan 2
2013 3 Australia 2
2014 2 UK 1
2015 0 Hawaii 1
China 1
New Zealand 1
Switzerland 1
Sweden 1

Table 4 2013). Leaders’ competency in emotional intelligence

Factors facilitating and inhibiting knowledge management
and general leadership skills has increased, for exam-
Facilitating factor Inhibiting factors ple by introducing peer coaching (Codier et al. 2011)
Themes Subthemes Subthemes
and conflict coaching (Brinkert 2011). The Adminis-
Organisation Support of learning Lack of motivation to learn trative Leadership programme, which was conducted
culture Sharing knowledge Lack of support for learning in the United States, has increased leaders’ networking
and learning together Lack of knowledge
Feedback Organisational traits
with colleagues and information sharing. This pro-
(non-Magnet status, gramme has also improved their ability to form part-
small bed capacity, nerships between stakeholders in education and
task-oriented discipline)
Leadership Leadership model
Lack of time resources working life (Omoike et al. 2011).
Leader’s traits
Lack of human resources
Leader’s competency
Factors inhibiting knowledge management
Two main themes emerged out of factors inhibiting
competency at work unit by hiring nurses with solid knowledge management (Table 4): organisation cul-
educational foundations or who have completed spe- ture and management of human resources. Inhibiting
cialisation training (Hsu et al. 2011, Pepin et al. 2011). factors related to the organisation culture include a
Leadership models, leader’s traits and leader’s com- lack of motivation, support and knowledge. Factors
petence are sub-themes related to leadership. In rela- related to lack of motivation include unspecified per-
tion to leadership models, transformational leadership sonnel roles and responsibilities, poor rewarding sys-
and Magnet hospital status have been found to facili- tems and unwillingness to learn from errors (Carr &
tate competency among employees (Strickland & Clarke 2010, Leggat & Balding 2013). Motivation
O’Leary-Kelley 2009, Spicer et al. 2010, Leggat & might also be negatively affected by excessive pres-
Balding 2013). The term ‘Magnet hospital status’ sures to succeed and, in contrast, lack of interest in
denotes an institution that has successfully attracted development work (Carr & Clarke 2010, Akerjordet
and retained nurses. Magnet hospitals value high qual- et al. 2012).
ity competency at all organisational levels and continu- A lack of organisational support for training and
ing improvement of competency (Salmond et al. 2009). developing in the profession and as a leader also inhi-
Knowledge management-facilitating leadership bits knowledge management (Pepin et al. 2011, Leg-
includes the leader’s commitment in his or her task gat & Balding 2013). Other inhibiting factors include
and the clarity, responsibility, reliability and stability the lack of financing and technology as well as insuffi-
of the leader’s role (Chen 2012, Leggat & Balding cient support for research activities in the organisation
2013). Other related factors include strategic plan- (Strickland & O’Leary-Kelley 2009, Akerjordet et al.
ning, strong leadership and team work (Leggat & 2012). Insufficient provision of information and edu-
Balding 2013, Romain-Glassey et al. 2014). Compe- cation in the organisation are also inhibiting factors.
tency in leadership can be ascertained by the leaders’ Lack of distributing existing knowledge widely at the
solid educational foundation and maintained and pro- different organisational levels also has similar effects.
moted with continuous training and guidance (Hsu An organisation where knowledge is only available for
et al. 2011, Omoike et al. 2011, Leggat & Balding few people and units is vulnerable (Carr & Clarke
2010, Akerjordet et al. 2012, Leggat & Balding
2013). Inhibiting factors related to organisational
traits include the small capacity of an organisation, its
non-Magnet status (Strickland & O’Leary-Kelley
2009) and an individualistic and task-oriented organi-
sation culture (Leggat & Balding 2013).
Lack of time and human resources are factors inhibit-
ing knowledge management in relation to the theme of
leadership. Lack of time resources is a result of
short-term goals and insufficiency of human resources
reserved for the development of competencies (Strick-
land & O’Leary-Kelley 2009, Carr & Clarke 2010,
Akerjordet et al. 2012). Development of competencies
without time specially allocated for the process causes
time-pressure-related stress in employees (Guest et al.
2013). Factors related to lack of human resources
include failed recruitments, low number of employees
related to workload, and uncertainty and temporariness
of the role of supervisors (Guest et al. 2013, Leggat &
Balding 2013).
