Nurses’ expectations about the succession of leaders in the hospital context*

Objective: to analyze the expectation of nurses about the succession of leaders in the hospital context. Method: a descriptive and exploratory study of a qualitative approach carried out with 36 nurses from a public university hospital selected using the snowball technique. The data collection was done through semi-structured interviews that were recorded and analyzed based on the assumptions of the Content Analysis technique, Thematic modality. Ethical criteria were adequately met. Results: the reports comprised two central categories, “Who Will Take My Place?” and “Potential and Openness to Plan the Succession of Leadership in Nursing,” the latter being divided into two subcategories: “Nursing leadership in the hospital five years from now” and “Strengths for the implementation of a leadership succession plan”. Conclusion: from the results, positive aspects of the diagnosis of the leadership profile in the institution that favor the development of succession planning were verified. In addition, it was possible to perceive the necessity of the development of this planning in the hospital and its importance for the succession of leadership in Nursing. In this context, this study presents itself with an innovative character for exposing a theme that aims to potentiate the future of Nursing.

involves the identification, development and evaluation of individuals for future leadership positions, ensuring continuity of leadership within an organization" (14) . The SP allows key positions in organizations to be filled internally when they are vacant because of retirement, internal conflict or health leave, for example (19) . Using this strategy prevents key positions from becoming vulnerable (19) and ensures the continuity of projects, culture and institutional achievements (17) .
Evidence of the importance of this issue stems from the aging of Nursing leaders noted by the imminent retirement of experienced nurses projected in the short and medium term (8,(10)(11)(14)(15)18,(20)(21) . In addition, the difficulty of recruiting new leaders has been evidenced in studies that point out little willingness of young people to take leadership positions (13)(14)18,(20)(21) .  (22) . This scenario indicates that the implementation of SP in organizations can prepare in advance new generations of leaders in Nursing (23) . It is also worth considering that the composition and coexistence between these generations can be limiting or potent for the succession process, depending on their conduct.
The justification for the accomplishment of this study is based on the literature review in which it was verified that the succession of leaderships is an innovative and incipient theme at the national level. Although Brazilian nurses have advanced in leadership studies, there are no researches with this focus, although some mention the importance of the nurse training process as a leader both in academic and practical contexts as part of their professional development (4,9,(24)(25)(26)(27) .

This research brings an innovative approach to
Nursing leadership by awakening the need to develop, in a dynamic and systematized way, the formation of new leaderships in Nursing. This process can favor the future and the preservation of the legacy of generations of more experienced nurses, as well as the advancement of the profession and the accomplishment of research with another perspective on leadership and management. It is also hoped that the study will inspire other researchers in the search for strategies that favor the good coexistence between the generations of nurses in the different spaces where they work.
Thus, the objective of the study was to analyze the nurses' expectations about the succession of leaders in the hospital context. Nogueira ALG, Munari DB, Ribeiro LCM, Bezerra ALQ, Chaves LDP.

Method
A descriptive and exploratory study with a qualitative approach, whose purpose is "to use non-quantitative methods to contribute with new knowledge and provide other perspectives in the health area" (28) (29) in which, at the end of the interview, each nurse indicated two others to participate in the study, and so on. The use of this criterion allowed that they had leaders representing all levels of performance. Those nurses who were indicated and, at the time of the interview, were separated from the activities for any reason were excluded.
The study sample was intentional, composed of 36 nurses, and, in order to delimit the number of participants, the data saturation criterion was used. This process was defined when we observed the repetition of perception about the same data (30) . The continuous process of analyzing the data of each interview ensured the consistency and robustness of the information.
To obtain the data, we used in-depth and semistructured interviews that explored participants' experiences and the meanings they attribute to the studied subject. The meetings for the collection were previously scheduled according to the availability of the participants. All the interviews were carried out in the hospital's premises, in a place that allowed privacy, during working hours, with the institutional consent.
The questions that made up the interview script focused on the institution's concern regarding the replacement of nursing leaderships; how nurses saw this leadership in the institution in the coming years and what their expectations and willingness to participate in a proposal for a leadership succession plan. In addition, questions related to the professional profile related to leadership. In the first contact with the participants, the objective of the study was presented and the signing of the Free and Informed Consent Term (FICT) was requested. The interviews had an average duration of 40 minutes and were recorded in digital media with the acquiescence of the interviewees.
As the interviews were carried out, the information was transcribed for a preliminary analysis and identification of its saturation (30) . The data was submitted to Content Analysis, Thematic modality, by track, which is the process done from the clues given by the findings, leading to the construction of categories. The opposite of this process is called box analysis where the data is distributed in pre-determined analytical focus. In this process, the stages of pre-analysis, material exploration and treatment of results, inference and interpretation (31) .
To assist in this phase, WebQDA 2016 software was used for data storage and coding. WebQDA was a tool that optimized data coding by allowing the system to feed the interview transcripts. These were arranged in the After the sources were defined, the "tree codes" were created, so called because they allow branching. Each tree code was used to represent a category and its branches represented the subcategories, identifying the fragments of phrases, words or phrases that illustrated the codes created and represented the quotes of the participants' speeches. In this way, analytical development generated two central categories, one of them being divided into two subcategories.
For the presentation of the data, codes have been created for each participant. In the elaboration of these codes, the first letter of the position that the nurse performs in the institution was assigned, numbering it according to the order of transcription.
Thus, the nurses linked to the Nursing Board with the code "D" (D1 to D5) were grouped; to the heads of units, the code "C" (C1 to C8) was assigned; the code "L" (L1 to L7) and, to the supervisors, the "S" code (S1 to S16).

