The influence of nursing unit empowerment and social capital on unit effectiveness and nurse perceptions of patient care quality.

OBJECTIVE: This study tested a multilevel model examining the effects of work-unit structural empowerment and social capital on perceptions of unit effectiveness and nurses' ratings of patient care quality. BACKGROUND: Structural empowerment and social capital are valuable resources for staff nurses that promote work effectiveness and high-quality patient care. No studies have examined social capital in nursing at the group level. METHODS: A cross-sectional survey of 525 nurses in 49 nursing units in 25 acute care hospitals in Ontario was conducted to test the hypothesized multilevel model using structural equation modeling. RESULTS: Both unit-level structural empowerment and social capital had significant effects on unit effectiveness (ß = .05 and ß = .29, P < .05, respectively). Unit-level predictors explained 87.5% of level 2 variance in individual nurses' ratings of patient care quality. CONCLUSIONS: This study provides a better understanding of how unit-level structural empowerment and social capital affect both unit- and individual-level outcomes.

Predictors of new graduate nurses' workplace well-being: testing the job demands-resources model.

BACKGROUND: New graduate nurses currently experience a stressful transition into the workforce, resulting in high levels of burnout and job turnover in their first year of practice. PURPOSE: This study tested a theoretical model of new graduate nurses' worklife derived from the job demands-resources model to better understand how job demands (workload and bullying), job resources (job control and supportive professional practice environments), and a personal resource (psychological capital) combine to influence new graduate experiences of burnout and work engagement and, ultimately, health and job outcomes. METHODOLOGY/APPROACH: A descriptive correlational design was used to test the hypothesized model in a sample of newly graduated nurses (N = 420) working in acute care hospitals in Ontario, Canada. Data were collected from July to November 2009. Participants were mailed questionnaires to their home address using the Total Design Method to improve response rates. All variables were measured using standardized questionnaires, and structural equation modeling was used to test the model. FINDINGS: The final model fit statistics partially supported the original hypothesized model. In the final model, job demands (workload and bullying) predicted burnout and, subsequently, poor mental health. Job resources (supportive practice environment and control) predicted work engagement and, subsequently, lower turnover intentions. Burnout also was a significant predictor of turnover intent (a crossover effect). Furthermore, personal resources (psychological capital) significantly influenced both burnout and work engagement. PRACTICE IMPLICATIONS: The model suggests that managerial strategies targeted at specific job demands and resources can create workplace environments that promote work engagement and prevent burnout to support the retention and well-being of the new graduate nurse population.

Situational and dispositional influences on nurses' workplace well-being: the role of empowering unit leadership.

BACKGROUND: Unit-level leadership and structural empowerment play key roles in creating healthy work environments, yet few researchers have examined these contextual effects on nurses' well-being. OBJECTIVES: The aim of this study was to test a multilevel model of structural empowerment examining the effect of nursing unit leadership quality and structural empowerment on nurses' experiences of burnout and job satisfaction and to examine the effect of a personal dispositional variable, core self-evaluation, on these nurse experiences. METHODS: Nurses (n = 3,156) from 217 hospital units returned surveys that included measures of leader-member exchange, structural empowerment, burnout, core self-evaluation, and job satisfaction. Multilevel structural equation modeling was used to test the model. RESULTS: Nurses' shared perceptions of leader-member exchange quality on their units positively influenced their shared perceptions of unit structural empowerment (Level 2), which resulted in significantly higher levels of individual nurse job satisfaction (Level 1). Unit-level leader-member exchange quality also directly influenced individual nurse job satisfaction. Unit leader-member exchange quality and structural empowerment influenced emotional exhaustion and cynicism differentially. Higher unit-level leader-member exchange quality was associated with lower cynicism; higher unit-level structural empowerment was associated with lower emotional exhaustion. At Level 1, higher core self-evaluation was associated with lower levels of both emotional exhaustion and cynicism, both of which were associated with lower job satisfaction. DISCUSSION: This study provides a theoretical understanding of how unit leadership affects both unit- and individual-level 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.

Effects of work environments on nurse and patient outcomes.

