creativity in nursing

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Nurses’ Creativity: Advantage or Disadvantage

Sara shahsavari isfahani, mohammad ali hosseini, masood fallahi khoshknab, hamid peyrovi, hamid reza khanke.

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Corresponding Author: Mohammad Ali Hosseini, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran. Tel: +98-2122180132, Fax: +98-2122180132, E-mail: [email protected]

Received 2014 Jun 2; Revised 2014 Jul 7; Accepted 2014 Aug 13; Collection date 2015 Feb.

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/ ) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Recently, global nursing experts have been aggressively encouraging nurses to pursue creativity and innovation in nursing to improve nursing outcomes. Nurses’ creativity plays a significant role in health and well-being. In most health systems across the world, nurses provide up to 80% of the primary health care; therefore, they are critically positioned to provide creative solutions for current and future global health challenges.

The purpose of this study was to explore Iranian nurses’ perceptions and experiences toward the expression of creativity in clinical settings and the outcomes of their creativity for health care organizations.

Patients and Methods

A qualitative approach using content analysis was adopted. Data were collected through in-depth semistructured interviews with 14 nurses who were involved in the creative process in educational hospitals affiliated to Jahrom and Tehran Universities of Medical Sciences in Iran.

Four themes emerged from the data analysis, including a) Improvement in quality of patient care, b) Improvement in nurses’ quality of work, personal and social life, c) Promotion of organization, and d) Unpleasant outcomes.

Conclusions

The findings indicated that nurses’ creativity in health care organizations can lead to major changes of nursing practice, improvement of care and organizational performance. Therefore, policymakers, nurse educators, nursing and hospital managers should provide a nurturing environment that is conducive to creative thinking, giving the nurses opportunity for flexibility, creativity, support for change, and risk taking.

Keywords: Qualitative Content Analysis, Nurses, Creativity, Innovation, Outcomes, Iran

1. Background

Recently, global nursing experts have been aggressively encouraging nurses to pursue creativity and innovation in nursing in order to improve nursing outcomes ( 1 , 2 ). The world of healthcare is changing ( 3 ). Today’s health care organizations need creative and innovative solutions. Creativity and innovation are not new concepts to the nursing profession. Nurses worldwide are engaged in innovative activities on a daily basis; activities motivated by the need to improve care outcomes and reduce costs to the health system ( 4 ). Failure to acknowledge and encourage creativity in nurses may hinder future development and innovations in nursing practice and in nursing science ( 5 ). Nurses often encounters unexpected situations and involves taking care of patients with different backgrounds and health conditions; hence, they need to go beyond nursing routine and acquire creative thinking to make useful decisions ( 6 ). In most health systems, nurses are the main professional component of ‘front line’ staff providing up to 80% of primary health care. As such, they are critically positioned to provide the creative and innovative solutions for current and future global health challenges ( 4 ).

Moreover, being effective, health care organizations must facilitate creative responses to increasingly complex health problems. These organizations and their staff must innovate and make change as health care needs and demands shift. Meeting these challenges requires the complete use of entire available human and mental resources ( 4 ). Among the most important of these resources is creativity, which is the capacity to think of old problems in new ways to change the perspectives, or to create novel and useful approaches to construct our organizations’ work better and to meet the needs of patients ( 7 ).

Creativity is a major issue in nursing profession and the most important characteristic of nurses and in the health care, it is a complex issue ( 8 ). The term creativity and innovation are often used interchangeably; however, there is a clear distinction between them, creativity is the generation of novel and useful ideas, while innovation is the implementation of the ideas ( 9 ).

Recent nursing literature has repeatedly proclaimed the need for creativity in nursing ( 10 ). Studies have shown that creativity is not highly rewarded in practice; however, it is supposed to be in the theory ( 11 ) and although creativity has been featured in the nursing literature for many years, it has been the subject of only a small amount of research in nursing. Therefore, an edified understanding of creativity and its dynamics and place in nursing has never been attained ( 12 ). Also, the most studies on creativity have been conducted in nursing education ( 13 ), but creativity in the clinical settings and its outcomes for patients, nurses and health care organizations have not been extensively studied and its consequences is still not clear. Hence, the area of creativity within the medicine and nursing appears underdeveloped and the outcomes of creativity in these fields are unknown ( 14 ). In addition, most researches about the nursing creativity in Iran have been conducted with quantitative approach ( 15 - 17 ). Therefore, considering the existing evidence in Iran and lack of comprehensive study on the nurses’ creativity, this study explores the perception and experiences of creative nurses about outcomes of their creativity in clinical settings in the cultural context of Iran.

2. Objectives

Considering the importance of creativity in nursing and the role of nurses in health care organizations, this study aimed to determine the Iranian nurses’ perceptions and experiences of creativity in clinical settings and the outcomes of their creativity for health care organizations.

3. Patients and Methods

A qualitative approach using content analysis was adopted for this study to facilitate a rich description of the understanding and experiences of creative clinical nurses about outcomes or consequences of creativity in health care settings in an Iranian context.

3.1. Data Collection

Data were collected through a semistructured interview. It was composed of two open-ended questions (interview guide) as follows: Have had any experience regarding creativity in your workplace? And, what were the outcomes of creativity for you, patients, and hospitals? Also, some probing questions were asked for additional clarification to answers given by the participants. No prejudices or personal opinions were involved in the interview process, and semistructured guidelines were adopted to guide interviewees to express their experiences as far as possible. Interviews lasted between 30 - 90 minutes and were performed in a quiet place in participants’ working units. After recording the interviews, they were transcribed verbatim immediately and analyzed. All interviews were performed by one female interviewer and were audiotaped with the nurses’ consent. The interviewer received formal qualitative curriculum training and had clinical practicum teaching experience of 21 years, which would help the participant enter the interview situation and build a trustworthy relationship. The data collection, data analysis and participants’ selection was continued until data saturation occurred and a rich description of nurses’ experiences was obtained. The data collection was interrupted after 14 interviews, because it was clear that no new concepts had emerged after 13 interviews.

3.2. Setting and Participants

In this study, 14 nurses (5 females and 9 males) who had worked in different units of educational hospitals affiliated to Jahrom and Tehran Medical Universities, Iran, were recruited by purposeful sampling with the maximum variation sampling to achieve variation in nurse's gender and work experiences as well as educational levels ( Table 1 ). Two nurses refused to participate in the study after initial agreement (both because of problems in setting time for interview). This study was conducted from June 2012 to December 2013. Inclusion criteria, including the nurses who had offered novel and useful ideas, products, services or procedures in clinical settings and had willingness to participate in the study. In this study, matrons, supervisors, and head nurses were asked to nominate nurses who provided creativity and innovation at workplace.

