Impact of Managers' Coaching Conversations on Staff Knowledge Use and Performance in Long-Term Care Settings.

BACKGROUND: Extended lifespans and complex resident care needs have amplified resource demands on nursing homes. Nurse managers play an important role in staff job satisfaction, research use, and resident outcomes. Coaching skills, developed through leadership skill-building, have been shown to be of value in nursing. AIMS: To test a theoretical model of nursing home staff perceptions of their work context, their managers' use of coaching conversations, and their use of instrumental, conceptual and persuasive research. METHODS: Using a two-group crossover design, 33 managers employed in seven Canadian nursing homes were invited to attend a 2-day coaching development workshop. Survey data were collected from managers and staff at three time points; we analyzed staff data (n = 333), collected after managers had completed the workshop. We used structural equation modeling to test our theoretical model of contextual characteristics as causal variables, managers' characteristics, and coaching behaviors as mediating variables and staff use of research, job satisfaction, and burnout as outcome variables. RESULTS: The theoretical model fit the data well (χ2 = 58, df = 43, p = .06) indicating no significant differences between data and model-implied matrices. Resonant leadership (a relational approach to influencing change) had the strongest significant relationship with manager support, which in turn influenced frequency of coaching conversations. Coaching conversations had a positive, non-significant relationship with staff persuasive use of research, which in turn significantly increased instrumental research use. Importantly, coaching conversations were significantly, negatively related to job satisfaction. LINKING EVIDENCE TO ACTION: Our findings add to growing research exploring the role of context and leadership in influencing job satisfaction and use of research by healthcare practitioners. One-on-one coaching conversations may be difficult for staff not used to participating in such conversations. Resonant leadership, as expected, has a significant impact on manager support and job satisfaction among nursing home staff.

The protective role of self-efficacy against workplace incivility and burnout in nursing: A time-lagged study.

BACKGROUND: Incivility has negative consequences in the workplace and remains a prevalent issue in nursing. Research has consistently linked incivility to nurse burnout and, in turn, to poor mental health and turnover intentions. To retain high-quality nurses, it is important to understand what factors might protect nurses from the negative effects of workplace mistreatment. PURPOSE: The aim of the study was to investigate the role of relational occupational coping self-efficacy in protecting nurses from workplace incivility and related burnout and turnover intentions. METHODOLOGY: A two-wave national sample of 596 Canadian nurses completed mail surveys both at Time 1 and one year later at Time 2. Structural equation modeling was used to test the hypothesized model. RESULTS: The model showed a good fit, and most of the hypothesized paths were significant. Overall, the results supported the hypothesized protective effect of relational occupational coping self-efficacy against incivility and later burnout, mental health, and turnover intentions. CONCLUSION: Relational occupational coping self-efficacy is an important protective factor against negative work behavior. PRACTICE IMPLICATIONS: Organizations should provide nurses with opportunities to build their coping strategies for managing job demands and difficult interpersonal interactions. Similarly, providing exposure to effective role models and providing meaningful verbal encouragement are other sources of efficacy information for building nurses' relational coping self-efficacy.

The Effect of Authentic Leadership, Person-Job Fit, and Civility Norms on New Graduate Nurses' Experiences of Coworker Incivility and Burnout.

OBJECTIVE: This study examined the influence of authentic leadership, person-job fit with 6 areas of worklife, and civility norms on coworker incivility and burnout among new graduate nurses. BACKGROUND: New graduate nurses report experiencing high levels of workplace incivility from coworkers, which has been found to negatively impact their job and career satisfaction and increase their intention to leave. The role of civility norms in preventing burnout and subsequent exposure to incivility from coworkers has yet to be examined among new graduate nurses. METHODS: A cross-sectional mail survey of 993 new graduate nurses across Canada was conducted. RESULTS: The results supported the hypothesized relationships between study variables. CONCLUSIONS: Civility norms play a key role in preventing early career burnout and coworker incivility experienced by new graduate nurses. Leaders can influence civility norms by engaging in authentic leadership behaviors and optimizing person-job fit.

