The impact of individual and organizational resources on nurse outcomes and intent to quit.

AIM: To examine the impact of an individual resource factor (psychological capital) and an organizational resource (management support) on nurses' intentions to quit. BACKGROUND: Nursing work can be stressful and as a consequence, nurses suffer greater stress and stress-related sickness, including depression, than the general population. Stress can be mitigated in the workplace depending on the availability of resources in the workplace. Resources can come from the organization or the individual themselves. DESIGN: The study is quantitative using a cross-sectional design. METHODS: The study analysed data from 242 nurses working in five Australian hospitals in the one regional network during 2013. FINDINGS: The predictors explained almost half of the variance of nurses' intent to quit. Psychological capital had the dual benefits of reducing nurses' perceptions of psychological distress and simultaneously increasing their job satisfaction. CONCLUSION: Psychological capital is an example of the personal resources a nurse brings to work. Nurse managers can now understand the impact of a new form of protective resources that influence the levels of strain felt by nurses. If nurses present with low psychological capital, then up-skilling nurses with these personal attributes will positively impact on their health and well-being and, in turn, enhance the care of patients.

Nurse safety outcomes: old problem, new solution - the differentiating roles of nurses' psychological capital and managerial support.

AIM: The aim of this study was to examine the impacts of nurses' psychological capital and managerial support, plus specific safety interventions (managerial safety priorities, safety training satisfaction), on nurses' in-role safety performance. BACKGROUND: Most hospitals in industrialized countries have adopted selective (often the least costly) aspects of safety, usually related to safety policies. However, patient safety remains a challenge in many countries. Research shows that training can be used to upskill employees in psychological capital, with statistically significant organizational and employee benefits, but this area is under-researched in nursing. DESIGN: Data were collected using a survey-based, self-report strategy. The emerging patterns of data were then compared with the findings of previous research. METHODS: Quantitative survey data were collected during 2014 from 242 nurses working in six Australian hospitals. Two models were tested and analysed using covariance-based Structural Equation Modelling. RESULTS: Psychological capital and safety training satisfaction were important predictors of nurses' in-role safety performance and as predictors of nurses' perceptions of whether management implements what it espouses about safety ('managerial safety priorities'). Managerial support accounted for just under a third of psychological capital and together, psychological capital and managerial support, plus satisfaction with safety training, were important to nurses' perceptions of in-role safety performance. CONCLUSION: Organizations are likely to benefit from upskilling nurses and their managers to increase nurses' psychological capital and managerial support, which then will enhance nurses' satisfaction with training and in-role safety performance perceptions.

Nurses' supervisors, learning options and organisational commitment: Australia, Brazil and England.

AIM: To examine the relationships between leader-member exchange (LMX), workplace learning options (teamwork, training and development), empowerment and organisational commitment, for nurses in Australia, England and Brazil. BACKGROUND: The supervisor-employee relationship is fundamental to management theory and practice within the work context of Organisation for Economic Cooperation and Development (OECD) countries. METHODS: Survey-based, self-report data were collected from 1350 nurses in 23 acute-care hospitals during 2011. RESULTS: Significant relationships were found between key Social Exchange Theory antecedents (LMX and teamwork) and outcomes (organisational commitment) for nurses in Australia and England, but not in Brazil. As expected, the path between teamwork and organisational commitment was significant in the three countries. CONCLUSIONS: The findings affirm the importance of LMX as a management tool affecting employee outcomes in OECD countries. In contrast, LMX cannot be assumed to play an important role within a context that operates a dual employment structure coupled with a culture accepting of 'Jeitinho' workplace relationships. IMPLICATIONS FOR NURSING MANAGEMENT: Informal workplace relationships - 'Jeitinho' (similar to the Chinese 'guanxi') may be worthy of examination within BRICS (Brazil, Russia, India, China and South Africa) countries such as Brazil.

Abusive supervision and links to nurse intentions to quit.