Table 1. Participants’ Characteristics of the Study a .

a Abbreviations: MSN, master of science in nursing; BSN, bachelor of science in nursing; ADN, associate degree in nursing; LPN, licensed practical nurse.

3.3. Ethical Considerations

The Ethical and Research Committee of University of Social Welfare and Rehabilitation Sciences in Tehran approved this study (2ID11767). Before starting each interview, all participants were informed about the objectives and method of the study. They were also informed that participation in the study is voluntary; therefore, they could refuse to participate or withdraw from the study at any time. Moreover, the participants were reassured that their responses would be kept confidential and their identities would not be revealed in research reports and publications of the study. Finally, the participants who agreed to participate in the study were asked to sign a written consent.

3.4. Data Analysis

Data were analyzed using a conventional content analysis approach. To analyze the data, ‘Framework’ as a method of qualitative data analysis was used. ‘Framework’ is an analytical process, which involves a number of distinct though highly interconnected stages ( 18 ). It has five key stages. In the first stage or familiarization stage, we transcribed the data verbatim and read each interview several times to gain a sense of content. The second stage or identifying a thematic framework, involved dividing the text into meaning units. The condensed meaning units were abstracted and labeled with a code, which constitute the manifest content. In the third stage or indexing, we compared the various codes based on differences and similarities and sorted them into subcategories and categories and collated all the relevant coded into data extracts within the identified categories. In the fourth stage or charting, we read all the collated extracts for each category and considered whether they appeared to form a coherent pattern. Then, we considered the validity of individual categories in relation to the dataset and whether our candidate categories “accurately” reflected the meaning evident in the dataset as a whole. Two researchers independently examined the data for categories. In the fifth stage or mapping and interpretation, we defined and further refined the categories ( 18 ).

3.5. Consideration of Rigor

Similar to all qualitative approaches, content analysis entails discovering and exploring the processes in the findings ( 19 ). To ensure credibility, member checking was used in which the first author performed a member check for 9 participants through providing a summary of identified themes for clarification. Data were coded by the authors after they were compared with each another. In cases of disagreement, explanation and clarification were provided by the research team to reach the final confirmation.

In total, 14 nurses (9 males and 5 females) aged 27 - 57 years old participated in this study. Their work experiences were between 7 - 30 years and most of them had worked in different units of the hospital ( Table 1 ). Data analysis resulted in identifying four main themes: a) Improvement in patients’ quality of care, b) Improvement in nurses’ quality of work, personal and social life, c) Promotion of organization and d) Unpleasant outcomes. The rest of the text discusses the meaning of each theme, with quotations from participants.

4.1. Improvement in Patients’ Quality of Care

When nurses were asked their experiences about outcomes of creativity in clinical settings, they pointed to the more cooperation of patients, doing the work more convenient and achieving better therapeutic results.

A nurse with 15 years of work experience stated that: "I made little crafts such as sofas and chairs or little fishes with waste papers, and next morning when I wanted to give medication, first I gave it to the child. Therefore, I communicate with the kids in this way that it caused my work to be more convenient. For example, The child used the drug much better and was more cooperative during change dressing.

Furthermore, participants mentioned that creativity caused facilitation of patient care and the patients received better care and had higher satisfaction. For example a nurse with 7 years of work experience who had made a stretcher that equipped with a cassette for taking X-ray and especially for patients with multiple trauma stated: “There, they put the radiology cassette in the drawer under the stretcher to take an X-ray; so, there is no need to move the patient from the stretcher to the radiology bed”.

One nurse with 11 years of work experience also stated: “I used odorless Whitex (a commercial disinfectant solution in Iran) in surgical wards for cleaning surfaces and this leads to high patients’ satisfaction because smelling Whitex bothered them.’’

4.2. Improvement in Nurses’ Quality of Work, Personal and Social Life

Some participants believed that expressing creative ideas in the workplace had had positive effects on their physical and mental health and they achieved self-belief and felt happiness. Also, pleasure of discovering new creative ideas and doing a larger work had given them intrinsic satisfaction and feeling of pride.

One nurse with 14 years of work experience cited that: “This means that you're satisfied and happy of doing the right thing, it will make you happy.’’

Also, a nurse with 30 years of work experience mentioned that: “I thought if I want to go short, do not look for a bigger work or a larger service, I really do not enjoy, and maybe even have a negative impact on my health.’’

A nurse with 17 years of work experience cited that: “The first thing that creativity had had for me is self-belief. I found a kind of confidence. For example, when the colleagues say: can you make a certain thing? I felt confidence. This was the most important thing for me.”

Moreover, participants pointed out to the gaining social respect in the community and they believed that creativity in nursing causes acceptance of friends and the community, being known, being seen with a positive outlook and being a model for other nurses or students.

One nurse with 20 years of work experience stated: “when friends praise that you offered a new job, had an invention, or an innovation, maybe I am satisfied with these aspects, well it's good in the community. For example, when they say you are creative, one feels that he is difference with the other people and this is due to the feedbacks that community gives to you.”

In addition, participants mentioned that creativity is the main engine for the development of health care workers and organizations. And nurses’ creativity leads to innovation, entrepreneurship, and is a source of income.

A creative and entrepreneur nurse with 13 years of work experience: “If there were problems in the operating room, I designed and made them. Then, I established a company in Industrial Park and I just make some of the medical devices for production in the company and I have about 8 - 9 workers.”

4.3. Promotion of Organization

According to the nurses who participated in the study, creativity, innovation, and entrepreneurship in nursing has led to growth and promotion of the agency and nurses have had more desire to work.

One nurse with 7 years of work experience stated: “My creativity and appliances that I had made has led the university to promote a lot. For example, the university announced that it was supposed to have 3 patent annually based on their strategic plan. My creativity had many benefits for them. Vice Chancellor of Research and Technology in the Ministry of Health wrote that this university has grown by 200 percent. Well, they were grown. Also, they had a positive view and said if we encourage someone, others are also encouraged.”

Also, participants believed that creativity has led to reduction of hospital costs, building devices similar to foreign samples with better quality, using the supplies in the hospital and greater comfort of patients and coworkers (health workers).

