Managers' leadership and critical care nurses' intent to stay.

BACKGROUND: Cyclical fluctuations in turnover of critical care nurses are a large and complex problem. Managers' leadership characteristics may be a determinant of critical care nurses' intent to stay in the job. OBJECTIVE: To examine the direct and indirect effects of nurse-managers' characteristics of power, influence, and leadership style on critical care nurses' intent to stay in the nurses' employment positions. METHODS: The sample was 255 staff nurses in intensive care units at 4 urban hospitals. Established instruments with sound reliability and validity were used to assess the predictor, intervening, and outcome variables. Path analysis was used to examine the relationships in a conceptual model of intent to stay. RESULTS: The model explained 52% of the variance in intent to stay, and managers' characteristics were significant at each stage. Managers' position power and influence over work coordination had a direct link to intent to stay; structuring expectations and consideration contributed indirectly through the variables of instrumental communication, autonomy, and group cohesion. Instrumental communication, autonomy, and group cohesion decreased job stress and thus increased job satisfaction. Job satisfaction was directly linked with intent to stay. CONCLUSIONS: Inclusion of nurse-managers' characteristics explained more variance in intent to stay than did previous models. Managers with leadership styles that seek and value contributions from staff, promote a climate in which information is shared effectively, promote decision making at the staff nurse level, exert position power, and influence coordination of work to provide a milieu that maintains a stable cadre of nurses.

Psychometric evaluation of the Organizational Job Satisfaction Scale.

Findings are reported from a replicated evaluation of the psychometric properties of the Organizational Job Satisfaction Scale. Data lend strong support for the scale which assesses four dimensions of organizational job satisfaction. Principal component factor analysis of data from two independent samples of urban staff registered nurses (RNs) (n = 496; n = 532) confirmed four dimensions of pay, interaction, administration, and status. Cronbach's alpha for subscales ranged from .76 to .88. Pearson correlation coefficients for the interrelationships among subscales and an estimate of theta verified internal consistency. The Organizational Job Satisfaction Scale scores correlated significantly with a criterion measure of job enjoyment. Hypothesis testing of theoretically predictable relationships supported construct validity. Scores on the organizational job satisfaction subscales correlated significantly with automony, stress, and commitment. Item revisions and recommendations for future use of the instrument are discussed.

Manager leadership and retention of hospital staff nurses.

This study used causal modeling to trace the effects of manager leadership characteristics on staff registered nurse (RN) retention in 4 urban hospitals. Unique to the study were the all-RN sample, using Leavitt's (1958) model of behavior within an organization to group variables, manager characteristics and unit structure variables as predictors, and focus on the work unit rather than the hospital. Effects of manager characteristics were traced to retention through work characteristics, job stress, job satisfaction, commitment, and intent to stay. Theoretical variables explained 22% of the retention variance. Manager consideration of staff and RN intent to remain directly affected retention; other variable effects passed through intent to stay. Different predictors were important to retention, unit separation, and turnover.

Control over nursing practice: a construct coming of age.

The purpose of this study was to assess the psychometric properties of the Control Over Nursing Practice Scales using data from registered nurses (N = 1117) employed in four acute care hospitals in the Midwest. Psychometric evaluation included dimensional analysis, reliability estimation, and validity assessment of six dimensions of a 33-item instrument: responsibility and influence of head nurses, staff nurses, and committees; access to ideas; use of personal resources; and research utilization. Factor analysis reproduced six dimensions that explained 61% of the variance. Coefficient alphas ranged from .75-.89. Correlations between Control Over Nursing Practice with autonomy, group cohesion, job stress, and job satisfaction supported construct validity. Empirical testing of known group differences to obtain new information about the construct revealed that critical care nurses scored higher on research utilization than medical-surgical or obstetrical nurses; baccalaureate-prepared nurses scored higher than associate or diploma nurses on responsibility and influence: committees. Contrary to our hypothesis, there were no differences between part-time and full-time nurses on any of the six dimensions.

