Testing the effects of an empowerment-based leadership development programme: part 2 - staff outcomes.

AIM: To determine if nurse leaders' attendance at a leadership development programme based on an empowerment framework would increase staff perceptions of organisational support and organisational commitment. BACKGROUND: Leadership empowering behaviours are teachable relational competencies that have been associated with quality leader-staff relationships and positive staff outcomes. METHODS: A quasi-experimental, pre-test-post-test design was used to compare perceptions of staff whose leaders participated in a year-long leadership programme with staff of similar leaders who did not attend the programme. A series of multiple regression analyses were used to test the conceptual model of programme effects. RESULTS: Leaders' programme participation was directly associated with greater staff organisational commitment 1 year after the programme. Both programme attendance and leader-empowering behaviours were found to act as independent catalysts for staff empowerment, with structural empowerment partially mediating the effects of leader empowering behaviours on organisational commitment. CONCLUSIONS: Leader participation in a development programme based on an empowerment framework may be an important means of increasing staff organisational commitment, a key predictor of staff turnover. IMPLICATIONS FOR NURSE MANAGEMENT: Leadership development programmes should emphasize relational competencies, including leader empowering behaviours, given their potential for enhancing organisational commitment.

Testing the effects of an empowerment-based leadership development programme: part 1 - leader outcomes.

AIM: To determine if a leadership development programme based on an empowerment framework significantly increased leaders' use of empowering behaviours. BACKGROUND: Leadership programmes are effective ways to prepare nurse leaders for their complex roles. Relational competencies, such as leader empowering behaviours, are associated with improved leader, staff and practice environment outcomes. METHODS: A quasi-experimental, pre-test-post-test design was used to compare perceptions and self-reported behaviours of leaders who participated in a year-long leadership programme with those of similar leaders who did not attend the programme. Multiple regression analyses were used to evaluate a conceptual framework of leader empowerment. RESULTS: The leadership programme was directly associated with leaders' perceptions of using more empowering behaviours. Leader empowering behaviours were also associated with feelings of being structurally empowered, mediated through feelings of being psychologically empowered, although the source of empowerment needs further investigation. CONCLUSIONS: Leaders' use of empowering behaviours can be increased through focused training and through a workplace empowerment process. IMPLICATIONS FOR NURSE MANAGEMENT: Leader empowering behaviours have been shown to be associated with more engaged staff and healthier work environments. Based on study results, we suggest that these behaviours are teachable, and they should be emphasized in leadership development programmes.

A hospital-level analysis of the work environment and workforce health indicators for registered nurses in Ontario's acute-care hospitals.

The purpose of this study was to explore the relationship between hospital-level indicators of the work environment and aggregated indicators of health and well-being amongst registered nurses working in acute-care hospitals in Ontario, Canada. This ecological analysis used data from a self-reported survey instrument randomly allocated to nurses using a stratified sampling approach. Multivariable linear regression models were used to examine hospital-level associations for burnout, musculoskeletal pain, self-rated general health, and absence due to illness. The unit of analysis was the hospital (n = 160), with individual nurse responses (n = 6,609) aggregated within hospitals. After controlling for basic differences in nurse workforces, including mean age and education, higher (better) work-environment scores were found to be generally associated with higher health-indicator scores, while a larger proportion of full-time than part-time nurses was found to be associated with lower (poorer) health scores. This study may provide direction for policy-makers in coping with the recruitment and retention of nursing staff in light of the current nursing shortage.

Evaluating physical therapists' perception of empowerment using Kanter's theory of structural power in organizations.

BACKGROUND AND PURPOSE: Little is known about physical therapists' perceptions of empowerment. In this study, Kanter's theory of structural power in organizations was used to examine physical therapists' perceptions of empowerment in a large Canadian urban teaching hospital. Kanter's theory, which has been studied extensively in the nursing profession, proposes that power in organizations is derived from access to information, support, resources, opportunity, and proportions. SUBJECTS AND METHODS: A convenience sample of physical therapists who had been working in the hospital longer than 3 months was used to determine the scores for the physical therapists' ratings of empowerment using the Conditions of Work Effectiveness Questionnaire. RESULTS: Physical therapists' scores were similar to reported staff nurses' scores for access to support, information, resources, and opportunity (mean=2.89, 2.91, 2.62, 3.25, respectively). Physical therapists' scores were higher than the majority of reported staff nurses' and nurse managers' scores for access to sources of informal and formal power structures (mean=2.81 and 3.29, respectively). There was a relationship between the empowerment score and the physical therapists' global rating of empowerment. Unlike studies of nurses, there were no relationships when demographic attributes and empowerment scores were examined. DISCUSSION AND CONCLUSION: Evidence for the validity of Kanter's theory of empowerment was found. Kanter's theory can provide physical therapists and their managers with a useful framework for examining critical organizational factors (access to information, support, opportunity, and resources) that contribute to employees' perceptions of empowerment. A baseline measure for comparing future empowerment scores of this sample is available. Further work to examine the application of Kanter's theory to other samples of physical therapists appears to be warranted.