A nurse with 14 years of work experience cited that: “I designed and built a bed special for doing percutaneous nephrolitotomy in the operating room, at that time it was about 240 million rials (or around 240,000 dollars). I designed it and put in the hospital, the entire cost for building it, was 8000,000 rials (or around 1000 dollars).”

4.4. Unpleasant Outcomes

In addition to positive or pleasant outcomes, nurses implied to unpleasant or negative outcomes including: lack of support by some managers and authorities including little encouragement, providing low-cost financing, paying out-of-pocket personally, disruption of family roles, hard- working, cutting out a lot of things in life, and long-time warranty of devices that were made by creative nurses.

One nurse with 25 years of work experience stated: "Well according to the current situation, I can say that what I expected, outcome is not pretty for me both from incentives, (I mean the system), and financial aspects."

And a nurse with 27 years of work experience cited that: "Do you think a creative person as a father in the home could be a positive and effective parent for the children. Can he be? Not really. Unfortunately it is not supported, the creative nurse must work very hard, and cutting out a lot of things in the life, and this is a fact."

5. Discussion

In the present research, nurses were asked about outcomes of their creativity in clinical settings. Findings indicated good information about the unique experiences and perspectives of creative nurses and showed that creativity has many benefits for the patients, nurses, their colleagues, as well as the hospitals and the universities. Also, it had some negative effects on nurses that sometimes led to discouragement and displeasure. However, nurses’ experiences indicated that positive aspects outweighed the negative ones. Therefore, we can say that nurses’ creativity for health care system is a privilege, not a disadvantage.

As the complexity of health care and nursing escalates, health care providers are challenged to think more creatively and develop innovations that advance the knowledge, learning, and service contributions of their discipline to the health care enterprise. Nursing requires creative thought and innovative action in service of the greater good ( 20 ). Examining the first theme showed that nurses’ creativity causes high quality of patients care. It prevents more invasive procedures, more cooperation and satisfaction of the patients, and facilitation of patients’ care. Achieving high quality in patient care is important because of the pivotal role of delivering direct care in nursing as well as the growing emphasis on improving hospitals’ credibility and clinical status. In addition, patient satisfaction is considered as an indicator of quality of health care services ( 21 ). Creativity gives the nurses feeling of empowerment. Empowerment energizes the people who are closest to the patients and the technology to continuously look for ways to provide high quality patient care and to improve processes. The accumulation of ideas, both great and little by many people, will result in better patient care and practical efficiencies ( 22 ). In addition, creative modalities offer nurses a new perspective on how to care for patients. The link between creativity and healing is well-documented ( 23 ). Ultimately, fostering the ethics of change, innovation and creativity led to the development of professional nursing practices and advanced patient care ( 24 ).

The second theme indicated that creativity causes improvements in nurse’s quality of work, personal and social life. Nurses stated that creativity leads to innovation, entrepreneurship, establishment of a company, manufacturing of medical equipment’s and this makes financial benefits for them. Nurses’ innovation is the key to the change and transformation in health care systems ( 25 ). In Iran, creativity, innovation and entrepreneurial skills has not been considered as part of the "formal education" and socialization of nurses in the workplace. Creativity and innovation in nursing is outspread, accidental issue and is not as organized and managed, and not being seen as part of the work to be done by the health care workers, but is seen as something extra to the "real work" of nurses. Therefore, it is essential to manage creativity and innovation in nursing education and practice since it is a developing process and does not happen quickly. Also, internal climate of health care organizations must provide and support the nurses’ innovation and entrepreneurship.

Nurses’ experiences indicated that creativity enhanced self-esteem, self-belief and feeling of happiness. Successfully, dealing with a difficult situation increases belief in the ability to handle other similar situations. Creatively resolving a present problem boost the individuals’ feeling of confidence ( 26 ). Creativity also leads to more satisfaction. When an individual faces with a worrisome problem and uses his or her ingenuity to solve it, an increased sense of satisfaction will be resulted in ( 26 ). Also, satisfaction with creativity is supported, at organizational level, by teamwork, autonomy, domain-relevant competences, and at the individual level, is enhanced by the strength of intrinsic initial motivations ( 27 ).

Nurses experienced social respect and feeling of pride and they stated that creativity had positive effect on their physical and mental health. Pride is produced when an outcome is perceived as the result of an individual’s own actions, particularly if he or she receives accolades from others ( 26 ). Also, the creative process is seen as a process of discovery, which stimulates and guides expression by the creator, eliciting positive feelings and emotions, thereby promoting their health and well-being ( 14 ). In addition, the results of studies indicated that participating in creative activities can have a positive effect on behavioral changes, self-confidence, self-esteem, levels of knowledge and physical activity ( 28 ).

Creative nurses pointed out that creativity led to promotion of health care organization. Creativity and innovation are keys to the survival and growth of both health care system and nursing. The nurse gains personal satisfaction, rewards, and recognition, whereas the organization survives, thrives, and prospers ( 29 ). Therefore, creativity and innovation are key elements for improvement of the organization, and, more specifically, for nursing to find alternatives for solving the problems related to the occupation as a whole ( 30 ).

Creative nurses experienced some negative outcomes, such as disturbances in family role, high workload and time pressure that caused them being fatigue and also impediment to creativity. Creativity takes time, a great deal of hard work, and strenuous mental energy ( 31 ). Therefore, providing sufficient time is a factor for promoting creativity, time is necessary to think creatively, to explore different perspectives, and to play with ideas ( 32 ). In addition, when workload pressure goes beyond a certain threshold in the work environment, represent an impediment to creativity ( 27 ).

The nurses pointed to the lack of financial support and attention of managers, so in order to establish a promoting climate for creativity to prosper, the organization should provide a warm intellectual environment that gives employees recognition, prestige, and an opportunity to participate. Nurse managers should promote creativity through sensitivity that gives nurses the attention they want and treats them as distinct individuals ( 33 ). Consequently, creativity is crucial in all institutions where nurses are trained. The critical importance of identifying, nurturing and protecting innovators, as well as the role of managers and mentors, is emphasized.

