Examining regulatory focus in the acceleration and deceleration of engagement and exhaustion cycles among nurses.

BACKGROUND: Given that emotional exhaustion and nurse engagement have significant implications for nurse well-being and organizational performance, determining how to increase nurse engagement while reducing nurse exhaustion is of value. PURPOSE: Resource loss and gain cycles, as theorized in conservation of resources theory, are examined using the experience of emotional exhaustion to evaluate loss cycles and work engagement to evaluate gain cycles. Furthermore, we integrate conservation of resources theory with regulatory focus theory to examine how the ways in which individuals approach work goals serves as a facilitator to the acceleration and deceleration of both of these cycles. METHODOLOGY/APPROACH: Using data from nurses working in a hospital in the Midwest United States at six time points spanning over 2 years, we demonstrate the accumulation effects of the cycles over time using latent change score modeling. RESULTS: We found that prevention focus was associated with the accelerated accumulation effects of emotional exhaustion and that promotion focus was associated with the accelerated accumulation effects of work engagement. Furthermore, prevention focus attenuated the acceleration of engagement, but promotion did not influence the acceleration of exhaustion. CONCLUSION: Our findings suggest that individual factors such as regulatory focus are key to helping nurses to better control their resource gain and loss cycles. PRACTICE IMPLICATIONS: We provide implications for nurse managers and health care administrators to help encourage promotion focus and suppress prevention focus in the workplace.

How leaders perceive employee deviance: Blaming victims while excusing favorites.

Drawing from theories of attribution and perception, we posit that employees who are victims of rudeness are themselves (inappropriately) evaluated by leaders as being interpersonally deviant. We further theorize that employees who are themselves rude to others at work are evaluated negatively, but not when they have high-quality relationships with leaders or are seen as high performers. We tested our predictions across 4 studies. Our first study included 372 leader-follower pairs. Our second study extended to dyadic interactions among employees by using an employee roster method, resulting in paired data from 149 employees (2,184 dyads) across 5 restaurant locations. Our third and fourth studies utilized a policy-capturing design in which individuals provided performance evaluations for fictitious employees. We find that victims of rudeness are viewed by leaders as deviant, and that leaders are less likely to perceive rude employees as deviant when these perpetrators are seen as having high levels of leader-member exchange (LMX) or performance. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The supportive spouse at work: Does being work-linked help?

Using a sample of 639 dual-career couples, we examined the role of work-related spousal support on work-family balance and subsequent outcomes for both the job incumbent as well as his or her spouse. We further investigated whether the resource of work-related spousal support contributed to greater balance for those couples who were work-linked (work in same organization, same occupation, or both) and those who were not. We found work-related spousal support contributed to work-family balance and subsequent improved family satisfaction and job satisfaction of the job incumbent. Furthermore, support crossed over to the spouse through increased work-family balance to decrease stress transmission to enhance family satisfaction and reduce relationship tension of the spouse. Implications for researchers and organizational leaders are discussed.

Productive and counterproductive job crafting: A daily diary study.

The present study aims to uncover the way daily job crafting influences daily job performance (i.e., task performance, altruism, and counterproductive work behavior). Job crafting was conceptualized as "seeking resources," "seeking challenges," and "reducing demands" and viewed as strategies individuals use to optimize their job characteristics. We hypothesized that daily job crafting relates to daily job demands and resources (work pressure and autonomy), which consequently relate to daily work engagement and exhaustion and ultimately to job performance. A sample of 95 employees filled in a quantitative diary for 5 consecutive working days (n occasions = 475). We predicted and found that daily seeking resources was positively associated with daily task performance because daily autonomy and work engagement increased. In contrast, daily reducing demands was detrimental for daily task performance and altruism, because employees lower their daily workload and consequently their engagement and exhaustion, respectively. Only daily seeking challenges was positively (rather than negatively) associated with daily counterproductive behavior. We conclude that employee job crafting can have both beneficial and detrimental effects on job performance.

Dynamics of a wellness program: a conservation of resources perspective.