Starting Out: A time-lagged study of new graduate nurses' transition to practice.

BACKGROUND: As the nursing profession ages, new graduate nurses are an invaluable health human resource. OBJECTIVES: The purpose of this study was to investigate factors influencing new graduate nurses' successful transition to their full professional role in Canadian hospital settings and to determine predictors of job and career satisfaction and turnover intentions over a one-year time period in their early employment. DESIGN: A national two-wave survey of new graduate nurses across Canada. PARTICIPANTS: A random sample of 3906 Registered Nurses with less than 3 years of experience currently working in direct patient care was obtained from the provincial registry databases across Canada. At Time 1, 1020 of 3743 eligible nurses returned completed questionnaires (usable response rate=27.3%). One year later, Time 1 respondents were mailed a follow-up survey; 406 returned a completed questionnaire (response rate=39.8%). METHODS: Surveys containing standardized questionnaires were mailed to participants' home address. Descriptive statistics, correlations, and hierarchical linear regression analyses were conducted using SPSS software. RESULTS: Overall, new graduate nurses were positive about their experiences and committed to nursing. However, over half of new nurses in the first year of practice reported high levels of emotional exhaustion and many witnessed or experienced incivility (24-42%) at work. Findings from hierarchical linear regression analyses revealed that situational and personal factors explained significant amounts of variance in new graduate nurses' job and career satisfaction and turnover intentions. Cynicism was a significant predictor of all four outcomes one year later, while Psycap predicted job and career satisfaction and career turnover intentions. CONCLUSIONS: Results provide a look into the worklife experiences of Canadian new graduate nurses over a one-year time period and identify factors that influence their job-related outcomes. These findings show that working conditions for new graduate nurses are generally positive and stable over time, although workplace mistreatment is an issue to be addressed.

The effects of authentic leadership, six areas of worklife, and occupational coping self-efficacy on new graduate nurses' burnout and mental health: A cross-sectional study.

BACKGROUND: New nurse burnout has personal and organizational costs. The combined effect of authentic leadership, person-job fit within areas of worklife, and occupational coping self-efficacy on new nurses' burnout and emotional wellbeing has not been investigated. OBJECTIVES: This study tested a model linking authentic leadership, areas of worklife, occupational coping self-efficacy, burnout, and mental health among new graduate nurses. We also tested the validity of the concept of interpersonal strain at work as a facet of burnout. DESIGN: A cross-sectional national survey of Canadian new graduate nurses was conducted. PARTICIPANTS: Registered nurses working in direct patient care in acute care settings with less than 3 years of experience were selected from provincial registry databases of 10 Canadian provinces. A total of 1009 of 3743 surveyed new graduate nurses were included in the final sample (useable response rate 27%). METHODS: Participants received a mail survey package that included a letter of information, study questionnaire, and a $2 coffee voucher. To optimize response rates non-responders received a reminder letter four weeks after the initial mailing, followed by a second survey package four weeks after that. Ethics approval was obtained from the university ethics board prior to starting the study. Descriptive statistics and scale reliabilities were analyzed. Structural equation modelling with maximum likelihood estimation was used to test the fit between the data and the hypothesized model and to assess the factor structure of the expanded burnout measure. RESULTS: The hypothesized model was an acceptable fit for the data (χ(2) (164)=1221.38; χ(2) ratio=7.447; CFI=.921; IFI=.921; RMSEA=.08). All hypothesized paths were significant. Authentic leadership had a positive effect on areas of worklife, which in turn had a positive effect on occupational coping self-efficacy, resulting in lower burnout, which was associated with poor mental health. CONCLUSIONS: Authentic leaders may play an important role in creating positive working conditions and strengthening new nurses' confidence that help them cope with job demands, thereby protecting them from developing burnout and poor mental health. Leadership training to develop supervisors' authentic leadership skills may promote the development of person-job fit, thereby increasing occupational self-efficacy and new nurses' wellbeing.

Resonant leadership and workplace empowerment: the value of positive organizational cultures in reducing workplace incivility.

