الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The first line nurse manager (FLNM) has a multifaceted role in the healthcare setting. FLNMs have the core mandate of translating organizational strategic vision, mission, values, and objectives into action at the unit level. So, FLNMs’ competencies have been considered as the single biggest contributor towards the differences between effective and ineffective FLNM. Developing a measurement instrument that would lead to valid and reliable results is a challenging task in any research field. Since there are no studies found in relation to developing an instrument to assess FLNMs’ job competencies related to staff nurses’ performance and retention in Egypt. This study aimed to develop an instrument to assess FLNMs’ job competencies related to staff nurses’ performance and retention.
The setting of the study:
This study was conducted in the four largest hospitals at El-Beira Governorate based on bed capacity, namely: National Medical Institute Hospital at Damanhour, Kafr El-Dawar General Hospital, Itay Al-Barud General Hospital, and Abo-Homs General Hospital.
Developing of the instrument:
The present study based on the Input-Process-Output (IPO) framework of Donabedian was conducted into three phases.
In phase I: Theoretical importance and existence of the instrument construct through four steps, as follows:
1. Develop the first draft of an instrument based on the current related literature review and semi-structured interviews with the expert in the leadership field and nursing staff. The time of the interview with each participant took about 30 minutes. The interview was conducted in six months.
2. Generate dimensions and items the first version of the instrument for FLNMs’ competencies related to staff nurses’ retention and performance.
3. Content validity evaluation: test the first version of the instrument (198 items) through an evaluation conducted by the Nursing Faculty experts in the leadership field from Alexandria, Ain-Shams, and Cairo University. The total validity calculation for version (I) is S-CVI/Ave (0.81) and S-CVI/UA (0.72) for total items (198). Depending on the result of the instrument content validity, 55 items out of 198 were discarded as they had validity result < 75%. This resulted in the appearance of version (II) of the instrument which is composed of 143 items grounded in the per-mentioned twenty-one dimensions under the three domains.
4. Instrument development: test the second version of the instrument (143 items) through experts’ evaluation. The total validity calculation for version (II) is S-CVI/Ave (1.0) and S-CVI/UA (1.0) for total items (143) and, total Agreement (143 items). All items are included in the second version of the instrument.
In phase II: Representativeness and appropriateness of the data collection through test the applicability of version (II) of the instrument through three steps:
5. Instrument translation: version II was translated into Arabic by three accreditor translators, then back translation into English. The translated form is ready to use.
6. Pilot test: test the applicability of the second version of the instrument and determine the difficulties in using it. Based on the findings of the pilot study, no modification was made.
7. Data collection was collected from all FLNMs, who was available at the time of data collection and had at least one year of experience in the position, in the previously mentioned settings using the second version of the Instrument.
In phase III: statistical analysis of the constructed instrument through three steps:
8. Reliability assessment was conducted for the second version of the instrument to determine the internal consistency by Cronbach’s alpha coefficient test for overall items of the instrument was 0.95 and for each domain of FLNMs’ competencies instrument was 0.82 for the domain of Science, 0.96 for the domain of Art and 0.78 for the domain of Leader Within. All items were included in the second version of an instrument. The results indicated a high level of internal consistency. So, all items of the second version of the instrument were included.
9. Sampling adequacy test to run principal component analysis through measure Kaiser–Meyer–Olkin and Bartlett’s Test for FLNMs’ competencies instrument. The KMO measure for sampling adequacy was 0.84 this result according to Kaiser was meritorious (very good) indicating the sample size was large enough to assess the factor structure.
10. Construct validity: measure Principal component analysis for FLNMs’ competencies instrument through estimating the factor loading and communalities. The items initial commonalties were 1.00 for all the instrument items and the commonalties after extraction was 120 items which were included in the final version of the instrument (15 items more than 0.9, 49 items more than 0.8, and 56 items more than 0.7). The result was the final version of the instrument for FLNMs’ competencies related to staff nurses’ performance and retention which had 120 items grounded in twenty-one dimensions in three major domains.
Based on the finding of the study, the following recommendations are suggested:
A- Recommendations for educational settings
Conduct a variety of leadership and management training programs to equip FLNMs with appropriate and relevant knowledge, skills, and attitudes to develop their competencies.
Develop managerial competencies handout for FLNMs and professional nurses.
B- Recommendations for healthcare administrators:
Use FLNMs’ competencies instrument as an assessment tool to evaluate FLNMs’ competencies in their healthcare setting.
Use FLNMs’ competencies instrument in different healthcare setting such as an auditing tool and an interview guide to assess FLNMs’ competencies.
Develop a training program to improve FLNMs’ competencies include managerial skills such as communication, problem-solving, and decision-making skills.
C- Recommendations for FLNMs:
Conduct frequent meetings with staff nurses to give appropriate feedback about their performance.
Listen and give more attention to satisfy their nursing staff needs, formulate a plan to raise their morale and retention.
Follow the ethical and professional behaviors with the healthcare team, patients, and their families.
D- Recommendations for further studies:
1. Replication of this study in a wider context of diverse healthcare settings to facilitate generalization of the study findings.
2. A study to determine the validity and reliability of a developed instrument for FLNMs’ competencies with other FLNMs in the different healthcare settings.
3. A study to develop a strategy to improve FLNMs’ competencies related to staff Nurses’ performance and retention.