We leverage conservation of resources theory to explain possible dynamics through which a holistic wellness program results in positive longer-term outcomes. Specifically, we hypothesize that wellness self-efficacy at the end of a wellness program will create a positive resource gain spiral, increasing psychological availability (a sense of having cognitive, physical, and emotional resources to engage oneself) 6 months later, and career satisfaction, 1 year later. To test these hypotheses, using a time-lagged with control group design, we gathered questionnaire data from 160 Episcopal priests who participated in a 10-day off-site wellness program. We developed a scale measuring self-efficacy in the 4 wellness areas the program was designed to improve: physical, spiritual, financial, and vocational. Our findings provide evidence from a field setting of a relatively untested tenet of conservation of resources theory, resource gain spirals. The wellness program that we studied served as an opportunity for participants to gain new resources in the form of wellness self-efficacy, which in turn helped participants experience positive outcomes over time. We discuss theoretical and practical implications of the findings.

The influence of workplace injuries on work-family conflict: job and financial insecurity as mechanisms.

Research examining the outcomes of workplace injuries has focused on high costs to the organization. In this study, we utilize conservation of resources theory to develop and test a model that explains how and under what circumstances workplace injuries impact employees' perceptions of how their work interferes with their family. Results from 194 registered nurses (along with 85 of their spouses), using path analytic tests of moderated mediation, provide support for the prediction that the mediated effect of workplace injury severity on work-family conflict (through job and financial insecurity) is weaker when employees perceive high levels of supervisor support. We discuss the implications of these findings for the study of job and financial insecurity and work-family conflict. Limitations of this study and directions for future research are also presented.

Living up to safety values in health care: the effect of leader behavioral integrity on occupational safety.

While previous research has identified that leaders' safety expectations and safety actions are important in fostering occupational safety, research has yet to demonstrate the importance of leader alignment between safety expectations and actions for improving occupational safety. We build on safety climate literature and theory on behavioral integrity to better understand the relationship between the leader's behavioral integrity regarding safety and work-related injuries. In a time-lagged study of 658 nurses, we find that behavioral integrity for high safety values is positively associated with greater reporting of fewer and less severe occupational injuries. The effects of behavioral integrity regarding safety can be better understood through the mediating mechanisms of safety compliance and psychological safety toward one's supervisor. We discuss the implications of our findings for future research on safety climate.

The moderating role of attention-deficit/hyperactivity disorder in the work engagement-performance process.

Attention-deficit/hyperactivity disorder (ADHD) is a cognitive disability that affects millions. Although individuals with ADHD are employed throughout many organizations and there is evidence that their performance is lower, scant research exists describing how ADHD impacts an individual's performance. In this article, we extend attentional control theory to examine how ADHD impacts both the effectiveness and efficiency of employee performance. Across 3 samples, 2 of general working adults (n = 257 and 170) and 1 of nurses (n = 243), we found that ADHD was associated with lower performance (rated via self-, coworker, and supervisor ratings) and that the relationship was strongest for in-role performance, suggesting that employees with ADHD may be diverting attention away from task-relevant behaviors. Furthermore, although work engagement was associated with higher performance, that relationship was diminished among those who experienced higher levels of ADHD, suggesting lower performance efficiency. We discuss the implications of these findings for research on attentional control and the management of those with ADHD at work.

The impact of furloughs on emotional exhaustion, self-rated performance, and recovery experiences.

The notion that strain can result as employees' resources are threatened or lost is well established. However, the transition from resource threats to resource losses is an important but understudied aspect of employee strain. We argue that the threat-to-loss transition triggers accelerated resource loss and a shift in how employees utilize their remaining resources unless employees engage in recovery experiences during the transition. Using a discontinuous change framework, we examine employee furloughs-the placement of employees on leave with no salary of any kind-in terms of the transition from resource threat to loss: Resources may be threatened when the furlough is announced and lost when the furlough occurs. Using 4 data collections with 180 state government employees, we found mean levels of emotional exhaustion increased and mean levels of self-reported performance decreased following the furlough. The discontinuous changes in exhaustion and performance were significantly impacted by employees' recovery experiences during the furlough. We discuss the implications of these findings for other threat-to-loss and recovery research as well as for organizations implementing furloughs.