Nursing leaders are indispensable in creating positive nursing work environments that retain an empowered and satisfied nursing workforce. Positive and supportive leadership styles can lower patient mortality and improve nurses' health, job satisfaction, organizational commitment, emotional exhaustion, and intent to stay in their position. The results of this study support the role of positive leadership approaches that empower nurses and discourage workplace incivility and burnout in nursing work environments. The findings also provide empirical support for the notion of resonant leadership, a relatively new theory of relationship-focused leadership approaches. This research adds to the growing body of knowledge documenting the key role of positive leadership practices in creating healthy work environments that promote retention of nurses in a time of a severe nursing shortage.

Impact of workplace mistreatment on patient safety risk and nurse-assessed patient outcomes.

OBJECTIVE: The aim of this study was to investigate the impact of subtle forms of workplace mistreatment (bullying and incivility) on Canadian nurses' perceptions of patient safety risk and, ultimately, nurse-assessed quality and prevalence of adverse events. BACKGROUND: Workplace mistreatment is known to have detrimental effects on job performance and in nursing may threaten patient care quality. METHODS: A total of 336 nurses from acute care settings across Ontario responded to a questionnaire that was mailed to their home address in early 2013, with a response rate of 52%. RESULTS: Bullying and incivility from nurses, physicians, and supervisors have significant direct and indirect effects on nurse-assessed adverse events (R = 0.03-0.06) and perceptions of patient care quality (R = 0.04-0.07), primarily through perceptions of increased patient safety risk. CONCLUSIONS: Bullying and workplace incivility have unfavorable effects on nurse-assessed patient quality through their effect on perceptions of patient safety risk.

An interprofessional socialization framework for developing an interprofessional identity among health professions students.

Although health professional educational programs have been successful in equipping graduates with skills, knowledge and professionalism, the emphasis on specialization and profession-specific education has enhanced the development of a uniprofessional identity, which has been found to be a major barrier to interprofessional collaborative person-centred practice (IPCPCP). Changes within healthcare professional education programs are necessary to enable a shift in direction toward interprofessional socialization (IPS) to promote IPCPCP. Currently, there is a paucity of conceptual frameworks to guide IPS. In this article, we present a framework designed to help illuminate an IPS process, which may inform efforts by educators and curriculum developers to facilitate the development of health professions students' dual identity, that is, an interprofessional identity in addition to their existing professional identity, as a first step toward IPCPCP. This framework integrates concepts derived from social identity theory and intergroup contact theory into a dual identity model of IPS.

Authentic leadership, empowerment and burnout: a comparison in new graduates and experienced nurses.

AIM: To examine the effect of authentic leadership and structural empowerment on the emotional exhaustion and cynicism of new graduates and experienced acute-care nurses. BACKGROUND: Employee empowerment is a fundamental component of healthy work environments that promote nurse health and retention, and nursing leadership is key to creating these environments. METHOD: In a secondary analysis of data from two studies we compared the pattern of relationships among study variables in two Ontario groups: 342 new graduates with <2 years of experience and 273 nurses with more than 2 years of experience. RESULTS: A multi-group path analysis using Structural Equation Modelling indicated an acceptable fit of the final model (χ(2) = 17.52, df = 2, P < 0.001, CFI = 0.97, IFI = 0.97 and RMSEA = 0.11). Authentic leadership significantly and negatively influenced emotional exhaustion and cynicism through workplace empowerment in both groups. CONCLUSIONS: The authentic behaviour of nursing leaders was important to nurses' perceptions of structurally empowering conditions in their work environments, regardless of experience level, and ultimately contributed to lower levels of emotional exhaustion and cynicism. IMPLICATIONS FOR NURSING MANAGEMENT: Leadership training for nurse managers may help develop the empowering work environments required in today's health-care organizations in order to attract and retain nurses.

Part 2: Nurses' career aspirations to management roles: qualitative findings from a national study of Canadian nurses.

