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.

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.

Elements of a nursing professional practice model.

The authors define a professional practice model (PPM) as a system (structure, process, and values) that supports registered nurse control over the delivery of nursing care and the environment in which care is delivered. A PPM has five subsystems: values, professional relationships, a patient care delivery model, a management approach, and compensation and rewards. Analysis of five PPMs described in the literature showed that the professional values addressed most often are nurse autonomy, nurse accountability, professional development, and emphasis on high-quality care. Teamwork, collaboration, and consultation consistently appeared as approaches to enhance professional relationships. Primary nursing and case management are the care delivery systems most often used in the models. Decentralizing decision making, expanding the scope and type of unit nurse manager responsibilities, and instituting structural changes to support professional practice were common activities in the management subsystem. Compensation and reward systems generally recognized professional achievement and contribution toward organizational goals. Recommendations for implementing and evaluating PPMs are offered.

Evolution of the American Nurses Association's position on health insurance for the aged: 1933-1965.

In 1958, the American Nurses Association (ANA) formally endorsed federal health insurance for the aged, a position contrary to that of organized medicine and hospitals. Understanding how ANA's organizational culture and position on health policy evolved was the purpose of this research. ANA documents from 1933 until passage of Medicare legislation in 1965 and interviews with four contemporary nursing executives of that period were analyzed. Powerful professional and economic external forces and internal divisions limited ANA's ability to influence health policy. Ultimately ANA's cultural values of caring and professional autonomy enabled dedicated leaders to build support, national alliances, and recognition for nursing.

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.

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.

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.

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.

Manager impact on retention of hospital staff: Part 1.

The impact of middle managers on retention of 71 hospital professionals was examined in this prospective study. Price and Mueller's 1981 model of turnover was expanded to include the leadership characteristics of middle managers. In Part 1, research design, methods, and descriptive results are presented. Data on predictor variables were obtained by two questionnaires comprised of established instruments. Retention data then were collected for 6 months. Part 2 of this series, the impact of the manager and recommendations for improving retention, will be presented in the April issue.