Emotional exhaustion and medication administration work-arounds: the moderating role of nurse satisfaction with medication administration.

BACKGROUND: Burnout is very common and has significant negative outcomes for both nurses and patients. However, this literature has only recently begun to address the processes that explain why health care provider burnout leads to negative patient outcomes. This article extends that literature by examining how satisfaction with work processes impacts the link between nurse burnout and work-arounds. PURPOSE: The purpose of this study was to examine the relationships between emotional exhaustion and potentially unsafe work practices (work-arounds) in the context of nursing administration of medication. METHODOLOGY/APPROACH: The data were collected using online survey software and pencil-and-paper surveys returned directly to the researchers. The study was conducted among nurses in 2 acute care hospitals in the Midwestern United States. For one of the samples, data on work-arounds were provided by the nurses' supervisors. For the other sample, data were collected at a 6-month interval. The survey included measures of emotional exhaustion (the Maslach Burnout Inventory), work-arounds, and nurse satisfaction with medication administration processes. FINDINGS: We found that exhaustion was associated with greater use of work-arounds of medication administration processes. We also found that when nurses were more satisfied with the medication administration process, exhausted nurses were less likely to engage in work-arounds. PRACTICE IMPLICATIONS: The findings suggest that although exhaustion in nurses can lead to potentially unsafe practices, satisfaction with the work process can either exacerbate or reduce the problem.

Psychological entitlement and abusive supervision: political skill as a self-regulatory mechanism.

BACKGROUND: Abusive supervision in the workplace is steadily increasing. Such behavior has been linked to a host of negative individual and organizational consequences. In a health care environment particularly, such behavior can have detrimental effects. PURPOSES: This study advances self-regulation theory by framing the entitlement-abusive supervision relationship in terms of a motive to obtain resources via a behavior that is not socially sanctioned. Furthermore, we argue that political skill serves as a self-regulating mechanism that reduces the motivation to secure personal resources through abusive behavior. METHODOLOGY/APPROACH: Our hypotheses were tested using a sample of nurses and their supervisors who were asked to complete a survey. A final sample of 132 supervisor-subordinate dyads was obtained. FINDINGS: Analysis suggests that supervisors high in psychological entitlement are more likely to be perceived by their subordinates as abusive. Political skill, however, moderated this relationship by serving as a regulatory mechanism that thwarts entitled supervisors from engaging in abusive behaviors. PRACTICE IMPLICATIONS: Our findings underscore the common concern that entitlement and abuse can be harmful for organizations. Entitled supervisors who are high in political skill may recognize that engaging in less aggressive influence behaviors may be more effective in achieving self-serving motives. Consequently, health care organizations need to be proactive in order to reduce entitlement and prevent abusive behaviors in the workplace.

Measuring nursing workarounds: tests of the reliability and validity of a tool.

OBJECTIVE: The purpose of this study was to validate a new tool to measure nursing workarounds. BACKGROUND: Workarounds are situations where one experiences a block in workflow and, rather than complete the work process as intended, creates an idiosyncratic solution to get around the block. There are limited options for validated measures of workarounds for researchers and administrators. METHODS: To validate the tool, we conducted a survey of registered nurses that included the newly developed tool of workarounds, and measures of deviance and job crafting. RESULTS: We found evidence for the content, factorial, discriminant, and criterion-related validity of the new workaround tool. Furthermore, the tool demonstrated adequate internal consistency and test-retest reliability. CONCLUSIONS: Interest in workarounds has been rapidly growing; however, high-quality research in this area has been limited by an inability to validly measure workarounds. This study represents an important step in fostering new research in workarounds.

Evaluating survey quality in health services research: a decision framework for assessing nonresponse bias.