AIM: Our aim was to investigate direct-care nurses' interests in formal management roles and factors that facilitate their decision-making. BACKGROUND: Based on a projected shortage of nurses by 2022, the profession could be short of 4200 nurse managers in Canada within the next decade. However, no data are currently available that identify nurses' interests in assuming manager roles. METHODS: Using focus group methodology, we conducted 18 focus groups with 125 staff nurses and managers in four regions across Canada. RESULTS: Major themes and subthemes influencing nurses' decisions to pursue management roles included personal demographic (education, age, clinical experience and life circumstances), personal disposition (leadership skills, intrinsic rewards and professional commitment) and situation (leadership development opportunities, manager role perceptions and presence of mentors). Although nurses see management roles as positive opportunities, they did not perceive the rewards to be great enough to outweigh their concerns. CONCLUSIONS: Findings suggested that organizations need to provide support, leadership development and succession opportunities and to redesign manager roles for optimum success. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders need to ensure that they convey positive images of manager roles and actively identify and support staff nurses with leadership potential.

Part 1: The influence of personal and situational predictors on nurses' aspirations to management roles: preliminary findings of a national survey of Canadian nurses.

AIM: To examine the influence of personal and situational factors on direct-care nurses' interests in pursuing nursing management roles. BACKGROUND: Nursing managers are ageing and nurses do not appear to be interested in nursing management roles, raising concerns about a nursing leadership shortage in the next decade. Little research has focused on factors influencing nurses' career aspirations to nursing management roles. METHODS: A national survey of nurses from nine Canadian provinces was conducted (n = 1241). Multiple regression was used to test a model of personal and situational predictors of nurses' career aspirations to management roles. RESULTS: Twenty-four per cent of nurses expressed interest in pursuing nursing management roles. Personal and situational factors explained 60.2% of nurses' aspirations to management roles. Age, educational preparation, feasibility of further education, leadership self-efficacy, career motivation, and opportunity to motivate others were the strongest predictors of aspirations for management roles. CONCLUSIONS: Personal factors were more strongly associated with career aspirations than situational factors. There is a steady decline in interest in management roles with increasing age. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leadership training to develop leadership self-efficacy (particularly for younger nurses) and organizational support for pursuing advanced education may encourage nurses to pursue nursing management roles.

Job and career satisfaction and turnover intentions of newly graduated nurses.

AIM: To describe new graduate nurses' worklife experiences in Ontario hospital settings in the first 2 years of practice and to examine predictors of job and career satisfaction and turnover intentions. BACKGROUND: With a large cohort of nurses approaching retirement, every effort must be made to ensure that the work environments of new graduate nurses are positive, promoting job satisfaction and commitment to the profession to address the nursing workforce shortage. METHOD: A cross-sectional analysis of data from a mail survey of new graduate nurses (n=342) in their first and second year of experience was used to address the research objectives. RESULTS: Overall, new graduate nurses were positive about their working conditions and there were few differences between nurses in their first and second years of practice. Structural and personal factors explained significant amounts of variance (31-68%) in both job and career satisfaction and turnover intentions. Empowerment, work engagement and burnout were important significant predictors. CONCLUSIONS: Modifiable workplace factors play an important role in influencing new graduates' job and career satisfaction and turnover intentions. IMPLICATIONS FOR NURSING MANAGEMENT: Managers can employ strategies to enhance quality work environments that promote retention of new graduates and lessen the nursing workforce shortage.

Nursing students' perceptions of clinical teachers' use of empowering teaching behaviours: instrument psychometrics and application.

The authors present findings of 2nd year nursing students' (N = 352) perceptions of their clinical teachers' use of empowering teaching behaviours (ETB) and to highlight steps undertaken to establish psychometric properties of the Empowering Teaching Behaviours Questionnaire-Student (ETBQ-S). The authors identify a) the process involved in the adoption of the ETBQ-S, b) ETBQ-S validity procedures completed prior to instrument implementation, c) results of nursing students' responses to the ETBQ-S, d) criterion validity, and e) ETBQ-S confirmatory factor analysis findings conducted after study completion. The ETBQ-S reliably measures five facets of empowering actions that clinical teachers can employ with nursing students in practice to enhance their confidence, involve them in decision-making and goal setting, make learning meaningful, and help them to become more autonomous nurses.