5.1. Limitations

While this study was performed with only 14 nurses, it provided a good description about the phenomenon of nurses’ creativity in clinical settings. The flexibility and other strengths of the qualitative methodology made it possible to explore nurses’ experiences. Results from this study can be used to establish guidelines on how to foster creativity in health care professionals, especially practical nurses and nursing students as future nurses. Moreover, as this is a qualitative study, the study group is in no way a representative sample. Hence, the results of this study are predominantly representative of the group of creative nurses who participated in this study and cannot be generalized to all nurses. However, generalizability was neither the aim nor the claim of this qualitative research study.

Acknowledgments

The authors would like to appreciate all the creative and innovative nurses for their cooperation and participation in this study.

Funding/Support: This article has been derived from a research project and was funded by Deputy of Research, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Authors’ Contributions: Study concept and design: Sara Shahsavari Isfahani, Mohammad Ali Hosseini and Hamid Peyrovi. Acquisition of data: Sara Shahsavari Isfahani. Analysis and interpretation of data: Sara Shahsavari Isfahani, Mohammad Ali Hosseini and Hamid Peyrovi. Drafting of the manuscript, Sara Shahsavari Isfahani. Critical revision of the manuscript for important intellectual content: Masood Fallahi Khoshknab, Hamid Peyrovi and Hamid Reza Khanke. Study supervision: Mohammad Ali Hosseini, Masood Fallahi Khoshknab, Hamid Peyrovi and Hamid Reza Khanke.

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• Published: 11 September 2024

Sparking nurses’ creativity: the roles of ambidextrous leadership and psychological safety

• Heba Emad El-Gazar   ORCID: orcid.org/0000-0002-0185-859X 1 ,
• Nadiah A. Baghdadi 2 ,
• Sally Mohammed Farghaly Abdelaliem 2 &
• Mohamed Ali Zoromba 3 , 4  

BMC Nursing volume  23 , Article number:  643 ( 2024 ) Cite this article

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The leadership practices of nurse managers significantly impact the creativity of staff nurses; however, the effects of ambidextrous leadership on nurses’ creativity are not yet clear. Additionally, the underlying mechanism of this relationship remains to be identified.

The study aimed to examine the effect of ambidextrous leadership on nurses’ creativity, directly and indirectly through psychological safety.

In this cross-sectional study, data were collected from October 2023 to January 2024 involving 241 nurses working at three hospitals in Port Said, Egypt. The Ambidextrous Leadership Scale, Psychological Safety Scale, and the Individual Creativity Scale were employed. Descriptive analysis, correlation analysis, and structural equation modeling were conducted.

Nurse managers’ ambidextrous leadership was positively associated with nurses’ creativity. Psychological safety fully mediated the association between ambidextrous leadership and nurses’ creativity.

The study suggests that enhancing the ambidexterity of nurse leaders can foster a sense of psychological safety, which, in effect, contributes to increased creativity among nurses.

Implication for nursing policymaking

There is a need for healthcare policies and strategies that are supportive of the implementation of ambidextrous leadership practices and promote psychological safety among nurses.

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Introduction

Healthcare organizations are currently experiencing a significant period of transformation driven by rapid technological advancements and shifting societal needs [ 1 ]. Consequently, it is crucial for healthcare leaders, particularly nurse managers, to maintain a balance between adopting innovative approaches and enhancing existing practices to deliver high-quality care [ 2 ]. Achieving this balance can be facilitated through the principle of ambidexterity [ 3 ], which entails leveraging established capabilities while simultaneously seeking new possibilities and integrating them with flexibility [ 4 ].

The academic nursing literature on ambidexterity has demonstrated that the ambidextrous behaviors of nurse managers are crucial for effectively managing current patient care while adapting to future changes [ 5 ]. Additionally, engaging nurse managers in ambidextrous leadership practices enhances their clinical leadership and increases work engagement among nursing staff [ 6 ]. However, to the best of the authors’ knowledge, it remains uncertain whether ambidextrous leadership fosters creativity among nurses. Given the pivotal role of nurses’ creativity in advancing the nursing sector, enhancing care quality, and improving patient outcomes [ 7 ], it is essential to elucidate the determinants of nurses’ innovative behaviors [ 8 ]. Therefore, investigating whether the ambidexterity behaviors of nurse managers can directly spark creativity in nurses is imperative, as this relationship has not yet been explored within the context of nursing.

Furthermore, this study aims to enhance understanding of the mechanisms that associate nurse managers’ ambidextrous leadership with nurses’ creativity. Although academic nursing inquiries have captured numerous consequential aspects of nurse managers’ ambidextrous leadership, we contend that these studies have neglected to explore how ambidextrous leadership produces its effects on nurses. Hence, the present study seeks to examine the effect of ambidextrous leadership on nurses’ creativity, directly and indirectly through psychological safety.

Literature review and hypotheses development

Ambidextrous leadership.

Ambidextrous leadership refers to the ability of leaders to simultaneously invest in current services and explore new opportunities for the future [ 9 ]. In the field of nursing, Hannah et al. characterize the ambidexterity of nurse managers as the dual capacity to manage ongoing patient care processes (production-oriented) while pursuing innovative care processes for future needs (development-oriented) [ 10 ]. This concept requires flexible trade-offs between two leadership strategies: exploration and exploitation. Exploration involves seeking new opportunities and experimenting with innovative ideas, whereas exploitation focuses on enhancing and perfecting existing processes and services to optimize efficiency [ 3 ]. Previous literature indicates that nurse managers’ ambidextrous leadership is positively associated with nurses’ work-to-family enrichment and improved mental health [ 11 ]. Nurses who report to an ambidextrous leader also tend to perform better in their roles, provide higher quality services [ 12 ], and demonstrate greater engagement in their work [ 6 ].

Ambidextrous leadership and creativity

Creativity is defined as the capacity to initiate novel or unprecedented elements within the nursing profession [ 13 ]. In healthcare, creativity refers to the process of implementing new and improved ideas to achieve better health promotion, disease prevention, and patient care [ 14 ]. Similarly, in nursing, creativity is defined as the development of new nursing practices to replace traditional ones or the improvement of existing practices [ 15 ]. To foster creativity within an organization, it is crucial for leaders to create an environment that encourages employees to take risks and engage in experimental trials [ 16 ]. Ambidextrous leadership is characterized by an openness to new ideas, a willingness to take risks, and a readiness to experiment with new opportunities [ 4 ]. Additionally, the literature on creativity suggests that creativity often emerges when individuals are confronted with contradictions and paradoxes [ 17 ]. Leaders who practice ambidextrous leadership effectively navigate between two seemingly contradictory approaches—exploration and exploitation [ 18 ]. Therefore, in applying this framework to nursing, we hypothesize:

H1. The ambidextrous leadership of nurse managers has a direct positive effect on nurses’ creativity.