Socialization of new graduate nurses in critical care.

OBJECTIVE: To examine the modified contingency theory of role socialization with new graduate nurses in critical care. DESIGN: Descriptive comparative. SETTING: Six midwestern hospitals with 12 types of critical care units. SAMPLE: Fifty new graduate nurses and 89 experienced registered nurses in critical care. OUTCOME MEASUREMENTS: The socialization variables of precepting, support systems, assignment congruence, role conception, self-confidence, affective responses, commitment, job satisfaction, confronting reality, mutual influence, resolution of outside life conflicts, and resolution of conflicting demands at work were measured. New graduates responded to questionnaires about socialization at 1 to 2 weeks, 3 months, and 6 months of employment. Experienced nurses completed a questionnaire about socialization once, simultaneously with the 1- to 2-week data collection for new graduates. RESULTS: At initial employment new graduates differed from experienced nurses in role conception, self-confidence, and commitment to profession. After 6 months of employment new graduates differed from experienced nurses in self-confidence and mutual influence. For new graduates, positive precepting experiences, support systems, and assignment congruence were related to high self-confidence, low anxiety, high commitment, high job satisfaction, and low role conflict and ambiguity. These variables were also associated with the development of role conception. CONCLUSIONS: The study results lend considerable support to the modified contingency theory of role socialization. Positive precepting experiences, support systems, and assignment congruence contributed to successful socialization for the new graduates in this study.

Shared governance. From vision to reality.

Quality patient care is best provided by competent clinical staff members who are committed to their work, organizational values, and goals, and who maintain employment over time. Shared governance has provided the framework for clinical nurses to become more committed to their practice through decision making and to assume accountability for the outcomes of their decisions. At a tertiary teaching facility, shared governance resulted in increased job satisfaction, commitment, and retention among staff nurses. The authors describe the journey from creation of the shared governance vision to reality, and the impact of the changes.

Absenteeism in acute care hospitals.

Lack of standardization in formulas for calculating absenteeism impeded comparison among institutions and comparison to rates reported for the health care industry. Even though illness related benefits, replacement costs for absent employees and attendance incentives absorbed scarce financial resources, more than 40% of hospitals had no standard for excessive absence. Directors of nursing were concerned about staffing and the possibility that employees were tiring to the point of becoming ill. Among directors, concern about absenteeism was greatest in urban hospitals of 100-200 beds.

Predictors of absenteeism among hospital staff nurses.

An organizational dynamics paradigm is examined for effectiveness in predicting absenteeism among staff RNs in four hospitals. Different predictor variables were important within each hospital. Discussion is focused on the manager role and organizational policies related to criteria for excessive absence, incentives for attendance, and deterrents to absence.

Nurse manager personal traits and leadership characteristics.

A portion of an Organizational Dynamics Paradigm provided the framework for examining urban hospital nurse managers' personality and staff nurses' perceptions of their leadership. Nurse managers' personality traits were comparable to American women in general. On motivation to manage they scored lower than business and health services managers and higher than female public school administrators. Staff nurses rated managers favorably on leadership style, power, and influence. Personality was linked modestly to motivation to manage and selected aspects of leadership.

Evaluation of a self-efficacy scale for preoperative patients.

Self-efficacy has been validated as a predictor of an individual's behavior in aversive situations. Traditionally, nurses have conducted preoperative instruction to help patients cope with the adversities of surgery. Assessing patients' self-efficacy is an additional way to assist them through the experience of surgery and plan their care. This study developed and tested an instrument to measure self-efficacy in adult preoperative patients. The instrument consists of two subscales: a 16-item efficacy expectation subscale and a 16-item outcome expectation subscale. The instrument was administered to 200 surgical patients to obtain descriptions of item characteristics, internal consistency reliability, and beginning construct validity. Evidence supports the validity and reliability of both self-efficacy subscales. The revised instrument can assist perioperative nurses in assessing preoperative patients' self-efficacy.

Patient outcomes. Are they linked to registered nurse absenteeism, separation, or work load?

