Norwegian home-care nurses describe leadership as invisible work

Registered nurses working close to older adults in Norwegian municipal home healthcare described their leadership as an “invisible” element of everyday care. In an exploratory qualitative study, the nurses focused on older adults and their needs, took responsibility for acting when appropriate, sought to maintain coherence, supported fellow workers and used varied approaches to lead. The analysis identified one overarching theme—“To lead close to is invisible work”—with four categories: person-orientation, responsibility, support and variety.

The findings indicate that leadership in this setting can be experienced as embedded in nursing work rather than recognized as a separate activity. The research examined municipal home healthcare, a publicly funded Norwegian service for people of all ages, although most of those receiving it are aged 65 or older. Care is assigned according to assessed needs and may include assistance with personal hygiene, wound care, nutrition and medication.

Registered nurses are key figures in this service, with responsibility for quality and continuity of care. The study focused on leadership close to older adults, a multi-actor endeavour involving older adults, their next of kin and care staff, and enacted at the microlevel of municipal home healthcare organizations. The authors describe this form of leadership as complex and underexplored, and sought to examine how registered nurses themselves experienced it.

Researchers used an exploratory, inductive qualitative design based on individual interviews, with the interview material analyzed through qualitative content analysis. This design was intended to illuminate the meaning of leadership from the perspective of the registered nurses carrying out the work, rather than quantify its prevalence or test its effects. The analysis produced the central theme of invisible leadership and organized it into four categories.

Person-orientation concerned focusing on the older adult and their needs. Responsibility involved acting when appropriate and maintaining coherence. Support included supporting fellow workers and other registered nurses, while variety captured the different ways nurses led.

The study therefore presents leadership close to older adults as a practical dimension of home healthcare that can remain difficult to see because it is woven into the surrounding care activity. Because the evidence comes from a qualitative account of registered nurses’ experiences, the findings describe how leadership was understood and enacted in this municipal setting; they do not establish a measured effect on clinical outcomes, patient safety or service performance. The authors interpret the results as aligning with value-based leadership practices, placing person-orientation, responsibility and support at the center of the nurses’ experiences.

The study does not determine how such visibility should be achieved or whether changing it would alter outcomes, workloads or municipal service organization.

Subject of Research: Registered nurses’ experiences of leadership close to older adults in Norwegian municipal home healthcare.

Article Title: “To lead close to is invisible work”: registered nurses’ experiences of leadership close to older adults in municipal home healthcare

Article References: Stien, T., Jonasson, L.-L., & Josefsson, K. (2026). “To lead close to is invisible work”: registered nurses’ experiences of leadership close to older adults in municipal home healthcare. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15849-5

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15849-5

Keywords: nursing leadership, municipal home healthcare, older adults, registered nurses, qualitative research, Norway, person-oriented care, care quality, continuity of care, lead, close, invisible