AIM: To determine the relationship between nurses' perceptions of their work environment and quality/risk outcomes for patients and nurses in acute care settings. BACKGROUND: Nurses are leaving the profession as a result of high levels of job dissatisfaction arising from current working conditions. To gain organizational support for workplace improvements, evidence is needed to demonstrate the impact of the work environment on patient care. METHOD: A multi-level design was used to collect data from nurses (n=679) and patients (n=1005) within 61 medical and surgical units in 21 hospitals in Canada. RESULTS: Using multilevel structural equation modelling, the hypothesized model fitted well with the data [χ(2)=21.074, d.f.=10, Comparative Fit Index (CFI)=0.985, Tucker-Lewis Index (TLI)=0.921, Root Mean Square Error of Approximation (RMSEA)=0.041, Standardized Root Mean Square Residual (SRMR) 0.002 (within) and 0.054 (between)]. Empowering workplaces had positive effects on nurse-assessed quality of care and predicted fewer falls and nurse-assessed risks as mediated through group processes. These conditions positively impacted individual psychological empowerment which, in turn, had significant direct effects on empowered behaviour, job satisfaction and care quality. CONCLUSIONS: Empowered workplaces support positive outcomes for both nurses and patients. IMPLICATIONS FOR NURSING MANAGEMENT: Managers employing strategies to create more empowered workplaces have the potential to improve nursing teamwork that supports higher quality care, less patient risk and more satisfied nurses.

Leader empowering behaviour: relationships with nurse and patient outcomes.

PURPOSE: This study aims to test a model examining the impact of leader empowering behaviour on experienced nurses' self-efficacy, interprofessional collaboration, job turnover intentions and adverse patient outcomes. DESIGN/METHODOLOGY/APPROACH: Structural equation modelling in Mplus was used to analyse cross-sectional survey data from experienced nurses in Alberta, Ontario, and Nova Scotia, Canada (n = 478). FINDINGS: The results supported the hypothesized model: (164) = 333.021, p = 0.000; RMSEA = 0.047; CFI = 0.965; TLI = 0.959; SRMR = 0.051. Indirect effects were observed between leader empowering behaviour and nurses' assessment of adverse events and leader empowering behaviour and nurses' job turnover intentions through interprofessional collaboration. RESEARCH LIMITATIONS/IMPLICATIONS: Leader empowering behaviour plays a role in creating collaborative conditions that support quality patient care and the retention of experienced nurses. PRACTICAL IMPLICATIONS: The findings will be of interest to academic and hospital leaders as they consider strategies to retain experienced nurses, such as nurse manager selection, development and performance management systems. ORIGINALITY/VALUE: The influx of new graduate nurses to the nursing profession and changing models of care requires the retention of experienced nurses in the workforce. The findings suggest that leader empowering behaviour and interprofessional collaboration are important factors in supporting quality patient care and stabilizing the nursing workforce.

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.

New graduate burnout: the impact of professional practice environment, workplace civility, and empowerment.

The future of professional nursing depends on finding ways to create high-quality work environments that retain newcomers to the profession. The purpose of this study was to examine the combined effect of supportive professional practice environments, civil working relationships, and empowerment on new graduates' experiences of burnout at work. The results support previous evidence of the importance of working environments that enable new graduates to practice according to professional standards learned in their educational programs. Further, the results provide a more comprehensive understanding of the impact of workplace conditions on new graduate burnout by demonstrating the additive value of working in collegial work settings in which nurses respected others and refrain from incivility behaviors in their day to day work. Given the current nursing shortage, every effort must be made to ensure that new graduates are exposed to high-quality work environments that engage them with their work.

Situational and dispositional predictors of nurse manager burnout: a time-lagged analysis.

BACKGROUND: Burnout among nurses is a serious condition that threatens their own health and that of their patients. In current health care settings, nurses are particularly at risk for burnout given the increased patient acuity and the worsening nursing shortage. AIM: This study examined the influence of effort-reward imbalance, a situational variable, and core self-evaluation, a dispositional variable, on nurse managers' burnout levels over a 1-year period. METHODS: A predictive longitudinal survey design was used to examine the relationships described in the model. One hundred and thirty-four nurse managers responded to a mail survey at two points in time. RESULTS: As hypothesized, both personal and situational factors influenced nurse manager burnout over a 1-year time frame. Although burnout levels at Time 1 accounted for significant variance in emotional exhaustion levels 1 year later (beta = 0.355), nurses' effort-reward imbalance (beta = 0.371) and core self-evaluations (beta = -0.166) explained significant additional amounts of variance in burnout 1 year later. CONCLUSION: Both personal and situational factors contribute to nurse manager burnout over time. Implications for nursing management Managers must consider personal and contextual factors when creating work environments that prevent burnout and foster positive health among nurses at work.