The antecedents and consequences of empowerment: a gender analysis.

Kanter argues that empowerment has many positive consequences. Not only do empowered employees work more effectively, but they are more likely to express positive attitudes toward their organization. Although support for Kanter's model has been found in several studies of nurses, these studies have not explored the possibility of gender differences. Do men in nursing have the same access as women do to structures that lead to empowerment? Moreover, do men and women react differently to empowerment? To answer these questions, we sampled 412 nurses (195 men; 217 women) about their access to empowerment structures and their trust and commitment to their organization. We found no support for the suggestion that male nurses are less empowered because of their "token" status. Also, we found that the model predicted the responses of men and women equally. Our results suggest that empowerment provides an excellent way of enhancing organizational attitudes for both men and women.

The impact of workplace empowerment, organizational trust on staff nurses' work satisfaction and organizational commitment.

A predictive, nonexperimental design was used to test Kanter's work empowerment theory in a random sample of 412 staff nurses selected from the professional registry list of a central Canadian province. Kanter argues that work environments that provide access to information, support, resources, and opportunity to learn and develop are empowering and influence employee work attitudes, productivity, and organizational effectiveness. Test results suggest that fostering environments that enhance perceptions of empowerment will have positive effects on organizational members and increase organizational effectiveness.

Testing Karasek's Demands-Control Model in restructured healthcare settings: effects of job strain on staff nurses' quality of work life.

BACKGROUND: Job strain among staff nurses has become an increasingly important concern in relationship to employee performance and commitment to the organization in current restructured healthcare settings. OBJECTIVES: The purpose of this study was to test Karasek's Demands-Control Model of job strain by examining the extent to which the degree of job strain in nursing work environments affects staff nurses' perceptions of structural and psychological empowerment, work satisfaction, and organizational commitment. METHOD: A predictive, nonexperimental design was used to test these relationships in a random sample of 404 Canadian staff nurses. Karasek's Job Content Questionnaire, the Conditions of Work Effectiveness Questionnaire-II, Spreitzer's Psychological Empowerment Questionnaire, Meyer and Allen's Organizational Commitment Questionnaire, and the Global Satisfaction Scale were used to measure the major study variables. RESULTS: Nurses with higher level of job strain were found to be significantly more empowered, more committed to the organization, and more satisfied with their work. CONCLUSIONS: Support for Karasek's Demands/Control theory was established in this study.

Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter's model.

OBJECTIVE: In this study, we tested an expanded model of Kanter's structural empowerment, which specified the relationships among structural and psychological empowerment, job strain, and work satisfaction. BACKGROUND: Strategies proposed in Kanter's empowerment theory have the potential to reduce job strain and improve employee work satisfaction and performance in current restructured healthcare settings. The addition to the model of psychological empowerment as an outcome of structural empowerment provides an understanding of the intervening mechanisms between structural work conditions and important organizational outcomes. METHODS: A predictive, nonexperimental design was used to test the model in a random sample of 404 Canadian staff nurses. The Conditions of Work Effectiveness Questionnaire, the Psychological Empowerment Questionnaire, the Job Content Questionnaire, and the Global Satisfaction Scale were used to measure the major study variables. RESULTS: Structural equation modelling analyses revealed a good fit of the hypothesized model to the data based on various fit indices (chi 2 = 1140, df = 545, chi 2/df ratio = 2.09, CFI = 0.986, RMSEA = 0.050). The amount of variance accounted for in the model was 58%. Staff nurses felt that structural empowerment in their workplace resulted in higher levels of psychological empowerment. These heightened feelings of psychological empowerment in turn strongly influenced job strain and work satisfaction. However, job strain did not have a direct effect on work satisfaction. CONCLUSIONS: These results provide initial support for an expanded model of organizational empowerment and offer a broader understanding of the empowerment process.

Voices from the trenches: nurses' experiences of hospital restructuring in Ontario.