Results
Thirty-six nurses were enrolled in the study, 33 of whom were women and three were men. Table 1 illustrates data to understand a more detailed profile of these people. The data from the individual interviews after being analyzed generated two thematic categories that will be presented in Figure 1.
Category 1, "Who will take my place?", Expresses the awareness of the group of nurses regarding the issues related to the succession of nursing leaders in the hospital. This is a concern of the majority, regardless of the position. In this stratum, we still explore the reflections regarding the characteristics of the institution regarding the approximation of the outgoing nurses that occupy managerial positions and need to be replaced, as well as points out the need to prepare people to continue the service and routine of the hospital, as shown in demonstrates the availability of nurses to develop such a plan for the institution. The data is shown in Figure 3.

Perspectives of the nursing leadership succession of nurses managers and caregivers
Who will take my place??
Potential and openness to plan succession of leadership in Nursing Nursing leadership at the hospital in five years tim Strengths for the implementation of a leadership succession plan Nogueira ALG, Munari DB, Ribeiro LCM, Bezerra ALQ, Chaves LDP.

Who will take my place?
Both I and other Nursing leaders are close to retiring, it's only another five years, we sit down and talk about it, how it's going to be, who will replace us .... who will you lead? (D1) From the beginning, when I was a team, I wanted to work with new people, I already knew some people, and I already thought that my days inside the institution were counted, so I thought I needed people to continue the service, I just planted the seed, it needs to bear fruit and bear good fruit, so I had this concern of having a new team. (D4) Undoubtedly, it is a concern of all of us. It's very casual this conversation, a common conversation, when you need to change someone's place, when you need to go some to key places, you know, there is no formality in this sense, we talk about how it will be, but it's a question in our head . (C1) In several moments, my immediate boss arrives and makes direct notes, you will replace me. (C4) I realize that yes, we have our Head of Nursing, who is a born leader, when someone new arrives, she says thus: "you will be our successor," she has a lot of that concern. (C8) I talk a lot to the boys, because I want them to follow up, I'm jealous of the service. For him to be in good hands, then, all who have to want this. (D4) The built cannot be discarded, so when someone is going to retire, there is a concern with who will replace that person's place, now, prepare a person to be assuming, we do not have that hierarchy to do it here, I've never seen, until because of the same sizing. (L7) I think there will be a great demand for retirement, we had many at the beginning of this year and, five years from now, it must be bigger, I'll be in this group! This group of my group, we entered the public service in 90, we will be retired in five years or even less and you will assume and the prospect is good, as long as you are committed to the institution, at least knowledge, you are having, allied knowledge with commitment would be idea.   (16)(17)19) .
Most of the representatives of generation X (12), Likewise, the fact that most of the participants (58.3%) did not receive leadership guidance when they took office was highlighted. This data reveals that collaboration between the positions does not seem to be a formal concern in the institution. Despite the advances and evidences of leadership studies, this is still not seen as a competence to be developed (11)(12)20) .
In practice, it is considered as a "cream" characteristic and, for this reason, it is little valued as something to be learned. In organizations that have the SP implemented, collaboration is a key point and part of the organizational culture (20) . The awareness of nurse assistants and managers on the importance of effective communication and true spirit of collaboration is a key aspect in organizations that value the intergenerational work of nurses (3,11,16) . indicate that it is possible to take advantage of this transition phase to prepare a new generation of leaders for the hospital, as will be seen below.
The data that illustrates the first category, "Who will take my place?", Portray the feeling of concern for the future, not to lose what was built, above all, to preserve what has been won by each more experienced nurse, as  (22) . For this reason, understanding in depth how these processes happen can help in the preservation of an invaluable intellectual heritage.
The essence of this first category goes back to the idea that more experienced nurses care about who will take their places and whether this person will be able to maintain what was earned during a lifetime of work.
Nurses representing the Baby Boomers generation, in particular, are professionals with a sense of belonging to their workplace, defend the institution, are proud of their achievements and their own trajectory (22) .
In this sense, the participants of the study, faced with questions about the succession of leaders, see that it is necessary to prepare people to give continuity to what was built. Thus, the contingent of professionals of generation Y could count on the experience of those of the generation Baby Boomers and the generation X for its formation in the next years. Studies of the effects of leadership development programs point to advantages of this process and also reinforce the importance of younger people knowing how the most experienced work and solve problems, although these moments are still limited by the lack of opportunities (6,8,(10)(11) .
