Within healthcare, studies support that nurse manager leadership behaviours positively influence nursing outcomes. However, how this behaviour promotes positive outcomes is less well understood. Integrating a ‘positive deviance framework’ and a ‘model for reflection’, this paper uniquely uncovers positive nurse manager behaviours that deviate from ‘business as usual’ in managing and leading healthcare staff. Applying an interpretivist lens to qualitative data collected from 24 nurse managers from Australia and Seychelles, the outcomes illustrate examples of positive leadership, exemplary performance, and uncommon behaviours and actions amongst nurse managers resulting in positive nursing experiences and positive organisational outcomes. Nurse managers practising positive leadership and taking on an employee champion role, underscore these behaviours. This study contributes to the research of positive outcomes, processes, and attributes of healthcare organisations and their members.

The aim of this study was to investigate the challenges that nurse unit managers (NUMs) face while working in acute care settings, the strategies they use to deal with these challenges, and the effectiveness of these strategies from the perspectives of NUMs and their supervisors. NUMs (N = 22) and directors of nursing (N = 3) were interviewed for this study. Thematic analysis revealed 14 challenges relating primarily to NUMs interactions with others, both within and outside of their wards/units. These challenges related to the managerial, but not clinical, aspects of their roles; 16 strategies for managing these challenges were identified, the effectiveness of which seemed dependent on how well they were executed. The strategies are: seeking assistance and support; trial and error; satisficing; taking responsibility for own professional development; scheduling of time; working longer hours; delegation; adaptive staffing and rostering; being a visible presence on the ward; team development; facilitating professional development for staff; being available for staff; negotiation and collaboration; communication; working with the processes of a large organisation; and complying with the demands of others, The findings make a strong case for NUMs to be supported in undertaking comprehensive management education.