LAUSR

AIM This study illuminates the meaning and purpose of clinical presence in nursing leadership in municipal homecare from the first line nurse manager's own perspective. BACKGROUND Being a first line nurse manager in the context of homecare is demanding due to demographic changes and an ever-increasing number of elderly suffering from chronic diseases. Leading in this context entails leading from a distance because patients live and receive care in their homes. First line nurse managers express the importance of clinical presence. However, there is a paucity of studies from homecare of the meaning and purpose of presence. The theory of caritative leadership and the model of caring in nursing leadership served as the starting point for this study. METHODS Hermeneutic abductive approach using a purposive sample of three semistructured focus group interviews with 11 first line nurse managers in homecare in three Nordic countries. RESULT This study shows that first line nurse managers described the meaning and purpose of their clinical presence in homecare as safeguarding the patient by taking overall responsibility for care, securing the patients' voices, building and maintaining trustful relations, and securing a sensible economy. CONCLUSION Our findings indicate that clinical presence serves the purpose of taking the overall responsibility for care and safeguarding the patient. Presence is perceived a necessity to verify staff providing the best possible care. First line nurse managers acted metaphorically as a shield to protect patientcare, which is the main concern in their leadership. The findings add new knowledge to the significance of caring in nursing leadership and the theory of caritative leadership. IMPLICATIONS FOR NURSING MANAGEMENT First line nurse managers need to be clinically present in order to safeguard the patient and to fulfill their threefold responsibilities for the patient, the staff and the economy. This study might also contribute to the political discussion concerning why nurses has to be first line nurse managers and cannot be replaced by economists. This article is protected by copyright. All rights reserved.