Nurses, the largest occupational group in health care, have been disproportionately affected by health care restructuring initiatives. A survey of registered nurses in Ontario was conducted in the fall of 1998 to examine factors influencing their work life quality in hospital settings. As a part of this survey, respondents were provided with an opportunity to share their concerns about work conditions in an open ended section of the questionnaire. Almost sixty percent of the nurses chose to respond to the open ended question (n = 230), divided equally between males and females. The purpose of the qualitative component of the study was to obtain a more in depth analysis of the effects of hospital restructuring initiatives on staff nurses' working conditions. All geographic areas of the province were represented in the responses. A content analysis of the data was conducted to determine major themes. Similar themes were found across all geographic areas. The four major categories of concerns that emerged from the qualitative analysis were quality of worklife, quality of patient care, relations with management, and cumulative impact of work conditions on feelings and attitudes. Nurses' perceptions of their quality of work life, concern for the quality of patient care and their emotional and attitudinal responses were very similar to those reported in a recent study of hospital staff nurses in the United States. The decade of the 1990's has been characterized as one of constant change bordering on chaos within the health care system in Canada and the United States. In Canada, government fiscal policies have resulted in less money being directed toward health care forcing the system to reorganize in order to meet new financial realities. Many of the organizing efforts have been directed toward the acute care sector of the health care system. Nurses, as the largest occupational group within the health care system, have been disproportionately affected by these efforts. The purpose of this study was to tap nurses concerns about the effects of these changes on their personal and work experiences.

A relaxation training program to increase self-efficacy for anxiety control in Alzheimer family caregivers.

This study investigated whether relaxation training would increase caregivers' self-efficacy for controlling anxiety associated with difficult behaviors by care recipients. Thirty-six individuals caring for relatives with Alzheimer's disease were taught four types of relaxation techniques. Caregivers' self-efficacy increased following the intervention. Length of time spent in the caregiving role and duration of time since care recipients' diagnosis were significantly related to caregiver self-efficacy before the intervention, but became non-significant following the intervention. An insignificant decrease in incidence of reported behavioral problems occurred following the intervention.

Consortium approach for nurse practitioner education.

In 1995, a 10-university consortium approach to deliver a post-baccalaureate primary care nurse practitioner programme funded by the Ontario Ministry of Health was launched throughout Ontario, Canada. A combination of traditional and distance teaching methods, in English and French, were used. A 5-year research project was initiated to evaluate the entire programme, the effect of nurse practitioners on patient and health-care system outcomes and examine practice patterns. Participants included deans and directors (n = 10), regional co-ordinators (n = 5) and course developers, some of whom were also course professors (n = 8). This article is a report of the evaluation of the consortium programme after the first year from the perspective of groups involved in implementation and delivery. Results of qualitative analyses of participant perceptions from researcher-led focus groups and asynchronous electronic interviews provided the framework for the evaluation, and revealed the rationale for the consortium method, strengths, limitations and recommendations. Sharing ideas, resources and delivery and increased student access in remote areas were perceived as positive outcomes. Limitations included the short time period to develop programme content, identify and plan for distance education resources, and too little communication between universities and students. Researchers concluded that the consortium approach was effective for nurse practitioner education. Key factors identified for programme planning were communication, resources, curriculum and workload. Included among the recommendations was to allow sufficient time for role and course development before beginning a similar programme.

Organizational trust and empowerment in restructured healthcare settings. Effects on staff nurse commitment.

In today's dramatically restructured healthcare work environments, organizational trust is an increasingly important element in determining employee performance and commitment to the organization. The authors used Kanter's model of workplace empowerment to examine the effects of organizational trust and empowerment on two types of organizational commitment. A predictive, nonexperimental design was used to test Kanter's theory in a random sample of 412 Canadian staff nurses. Empowered nurses reported higher levels of organizational trust, which in turn resulted in higher levels of affective commitment. However, empowerment did not predict continuance commitment--that is, commitment to stay in the organization based on perceived lack of other job opportunities. Because past research has linked affective commitment to employee productivity, these results suggest that fostering environments that enhance perceptions of empowerment and organizational trust will have positive effects on organizational members and increase organizational effectiveness.

The effects of family nursing and family medicine clinical rotations on nursing and medical students' self-efficacy for health promotion counseling.

The effects of community-based family nursing and medicine clinical rotations on students' confidence in their knowledge and ability to counsel clients in selected health promotion areas were examined from the perspective of Bandura's (1986) self-efficacy theory. Nursing students (n=66) enrolled in a community family nursing course and medical students (n=71) enrolled in a 6-week family practice clerkship rotation completed questionnaires at three points: prior to, at completion of, and 3 months following their clinical rotations. Nursing and medical students' self-efficacy levels at pretest were similar. At-posttest, nursing students' self-efficacy was significantly higher than that of the medical students. This difference was sustained at 3 months follow up. Students' conception of health (clinical vs. nonclinical) did not have an effect on posttest self-efficacy levels. Self-efficacy scores accounted for 63% of the variance in the nursing students' self-reported use of health promotion principles in their daily practice; but only 11% of the variance in medical students' daily practice. The results of this exploratory study provide information to guide theory-informed curricular decisions to design clinical learning activities that foster the development of health promotion counseling skills in both nursing and medical students.