Mediating role of psychological safety

Psychological safety is the confidence to act authentically, unafraid of damaging one’s self-image or hindering career advancement [ 19 ]. Research indicates significant benefits of psychological safety among nurses; for instance, those with higher levels of psychological safety demonstrate increased job satisfaction, decreased intentions to leave their positions, and improved patient safety [ 20 ]. This study argues that ambidextrous leadership—characterized by the ability to effectively balance between the distinct leadership styles of exploration, which involves openness to search, risk-taking, and experimentation, and exploitation, which focuses on refining and perfecting existing processes to optimize efficiency [ 3 ]—can significantly enhance psychological safety within staff. The ability of leaders to adeptly switch between these styles, according to situational demands they encounter [ 21 ], builds trust in their leadership capabilities and confidence in their mastery. This, in turn, bolsters the psychological safety perceived by employees [ 22 ], thereby enabling them to embrace risks and cultivate an open, explorative mindset [ 23 ] that can ultimately lead to heightened creativity [ 24 ]. Therefore, in applying this framework to nursing, we hypothesize:

H2. The ambidextrous leadership of nurse managers has a direct positive effect on nurses’ psychological safety.

H3. The ambidextrous leadership of nurse managers has an indirect effect on nurses’ creativity via the mediating role of psychological safety.

Conceptual model depicted in Fig.  1 .

Conceptual model

Subjects and methods

Study design.

We conducted a descriptive, cross-sectional study in accordance with the STROBE guidelines, seeking to examine the effect of ambidextrous leadership on nurses’ creativity, directly and indirectly through psychological safety.

Participants and setting

We recruited inpatient ward nurses from three hospitals in Port Said, Egypt, two of which were health insurance hospitals, and one was a public hospital. Participants were selected through a three-stage sampling method. Firstly, random sampling was employed to pick those three hospitals from the list of hospitals within the region. Secondly, we employed stratified sampling to determine the number of nurses needed from each hospital. Thirdly, the nurses were selected conveniently from each hospital. The inclusion criteria were: (a) possession of a registered nurse license; (b) employment for at least 12 months and working under the current direct nurse manager for at least 6 months; (c) willingness to participate. Trainee nurses or nurses in managerial positions were excluded.

The sample size for our study was determined using a prior sample size calculation for structural equation modeling (SEM) software [ 25 ]. This calculation was based on a power level of 0.95, an anticipated effect size of 0.3, a desired probability level of 0.01, the presence of three latent variables, and 34 observed variables, which yielded a minimum required sample of 237 participants. To account for a potential 20% failure rate, we initially recruited 285 participants. Out of these, we received 253 responses and identified 12 as invalid, resulting in a final sample size of 241 nurses; a valid response rate of 84.6%.

Instruments

Scales employed in the current study were translated from English to Arabic via a translation-back-translation procedure [ 26 ]. Specifically, two bilingual research assistants first translated the original English items into Arabic. Then, a third research assistant translated the items back into English. We collaborated to resolve any discrepancies between the original and the back-translated versions. Following this, a panel of seven experts, including four nursing professors, one nursing director, and two ward nurses with master’s degrees in nursing, reviewed the translated version alongside the original to ensure equivalence of terms and verify that the language was clear and straightforward. Some words were modified to better suit the context of Egyptian nurses. Before the final administration, a pre-study involving 24 nurses was conducted to ensure the comprehensibility of the questionnaire. Unless otherwise specified, a five-point Likert scale was used to assess each measure, ranging from “1 = strongly disagree” to “5 = strongly agree.”

Demographic characteristics

Demographic information for each participant, including age, gender, marital status, education, and years of working in nursing and in the current unit, was collected.

The 14-item Managers’ Ambidexterity Scale [ 3 ] was utilized to examine nurses’ perceptions of their nurse managers’ ambidextrous leadership behaviors. This scale comprises two subscales: exploration leadership behaviors and exploitation leadership behaviors, each containing seven items. A sample item is “My managers focus on strong renewal of services or processes.” Participants responded using a 7-point scale, ranging from “1 = to a very small extent” to “7 = to a very large extent,” where higher scores indicate that nurses perceive a higher level of their nurse managers’ ambidextrous leadership practices. The findings of the confirmatory factor analysis (CFA) in this study demonstrated a satisfactory fit: χ2/df = 2.47, RMSEA = 0.078, TLI = 0.95, IFI = 0.96, CFI = 0.96.

• Psychological safety

The seven-item Psychological Safety Scale [ 19 ] was used to assess nurses’ level of psychological safety. A sample item is “It is safe to take a risk on this team.” Higher scores indicate greater psychological safety. The findings of the CFA in this study demonstrated a satisfactory fit: χ2/df = 2.31, RMSEA = 0.074, TLI = 0.98, IFI = 0.98, CFI = 0.98.

The 13-item Individual Creativity Scale [ 27 ] was employed to measure nurses’ level of creativity. A sample item is “Suggests new ways to increase quality.” Higher scores indicate greater creativity. The findings of the CFA in this study demonstrated a satisfactory fit: χ²/df = 2.45, RMSEA = 0.078, TLI = 0.94, IFI = 0.95, CFI = 0.95.

We conveniently recruited 24 nurses from study hospitals to conduct a pre-study; these nurses were not included in the subsequent full study. The objective of the pre-study was to evaluate the understandability and clarity of the study questionnaires. The respondents confirmed that the questionnaires were clear and understandable, and no modifications were deemed necessary. In this pre-study, the Cronbach’s alpha values were 0.93 for the Ambidextrous Leadership Scale, 0.94 for the Psychological Safety Scale, and 0.91 for the Individual Creativity Scale.

Data was gathered from October 2023 to January 2024, following approval from hospital management and after securing the cooperation of head nurses in each ward. Copies of the questionnaire, along with envelopes, were distributed to nurses on-site during the morning shift. Each questionnaire was accompanied by a cover page that outlined the purpose and nature of the study and emphasized the principles of anonymity, confidentiality, and voluntary participation. To maintain anonymity, respondents were instructed to place their completed questionnaires in the provided envelopes, seal them, and individually return them to the researchers within three days.