The data for Table 2, which illustrates the second category, "Potential and openness to plan the succession of leadership in Nursing", were organized into two subcategories.
The first one, "Nursing leadership in the hospital five years from now," shows the perspective of nurses related to the succession of leadership in the medium term.
These are directly linked to the possibility of renewal of the current leaders of the institution, due to the proximity of retirees of those who are more experienced.
Research highlights the importance of conducting an annual analysis of the leadership gaps in Nursing in the institutions, which allows the identification of predictable vacancies based on projected promotions in pensions and possible successors to take up these vacancies (32) .
The statements that illustrate the category, in general, bring a positive expectation to the hospital's nursing leadership over the next five years. Among the aspects that seem to favor future and promising changes is the identification of the potential of the younger group and its training, given that many nurses of generation Y are masters or doctors or are still qualifying.
In this sense, this concern expressed in the nurses' speech was also glimpsed that the replacement of the leaders is done considering the possibilities of training new nurses for the management and leadership.
Studies (15)(16)(17) point out that maintaining the internal intellectual capital of leaders enables the identification of high-potential nurses at all organizational levels to provide formal leadership development. Identifying high potential leaders and their strategic development can help ensure a suitable set of successors (32) . it is important to consider that, rather than renewing the group of professionals, it is desirable to prepare them, as some statements.
In this sense, it is emphasized that international studies (6,11,20,23,(32)(33)(34)  As the data from this study indicate, a survey indicates that generation Y professionals will assume leadership positions in the coming decades (32) . For this reason, identifying high-potential internal intellectual capital is critical to the success of Succession Planning in Nursing (8,10,18,(33)(34)(35)(36) . This step is one of the elements to think of a succession planning that, among other aspects, also includes strategies of retention of the professionals in the services and development of orientation programs for the leadership. In addition, to be effective, it is the implanted system itself that reveals, shapes and sustains the succession planning of leaders, making it part of their organizational culture (37) .
In the second subcategory, "Strengths for the Implementation of a Leadership Succession Plan," data were compiled that trace back to the idea that it is possible and necessary to begin organizing such planning at the institutional level. A succession plan should be able to develop a leadership system with values based on principles to be achieved by professionals with openness to change and vision, courage to innovate and humility to learn continuously, since this is the challenge of the leader of the future (2) .
The data indicate a positive perspective of the nurses regarding the possible implantation of a SP in the hospital, based on the perception that there is openness of the institution and the nurses managers and assistants for this change. The support of the Nursing managers and the integration of the SP to the strategic planning of the institution is necessary for it to be successful (34) .
An organizational culture of encouragement, leadership development and succession is essential for modeling new roles (38) .
The nurses emphasized the SP as a necessary conduct to systematize isolated actions made by one or Rev. Latino-Am. Enfermagem 2019;27:e3178.
another person. In addition, they consider that it can contribute to a better formation and qualification of leaders, to promote positive changes and the continuity of leadership in the institution.
Succession planning and leadership development enable the formation of a cadre of trained nurses to be potential successors, thus enabling continuity of leadership (13,21,(32)(33) . It also improves the work environment, patient care and nurses' satisfaction (3,17,32,37) , being crucial for the future of the Nursing profession (34) .
In the conclusion of an investigation conducted in the United States, the authors point out that "the way is clear: the nurse's leadership competence influences job satisfaction and makes working environments healthy, which in turn influences the best way to get positive results from customers" (3) .
One of the lines highlights a nurse's belief in the future and the need to systematize a hospital succession plan. This narrative reported to a recent study whose reflexive conclusion was: "The most significant contribution that leaders can make to the future of nursing is to develop their successors" (10) .
Thus, the SP should contribute to the training and development of skills and abilities necessary for the role of Nursing leaders able to act in a diversified, complex and highly competitive professional and organizational context. It is worth highlighting that the data of this research made possible the development of a planning for the succession of leaders, using the appreciative investigation as a method of research and planning, whose results are being prepared for dissemination.