PURPOSE: To investigate forms of abusive supervision, namely personal attacks, task attacks, and isolation, and their links to outcomes for nurses, including job satisfaction, psychological strain, and intentions to quit. DESIGN: Cross-sectional survey design. Data collected from July to November 2012. METHODS: Two hundred and fifty public sector nurses employed at five general acute Australian hospitals completed the survey (response rate of 33%). FINDINGS: Structural equation modeling on the forms of abusive supervision (personal, task, isolation) and nurse outcomes indicated goodness of fit statistics that confirmed a well-fitting model, explaining 40% of the variance in intent to quit, 30% in job satisfaction, and 33% in strain. An indirect relationship from personal attacks to intentions to quit, via strain, was observed. Task attacks were related directly, and indirectly via job satisfaction, to increased intentions to quit. Surprisingly, isolation was positively related to job satisfaction. CONCLUSIONS: Abusive supervision impacted nurse outcomes. Specifically, personal abuse had personal and health impacts; work-focused abuse had work-oriented effects. Applying appraisal theory suggests that personal attacks are primarily assessed as stressful and unchangeable; task-oriented attacks are assessed as stressful, but changeable; and isolation is assessed as benign. The findings highlight the impact of abusive supervision, especially task attacks, on outcomes important to nurse retention. CLINICAL RELEVANCE: The findings can be used to devise programs to educate, train, and support supervisors and their subordinates to adhere to zero tolerance policies toward antisocial workplace behaviors and encourage reporting incidents.

The role of support antecedents in nurses' intentions to quit: the case of Australia.

AIMS: The study used Social Exchange Theory as a lens to examine associations between nurses' support antecedents (supervisor-nurse relationships and perceived organizational support) and their job attitudes (job satisfaction, organizational commitment and engagement). BACKGROUND: Similar to many other westernized countries, there is a shortage of nurses working as nurses in Australia. The attrition of nurses from the workplace continues to be a challenge for many countries, with resultant calls for improved retention rates. DESIGN: The design employed in this study was a Survey. METHODS: A self-report survey of 1600 nurses employed in five private sector hospitals throughout Australia was completed during 2010-2011, resulting in 510 completed surveys. RESULTS: A mediation path model was developed to test the hypotheses and results of Partial Least Squares analysis showed that both support antecedents (supervisor-nurse relationships and perceived organizational support) positively led to engagement and job satisfaction. Subsequently, nurses more satisfied with their jobs were also more committed to their organizations, ultimately leading to lower intentions to quit. In addition, job satisfaction was found to mediate the relationships between organizational commitment and turnover intentions, plus between supervisor-subordinate relationships and turnover intentions. CONCLUSION: In the context of a shortage of nurses and higher than average turnover rates, the findings suggest that it is important to improve nurses' job satisfaction and organizational commitment to improve retention. However, the findings also suggest that workplace relationships and organizational management are currently far from ideal.

The impact of workplace relationships on engagement, well-being, commitment and turnover for nurses in Australia and the USA.

AIMS: We examined the impact of workplace relationships (perceived organizational support, supervisor-nurse relationships and teamwork) on the engagement, well-being, organizational commitment and turnover intentions of nurses working in Australian and USA hospitals. BACKGROUND: In a global context of nurse shortages, knowledge about factors impacting nurse retention is urgently sought. We postulated, using the Social Exchange Theory, that nurses' turnover intentions would be affected by several factors and especially their relationships at work. DESIGN: Based on the literature review, data were collected via a self-report survey to test the hypotheses. METHODS: A self-report survey was used to gather data in 2010-2012 from 510 randomly chosen nurses from Australian hospitals and 718 nurses from US hospitals. A multi-group structural equation modelling analysis identified significant paths and compared the impact between countries. RESULTS: The findings indicate that this model was more effective in predicting the correlations between variables for nurses in Australia compared with the USA. Most paths predicted were confirmed for Australia, except for the impact of teamwork on organizational commitment and turnover, plus the impact of engagement on turnover. In contrast, none of the paths related to supervisor-subordinate relationships was significant for the USA; neither were the paths from teamwork to organizational commitment or turnover. CONCLUSION: Our findings suggest that well-being is a predictor of turnover intentions, meaning that healthcare managers need to consider nurses' well-being in everyday decision-making, especially in the cost-cutting paradigm that pervades healthcare provision in nearly every country. This is important because nurses are in short supply and this situation will continue to worsen, because many countries have an ageing population.

Examining the antecedents of engaged nurses in Italy: perceived organisational support (POS); satisfaction with training and development; discretionary power.

