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Healthcare environments are increasingly demanding environments rendering nurses a vulnerable group experiencing a high degree of stress due not only through exposure to high patient acuity but also by understaffing, limited support, and long working hours (Hart, Brannan, & De Chesnay, 2014). Understaffing means that some nursing care activities may be missed, thus adding to frustrations (Jones, Hamilton, & Murry, 2015). Managers are being asked to do more with less, as resources become increasingly scarce (Jones et al., 2015). At the same time, a myriad of sociocultural issues are to be taken care of, for example, managing variant religious and cultural backgrounds (Khattab & Johnston, 2015); gender and LGBTQ equalities (Botti, Corsi, & D'Ippoliti, 2014; Eliason, Dejoseph, Dibble, Deevey, & Chinn, 2011); aging workforce (Vasconcelos, 2015); staff with disabilities (Hogan, Kyaw-Myint, Harris, & Denronden, 2012) or chronic health problems (Stynen, Jansen, & Kant, 2015); or psychosocial and/or addiction issues (Tsounis & Sarafis, 2016) all of which may compound an already challenging work life. The ways by which nurses adapt and react to their workplace environments is mostly influenced by personal attributes such as self-efficacy, coping, control and personal competence, however there is also much that managers can do to support these staff by fostering a positive organisational culture in the workplace (Hart et al., 2014). Supportive work environments focus on effective human resource management such as ensuring appropriate staffing and skill mix, but also focus on strengthening interpersonal relationships and encouraging staff to find meaning in their work, as this is believed to contribute positively to personal and organisational well being (Hart et al., 2014). Supports also centre on developing skilled communication, meaningful collaborations, effective decision-making, recognition of staff and authentic leadership (Hart et al., 2014). While the stress that nurses experience has been well documented, with specific targeted interventions receiving much attention worldwide, recently there has been a greater focus on exploring holistic environmental supportive measures to improve the workplace environment for nurses (Hart et al., 2014). This is in response to a growing concern that modern health care delivery has lost its ethical and moral values and is finding it difficult to provide safe, timely, and compassionate care to its clients (Hayter, 2013). Overall, there is an impetus to change the culture of organisations to be more caring and compassionate. It is suggested that staff who experience a compassionate work environment are ultimately more likely to provide compassionate patient centered care (Davies & Mannion, 2013). Compassionate health care environments require compassionate leaders. Hence, a new leadership style is mooted to nurture staff to enable them to deliver compassionate care (Hayter, 2013) alongside of effective working (Hauck, Winsett, & Kuric, 2013). To change the work environment, managers need training and long-term support to adopt and maintain a compassionate leadership style (McKee, Johnston, & Massimilian, 2006; Riess, Kelley, Bailey, Dunn, & Phillips, 2012; Seppälä, Hutcherson, Nguyen, Doty, & Gross, 2014). The nature of leadership required to support healthy work environments that nourish others and foster meaningful work engagement has received researchers and educators attention, but there is no one-size-fits all solution, as organisations and people are constantly evolving. It is evident; however, that nurse managers are not always effectively prepared for their role as managers and often lack the necessary leadership knowledge and skills (Pegram, Grainger, Sigsworth, & While, 2014). Besides authentic, conscious, transformational, ethical and authentic leadership styles, spiritual leadership has been receiving increasing scrutiny in recent years that might usefully embrace a values based approach, but also be supportive of staff (Reimer-Kirkham, Pesut, Sawatzky, Cochrane, & Redmond, 2012). The values that need strengthening in healthcare, such as integrity, trust, respect and honesty and compassion are key components of spiritual leadership (Caldeira & Hal, 2014; Reimer-Kirkham et al., 2012). Spiritual leadership involves helping others to have significance and meaning in their work (Caldeira & Hal, 2014) and contributes to the development of a sense of community (Pirkola, Rantakokko, & Suhonen, 2016). Numerous studies reveal positive outcomes with work based spiritual leadership initiatives although organizations are often reluctant to take this type of holistic approach to human resource development (Ahmed, Arshad, Mahmood, & Akhtar, 2016). So far, the general thrust of workplace spirituality research has focused on individuals examining concepts such as spiritual well-being (Soleimani et al., 2016), spiritual distress and spiritual development (Davoodvand, Abbaszadeh, & Ahmadi, 2017; Tiew, Creedy, & Chan, 2013; Weinberg & Locander, 2014); dimensions of inner life; meaningful work; interconnectedness; transcendence and alignment between values (Pirkola et al., 2016). Studies consistently demonstrate that spiritual values in employees are positively associated with their mental well-being and low occupational stress, whereas spiritual practices are positively associated with low work-related exhaustion and burnout (Arnetz et al., 2013; Nowrouzi et al., 2015). Spirituality enhances employee well-being and quality of life. It offers employees a sense of purpose and meaning at work and a sense of interconnectedness and community (Karakas, 2010). Indeed, many empirical studies demonstrate a positive effects of workplace spirituality on job commitment, satisfaction, and performance; demonstrating results in altruism and conscientiousness, self-career management, reduced inter-role conflict, reduced frustration, organization based self-esteem, involvement, retention, and ethical behaviour (Çelik, 2012; Geigle, 2012). Therefore, harnessing spirituality in the workplace is strongly advocated (Ahmed et al., 2016). Spirituality and its enactment at organisational level is far less studied (Pirkola et al., 2016). Hence, what precisely constitutes spiritual leadership and how to make it work requires further exploration and testing (Alcázar, Fernández, & Gardey, 2013; Kulik 2014). It is clear that an effective leader cannot promote a single spiritual framework since employees have multiple and sometimes, divergent spiritual backgrounds and attitudes. It is also perhaps too much to suggest that enhancing workplace spirituality can effectively foster connections or repair dysfunctional workplace relationships (Bolton, 2010). There are also a number of other challenges to the proposal of spiritual leadership including the risk or perception of proselytizing and the risk of spirituality being perceived as a fad or a manipulative management ploy (Karakas, 2010). Therefore, making the change towards nurturing working environment must be carefully considered, explained, and free from hidden agendas. A new approach to leading and managing is suggested to foster environments that nurture staff. There is also an emerging gap for research and education on the type of leadership that can effectively drive and harness the required attributes necessary in individuals or organisations to navigate this journey. Key emerging attributes are supporting, recognising and encouraging staff; relationship building and demonstrating compassion. Leaders need to connect with workers and the wider communities at an emotional and spiritual level. Consequently, a values based leadership model might be more useful to healthcare organisations and spiritual leadership is an emergent approach that warrants further research and exploration in this context. Key elements in this development should be supporting, recognising and encouraging staff via relationship building and demonstrating compassion. In this process, managers have to be continuously supported in their tasks to effectively drive and harness the required attributes necessary to navigate this journey. To make a permanent change more empirical research on this type of leadership models is needed as well. This calls for health care organisations to loosen their reluctant economically driven decision making models and make a brave step towards sustainable workforce management in order to guarantee better working environment for employees and more compassionate care for patients and their families.
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