To lead and to be led in municipal elderly care in Sweden as perceived by registered nurses.

AIM To describe registered nurses' (RNs) perceptions of their own leadership and of their immediate line management, as well as leadership's organizational prerequisites in municipal elderly care. BACKGROUND Nursing leadership is a main factor influencing care quality. In spite of this, there is a leadership crisis in municipal elderly care. METHOD A descriptive design utilizing a questionnaire. The setting was 60 residential care homes in Sweden with 213 participating nurses. The response rate was 62%. RESULTS Most nurses (59%) viewed themselves as leaders of a smaller group, whereas 28% did not consider themselves as leaders at all. Few nurses had the will to develop their leadership competence. In all, 25% of the nurses had unresolved serious conflicts with their immediate line management. Half perceived receiving no or little feedback from their immediate line management. A majority had no organized supervision. They perceived, on average, organizational prerequisites as unclear, with few possibilities for leadership competence development. CONCLUSIONS Nurses need to be more willing to develop their leadership skills. Nurses need managers to support them in their leadership roles. They need distinct and supportive organizational prerequisites for leadership. IMPLICATIONS FOR NURSING MANAGEMENT It is crucial to provide distinct and supportive organizational prerequisites for nursing leadership.