Common method variance (CMV)

Considering the use of a cross-sectional research design in this study, several procedural remedies were implemented to mitigate common method variance (CMV). Specifically, scale items were subjected to expert review and pre-testing. Participants were informed that the research was conducted for academic purposes and that their names were not required. Additionally, the questionnaire included items with varying scale formats, and these items were randomly distributed throughout the questionnaire [ 28 ]. It was also essential to assess the extent to which CMV might influence the findings. Following the recommendations of Podsakoff et al., we employed Harman’s one-factor test to evaluate the presence of CMV [ 29 ]. The analysis indicated that the first factor explains 42.54% of the variance, which is below the threshold of 50% [ 30 ].

Data analysis

Analyses in this study were conducted using SPSS 28.0 and Amos 25.0 software. Descriptive statistics were utilized to summarize the demographic characteristics and scores of the study variables. The differences in nurses’ demographic characteristics related to primary study variables were examined using independent t-tests and analysis of variance (ANOVA). Pearson correlation analysis was employed to investigate the relationships between the study variables. The reliability and validity of the study measures were confirmed. SEM was used to test the measurement model and to explore the mediating role of psychological safety in the relationship between ambidextrous leadership and nurses’ creativity. The goodness-of-fit indices were assessed according to the criteria of χ2/df < 3, RMSEA < 0.08, and TLI, IFI, and CFI ≥ 0.90 [ 31 ]. Statistical significance was determined at a two-tailed p-value of < 0.05.

Participants’ characteristics

The majority of the study participants were female (71.8%), married (78.0%), and held an associate degree in nursing (39.4%), with a mean age of 31.72 years (SD = 7.42). The mean experience of the participants in nursing was 11.52 years (SD = 7.28), while their experience in their current unit was 5.63 years (SD = 3.23). There were no significant differences in participants’ demographics across the study variables (Table  1 ).

Measurement model

To verify the validity of the measurement model, a series of CFAs were conducted. The results showed that the three-factor model, encompassing ambidextrous leadership, psychological safety, and creativity, demonstrated a satisfactory fit (χ²/df = 1.68, RMSEA = 0.053, TLI = 0.94, IFI = 0.95, CFI = 0.94), in comparison to the two-factor model that combined ambidextrous leadership and psychological safety (χ²/df = 3.96, RMSEA = 0.111, TLI = 0.74, IFI = 0.76, CFI = 0.76), and the one-factor model that merged all variables (χ²/df = 6.26, RMSEA = 0.148, TLI = 0.54, IFI = 0.57, CFI = 0.56).

The convergent and discriminant validity of the study measures were assessed. Convergent validity was evaluated through a check of factor loadings, construct reliability (CR), and average variance extracted (AVE) values. For all study measures, all indicator factor loadings (ranging from 0.64 to 0.89) were higher than the recommended value of 0.5; the CR values (ranging from 0.87 to 0.94) exceeded the benchmark of 0.7; and the AVE (ranging from 0.56 to 0.77) was above the acceptable level of 0.5 [ 32 ], providing evidence for convergent validity. The discriminant validity was evaluated by a check of HTMT estimates, and comparing the square roots of the AVE with the variance shared between the constructs. HTMT values (ranging from 0.50 to 0.68) were below the cut-off point of 0.85 [ 33 ]; and the square roots of the AVE for the three constructs exceeded the inter-construct correlations, providing good discriminant validity [ 34 ]. Additionally, Cronbach’s alphas for all instruments (ranging from 0.93 to 0.95), exceeded the recommended 0.70 [ 35 ], demonstrating acceptable internal consistency for the study instruments (Table  2 ).

Preliminary analysis

Means, standard deviations, and correlations among variables are presented in Table  2 . The mean scale scores for ambidextrous leadership, psychological safety, and creativity were 4.26 (SD: 0.89), 3.71 (SD: 0.88), and 3.53 (SD: 0.90), respectively. These mean scores suggest that the participating nurses perceived their direct nurse managers to have a moderate level of ambidexterity, while reporting relatively high levels of psychological safety and creativity. Additionally, there was a significant positive relationship between ambidextrous leadership and nurses’ psychological safety ( r  = 0.55, p  < 0.01), and creativity ( r  = 0.48, p  < 0.01). Also, there was a significant positive relationship between nurses’ psychological safety and creativity ( r  = 0.64, p  < 0.01).

Hypotheses testing

We applied SEM to validate the study’s hypotheses. First, the direct effect of ambidextrous leadership on nurses’ creativity was examined. The results indicated that ambidextrous leadership significantly contributed to nurses’ creativity (β = 0.53, p  < 0.001), accounting for 28% of the variance in nurses’ creativity with a good fit of the model: χ²/df = 1.79, RMSEA = 0.057, TLI = 0.94, IFI = 0.95, CFI = 0.95, thus supporting H1 (Fig.  2 ). Subsequently, we assessed the mediating effect of nurses’ psychological safety in the relationship between ambidextrous leadership and creativity using 5000 bootstrap samples and 95% confidence intervals. The mediation model exhibited a satisfactory fit: χ²/df = 1.68, RMSEA = 0.053, TLI = 0.94, IFI = 0.95, CFI = 0.94. Ambidextrous leadership was found to positively contribute to nurses’ psychological safety (β = 0.63, p  < 0.001), confirming H2. In addition, psychological safety positively contributed to nurses’ creativity (β = 0.61, p  < 0.001). The indirect effect of ambidextrous leadership on creativity was significant (β = 0.38, 95% confidence interval: 0.29–0.49). Furthermore, the relationship between ambidextrous leadership and creativity became non-significant when psychological safety was added in the model (β = 0.12, p  = 0.116). These findings support the full mediation of psychological safety in the relationship, thus confirming H3. Together, ambidextrous leadership and psychological safety explained 47.0% of the variance in nurses’ creativity (Fig.  3 ; Table  3 ).

Direct link model between ambidextrous leadership and creativity

Mediation model

This study investigated the effect of ambidextrous leadership on nurses’ creativity, directly and indirectly through psychological safety. Initially, the findings demonstrated that nurse managers’ ambidextrous leadership can significantly enhance nurses’ creativity. Ambidextrous leaders, capable of employing open leadership behaviors [ 36 ], encourage nurses to perform their work in unique ways, incorporating diverse ideas, which assists them in meeting the creative demands of the innovation process [ 37 ]. In the nursing field, these results align with prior studies that have shown how ambidexterity can foster innovative behaviors [ 38 ]. These findings are also consistent with a non-nursing study by Cheng, which suggests that ambidextrous leadership contributes to the innovative behaviors of followers [ 39 ]. Additionally, these results are congruent with findings indicating that ambidextrous leadership encourages employees to express new ideas [ 40 ].