Using empowerment to build trust and respect in the workplace: a strategy for addressing the nursing shortage.

In this study of 273 staff nurses, higher levels of structural empowerment were found to positively influence perceptions of interactional justice, respect, and trust in management, which, ultimately, increased perceptions of job satisfaction and organizational commitment.

Effects of unit empowerment and perceived support for professional nursing practice on unit effectiveness and individual nurse well-being: a time-lagged study.

BACKGROUND: Recruitment and retention strategies have emphasized the importance of positive work environments that support professional nursing practice for sustaining the nursing workforce. Unit leadership that creates empowering workplace conditions plays a key role in establishing supportive practice environments that increase work effectiveness, and, ultimately, improves job satisfaction. OBJECTIVES: To test a multi-level model examining the effect of both contextual and individual factors on individual nurse job satisfaction. At the unit level, structural empowerment and support for professional nursing practice (organizational resources) were hypothesized to be predictors of unit level effectiveness. At the individual level, core self-evaluation, and psychological empowerment (intrapersonal resources) were modeled as predictors of nurse job satisfaction one year later. Cross-level unit effects on individual nurses' job satisfaction were also examined. DESIGN: This study employed a longitudinal survey design with 545 staff nurses from 49 hospital units in Ontario, Canada. Participants completed a survey at two points in time (response rate of 40%) with standardized measures of the major study variables in the hypothesized model. Multilevel structural equation modeling was used to test the model. RESULTS: Nurses shared perceptions of structural empowerment on their units indirectly influenced their shared perceptions of unit effectiveness (Level 2) through perceived unit support for professional nursing practice, which in turn, had a significant positive direct effect on unit effectiveness (Level 2). Unit effectiveness was also strongly related to individual nurse job satisfaction one year later. At Level 1, higher core self-evaluation had a direct and indirect effect on job satisfaction through increased psychological empowerment. CONCLUSIONS: The results suggest that nurses' job satisfaction is influenced by a combination of individual and contextual factors demonstrating utility in considering both sources of nurses' satisfaction with their work in creating effective nursing work environments.

Nursing professional practice environments: setting the stage for constructive conflict resolution and work effectiveness.

OBJECTIVE: The aim of this study was to examine the impact of nurses' perceived professional practice environment on their quality of nursing conflict management approaches and ultimately their perceptions of unit effectiveness from the perspective of Deutsch's theory of constructive conflict management. BACKGROUND: Rising reports of hostility and conflict among Canadian nurses are a concern to nurses' health and the viability of effective patient care delivery. However, research on the situational factors that influence nurses' ability to apply effective conflict resolution skills that lead to positive results in practice is limited. METHODS: A nonexperimental, predictive design was used in a sample of 678 registered nurses working in community hospitals within a large metropolitan area in Ontario. RESULTS: The results supported a modified version of the hypothesized model [chi2(1) = 16.25, Goodness of Fit = 0.99, Comparative Fit Index = 0.98, Root-Mean-Square Error of Approximation = 0.15] linking professional practice environment and core self-evaluation to nurses' conflict management and, ultimately, unit effectiveness. Professional practice environment, conflict management, and core-self evaluation explained approximately 46.6% of the variance in unit effectiveness. CONCLUSION: Positive professional practice environments and high core self-evaluations predicted nurses' constructive conflict management and, in turn, greater unit effectiveness.

Empowering nurses for work engagement and health in hospital settings.

Employee empowerment has become an increasingly important factor in determining employee health and wellbeing in restructured healthcare settings. The authors tested a theoretical model which specified the relationships among structural empowerment, 6 areas of worklife that promote employee engagement, and staff nurses' physical and mental health. A predictive, non-experimental design was used to test the model in a random sample of staff nurses. The authors discuss their findings and the implication for nurse administrators.