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.

Effect of transformational leadership on job satisfaction and patient safety outcomes.

BACKGROUND: Improving patient safety within health care organizations requires effective leadership at all levels. PURPOSE: The objective of this study was to investigate the effects of nurse managers' transformational leadership behaviors on job satisfaction and patient safety outcomes. METHODS: A random sample of acute care nurses in Ontario (N = 378) completed the crosssectional survey. Hypothesized model was tested using structural equation modeling. FINDING: The model fit the data acceptably. Transformational leadership had a strong positive influence on workplace empowerment, which in turn increased nurses' job satisfaction and decreased the frequency of adverse patient outcomes. Subsequently, job satisfaction was related to lower adverse events. CONCLUSION: The findings provide support for managers' use of transformational leadership behaviors as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and nurses.

Toward a comprehensive, theoretical model of compassion fatigue: An integrative literature review.

This study was an integrative literature review in relation to compassion fatigue models, appraising these models, and developing a comprehensive theoretical model of compassion fatigue. A systematic search on PubMed, EbscoHost (Academic Search Premier, E-Journals, Medline, PsycINFO, Health Source Nursing/Academic Edition, CINAHL, MasterFILE Premier and Health Source Consumer Edition), gray literature, and manual searches of included reference lists was conducted in 2016. The studies (n = 11) were analyzed, and the strengths and limitations of the compassion fatigue models identified. We further built on these models through the application of the conservation of resources theory and the social neuroscience of empathy. The compassion fatigue model shows that it is not empathy that puts nurses at risk of developing compassion fatigue, but rather a lack of resources, inadequate positive feedback, and the nurse's response to personal distress. By acting on these three aspects, the risk of developing compassion fatigue can be addressed, which could improve the retention of a compassionate and committed nurse workforce.

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.

Factors influencing new graduate nurse burnout development, job satisfaction and patient care quality: a time-lagged study.

AIM: To test a hypothesized model linking new graduate nurses' perceptions of their manager's authentic leadership behaviours to structural empowerment, short-staffing and work-life interference and subsequent burnout, job satisfaction and patient care quality. BACKGROUND: Authentic leadership and structural empowerment have been shown to reduce early career burnout among nurses. Short-staffing and work-life interference are also linked to burnout and may help explain the impact of positive, empowering leadership on burnout, which in turn influences job satisfaction and patient care quality. DESIGN: A time-lagged study of Canadian new graduate nurses was conducted. METHODS: At Time 1, surveys were sent to 3,743 nurses (November 2012-March 2013) and 1,020 were returned (27·3% response rate). At Time 2 (May-July 2014), 406 nurses who responded at Time 1 completed surveys (39·8% response rate). Descriptive analysis was conducted in SPSS. Structural equation modelling in Mplus was used to test the hypothesized model. RESULTS: The hypothesized model was supported. Authentic leadership had a significant positive effect on structural empowerment, which in turn decreased both short-staffing and work-life interference. Short-staffing and work-life imbalance subsequently resulted in nurse burnout, lower job satisfaction and lower patient care quality 1 year later. CONCLUSION: The findings suggest that short-staffing and work-life interference are important factors influencing new graduate nurse burnout. Developing nurse managers' authentic leadership behaviours and working with them to create and sustain empowering work environments may help reduce burnout, increase nurse job satisfaction and improve patient care quality.

The effects of authentic leadership, organizational identification, and occupational coping self-efficacy on new graduate nurses' job turnover intentions in Canada.

BACKGROUND: Nurses' turnover has a costly impact on organizations, patients, and nurses. Numerous studies have highlighted the critical role of nursing leadership in enhancing new nurses' retention. PURPOSE: To examine the influence of authentic leadership on new nurses' job turnover intentions through their personal identification with the leader, organizational identification, and occupational coping self-efficacy. METHODS: Secondary data analysis of a cross-sectional national study of Canadian new graduate nurses was conducted using structural equation modeling. FINDINGS: Authentic leadership had a significant positive effect on nurses' personal identification with their leader and their organization. Personal identification mediated the relationship between authentic leadership and organizational identification. Organizational identification had a significant positive effect on occupational coping self-efficacy, which, in turn, had a negative effect on new graduate nurses' job turnover intentions. DISCUSSION: The findings demonstrate the vital role authentic leadership plays in retaining new graduate nurses. Authentic leaders foster personal and organizational identification among new graduate nurses, leading to increase in the confidence in their ability to manage work-related challenges, which subsequently results in positive outcomes in both new graduate nurses and the organization.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice.

