Validation of the Implementation Climate Scale in Nursing.

BACKGROUND: One critical factor in effective implementation of evidence-based practices (EBPs) in nursing is an organizational context that facilitates and supports implementation efforts. Measuring implementation climate can add useful insights on the extent to which the organizational context supports EBP implementation. AIMS: This study cross-validates and examines the psychometric properties of the Implementation Climate Scale (ICS), which measures nurses' perceptions of their unit's climate for EBP implementation. METHODS: This study analyzed ICS data from two cross-sectional studies, including 203 nurses from California and 301 nurses from Florida. Analyses included evaluation of internal consistency, multilevel aggregation statistics, and confirmatory factor analyses. RESULTS: The 18-item ICS demonstrated comparable psychometric properties to the original measure development paper in both samples. Confirmatory factor analyses provided support for the scale's factor structure in both samples. LINKING EVIDENCE TO PRACTICE: The ICS is a pragmatic measure that can be used to assess unit implementation climate in nursing contexts. Results from the ICS from nurses and nurse leaders can provide insights into implementation-specific barriers and facilitators within the organizational context.

EBP Implementation Leadership of Frontline Nurse Managers: Validation of the Implementation Leadership Scale in Acute Care.

BACKGROUND: Frontline nurse managers influence the implementation of evidence-based practices (EBP); however, there is a need for valid and reliable instruments to measure their leadership behaviors for EBP implementation in acute care settings. AIM: The aim of this study was to evaluate the validity and reliability of the Implementation Leadership Scale (ILS) in acute care settings using two unique nurse samples. METHODS: This study is a secondary analysis of ILS data obtained through two distinct multisite cross-sectional studies. Sample 1 included 200 registered nurses from one large Californian health system. Sample 2 was 284 registered nurses from seven Midwest and Northeast U.S. hospitals. Two separate studies by different research teams collected responses using written and electronic questionnaires. We analyzed each sample independently. Descriptive statistics described individual item, total, and subscale scores. We analyzed validity using confirmatory factor analysis and within-unit agreement (awg). We evaluated factorial invariance using multigroup confirmatory factor analyses and evaluating change in chi-square and comparative fit index values. We evaluated reliability using Cronbach's alpha. RESULTS: Confirmatory factor analyses in both samples provided strong support for first- and second-order factor structure of the ILS. The factor structure did not differ between the two samples. Across both samples, internal consistency reliability was strong (Cronbach's alpha: 0.91-0.98), as was within-unit agreement (awg: 0.70-0.80). LINKING EVIDENCE TO ACTION: Frontline manager implementation leadership is a critical contextual factor influencing EBP implementation. This study provides strong evidence supporting the validity and reliability of the ILS to measure implementation leadership behaviors of nursing frontline managers in acute care. The ILS can help clinicians, researchers, and leaders in nursing contexts assess frontline manager implementation leadership, deliver interventions to target areas needing improvement, and improve implementation of EBP.

Moderators of the negative outcomes of nurse manager stress.

OBJECTIVE: The objective of this study was to examine moderators of the negative effects of nurse managers' stress. BACKGROUND: Nurse managers have important and stressful jobs. Stress affects outcomes such as job satisfaction and intent to quit. METHODS: A quantitative, cross-sectional survey design was used to obtain a convenience sample to examine which factors buffered negative effects of stress. RESULTS: Nurse managers reported high levels of stress, although stress decreased with age. Autonomy was the most effective buffer, followed by social support and predictability. CONCLUSIONS: Nurse managers should be offered autonomy and encouraged to seek support from supervisors and coworkers to reduce the negative effects of stress.

A Multilevel Analysis of U.S. Hospital Patient Safety Culture Relationships With Perceptions of Voluntary Event Reporting.