The influence of personal dispositional factors and organizational resources on workplace violence, burnout, and health outcomes in new graduate nurses: a cross-sectional study.

BACKGROUND: The alarmingly high rate of illness-related absenteeism among nurses and recent reports of workplace violence and burnout are problematic for both the current workforce shortage and the recruitment and retention of new nurses. OBJECTIVES: To test a model derived from Leiter and Maslach's (2004) Six Areas of Worklife Model linking workplace factors (six areas of worklife, experiences of bullying and burnout) and a personal dispositional factor (psychological capital) to new graduates mental and physical health in their first year of practice. METHODS: A cross-sectional survey design was utilized to survey 165 Ontario nurses with one year or less experience in nursing. Participants completed measures of nurses' work environment quality, psychological capital, bullying exposure, burnout, and physical and mental health. Structural equation modelling was used to test the hypothesized model. RESULTS: The fit indices suggested a reasonably adequate fit of the data to the hypothesized model (χ2=27.75, df=12, CFI=.97, IFI=.97, RMSEA=.09), however an additional direct path from psychological capital to emotional exhaustion substantially improved the model fit (χ2=17.94, df=11, CFI=.99, IFI=.99, RMSEA=.06). Increased psychological capital positively influenced nurses' perceived person-job fit, which in turn was negatively related to bullying exposure and emotional exhaustion, and ultimately influenced their physical and mental health. CONCLUSIONS: The findings suggest that psychological capital and perceived person-job fit are key variables in new graduate nurses' worklife, which may contribute to decreased nurses' burnout and increased physical and mental well-being. The results support an expanded conceptualization of the areas of worklife model.

Nurse turnover: a literature review - an update.

BACKGROUND: Concerns related to the complex issue of nursing turnover continue to challenge healthcare leaders in every sector of health care. Voluntary nurse turnover is shown to be influenced by a myriad of inter-related factors, and there is increasing evidence of its negative effects on nurses, patients and health care organizations. OBJECTIVES: The objectives were to conduct a comprehensive review of the related literature to examine recent findings related to the issue of nursing turnover and its causes and consequences, and to identify on methodological challenges and the implications of new evidence for future studies. DESIGN: A comprehensive search of the recent literature related to nursing turnover was undertaken to summarize findings published in the past six years. DATA SOURCES: Electronic databases: MEDLINE, CINAHL and PubMed, reference lists of journal publications. REVIEW METHODS: Keyword searches were conducted for publications published 2006 or later that examined turnover or turnover intention in employee populations of registered or practical/enrolled or assistant nurses working in the hospital, long-term or community care areas. Literature findings are presented using an integrative approach and a table format to report individual studies. RESULTS: From about 330 citations or abstracts that were initially scanned for content relevance, 68 studies were included in this summary review. The predominance of studies continues to focus on determinants of nurse turnover in acute care settings. Recent studies offer insight into generational factors that should be considered in strategies to promote stable staffing in healthcare organizations. CONCLUSIONS: Nursing turnover continues to present serious challenges at all levels of health care. Longitudinal research is needed to produce new evidence of the relationships between nurse turnover and related costs, and the impact on patients and the health care team.

The impact of civility interventions on employee social behavior, distress, and attitudes.

Although incivility has been identified as an important issue in workplaces, little research has focused on reducing incivility and improving employee outcomes. Health care workers (N = 1,173, Time 1; N = 907, Time 2) working in 41 units completed a survey of social relationships, burnout, turnover intention, attitudes, and management trust before and after a 6-month intervention, CREW (Civility, Respect, and Engagement at Work). Most measures significantly improved for the 8 intervention units, and these improvements were significantly greater than changes in the 33 contrast units. Specifically, significant interactions indicating greater improvements in the intervention groups than in the contrast groups were found for coworker civility, supervisor incivility, respect, cynicism, job satisfaction, management trust, and absences. Improvements in civility mediated improvements in attitudes. The results suggest that this employee-based civility intervention can improve collegiality and enhance health care provider outcomes.

Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey.