AIM: To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles. BACKGROUND: Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services. METHOD: A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces. RESULTS: New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads. CONCLUSIONS: The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.

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.

The influence of areas of worklife fit and work-life interference on burnout and turnover intentions among new graduate nurses.

AIM: To examine the relationships among the overall person-job match in the six areas of worklife, work-life interference, new nurses' experiences of burnout and intentions to leave their jobs. BACKGROUND: As a large cohort of nurses approaches retirement, it is important to understand the aspects of the nurses work-life that are related to turnover among new graduate nurses to address the nursing workforce shortage. METHODS: Secondary analysis of data collected in a cross-sectional survey of 215 registered nurses working in Ontario acute hospitals was conducted using structural equation modelling. RESULTS: The fit indices suggested a reasonably adequate fit of the data to the hypothesised model [χ(2)  = 247, d.f. = 122, P = 0.001, χ(2) /d.f. = 2.32, Incremental Fit Index (IFI) = 0.954, Comparative Fit Index (CFI) = 0.953, Root Mean Square Error of Approximation (RMSEA) = 0.06]. Person-job match in six areas of worklife had a direct negative effect on burnout (emotional exhaustion and cynicism), which in turn had a direct positive effect on turnover intentions. Work-life interference also influenced turnover intentions indirectly through burnout. CONCLUSION: The study findings demonstrate that new graduate nurses' turnover intentions are a recurring problem, which could be reduced by improving nurses' working conditions. Retention of new graduate nurses could be enhanced by creating supportive working environments to reduce the susceptibility to workplace burnout, and ultimately, lower turnover intentions. IMPLICATIONS FOR NURSING MANAGEMENT: Managers must employ strategies to enhance workplace conditions that promote a person-job fit and work-life balance to improve retention of new graduate nurses, and, thereby, lessen the nursing shortage.

New nurses' perceptions of professional practice behaviours, quality of care, job satisfaction and career retention.

AIM: To test a model examining the effects of structural empowerment and support for professional practice on new graduate nurses' perceived professional practice behaviours, perceptions of care quality and subsequent job satisfaction and career turnover intentions. BACKGROUND: The nursing worklife model describes relationships between supportive nursing work environments and nurse and patient outcomes. The influence of support for professional practice on new nurses' perceptions of professional nursing behaviours within this model has not been tested. METHODS: Structural equation modelling in Mplus was used to analyse data from a national survey of new nurses across Canada (n = 393). FINDINGS: The hypothesised model was supported: χ²(122) = 346.726, P = 0.000; CFI = 0.917; TLI = 0.896; RMSEA = 0.069. Professional practice behaviour was an important mechanism through which empowerment and supportive professional practice environments influenced nurse-assessed quality of care, which was related to job satisfaction and lower intentions to leave nursing. CONCLUSION: Job satisfaction and career retention of new nurses are related to perceptions of work environment factors that support their professional practice behaviours and high-quality patient care. IMPLICATIONS: Nurse managers can support new graduate nurses' professional practice behaviour by providing empowering supportive professional practice environments.

The influence of empowerment, authentic leadership, and professional practice environments on nurses' perceived interprofessional collaboration.

AIM: The aim of this study was to examine the influence of structural empowerment, authentic leadership and professional nursing practice environments on experienced nurses' perceptions of interprofessional collaboration. BACKGROUND: Enhanced interprofessional collaboration (IPC) is seen as one means of transforming the health-care system and addressing concerns about shortages of health-care workers. Organizational supports and resources are suggested as key to promoting IPC. METHODS: A predictive non-experimental design was used to test the effects of structural empowerment, authentic leadership and professional nursing practice environments on perceived interprofessional collaboration. A random sample of experienced registered nurses (n = 220) in Ontario, Canada completed a mailed questionnaire. Hierarchical multiple regression analysis was used. RESULTS: Higher perceived structural empowerment, authentic leadership, and professional practice environments explained 45% of the variance in perceived IPC (Adj. R² = 0.452, F = 59.40, P < 0.001). CONCLUSIONS: Results suggest that structural empowerment, authentic leadership and a professional nursing practice environment may enhance IPC. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders who ensure access to resources such as knowledge of IPC, embody authenticity and build trust among nurses, and support the presence of a professional nursing practice environment can contribute to enhanced IPC.

Nursing Clinical Instructor Experiences of Empowerment in Rwanda: Applying Kanter's and Spreitzer's Theories.

