To command is to serve: Senior leadership and policy-making predict hospital ward functioning in emergency

Aim: To examine personal, ward and organisational factors related to the functioning of general hospital staff under missile attack. Background: The summer of 2014 is remembered in Israel for missile attacks from the Gaza Strip targeting the civilian population of southern Israel. Methods: The study was carried out in two steps: (1) Qualitative—a focus group to identify the issues faced by the staff of a hospital under fire, (2) Quantitative—a cross-sectional study among 409 hospital workers to explore: (a) personal involvement in decision-making, (b) clarity of directives, (c) coping with emergency on the ward and on (d) the management level, (e) personal professional functioning. Results: A statistically significant positive correlation was found between personal involvement in decision- and policy-making, the clarity of directives and hospital ward functioning. A regression analysis demonstrated that executive management and leadership, clarity of directives and workers’ personal functioning statistically significantly explained 46.1% (R ²  = 0.461) of the variance in ward functioning during emergency. Conclusion: Clarity of directives and executive management and leadership in emergency were positively associated with ward functioning and coping with emergency. Implications for Nursing Management: To ensure proper hospital functioning during emergency, managers must demonstrate personal involvement and leadership, providing clear directives.