OBJECTIVE: To address the issue of nonresponse as problematic and offer appropriate strategies for assessing nonresponse bias. STUDY DESIGN: A review of current strategies used to assess the quality of survey data and the challenges associated with these strategies is provided along with appropriate post-data collection techniques that researchers should consider. PRINCIPAL FINDINGS: Response rates are an incomplete assessment of survey data quality, and quick reactions to response rate should be avoided. Based on a five-question decision making framework, we offer potential ways to assess nonresponse bias, along with a description of the advantages and disadvantages to each. CONCLUSIONS: It is important that the quality of survey data be considered to assess the relative contribution to the literature of a given study. Authors and funding agencies should consider the potential effects of nonresponse bias both before and after survey administration and report the results of assessments of nonresponse bias in addition to response rates.

Safety leadership: extending workplace safety climate best practices across health care workforces.

PURPOSE: Hospitals within the United States consistently have injury rates that are over twice the national employee injury rate. Hospital safety studies typically investigate care providers rather than support service employees. Compounding the lack of evidence for this understudied population is the scant evidence that is available to examine the relationship of support service employees'perceptions of safety and work-related injuries. To examine this phenomenon, the purpose of this study was to investigate support service employees' perceptions of safety leadership and social support as well as the relationship of safety perception to levels of reported injuries. DESIGN/METHODOLOGY/APPROACH: A nonexperimental survey was conducted with the data collected from hospital support service employees (n = 1,272) and examined. (1) relationships between safety leadership (supervisor and organization) and individual and unit safety perceptions; (2) the moderating effect of social support (supervisor and coworker) on individual and unit safety perceptions; and (3) the relationship of safety perception to reported injury rates. The survey items in this study were based on the items from the AHRQ Patient Safety Culture Survey and the U.S. National Health Care Surveys. FINDINGS: Safety leadership (supervisor and organization) was found to be positively related to individual safety perceptions and unit safety grade as was supervisor and coworker support. Coworker support was found to positively moderate the following relationships: supervisor safety leadership and safety perceptions, supervisor safety leadership and unit safety grade, and senior management safety leadership and safety perceptions. Positive employee safety perceptions were found to have a significant relationship with lower reported injury rates. VALUE/ORIGINALITY: These findings suggest that safety leadership from supervisors and senior management as well as coworker support has positive implications for support service employees' perceptions of safety, which, in turn, are negatively related to lower odds of reporting injuries.

Behavioral integrity for safety, priority of safety, psychological safety, and patient safety: a team-level study.

This article clarifies how leader behavioral integrity for safety helps solve follower's double bind between adhering to safety protocols and speaking up about mistakes against protocols. Path modeling of survey data in 54 nursing teams showed that head nurse behavioral integrity for safety positively relates to both team priority of safety and psychological safety. In turn, team priority of safety and team psychological safety were, respectively, negatively and positively related with the number of treatment errors that were reported to head nurses. We further demonstrated an interaction effect between team priority of safety and psychological safety on reported errors such that the relationship between team priority of safety and the number of errors was stronger for higher levels of team psychological safety. Finally, we showed that both team priority of safety and team psychological safety mediated the relationship between leader behavioral integrity for safety and reported treatment errors. These results suggest that although adhering to safety protocols and admitting mistakes against those protocols show opposite relations to reported treatment errors, both are important to improving patient safety and both are fostered by leaders who walk their safety talk.

CAH staff perceptions of a clinical information system implementation.

OBJECTIVES: This study examines staff perceptions of patient care quality and the processes before and after implementation of a comprehensive clinical information system (CIS) in critical access hospitals (CAHs). STUDY DESIGN: A prospective, nonexperimental design, evaluation study. METHODS: A modified version of the Information Systems Expectations and Experiences (I-SEE) survey instrument was administered to staff in 7 CAHs annually over 3 years to capture baseline, readiness, and postimplementation perceptions. RESULTS: Descriptive analyses examined 840 survey responses across 3 survey administrations and job categories (registered nurses [RNs], providers, and other clinical staff). Analysis of variance compared responses for main effects (ie, administration, staff position, hospital, and cohort) and interactions between groups over time. Correlations examined the relationships between variables. In general, the responses indicate a high level of positive perceptions regarding the processes and quality of care in these hospitals. For most of the items, responses were quite consistent across the 3 survey administrations. Significant changes occurred for 5 items; 4 reflecting information flow and increased communication, and 1 reflecting a decrease in improved patient care. Overall, providers had lower mean responses compared with nurses and other clinical staff. Significant interactions between administrations and job categories were found for 4 items. CONCLUSIONS: Even though staff had overwhelmingly positive perceptions of patient care quality and processes, significant differences between providers, RNs, and other clinical staff were observed. Variability was also found across CAHs. Research on CIS implementation in small hospitals is rare and needed to guide the identification of factors and strategies related to success.