OBJECTIVES: Patient safety events offer opportunities to improve patient care, but, unfortunately, events often go unreported. Although some barriers to event reporting can be reduced with electronic reporting systems, insight on organizational and cultural factors that influence reporting frequency may help hospitals increase reporting rates and improve patient safety. The purpose of this study was to evaluate the associations between dimensions of patient safety culture and perceived reporting practices of safety events of varying severity. METHODS: We conducted a cross-sectional survey study using previously collected data from The Agency for Healthcare Research and Quality Hospital Survey of Patient Safety Culture as predictors and outcome variables. The dataset included health-care professionals in U.S. hospitals, and data were analyzed using multilevel modeling techniques. RESULTS: Data from 223,412 individuals, 7816 work areas/units, and 967 hospitals were analyzed. Whether examining near miss, no harm, or potential for harm safety events, the dimension feedback about error accounted for the most unique predictive variance in the outcome frequency of events reported. Other significantly associated variables included organizational learning, nonpunitive response to error, and teamwork within units (all P < 0.001). As the perceived severity of the safety event increased, more culture dimensions became significantly associated with voluntary reporting. CONCLUSIONS: To increase the likelihood that a patient safety event will be voluntarily reported, our study suggests placing priority on improving event feedback mechanisms and communication of event-related improvements. Focusing efforts on these aspects may be more efficient than other forms of culture change.

The potency of one-to-one contact with union leaders: enhancing self-efficacy to become a union steward.

Finding ways to encourage union members to become union leaders is a perennial problem for unions. P. A. Roby originally found the importance of one-to-one contact with union leaders in becoming a union steward. In this study, the authors examined stewards' descriptions of their one-to-one contact with a union leader before becoming a steward. They sought to (a) replicate and strengthen Roby's findings, (b) explore one-to-one contact as a self-efficacy (i.e., confidence) enhancing experience, and (c) identify self-efficacy enhancement modes to strengthen the potency of the contact experience. The results from a mostly open-ended questionnaire of 44 stewards mirrored Roby's findings. The results indicated that self-efficacy enhancement modes were present in the one-to-one contact experience and that the enhancement modes were related to self-efficacy to become a steward. Two of the modes, verbal encouragement and emotional inhibition, were independently related to self-efficacy. The authors suggest how leaders could increase the potency of their contact with members as a means of encouraging members to become stewards.

Civility norms, safety climate, and safety outcomes: a preliminary investigation.

Working environments that are both civil and safe are good for business and employee well-being. Civility has been empirically linked to such important outcomes as organizational performance and individuals' positive work-related attitudes, yet research relating civility to safety is lacking. In this study, we link perceptions of civility norms to perceptions of safety climate and safety outcomes. Drawing on social exchange theory, we proposed and tested a model in 2 samples wherein civility norms indirectly relate to safety outcomes through associations with various safety climate facets. Our results supported direct relationships between civility and management safety climate and coworker safety climate. Additionally, indirect effects of civility norms on unsafe behaviors and injuries were observed. Indirect effects of civility norms on unsafe behaviors were observed through coworker safety climate and work-safety tension. Indirect effects of civility norms on injuries were observed through management safety climate and work-safety tension for full-time employees, although these effects did not hold for part-time employees. This study provides initial evidence that researchers and practitioners may want to look beyond safety climate to civility norms to more comprehensively understand the origins of unsafe behaviors and injuries and to develop appropriate preventive interventions.

Predictors of nurse manager stress: a dominance analysis of potential work environment stressors.

BACKGROUND: Nurse managers have important but stressful jobs. Clinical or bedside nurse predictors of stress have been studied more frequently, but less has been done on work environment predictors for those in this first-line leadership role. Understanding the relative importance of those work environment predictors could be used to help identify the most fruitful areas for intervention, potentially improving recruitment and retention for nurse managers. OBJECTIVE: Using Role Stress Theory and the Job Demands-Resources Theory, a model was tested examining the relative importance of five potential predictors of nurse manager stress (i.e., stressors). The work environment stressors included role ambiguity, role overload, role conflict, organizational constraints, and interpersonal conflict. DESIGN AND SETTINGS: A quantitative, cross-sectional survey study was conducted with a convenience sample of 36 hospitals in the Southwestern United States. PARTICIPANTS: All nurse managers working in these 36 hospitals were invited to participate. Of the 636 nurse managers invited, 480 responded, for a response rate of 75.5%. METHODS: Questionnaires were distributed during nursing leadership meetings and were returned in person (in sealed envelopes) or by mail. RESULTS: Because work environment stressors were correlated, dominance analysis was conducted to examine which stressors were the most important predictors of nurse manager stress. Role overload was the most important predictor of stress, with an average of 13% increase in variance explained. The second- and third-most important predictors were organizational constraints and role conflict, with an average of 7% and 6% increase in variance explained, respectively. CONCLUSION: Because other research has shown deleterious effects of nurse manager stress, organizational leaders are encouraged to help nurse managers reduce their actual and/or perceived role overload and organizational constraints.

