Transformative agency and tensions in knowledge management—A qualitative interview study for nurse leaders

Aim To describe Finnish nurse leaders’ perceptions of and experiences with knowledge management. Background Health science research has traditionally focused on knowledge transfer and research evidence instead of knowledge management, culture and organisational learning. Systematic reviews indicate a lack of awareness about nurse leaders’ activities in knowledge management. Design Qualitative interview study according to the consolidated criteria for reporting qualitative research (see Supporting Information Table S1). Methods Data were collected at a Finnish public, social and healthcare organisation from 33 persons in 2015 and 2017 through 35 individual interviews and seven focus groups. Data were analysed by thematic analysis. Results Nurse leaders’ daily knowledge management activities included assurance of smooth work functions and decisions about sudden changes. When managing knowledge promotion, nurse leaders focused on the near future and served information providers, coaches and developers of operating culture. Anticipatory management of knowledge requirements emphasised nurse leaders’ roles as assessors and visionaries. Tensions while managing knowledge were related to the following: changes in clients’ service needs, insufficient structures and tools to support the assessment and joint development of competence, time and information management, the operating culture, and nurse leader support. Participants reported only few attempts to solve tensions and therefore little to no transformative agency. Conclusion Nurse leaders prioritised daily knowledge management over management of knowledge promotion and anticipatory management of knowledge requirements. Knowledge management in nursing is a complex task requiring a command of different kinds of agency and related leadership styles. The structures, processes and tools supporting knowledge management should be developed to ensure that activities are systematic. Relevance to clinical practice A description of nurse leaders’ perceptions of and experiences with knowledge management could improve recognition of nurse leaders’ agencies for knowledge management, identification of related tensions and application of lessons learned from tensions. This description could also promote nurses’ professional competence and supplement nurse leaders’ training.