Role of the nurse leader in nursing knowledge
management
The role of the nurse leader in knowledge manage-
ment contains two main themes; the facilitator and
the organiser. As a facilitator, the leader acts as a pro-
moter of collective learning in both units and the
organisation (Carr & Clarke 2010). The leader’s com-
mitment and assertiveness are facilitator traits (Chen
2012). The leader is interested in facilitating nursing
and professional growth. Additionally, he or she is
capable of forming personal relationships with staff
and providing them with role modelling and mentor-
ing (Anonson et al. 2014).
In the role of the organiser, the leaders coordinates
and visualises knowledge management and acts as a
situational leader and team coordinator. As a coordi-
nator, the leader is well acquainted with the substance
of nursing, aware of everything going on at the unit,
and capable of managing the different situations that
may emerge. Leaders also have an extensive perspec-
tive of the operations of their units (Tregunno et al.
2009). Leaders determine a mission, vision, strategy
and aims for knowledge management (Chen 2012).
They must also recognise development areas in
employee competencies (Leggat & Balding 2013).
Discussion
This is the first systematic review concerned with
examining the role of nurse leaders from the
viewpoint of knowledge management and the factors
facilitating and inhibiting the development of compe-
tency. According to this review, knowledge manage-
ment is facilitated by an organisation culture that
appreciates learning and emphasises the nurse leader’s
role (also Garneau & Pepin 2015). The interpretation
of culture varies between leaders and nursing staff.
Furthermore, better understanding of the workplace
culture and its connection with patient, nurse and
organisational factors would equip nurse leaders with
ideas on how to develop strategies for improving nurs-
ing-sensitive patient outcomes (Hahtela 2015).
Factors related to organisation culture and leader-
ship have a dual nature as they contain both facilitat-
ing and inhibiting factors. Non-Magnet hospital status
and lack of time and human resources is related to
factors inhibiting knowledge management. Carlson
and Plonczynski’s (2008) systematic review of 45 stud-
ies indicated that factors related to the organisation
were most frequently identified as obstacles; for
instance, insufficient time resources for reading studies
and implementing new ideas and lack of authority by
nurses inhibited realising changes.
Despite the dual nature of the factors facilitating and
inhibiting knowledge management, time and employee
resources only emerged as inhibiting factors. The
results of this review support the idea that increasing
time and employee resources will not alone facilitate
knowledge management (also Coventry et al. 2015).
Instead, facilitating knowledge management would
require leaders to actively support nurse commitment,
encourage, take into account and enable reciprocal
feedback, and offer enough training opportunities
(Bahtsevani et al. 2010, Gifford et al. 2011). According
to our results, nurse leaders can support infrastructures
that facilitate learning and the development of nurses’
competencies by providing tools and spaces for shared
knowledge creation and reward systems that acknowl-
edge competence development (also Flodgren et al.
2014, Saunders & Vehvilainen-Julkunen 2015).
According to Sandstro€ma et al. (2011) the
charac-
teristics of the role of leaders is a sum of personal
qualities, formal education and the context and organ-
isation in which leadership is practised. Leaders influ-
ence knowledge management by their personal
characteristics, the organisation and culture. Nurse
leaders influence the learning culture of the organisa-
tion as mentors and role models. Their role is pivotal
in implementing evidence-based procedures to avoid
unnecessary, ineffective or even harmful treatments
(Wallen et al. 2010). Leaders have reported risks and
anxiety associated with adopting an additional
leadership role. Nurse leaders need support and educa-
tion on knowledge management and EBP to be appro-
priate competent and courage to fill the role of a
knowledge management innovator and change man-
ager (Kitson et al. 2011). Some previous studies have
presented positive results regarding enhancing nurse
leaders’ capabilities in knowledge management
through training programmes (Gifford et al. 2011)
and mentorship programmes (Wallen et al. 2010).
The findings from this review indicate, leaders play
a multifaceted role in knowledge management, acting
as facilitators at the individual and organisational
levels, and organisers creating favourable conditions
for developing competency. The findings of Grealish
et al. (2014) and Everett and Sitterding (2011) were
similar. Nurse leaders are expected to support nurses
at all organisational levels in questioning practices,
thinking critically and basing their decisions on the
best available evidence. Leaders should respect nurses’
autonomy, authority and accountability. They provide
possibilities for shared leadership in knowledge man-
agement and give constant feedback on competence
development (also Bahtsevani et al. 2010). Everett and
Sitterding (2011) indicate that, through nursing staff,
transformative nurse leaders can influence patient care
and support producing remarkable outcomes. In
knowledge management, nurse leaders should have
abilities to enhance interdisciplinary relationships and
partnerships with universities and act as change
agents. According to Melnyk et al. (2012) nurses in
Magnet institutions report higher levels of more con-
sistent implementation of evidence-based practice,
availability of evidence-based practice experts, organi-
sational culture supporting evidence-based practice,
routine educational offerings in evidence-based prac-
tice and routine recognition of evidence-based practice
efforts than nurses in non-Magnet institutions.
