Impact of Nurse Manager’s Attributes on Multi-Cultural Nursing Teams: A Scoping Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This paper expresses an important goal of identifying key nursing practices from the literature that address the multicultural issues in the nursing community.  The paper is well reasoned, and the literature selected is appropriate. 

However, I have two issues with the paper that ought to be addressed.  First, it is not clear that the recommended nursing practices needed to manage cultural diversity among staff are any different than they would be for a staff that is not diverse.  This is probably because all nursing staffs are diverse in some ways, so the need to understand the foundational properties of that diversity are necessary needed.  The remedy for this issue is to spend a couple of paragraphs contrasting the findings of this review with a few other studies that seek to answer the question: How does scientific evidence characterize the personality traits, behaviors, competencies, and leadership styles of nurse managers that influence outcomes in nursing teams?  This is the same question of the study minus the word multicultural.  If there really is no difference in best nurse manager practices between multicultural and non-multicultural nurse teams, then I question the need for this review. 

The second issue is that the review fails to prioritize the results from the studies which creates a very confusing list of things nurse managers must do in leading multicultural teams.  That list on Table 3, provides 115 behaviors that are required.  The authors need to provide some guidance from the literature that makes this list less confusing.  Which are most important, and where should managers start?  If the literature provides no guidance in answering this question, then the review is not very helpful.  As it stands, the advice is "do everything!"  

If the study takes steps to address these issues it can be much more useful in accomplishing its goals.  

Author Response

Dear reviewer, kindly find the attachment file with the answers to your comments. Thank you for the opportunity to improve our manuscript.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Abstract is nicely written and very clear.

Suggestion for throughout the paper - be sure each paragraph has at least 3 sentences.

Introduction.

It is not clear why the first sentence specifically refers to health systems in Europe facing sustainability pressures, as this issue is impacting healthcare systems worldwide. Is this trying to set up the idea that nurses are being recruited internationally and therefore maybe recruiting more nurses from Europe?  I would suggest changing this to Health systems worldwide....as this appears to be an issue across the globe.  The rest of the paragraph seems to be explaining how nursing units may end up with multicultural workforces as hospitals are recruiting outside of their own country to deal with the nursing shortage.  

Also suggest adding a sentence to support that this situation has led to migration of people seeking care (something that shows that patients are seeking care in other countries than their own). Describe how and why the nursing shortage has led to this.

Line 58 abbreviate World Health Organization after this first use

Line  spell out GCC and USA etc for first use then abbreviate

Line 66 - break up this sentence. Suggest stopping at synergy. In nursing, this translates to a transformative process....

Line 77 - this one sentence cannot be a paragraph, suggest moving this to either the previous paragraph or the next one.

Line 85, move the word qualified to read However, qualified internationally recruited nurses..., or change to However, recruiting qualified international nurses. Suggest moving this sentence to after the next sentence.  So move the last sentence - Research shows that favourable nursing work.....and then the next sentence - Therefore, recruiting qualified international nurses will not address th4e nursing shortage problem....

Line 92 add one more sentence to this paragraph so there are at least 3.  

Line 100 - spell out JBI first use

Table 1 is a little confusing.  Suggest reworking this somehow. I would suggest switching the nurses outcomes with the attributes of nurse managers.  Also suggest either using personality traits or attributes not both. There might be a way to break up the table more so that the different categories stand out more or something. Maybe this could be more of a chart? 

Same comments for Table 2.  It isn't easy to read and understand.  Not sure if you could get these two tables into some kind of chart or graph? It might be too much content for that - but somehow it needs to be clearer and easier to read.

Table 3 is way too long. 

Table 4 -same comments as Table 1 and Table 2

3.3.3 - the content in this section is just listing out what is in the tables, especially after Table 4.  Suggest cutting this down and only including about half of this content.

Author Response

Dear reviewer, kindly find the attachment file with the answers to your comments. Thank you for the opportunity to improve our manuscript.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

This is a much-improved paper.  One addition to the paper, or one additional effort in some publication is to use it to lay out a research program aimed at identifying which of the leadership behaviors most discriminate between nursing units that are well integrated culturally from those that are not well integrated.  In other words, how can this field be advanced?  Good luck in your work.  

Reviewer 2 Report

Comments and Suggestions for Authors

The edits were well done and greatly improved the readability of the manuscript.