AIM: To test the psychometric properties of a newly developed measure of staff nurse clinical leadership derived from Kouzes and Posner's model of transformational leadership. BACKGROUND: While nurses have been recognized for their essential role in keeping patients safe, there has been little empirical research that has examined clinical leadership at the staff nurse level. METHODS: A non-experimental survey design was used to test the psychometric properties of the clinical leadership survey (CLS). Four hundred and eighty registered nurses (RNs) providing direct patient care in Ontario acute care hospitals returned useable questionnaires. RESULTS: Confirmatory factor analysis provided preliminary evidence for the construct validity for the new measure of staff nurse clinical leadership. Structural empowerment fully mediated the relationship between nursing leadership and staff nurse clinical leadership. CONCLUSION: The results provide encouraging evidence for the construct validity of the CLS. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing administrators must create empowering work environments to ensure staff nurses have access to work structures which enable them to enact clinical leadership behaviours while providing direct patient care.

New graduate nurses' experiences of bullying and burnout in hospital settings.

AIM: This paper is a report of a study conducted to test a model linking new graduate nurses' perceptions of structural empowerment to their experiences of workplace bullying and burnout in Canadian hospital work settings using Kanter's work empowerment theory. BACKGROUND: There are numerous anecdotal reports of bullying of new graduates in healthcare settings, which is linked to serious health effects and negative organizational effects. METHODS: We tested the model using data from the first wave of a 2009 longitudinal study of 415 newly graduated nurses (<3 years of experience) in acute care hospitals across Ontario, Canada. Variables were measured using the Conditions of Work Effectiveness Questionnaire, Negative Acts Questionnaire-Revised and Maslach Burnout Inventory-General Survey. RESULTS: The final model fit statistics revealed a reasonably adequate fit (χ² = 14·9, d.f. = 37, IFI = 0·98, CFI = 0·98, RMSEA = 0·09). Structural empowerment was statistically significantly and negatively related to workplace bullying exposure (ß = -0·37), which in turn, was statistically significantly related to all three components of burnout (Emotional exhaustion: ß = 0·41, Cynicism: ß = 0·28, EFFICACY: ß = -0·17). Emotional exhaustion had a direct effect on cynicism (ß = 0·51), which in turn, had a direct effect on efficacy (ß = -0·34). Conclusion. The results suggest that new graduate nurses' exposure to bullying may be less when their work environments provide access to empowering work structures, and that these conditions promote nurses' health and wellbeing.

A consistent framework will allow valid comparison.

The notion of a unified nationwide approach to measuring and monitoring healthy work environments is indeed an idea whose time has come, as Lowe and Chan point out in their paper. These authors present a compelling argument for why such an approach is needed and offer a potential framework that could be used to accomplish this goal. Clear articulation of quality indicators and concepts will be critical to successful implementation and adoption of the framework within various healthcare organizations. Once adopted, the framework will facilitate accurate comparison between organizations.

Context matters: the impact of unit leadership and empowerment on nurses' organizational commitment.

OBJECTIVE: The aim of this study was to test a multilevel model linking unit-level leader-member exchange quality and structural empowerment to nurses' psychological empowerment and organizational commitment at the individual level of analysis. BACKGROUND: Few studies have examined the contextual effects of unit leadership on individual nurse outcomes. Workplace empowerment has been related to retention outcomes such as organizational commitment in several studies, but few have studied the impact of specific unit characteristics within which nurses work on these outcomes. METHODS: We surveyed 3,156 nurses in 217 hospital units to test the multilevel model. RESULTS: A multilevel path analysis revealed significant individual and contextual effects on nurses' organizational commitment. Both unit-level leader-member exchange quality and structural empowerment had significant direct effects on individual-level psychological empowerment and organizational commitment. Psychological empowerment mediated the relationship between core self-evaluations and organizational commitment at the individual level of analysis. CONCLUSIONS: The contextual effects of positive supervisor relationships and their influence on empowering working conditions at the unit level and, subsequently, nurses' organizational commitment highlight the importance of leadership for creating conditions that result in a committed nursing workforce.