Using a correlation design, the authors explored the possible associations between patient outcomes and staff registered nurse absenteeism, separation from the work unit, and work load. Data analysis included a search for consistent patterns of relationships across acute care hospitals and over time. Nosocomial urinary tract and bloodstream infections correlated positively with absenteeism. The authors discuss clinical and methodological issues related to the findings.

Reliability of aggregated organizational data: an evaluation of five empirical indices.

Nursing systems research has included many levels of measurement such as individuals, work groups, organizations, and systems of organizations. Variables important to organizational survival often are measured at the individual level, with inferences made to the work group or the organization. This study demonstrated a process for determining the reliability of individual level data aggregated to the work group and organization levels. Data were analyzed on four variables: job enjoyment; manager's leadership style in terms of structuring expectations and consideration; and control over nursing practice. Job enjoyment was assessed over time. Registered staff nurses (n = 632), representing 54 nursing units from 4 large acute care hospitals, comprised the sample. The results indicated the assessment of reliability and validity is important at the level of inference and at each time interval. Aggregated data were deemed reliable when the following criteria were met: Cronbach's alpha > .60; intraclass correlation (1,k) > .60; and a significant F ratio. The interpretation of omega 2 as an indicator of effect size suggested that the validity of inference at the aggregated level is in question when effect size is negligible or small.

Situational supports and job stress: a correlational study.

This correlational study provides information for creating a nursing work environment that supports coping with stress. Questionnaire-generated data were collected from registered staff nurses (N = 538) in two urban, acute care hospitals. Results of multiple regression analysis indicated that situational support variables (autonomy, control over practice, group cohesion, substantive exchange, manager consideration) correlated inversely with job stress. Predictor variables and demographics explained 37% of the variance in situational job stress [F(13, 442) = 19.74, P < .001] and 28% of the variance in personal job stress [F(13, 442) = 13.03, P < .001]. The variables may serve as situational supports for nurses coping with job stress.

A decade of research in nurse anesthesia.

These investigators describe the characteristics of nurse anesthesia research reported in the AANA Journal in 1975-1976 and 1985-1986 and compare nurse anesthesia research to overall nursing research as reported by Brown, Tanner and Padrick. The amount of nurse anesthesia research remained stable, with an even greater focus on clinical practice than in nursing research overall. The 1980's research, as in all nursing, was more theoretically oriented than the 1970's studies. Nurse anesthesia research designs were mainly descriptive, with a trend toward explanatory and prospective. As in all nursing research, convenience samples of hospitalized individuals were most common. More pronounced in nurse anesthesia research than in nursing overall were deficiencies in reporting of reliability and validity of data, psychometric evaluation of instruments and use of statistics. Trends toward CRNA authorship and addressing ethical concerns were identified. Recommendations included increased emphasis on methodological studies, conceptual links and statistical analysis; extension to topics of nursing education and administration and characteristics of nurses; and replication of studies.

Absenteeism-retention links.

Absenteeism and its relationship to retention was explored using Price and Mueller's 1981 model of turnover. Data were obtained from 71 hospital professionals by two questionnaires comprised of established instruments. Absenteeism data then were collected for six months. An empirical model of absenteeism is proposed that demonstrates the linking variables with retention and also reflects complex associations of intent to stay with turnover and absenteeism. Recommendations for reduction of absenteeism are included.

Replication: key to research application.

Replication of research is critical to expanding the sample size and demonstrating applicability of research findings for different critical care patients or units. This author describes several options for developing a replication study in critical care.

Manager impact on retention of hospital staff: Part 2.

This is the second article in a two-part series based on a study of the impact of middle managers on retention of 71 hospital professionals. Research design, methods, and descriptive results were presented in Part 1 (March 1989). In Part 2, the impact of managers' motivation to manage, power, influence, and leadership style on retention is detailed. Recommendations for improving retention include interventions to increase employee job satisfaction and intent to stay, and to improve managers' performance and leadership.