Emotional exhaustion and workarounds in acute care: cross sectional tests of a theoretical framework.

BACKGROUND: As health care organizations strive to improve their work processes, attention is being paid to workarounds in the clinical setting. Some research has found a link between burnout and workarounds. Other research shows that the clinical work environment can influence burnout levels in clinical workers, particularly emotional exhaustion. OBJECTIVE: Underpinned by Conservation of Resources theory, we examined a conceptual model linking the work environment with workarounds in acute care nurses and other clinicians, and hypothesized that burnout, specifically emotional exhaustion, would mediate these relationships. STUDY DESIGN AND SETTING: A cross sectional survey study was conducted in a large tertiary hospital in North America. PARTICIPANTS: All clinical care providers in the hospital's medical units were invited to participate. The response rate was 45%, with nurses comprising 85% of respondents. METHOD: Questionnaires were mailed to employee homes using a two-wave methodology. RESULTS: Hypotheses were examined using structural equation modeling. Time pressure was positively related to exhaustion, and autonomy was negatively related. Exhaustion was positively related to workarounds, and mediated the time pressure and autonomy to workarounds relationships. Contrary to expectations, the physical environment was directly and negatively related to workarounds. CONCLUSION: Our findings suggest that the work environment may influence more than individual clinician well-being and exhaustion, it also may influence workaround behaviors that could lead to harm for patients and/or the organization. More attention should be paid to the mechanisms that influence workarounds.

The moderating effect of work-linked couple relationships and work-family integration on the spouse instrumental support-emotional exhaustion relationship.

Based on boundary theory and conservation of resources theory, we argue that employees with a spouse in the same occupation or workplace (referred to as work-linked couples) enhance the effectiveness of spousal instrumental support in reducing emotional exhaustion. In the first study of nurses (n = 103), we found that work-linked couples have more highly integrated work and family roles than participants whose spouses did not share an occupation or workplace. In a second study of working adults (n = 484), we found that work-linked couples have a stronger relationship between spouse instrumental support and the reduction of emotional exhaustion; this moderated relationship was mediated by their work-family integration. We discuss the implications of these findings for the study of work and family roles, social support, and emotional exhaustion, and provide suggestions for future research.

Rework and workarounds in nurse medication administration process: implications for work processes and patient safety.

BACKGROUND: Health care organizations have redesigned existing and implemented new work processes intended to improve patient safety. As a consequence of these process changes, there are now intentionally designed "blocks" or barriers that limit how specific work actions, such as ordering and administering medication, are to be carried out. Health care professionals encountering these designed barriers can choose to either follow the new process, engage in workarounds to get past the block, or potentially repeat work (rework). Unfortunately, these workarounds and rework may lead to other safety concerns. PURPOSE: The aim of this study was to examine rework and workarounds in hospital medication administration processes. METHODOLOGY/APPROACH: Observations and semistructured interviews were conducted with 58 nurses from four hospital intensive care units focusing on the medication administration process. Using the constant comparative method, we analyzed the observation and interview data to develop themes regarding rework and workarounds. From this analysis, we developed an integrated process map of the medication administration process depicting blocks. FINDINGS: A total of 12 blocks were reported by the participants. Based on the analysis, we categorized them as related to information exchange, information entry, and internal supply chain issues. Whereas information exchange and entry blocks tended to lead to rework, internal supply chain issues were more likely to lead to workarounds. PRACTICE IMPLICATIONS: A decentralized pharmacist on the unit may reduce work flow blocks (and, thus, workarounds and rework). Work process redesign may further address the problems of workarounds and rework.