Leader behavior impact on staff nurse empowerment, job tension, and work effectiveness.

OBJECTIVE: The authors tested a model linking specific leader-empowering behaviors to staff nurse perceptions of workplace empowerment, occupational stress, and work effectiveness in a recently-merged Canadian acute care hospital. SUMMARY BACKGROUND DATA: An integration of Kanter's organizational empowerment theory and Conger and Kunungo's model of the leader empowerment process constituted the theoretical framework for the study. Few published studies were found in which specific leader behaviors were linked empirically to staff nurses' workplace empowerment. METHODS: Staff nurses (n = 537) were surveyed shortly after a merger of two large tertiary hospitals. Structural equation modeling techniques were used to test the proposed model. RESULTS: Leader-empowering behaviors significantly influenced employees perceptions of formal and informal power and access to empowerment structures (information support, resources, and opportunity). Higher perceived access to empowerment structures predicted lower levels of job tension and increased work effectiveness. The amount of explained variance in the final model was 42%. CONCLUSIONS: Support for the model tested in this study highlights the importance of nurse managers' leadership behaviors within current turbulent healthcare organizations.

An exploratory study of nursing and medical students health promotion counselling self-efficacy.

Self-efficacy of nursing and medical students for client health promotion counselling was examined in an exploratory study using Bandura's (1977) self-efficacy theoretical perspective. Third-year nursing students (n = 41) and fourth-year medical students (n = 60) were compared on their self-efficacy for engaging in clients health promotion activities within 5 areas: smoking, exercise, nutrition, sexually-transmitted diseases and injuries. Their self-efficacy about their knowledge levels in the same 5 areas of health was also compared along with their perceptions of the relative impact of various curricular learning experiences on building health promotion counselling self efficacy. Self-efficacy scores were high for both groups. Nursing students scored significantly higher on both knowledge and ability to counsel patients in the areas of exercise, nutrition and injury prevention. In both groups, confidence in knowledge for health promotion activities was higher than ability to counsel patients. Learning specific health promotion strategies in class and actual practice were strongly associated with nursing students' self-efficacy while practice, feedback on performance, and role modelling were strongest for medical students.

Empowerment and staff nurse decision involvement in nursing work environments: testing Kanter's theory of structural power in organizations.

Work redesign initiatives have transformed approaches to patient care that will require increased control of nurses over both the content and context of their practice. A secondary analysis of two studies linking perceived work empowerment with two aspects of staff nurse decisional involvement using Kanter's (1977, 1993) theory of structural power in organizations is described. In these studies, the pattern of relationships among variables in Kanter's theory and two different facets of work decisional involvement (control over the content and context of nursing practice) were examined using structural equation modeling techniques. Consistent with theoretical expectations, perceptions of formal and informal power significantly influenced perceived access to work empowerment structures. Informal power was found to mediate the relationship between formal power and access to work empowerment structures. Formal and informal power and access to empowerment structures, in combination, were found to be significant predictors of the extent of involvement in decisions related to the content and context of nursing practice, respectively. The results provide empirical support for propositions derived from Kanter's theory of work empowerment, and provide potential guidance for theory-based management practices to enhance nurses' involvement in professional and organizational decision making.

The effects of teamwork on staff perception of empowerment and job satisfaction.

Rosabeth Moss Kanter's model of organizational empowerment was used to examine the effects of a multidisciplinary teamwork project initiated in preparation for a 1995 Canadian Council on Health Services Accreditation survey. Kanter maintains that work structures such as teams foster opportunities to learn and grow, provide access to information, support and resources, empower employees, and result in increased work satisfaction and effectiveness. Staff who participated on multidisciplinary teams to prepare for the accreditation survey (n = 210) and a random sample of staff who did not participate on the teams (n = 348) were surveyed to ascertain their perceptions of work-related empowerment and job satisfaction. Consistent with Kanter's propositions, members participating on teams had higher empowerment scores and perceived access to empowerment structures to be more important than members not participating on these teams. Overall, perceived access to empowerment structures was found to be significantly lower than perceived importance of access to the empowerment structures. The results of this study support the use of multidisciplinary teams as one work redesign strategy for enhancing work effectiveness in the health care environment.