BackgroundRegistered nurses lead the nursing care close to older adults in home healthcare. It is expected that there will be an increased need for home healthcare. In addition, more advanced care is now being performed in home healthcare, leading to increased demands for registered nurses. Therefore, the aims of this study are to explore and compare registered nurses' perceptions of their leadership close to older adults in municipal home healthcare, as well as to correlate their perceptions with age and work experience.MethodsThis study is a part of a larger web-based questionnaire survey, with a non-experimental and cross-sectional design. Descriptive and analytical statistics were used. A total of n = 71 registered nurses leading close to older adults participated, in seven municipalities in two geographic areas in Sweden.ResultsThe registered nurses perceived their ability as leaders close to older adults as high. The registered nurses had neither low or high trust in care staff's competence. They perceived to have space and access neither in a low or high degree in their work to develop sufficient competence in leadership and having nursing responsibility on an organisational level. Registered nurses' perceptions of their leadership differed depending on whether they had a specialist education or not; those with specialist education perceived to a higher degree that they could apply their professional experience in their work; interact with the older adult and their next of kin; assess individual needs and based on a holistic view of the older adult, create good relationships with the older adults' next of kin.ConclusionsRegistered nurses' specialist education may strengthen their leadership in home healthcare. Further research is needed to gain new knowledge of registered nurses' leadership in home healthcare, as well as care staff's' experiences of registered nurses' leadership in municipal home healthcare.

Background: Worldwide people are living longer. The need for healthcare for older adults is increasing. The trend is towards advanced home healthcare, where registered nurses are key figures. This implies challenges for municipal home healthcare, as well as for registered nurses’ leadership. The aim is to explore registered nurses’ perceptions of challenges and suggestions for improvements in their leadership close to older adults in municipal home healthcare. Methods: The present study is part of a larger web-based questionnaire survey with a cross-sectional design. The design is inductive, analysing data using qualitative content analysis and descriptive statistics. A questionnaire with open-ended and closed-ended questions was used. A total of n = 70 registered nurses leading close to older adults participated in seven municipalities in two geographic areas in Sweden. Results: The results show registered nurses’ perceptions of challenges as leaders close to older adults in terms of 11 categories. The categories are motivating for care, adjusting and coordinating nursing care to the older adult, relating to next of kin, managing communication difficulties, relating to social situations in the home, managing demands, working alone, having lack of time, collaborating with physicians, and care staff having low competence. The registered nurses suggested improvements for their leadership close to older adults in terms of nine categories. The categories are adjusting the work to the older adult, clarifying registered nurses’ responsibility, balancing demands and resources, setting time aside, improving staffs’ competence, ensuring staff’s competence development, improving the work environment, and cooperation between professions in the municipality, as well as between healthcare organizations. Conclusion: The results show that registered nurses’ leadership in municipal home healthcare implies a wide range of challenges. There is a need for strategies to improve the organizational preconditions to reduce challenges in registered nurses’ leadership in order to promote positive patient outcomes for safe and quality care.