Furthermore, the study findings revealed that nurse managers’ ambidextrous leadership can effectively enhance nurses’ psychological safety. Ambidextrous leaders are characterized by their flexibility to shift between two behaviors: exploration and exploitation [ 41 ]. Exploration leadership behaviors boost idea generation by encouraging unconventional thinking, promoting experimentation, fostering risk-taking, and supporting learning from errors [ 18 ]. Conversely, exploitation leadership behaviors facilitate idea implementation within the constraints posed by organizational features [ 3 ]. The interplay between these two behaviors fosters a sense of equilibrium, which in turn promotes a feeling of safety among nurses [ 42 ]. These results are similar to those reported in the non-nursing context, where ambidexterity on the part of leadership has been found to promote followers’ psychological safety [ 43 ].

In addition, the study findings showed that the psychological safety of nurses can effectively increase their creativity. This may be attributed to nurses with a sense of psychological safety feeling comfortable expressing their ideas, sharing opinions, and engaging in risk-taking behaviors [ 19 ]. Such an environment could motivate nurses to engage in creative thinking, which ultimately enhances their creativity. These results align with a recent study conducted among healthcare professionals, which demonstrated that when health professionals experience psychological safety, they become more creative in their work [ 44 ]. Additionally, Zhao et al. showed that ambidextrous leadership practices can enhance followers’ psychological safety, further supporting the link between ambidextrous leadership and creativity [ 45 ].

Lastly, the findings of this study suggest that psychological safety serves as a mediator in the relationship between the ambidextrous leadership of nurse managers and the creativity of nurses. This implies that when nurses perceive their managers as receptive to process improvements for better patient outcomes while effectively managing daily operations, they feel secure in expressing their ideas and taking charge without fear of retaliation. This sense of security can, in turn, spark the creativity of nurses. These findings corroborate prior research in non-nursing contexts, which indicates that positive [ 44 ] and situational leadership [ 46 ] behaviors can foster followers’ creativity by enhancing psychological safety.

Limitations

The study had several limitations worth mentioning. Firstly, data collection from one city in Egypt restricts the generalizability of the findings. Future research should aim to expand the geographical scope of data collection to enhance the external validity of the results. Secondly, employing a cross-sectional design restricts the capacity to determine causal relationships. Future investigations should employ longitudinal designs to more effectively ascertain causality. Lastly, reliance on self-reported data introduces the possibility of social desirability bias. This issue underscores the necessity for future studies to utilize alternative methods of data collection to reduce this bias.

Implications

The study enriches nursing science in three notable ways. First, it builds upon previous research regarding the outcomes of nurse managers’ ambidextrous leadership. Second, it deepens theoretical understanding of the factors influencing nurses’ creativity. Third, it introduces psychological safety as a mediating mechanism in the relationship between nurse managers’ ambidextrous leadership and the enhancement of nurses’ creative behaviors.

This study offers several implications for healthcare organizations and nursing management. The findings underscore the importance of cultivating ambidextrous leadership among nursing managers to enhance nurses’ creativity. As a result, hospital administrators should focus on developing the ambidextrous leadership skills of nurse managers, particularly head nurses. Since ambidexterity can be taught [ 40 ], training programs can be designed to enhance nurse managers’ ability to balance explorative and exploitative behaviors, thus creating a supportive environment that fosters nurses’ creativity. Additionally, during the hiring process of nurse managers, hospital administrators should prioritize candidates who demonstrate resilience, encourage innovative ideas, and support the adoption of innovative practices within safe boundaries.

Furthermore, the study highlights the mediating role of psychological safety in the relationship between nurse managers’ ambidextrous leadership and the enhancement of nurses’ creative behaviors. Therefore, healthcare organizations should establish a culture in which nurses feel comfortable expressing their thoughts and taking risks without fear of negative consequences. This can be achieved through transparent communication, regular feedback, inclusive decision-making processes, and by fostering a culture that views mistakes as opportunities for learning.

The study contributed novel insights to the field of nursing science by exploring the effect of ambidextrous leadership on nurses’ creativity, directly and indirectly through psychological safety. The findings indicated that nurse managers’ ambidextrous leadership can cultivate a psychological safety and creativity among nurses. Furthermore, the study supports the notion that psychological safety serves as a mediating mechanism through which the ambidextrous leadership of nurse managers can enhance nurses’ creativity.

Data availability

The datasets generated during and analyzed during the current study are not publicly available due to confidentiality agreements, but are available upon reasonable request from the corresponding author.

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Acknowledgements

Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2024R293), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. Authors would like to thank all of the responded nurses for their cooperation.

Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2024R 293), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.

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Nursing Administration Department, Faculty of Nursing, Port Said University, Port Said, Egypt

Heba Emad El-Gazar

Nursing Management and Education Department, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. BOX 84428, Riyadh, 11671, Saudi Arabia

Nadiah A. Baghdadi & Sally Mohammed Farghaly Abdelaliem

Nursing Department, College of Nursing, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia

Mohamed Ali Zoromba

Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt

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Contributions

HE and MZ planned the study and made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. HE, NB, SA, and ME were major contributors in writing and drafting the manuscript. NB and SA were major contributors in study measures translation and validation. All authors given final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Heba Emad El-Gazar .

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The study obtained ethical clearance from the Research Ethics Committee of the Faculty of Nursing at Port Said University, Egypt. Participants were thoroughly informed about the study’s objectives and their right to withdraw. Informed consent was then secured, and participation was strictly voluntary, ensuring confidentiality and anonymity.

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El-Gazar, H.E., Baghdadi, N.A., Abdelaliem, S.M.F. et al. Sparking nurses’ creativity: the roles of ambidextrous leadership and psychological safety. BMC Nurs 23 , 643 (2024). https://doi.org/10.1186/s12912-024-02277-1

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Published : 11 September 2024

DOI : https://doi.org/10.1186/s12912-024-02277-1

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Educators have known for decades that the key to student learning is engagement. In nursing, the best educators engage students through creative methods that translate learning into clinical practice.