AIM: This paper used Social Exchange Theory to empirically examine whether perceived organisational support, satisfaction with training and development and perception of discretionary power are antecedents of engagement for registered nurses working in Italian public and private hospitals (n = 827). BACKGROUND: According to Social Exchange Theory, effective workplace relationships support employees and encourage nurses to use training to enhance their workplace outcomes. METHOD: This research used a cross-sectional design. Data were collected from registered nurses working in six Italian hospitals using a survey-based, self-report strategy. RESULT: Regression analysis found that the variance of process-oriented supervision accounted for 6.9% of Italian registered nurse's perception of engagement, training and development accounted for 26.8% and discretionary power accounted for 2.1%. CONCLUSION: Workplace relationships enhance autonomy and engagement. Effective workplace relationship impacts positively on nurses' outcome. IMPLICATIONS FOR NURSING MANAGEMENT: This paper confirms the relevance of training to enhance engagement of nurses. It also confirms the importance of workplace relationships in enhancing autonomy and engagement. Previous research has identified the importance of nurses' autonomy in an environment where there are shortages of nurses. This study confirms a similar situation for Italian nurses. The findings underline the relevance of investments in continuous professional development to enhance nurses' engagement in private and public health-care settings.

The importance of supervisor-nurse relationships, teamwork, wellbeing, affective commitment and retention of North American nurses.

AIM: Using Social Exchange Theory, this study examines links between supervisor-nurse relationships, teamwork, psychological wellbeing and turnover intentions for nurses in the USA. BACKGROUND: Nurses in the USA comprise the biggest workforce of any country in the world. However, nurses continue to be in short supply even with an aggressive campaign to attract foreign nurses. The shortage of qualified registered nurses has negative implications for patient care and mortality because it affects problem-solving and teamwork as a result of poor communication among nurses. METHODS: The study uses a cross-sectional design and 730 completed surveys were obtained using a self-report strategy. RESULTS: The findings indicate that supervisor-nurse relationships, teamwork and wellbeing explain almost half of nurses' commitment to their hospital and their intentions to leave. Further, there was evidence of a generational effect in that Baby Boomer nurses perceived higher levels of wellbeing and commitment, and lower intention to leave. IMPLICATIONS FOR NURSING MANAGEMENT: These findings suggest that management must focus on improving the quality of workplace relationship as a first step in retaining skilled nurses. It may be time for management to embed performance indicators for all levels of management, linked to ensuring effective workplace relationships.

A systems model for the design of occupational health and safety management systems inclusive of work-from-home arrangements.

The study addressed an important knowledge gap in the literature by co-designing a model for OHS management systems inclusive of workers who work-from-home, with a focus on psychosocial risks. This qualitative research study utilised a series of co-design focus groups involving Australian regulators, health and safety managers and practitioners, senior managers, middle managers and workers who work-from-home, to better understand the types of measures that organisations can apply to improve their health and safety management systems. Using a systems approach, consideration was given to the organisation of the remote working system, the home-work interface for remote workers, the competencies of managers and employees in regard to their occupation health and safety (OHS) responsibilities, and the complexity of identifying, reporting and monitoring psychosocial hazards for employees working from home. The study identified a need for tools designed to support both managers and workers in promoting psychologically safe working from home.

The intention to continue nursing: work variables affecting three nurse generations in Australia.

AIMS: The aims of the study were to examine how seven variables impacted upon the intention of hospital nurses to continue working as nurses and to investigate whether there are generational differences in these impacts. BACKGROUND: There is a critical shortage of trained nurses working as nurses in Australia, as in many other Organisation for Economic Co-operation and Development member countries. The retention of nurses has been examined from the traditional management perspectives; however, this paper presents a different approach (Meaning of Working theory). METHODS: A self-report survey of 900 nurses employed across four states of Australia was completed in 2008. The sample was hospital nurses in Australia from three generational cohorts - Baby Boomers (born in Australia between 1946 and 1964), Generation X (1965-1979) and Generation Y (1980-2000). RESULTS: Six variables were found to influence the combined nurses' intentions to continue working as nurses: work-family conflict, perceptions of autonomy, attachment to work, importance of working to the individual, supervisor-subordinate relationship and interpersonal relationships at work. There were differences in the variables affecting the three generations, but attachment to work was the only common variable across all generations, affecting GenYs the strongest. CONCLUSION: The shortage of nurses is conceptualized differently in this paper to assist in finding solutions. However, the results varied for the three generations, suggesting the need to tailor different retention strategies to each age group. Implications for management and policy planning are discussed.

The impact of intuition and supervisor-nurse relationships on empowerment and affective commitment by generation.