The results of this review were limited regarding the
identification of the role of leaders in knowledge man-
agement. Previous studies on evidence-based practice
have also pointed out that the nature of nurse leader’s
role has not been fully identified (Andreasson et al.
2016). Wilkinson et al. (2011) found in their case
studies that the nurse leader’s role is under-articulated,
largely passive and limited by competing demands.
Knowledge of measurements for competency identifi-
cation and tracking and interventions that nurse lead-
ers can use in knowledge management is also limited.
Identifying nurse leaders’ role, measurements for com-
petency identification and tracking and interventions
in knowledge management are therefore important
future research challenges.
Study validity, reliability and limitations
Several test searches were made with numerous differ-
ent search terms before the information search
reported in this review. The final search terms and
phrases were selected with the help of an information
specialist and MeSH terms were used. Searches were
conducted in four databases. The number of databases
can be considered a limitation of this review. How-
ever, the databases are commonly used, cover many
scientific fields and are deemed the most comprehen-
sive in health sciences (Centre for Reviews and Dis-
semination 2009). The fact that all of the articles were
published in English might have caused some publica-
tion bias. In contrast, the studies originated from 12
different countries, which decreases possible bias to
some extent. Grey sources were not examined, but all
reference lists in the selected publications were exam-
ined to find additional publications.
Two researchers selected the publications. All selec-
tions were discussed at every stage of the selection pro-
cess. A senior researcher served as one of the
researchers in the selection process. Clear inclusion and
exclusion criteria were applied. The selection process
was carefully documented, making it easy to follow.
Details of the original articles were included in a table.
Criteria by Gifford et al. (2007) were used in assessing
the articles. The criteria are suitable for the assessment
of both qualitative and quantitative articles.
Factors limiting forming a synthesis included the
small scale of data in the selected studies; many stud-
ies had been conducted at a local level and in different
work communities. The small number of the articles
limited forming a synthesis of the role of nurse leaders
in knowledge management.
Conclusion
The results of this review indicated that there continues
to be little research available on knowledge manage-
ment despite the long tradition of nursing leadership
research. It can be argued that there is need for research
on how knowledge management in nursing can be used
to influence organisation-related obstacles on imple-
mentation of evidence-based practice. Research should
be focused on factors related to nurse leader and change
agent roles influence the effectiveness of the develop-
ment of competency, and how nurses’ professional
development can be supported.
In the future, it is important to study the cultural
factors with influence on knowledge management.
Further studies are also needed on the role of nurse
leaders’ knowledge of measurements for competency
identification and tracking and interventions for
enhancing the competency of nursing staff, as it
directly influences the quality of patient care. The con-
nections between knowledge management and patient
outcomes should be highlighted in future studies.
Nurse leaders need evidence-based interventions to
support shared learning and to create infrastructures
that facilitate competence development. These studies
should be conducted with a randomised controlled
trial or controlled before-after studies designs. Imple-
mentation strategies of knowledge management should
also be meticulously reported to enable repeating
interventions and comparing them.
Implications in leadership
The present findings provide evidence that factors
influencing knowledge management and nurse leaders’
role in it have been poorly studied. Research evidence
does not provide any innovative solutions to direct
knowledge management in clinical settings. Therefore,
innovative interventions should be developed and eval-
uated for implementing knowledge management, in
particular in the context of challenging work environ-
ments with growing workload and lack of time for
continuous professional development and lifelong
learning. This review is useful for developing factors
facilitating knowledge management, nurse leader’s
role and interventions on knowledge management.
Nurse leaders need to identify how they can (1) sup-
port learning, sharing knowledge and learning
together, (2) measure competency, (3) allocate time
and resources for competency development, (4)
reward employees based on their competency and
knowledge sharing, (5) improve transformational com-
petency, (6) create organisational culture facilitating
learning. The findings of this study suggest that the
Magnet hospital status, transformational leadership,
and enhancing interdisciplinary relationships and part-
nerships with universities could be successful means
for developing knowledge management.
Source of funding
This research received a grant from The Finnish Nurse
Association.
Ethical approval
Ethical approval was not required for this paper.
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Supporting information
Additional Supporting Information may be found in
the online version of this article:
Table S1. Evaluation of the studies according to
Gifford et al.’s presented criteria (2007).