The purpose of this study was to explore Rwandan nursing clinical instructors' (CIs) experiences of structural and psychological empowerment. CIs play a vital role in students' development by facilitating learning in health care practice environments. Quality nursing education hinges on the CI's ability to enact a professional role. A descriptive qualitative method was used to obtain an understanding of CIs empowerment experiences in practice settings. Kanter's Theory of Structural Power in Organizations and Spreitzer's Psychological Empowerment Theory were used as theoretical frameworks to interpret experiences. Interview data from 21 CIs were used to complete a secondary analysis. Most participants perceived the structural components of informal power, resources, and support while formal power and opportunity were limited, diminishing their sense of structural empowerment. Psychological empowerment for CIs stemmed from a sense of competence, meaning, impact and self-determination they had for their teaching roles and responsibilities in the practice setting.

Correlates of New Graduate Nurses' Experiences of Workplace Mistreatment.

OBJECTIVE: This study explores correlates of new graduate nurses' experiences of workplace mistreatment. BACKGROUND: New graduate nurses' experiences of workplace mistreatment, such as bullying, coworker incivility, and supervisor incivility, negatively influence nurses' work and health. It is unclear whether these forms of workplace mistreatment have similar precipitating factors and outcomes. METHODS: We surveyed 342 new graduate nurses in Ontario to explore correlates of 3 forms of workplace mistreatment. RESULTS: Workplace incivility and bullying were significantly related to authentic leadership, structural empowerment, worklife fit, and psychological capital. Bullying was more strongly related to job satisfaction, emotional exhaustion, and mental and physical health outcomes than supervisor and coworker incivility. CONCLUSIONS: New graduate nurses' experiences of 3 types of workplace mistreatment are related to organizational and health factors, although bullying appears to have stronger negative effects.

Linking nurses' perceptions of patient care quality to job satisfaction: the role of authentic leadership and empowering professional practice environments.

OBJECTIVES: A model linking authentic leadership, structural empowerment, and supportive professional practice environments to nurses' perceptions of patient care quality and job satisfaction was tested. BACKGROUND: Positive work environment characteristics are important for nurses' perceptions of patient care quality and job satisfaction (significant factors for retention). Few studies have examined the mechanism by which these characteristics operate to influence perceptions of patient care quality or job satisfaction. METHODS: A cross-sectional provincial survey of 723 Canadian nurses was used to test the hypothesized models using structural equation modeling. RESULTS: The model was an acceptable fit and all paths were significant. Authentic leadership had a positive effect on structural empowerment, which had a positive effect on perceived support for professional practice and a negative effect on nurses' perceptions that inadequate unit staffing prevented them from providing high-quality patient care. These workplace conditions predicted job satisfaction. CONCLUSION: Authentic leaders play an important role in creating empowering professional practice environments that foster high-quality care and job satisfaction.

The influence of authentic leadership and empowerment on nurses' relational social capital, mental health and job satisfaction over the first year of practice.

AIMS: To examine a theoretical model testing the effects of authentic leadership, structural empowerment and relational social capital on the mental health and job satisfaction of new graduate nurses over the first year of practice. BACKGROUND: Relational social capital is an important interpersonal organizational resource that may foster new graduate nurses' workplace well-being and promote retention. Evidence shows that authentic leadership and structural empowerment are key aspects of the work environment that support new graduate nurses; however, the mediating role of relational social capital has yet to be explored. DESIGN: A longitudinal survey design was used to test the hypothesized model. METHODS: One hundred ninety-one new graduate nurses in Ontario with <2 years of experience completed mail surveys in January-March 2010 and 1 year later in 2011. Path analysis using structural equation modelling was used to test the theoretical model. RESULTS: Participants were mostly female, working full time in medicine/surgery or critical care. All measures demonstrated acceptable reliability and validity. Path analysis results supported our hypothesized model; structural empowerment mediated the relationship between authentic leadership and nurses' relational social capital, which in turn had a negative effect on mental health symptoms and a positive effect on job satisfaction. All indirect paths in the model were significant. CONCLUSION: By creating structurally empowering work environments, authentic leaders foster relational social capital among new graduate nurses leading to positive health and retention outcomes.

Exposure to workplace bullying and post-traumatic stress disorder symptomology: the role of protective psychological resources.