AIM: This article reports a generational cohort and leader-member exchange theoretical frameworks-guided study of the influence of the supervisor-subordinate relationship on three generational nurse cohorts' use of intuition, perceptions of empowerment and affective commitment. BACKGROUND: Within a global context of nurse shortages, knowledge about factors influencing nurse retention is urgently sought. We postulated that nurses' use of intuition is the key to their empowerment and consequent commitment to the organization, and that impact would vary among the three large nurse generations. METHODS: A self-report survey was used to gather data in 2008, which were then analysed using correlations, regression analysis, manova and path analysis. Data were obtained from 900 Baby Boomer and Generations X and Y nurses, randomly chosen from seven private hospitals across Australia. RESULTS: The findings confirm the important impact of supervisor-nurse relationships upon all three generations' use of intuition. The findings add new knowledge about the differing importance of using intuition for Generation X, Generation Y and Baby Boomer nurses' perceptions of empowerment, suggesting it is more important to Baby Boomers and Generation X than to Generation Y. Further, the impact of using intuition differs significantly among the generational cohorts. CONCLUSIONS: The findings suggest the need for a more differentiated tailored style - sensitive to varying needs of the generations. Improving supervisor-nurse relationships is also critical, because of their impact upon nurses' use of intuition, perceptions of empowerment and affective commitment. Poor relationships lead to increased nurse replacement costs.

Communication, training, well-being, and commitment across nurse generations.

Within a context of global nurse shortages, replacing nurses is difficult; training and retention is a critical concern for healthcare management. Similarities and differences in the impact of supervisor-nurse relationships upon satisfaction with training and development, well-being and affective commitment were examined across 3 different nursing generations in Australia. Nine hundred nurses from 7 private hospitals (small, medium, and large) across Australia responded. Path analysis, using an ordinary least squares approach, and multivariate analysis were used to test the hypotheses. Three factors accounted for almost half the variance of Generation Xs' and Baby Boomers' and a third of Generation Ys' affective commitment. Practical implications for hospital management include differences in generations and the pivotal role of nurse supervisors. For all 3 generations of nurses, supervisor-subordinate communication relationships are important because they contribute to satisfaction with training and development and well-being, but also significantly impact affective commitment.

Supervisor-subordinate communication relationships, role ambiguity, autonomy and affective commitment for nurses.

AIM: This paper examine nurses' levels of satisfaction with their supervisor-subordinate communication relationships on their level of role ambiguity (in relation to their supervisors) and their resultant perceptions of autonomy and in turn, affective commitment. METHODS: A survey of 900 nurses working in private sector hospitals in Australia was used to collect data. RESULTS: The combined effects of supervisor-nurse communication relationships, nurses' role ambiguity in relation to their supervisors plus nurses' resultant perceptions of autonomy, definitely influenced nurses' level of affective commitment. Also, nurses were somewhat dissatisfied with their communication relationships with their supervisors, experienced role ambiguity, reported being only a little autonomous, and were subsequently only somewhat committed to their hospitals. Contribution: The findings contribute to addressing nurse retention challenges by identifying factors affecting nurses' organisational commitment. Not only will nurses be more productive (with less supervisor ambiguity), but high quality Nurse Unit Manager-nurse communication relationships are also likely to enhance perceptions of autonomy and thereby, encourage nurses' commitment to their organisation and intention to remain. IMPLICATIONS: These results raise the question as to whether the present management practices are ideal for retaining nurses who are in short supply in many Organisation for Economic Co-operation and Development countries.

The impact of supervisor-subordinate relationships on nurses' ability to solve workplace problems: implications for their commitment to the organization.

This chapter uses the structural and relational dimension of social capital theory (SCT) as a lens for examining the impact of the supervisor-subordinate relationship on nurses' perceptions of the usefulness of their workplace networks, sociability, and affective commitment. A survey was used to collect data from 1,064 Australian nurses. The findings suggest that nurses rely on very small workplace networks (typically only one other person) with which they have strong ties. Further, in over half of the cases, the supervisor (the Nurse Unit Manager (NUM)) holds the centric position. Moreover, for those nurses who did not include the NUM in their workplace network, their position appears even worse. For example, the usual reason given by nurses for not including the NUM was that the NUM was unavailable. This is a concern for health-care management because the past two decades have delivered many changes to the nursing profession, including a reduction in the number of nursing positions and subsequent higher workloads. The consequences suggest that without effective workplace networks, nurses are working under conditions where solving problems is more difficult.