Nursing classes are known to be academically challenging, but they don’t have to be boring. When students make a psychological investment in learning, they are more apt to retain the new information, studies show. Successful nurse educators utilize active and creative learning techniques to develop nurses who are well rounded, reflective, prepared, committed and caring, researchers said in “Nursing Student Engagement: Taking a Closer Look.”

“Nursing student engagement is critical for success within nursing programs and with the goal of remaining within the profession with longevity once the students graduate,” researchers said. “Nursing is a complex area to learn, understand, and integrate into a high-quality profession. Efforts to enhance or increase student/nursing engagement will inherently affect their responses to each other and the care style they exhibit during practice.”

Nurse educators who use creative and innovative teaching methods can capture student attention and overcome the “forgetting curve,” a 19 th -century theory that found information is lost over time if retention techniques are not implemented. Using creativity in the classroom is essential to curriculum development in nursing education. Registered nurses (RNs) who earn master’s in nursing degrees can become nurse educators who help shape the future of nursing education.

Inspiring Creativity in Nursing

Many of the leading learning theories identify creativity as an essential component of teaching. For example, the behaviorism theory states that educators should design strategies that stimulate and motivate learning. The cognitive learning theory says educators should provide creative opportunities that encourage learning. Constructivism states that different teaching exercises stimulate varied thought processes that promote learning.

For nurse educators, the key to inspiring creativity and student engagement is through self-reflection, researchers in Nursing2019 said. In a study titled “Strengthening Creativity in Nurse Educators,” Ahtisham Younas, MN RN, detailed strategies for developing and enhancing personal creativity, including:

Determine the soft-thinking skills that can be associated with positive outcomes.

Unlike hard-thinking skills that emphasize logic, reasoning, efficiency and specificity, soft thinking focuses on metaphors, dreaming, hunches and approximations. Hard thinking focuses on the differences between things and processes, while soft thinking seeks to find similarities and connections.

“Nurses working in a practice setting can evaluate their actions daily and identify the actions that improved patient outcomes,” Younas stated in the study. “Nurse educators can reflect on teaching and learning strategies and evaluate their effectiveness in improving student learning.”

Observe individual actions and do them differently

By breaking out of routines, patterns and established rules, individuals can discover, create and redesign thinking. Such changes can help individuals see the same information differently.

“Educators might try switching from traditional teaching strategies, such as lectures, to creative teaching strategies, such as role-playing and crossword puzzles,” Younas wrote.

Encourage and nurture imagination by asking and answering “what if” questions

“What if” questions encourage individuals to look beyond superficial situations and develop an open mind to ideas that challenge the norms.

Collaborate with other healthcare professionals

Seeking out other healthcare professionals, including experienced RNs and nurse educators, for ideas, suggestions and insights can lead to new approaches to education.

Overall, nurse educators should develop the habit of looking at situations from other viewpoints and remain curious about new teaching and learning approaches. Younas said creativity is “an essential capacity for nurse educators because it enables them to strengthen their problem-solving abilities, improve their teaching, improvise teaching and learning strategies and improve student learning.”

“Creativity could also be considered a channel to bridge the gap between nursing theory and practice. Educators should embrace this capacity and take steps to enhance it over time,” Younas said.

Enhancing Nursing Education Through Creativity

Nurse educators use a variety of techniques to ensure that students are learning and retaining information. To strengthen nursing education, nurse educators focus on these suggestions that emphasize big ideas and encourage critical thinking and reasoning skills:

• Streamline content to reduce redundancies
• Create a culture of wonder by encouraging questions
• Turn students into teachers
• Make learning active through concept mapping and role-playing

Another component that leads to success as a nurse educator is graduating from a nursing program with an MSN curriculum that supports creativity and critical thinking. Graduates of Duquesne University’s online master’s in nursing program and post-master’s certificate program learn the vital skills for working in both academic and clinical settings.

About Duquesne University’s online Master of Science in Nursing (MSN) Program

Duquesne University is a pioneer in nursing education, launching the first BSN program in Pennsylvania in 1937 and the first online nursing Ph.D. program in the nation in 1997. Graduates of the online MSN and online Post-Master’s Certificate in Nurse Education & Faculty Role programs have been lauded as some of the most creative and innovative nurse educators in the field today.

Both programs are 100 percent online, allowing nurses to continue their careers and personal lives while earning an advanced degree. Duquesne University MSN and post-master’s students are also able to add a concentration in Forensic Nursing or Transcultural Nursing to their course of study. For more information, contact Duquesne University today.

Nursing Student Engagement: Taking a Closer Look: OJN

Strengthening creativity in nurse educators: Nursing2019

Enhancing Your Creativity: A 10-Point Guide: Enhancing Your Creativity

5 Ways to Get Nursing Students Engaged in Your Classroom: LWW

Creativity: a refinement of the concept for nursing practice

Affiliation.

• 1 Widener University, Chester, Pennsylvania, USA. [email protected]
• PMID: 12519279
• DOI: 10.1046/j.1365-2648.2003.02516.x

Aims: This paper seeks to remove some of the ambiguity surrounding the conceptual meaning of creativity using techniques of concept refinement to advance the concept.

Background: Creativity is an essential component of nursing practice that occurs daily in nurse's interactions with clients, families and other nurses. Failure to acknowledge and encourage creativity in beginning nurses may hinder future development and innovations in nursing practice and in nursing science. In order to promote the development of creativity it is first necessary to clarify and refine the concept as it applies to nursing.

Design/methods: A comprehensive review of a variety of computer and online databases resulted in thousands of articles on creativity between the years 1966 and 1999. The final sample (n = 48) was obtained using both stratified random and purposive sampling techniques. A content analysis of the literature was conducted using methods identified by Morse and illustrated in the work of Hupcey et al. Having determined the concept to be partially mature, the concept was advanced using techniques of concept refinement.

Findings: Content analysis of the literature yielded three differing definitions for creativity: revelation, birth and reincarnation. Creativity occurs in the presence of intrinsic motivation and a nurturing environment. While value is often used to identify whether a product is creative, the value of the product cannot determine whether the process has occurred. The product produced determines evidence of the process of creativity.

Limitations: Limitations of this investigation are the use of secondary sources and the relatively small sample size (n = 48).

Conclusions: Refinement of the concept of creativity indicates that it is a process that may be developed and influenced by the environment and is recognized by the product produced. Further investigation is needed to explore methods and techniques for developing creativity in nursing.

Publication types

• Concept Formation*
• Creativity*
• Nurses / psychology
• Nursing Process
• Nursing Theory*