AIM: To examine the relationship between nurses' exposure to workplace bullying and Post-Traumatic Stress Disorder symptomology and the protective role of psychological capital (PsyCap). BACKGROUND: Workplace bullying has serious organisational and health effects in nursing. Few studies have examined the relation of workplace bullying to serious mental health outcomes, such as Post-Traumatic Stress Disorder. Even fewer have examined the effect of intrapersonal strengths on the health impact of workplace bullying. METHOD: A survey of 1205 hospital nurses was conducted to test the hypothesized model. Nurses completed standardized measures of bullying, Post-Traumatic Stress Disorder and PsyCap. RESULT: A moderated regression analysis revealed that more frequent exposure to workplace bullying was significantly related to Post-Traumatic Stress Disorder symptomology regardless of the PsyCap level. That is, PsyCap did not moderate the bullying/PTSD relationship in either group. Bullying exposure and PsyCap were significant independent predictors of Post-Traumatic Stress Disorder symptoms in both groups. Efficacy, a subdimension of PsyCap, moderated the bullying/Post-Traumatic Stress Disorder relationship only among experienced nurses. CONCLUSION: Workplace bullying appears to be predictive of Post-Traumatic Stress Disorder symptomology, a serious mental health outcome. IMPLICATIONS FOR NURSING MANAGEMENT: Workplace bullying is a serious threat to nurses' health and calls for programmes that eliminate bullying and encourage greater levels of positive resources among nurses.

The influence of empowerment and incivility on the mental health of new graduate nurses.

AIM: To test a model based on Kanter's theory of structural empowerment, which examines the relationships between new graduate nurses' perceptions of structural empowerment, workplace incivility and mental health symptoms. BACKGROUND: The initial years of practice can be particularly stressful for new graduate nurses, who may be particularly vulnerable to uncivil behaviour as a result of their status in the work environment. Disempowerment and incivility in the workplace may compound the mental health symptoms experienced by new graduate nurses. METHOD: A predictive, non-experimental design was used to examine the relationship between structural empowerment, workplace incivility and mental health symptoms in a sample of new graduate nurses working in hospital settings in Ontario (n = 394). RESULT: High levels of structural empowerment were significantly associated with fewer negative mental health symptoms in new graduates. However, co-worker incivility and supervisor incivility partially mediated the effect of structural empowerment on new graduate nurses' mental health symptoms. CONCLUSION: The findings suggest that empowering workplaces contribute to lower mental health symptoms in new graduate nurses, an effect that is diminished by incivility. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies that foster empowering work conditions and reduce uncivil behaviour are needed to promote positive mental health in new graduate nurses.

The influence of personal and workplace resources on new graduate nurses' job satisfaction.

AIMS: This study examined the influence of new graduate nurses' personal resources (psychological capital) and access to structural resources (empowerment and staffing) on their job satisfaction. BACKGROUND: Reports suggest that new graduate nurses are experiencing stressful work environments, low job satisfaction, and high turnover intentions. These nurses are a health human resource that must be retained for the replacement of retiring nurses, and to address impending shortages. Supportive workplaces that promote new graduate nurses' job satisfaction may play an important role in the retention of new nurses. METHODS: A secondary analysis of data from a larger study of new graduate nurses was conducted. Data collection was completed using self-reported questionnaires. Hierarchical multiple regression was used to test the hypothesised model. RESULTS: Psychological capital, structural empowerment and perceived staffing adequacy were significant independent predictors of job satisfaction. The final model explained 38% of the variance in job satisfaction. CONCLUSIONS: Both personal and structural workplace factors are important to new graduate nurses' job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should ensure empowerment structures are in place to support new graduate nurses' job satisfaction. Orientation processes and ongoing management support to build psychological capital in new graduate nurses will help create positive perceptions of the workplace, enhancing job satisfaction.

Examining the relationships between span of control and manager job and unit performance outcomes.

AIM: Our aim was to examine the combination of frontline manager (FLM) personal characteristics and span of control (SOC) on their job and unit performance outcomes. BACKGROUND: Healthcare downsizing and reform have contributed to larger spans for FLMs in Canadian hospitals and increased concerns about manager workload. Despite a heightened awareness of SOC issues among decision makers, there is limited empirical evidence related to the effects of SOC on outcomes. METHODS: A non-experimental predictive survey design was used to examine FLM SOC in 14 Canadian academic hospitals. Managers (n = 121) completed an online survey of work characteristics and The Ottawa Hospital (TOH) SOC tool. Unit turnover data were collected from organisational databases. RESULTS: The combination of SOC and core self-evaluation significantly predicted role overload, work control and job satisfaction, but only SOC predicted unit adverse outcomes and neither significantly predicted unit turnover. CONCLUSIONS: The findings contribute to an understanding of connections between the combination of SOC and core self-evaluation and manager job and unit performance outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Organisational strategies to create manageable FLM SOC are essential to ensure exemplary job and unit outcomes. Core self-evaluation is a personality characteristic that may enhance manager performance in the face of high spans of control.

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.