Predictors and outcomes of nurse leader job stress experienced by AWHONN members.

OBJECTIVE: To measure the relationships among stressors (personal factors, job/role factors, hospital factors), job stress, and outcomes experienced by nurse leaders and examine moderation of autonomy and leadership style on outcomes of job stress. DESIGN: A cross-sectional, quantitative design. SETTING: Acute and nonacute care settings throughout North America. PARTICIPANTS: A nonprobability convenience sample of 392 was drawn from a population of nurse leaders across the United States and Canada who were members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). METHODS: A mailing list was obtained from AWHONN, and a total of 3,986 recruitment and follow-up postcards were sent to nurse leaders. Participants were asked to complete the survey online or request a hard copy to return by mail. Study variables were measured using previously published scales with demonstrated psychometric properties. RESULTS: Nurse leaders reported stress averages above the midpoint of the scales. Personal factors did not significantly predict stress, but role overload, organizational constraints, and role ambiguity were found to be the best predictors of stress. Job satisfaction, intent to quit, and mental health symptoms were the most significant outcomes of stress. Autonomy moderated relationships between perceptions of stress and outcomes with low autonomy showing greater negative outcomes when levels of stress are higher. CONCLUSION: Nurse leaders experience significant job stress that may suggest a need to design and implement evidence-based interventions to reduce stress among this group.

Work-safety tension, perceived risk, and worker injuries: a meso-mediational model.

INTRODUCTION: Work-safety tension arises when workers perceive that working safely is at odds with effectively doing their jobs. We proposed that workers' perceptions of work-safety tension would be associated with higher levels of perceived risk, which would, in turn, relate to worker injuries on the job. METHOD: Grocery store workers (n=600) completed an online survey and organizational worker injury reports were obtained for a two-year period following the survey. Survey results were linked to subsequent worker injuries using hierarchical generalized linear modeling. RESULTS: We found support for the proposed meso-mediation model: department work-safety tension predicted subsequent worker injuries, partially through an association with workers' risk perceptions. CONCLUSIONS: Safety researchers and consultants and organizational leaders should look beyond typically-examined safety climate constructs, such as management commitment to safety, and pay particular attention to workers' perceptions of work-safety tension.

The role of organizational trust in safety climate's influence on organizational outcomes.

Based on elements of social exchange theory and other conceptualizations of trust, a model was developed situating organizational trust as a central component to the relationship that safety climate has with organizational outcomes. Specifically, the model specified that two facets of safety climate--upward safety communication and management attitudes toward safety--would be positively related to organizational trust. Increased levels of trust would then predict increased motivation to engage in safe job-related behaviors, increased job satisfaction, and decreased turnover intentions. Another hypothesis investigated whether job safety relevance would moderate the relationship between safety climate and trust. Online survey research was conducted with 599 employees from 97 work groups across a New England grocery store chain. Hierarchical linear modeling indicated support for trust mediating the relationship between safety climate and organizational outcomes; further, the relationship between safety climate and trust was stronger within work groups where safety was more relevant.

A short, valid, predictive measure of work-family conflict: item selection and scale validation.

The purpose of this research is to develop an abbreviated version of Carlson, Kacmar, and Williams's (2000) multidimensional measure of work-family conflict. The abbreviated measure would have high utility in research situations in which a measure representative of the entire theoretical construct is desired, but the use of a long measure is precluded, as in diary and longitudinal designs. Two 3-item abbreviated measures based on Carlson et al.'s multidimensional measures were developed, 1 to assess work-to-family conflict and 1 to assess family-to-work conflict. Two samples were used to provide concurrent and predictive validity evidence for the abbreviated measure. Results from Study 1 indicate that the abbreviated measure has the expected factor structure and exhibited concurrent and predictive validity that replicated results found with Carlson et al.'s 18-item measure. Results from Study 2 provide additional psychometric and construct validity evidence for the abbreviated measure; the abbreviated measure was internally consistent, exhibited good test-retest reliability, and was systematically related to measures of role stressors, work-family balance, and well-being outcomes.