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.

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.

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.

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.

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.

The role of incentives in nurses' aspirations to management roles.

OBJECTIVE: The objective of this study was to describe findings from a study examining nurses' perceptions of incentives for pursuing management roles. BACKGROUND: Upcoming retirements of nurse managers and a reported lack of interest in manager roles signal concerns about a leadership shortage. However, there is limited research on nurses' career aspirations and specifically the effect of perceived incentives for pursuing manager roles. METHODS: Data from a national, cross-sectional survey of Canadian nurses were analyzed (n = 1241) using multiple regression to measure the effect of incentives on nurses' career aspirations. RESULTS: Twenty-four percent of nurses expressed interest in pursuing management roles. Age, education, and incentives explained 43% of the variance in career aspirations. Intrinsically oriented incentives such as new challenges, autonomy, and the opportunity to influence others were the strongest predictors of aspirations to management roles. CONCLUSIONS: Ensuring an adequate supply of nurse managers will require proactive investment in the identification, recruitment, and development of nurses with leadership potential.

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.

Developing leadership practices in hospital-based nurse educators in an online learning community.

Hospital-based nurse educators are in a prime position to mentor future nurse leaders; however, they need to first develop their own leadership practices. The goal was to establish a learning community where hospital-based nurse educators could develop their own nursing leadership practices within an online environment that included teaching, cognitive, and social presence. Using a pretest/posttest-only nonexperimental design, 35 nurse educators from three Canadian provinces engaged in a 12-week online learning community via a wiki where they learned about exemplary leadership practices and then shared stories about their own leadership practices. Nurse educators significantly increased their own perceived leadership practices after participation in the online community, and teaching, cognitive, and social presence was determined to be present in the online community. It was concluded that leadership development can be enhanced in an online learning community using a structured curriculum, multimedia presentations, and the sharing and analysis of leadership stories. Educators who participated should now be better equipped to role model exemplary leadership practices and mentor our nurse leaders of the future.

On becoming a coach: a pilot intervention study with managers in long-term care.

BACKGROUND: Health care leaders have called for the development of communication and leadership skills to improve manager-employee relationships, employee job satisfaction, quality care, and work environments. PURPOSES: The aim of the study reported here was to pilot how a 2-day coaching workshop ("Coaching for Impressive CARE") conducted as a leadership development strategy influenced frontline care managers' coaching practices in residential long-term care (LTC) settings. We had four objectives: (a) to identify managers' perceptions of their role as a coach of employee performance in LTC facilities, (b) to understand managers' intentions to coach employee performance, (c) to examine opportunities and factors that contributed to or challenged implementation of workshop coaching skills in daily leadership/management practice, and (d) to examine managers' reports of using coaching practices and employee responses after the workshop. METHODS: We used an exploratory/descriptive design involving pre-/post-workshop surveys, e-mail reminders, and focus groups to examine participation of 21 LTC managers in a 2-day coaching workshop and their use of coaching practices in the workplace. FINDINGS: Focus group findings provided examples of how participants used their coaching skills in practice (e.g., communicating empathy) and how staff responded. Factors contributing to and challenging implementation of these coaching skills in the workplace were identified. Attitudes and intentions to be a coach increased significantly, and some coaching skills were used more frequently after the workshop, specifically planning for performance change with employees. PRACTICE IMPLICATIONS: The coaching workshop was feasible to implement, well received by participants, influenced their willingness to become coaches, and had some noted impact on their use of coaching behaviors in the workplace. Coaching skills by managers to improve staff performance with residents in LTC facilities can be learned.

Professional practice leadership roles: the role of organizational power and personal influence in creating a professional practice environment for nurses.

Professional practice leadership (PPL) roles are those roles responsible for expert practice, providing professional leadership, facilitating ongoing professional development, and research. Despite the extensive implementation of this role, most of the available literature focuses on the implementation of the role, with few empirical studies examining the factors that contribute to PPL role effectiveness. This article will share the results of a research study regarding the role of organizational power and personal influence in creating a high-quality professional practice environment for nurses. Survey results from nurses and PPLs from 45 hospitals will be presented. Path analysis was used to test the hypothesized model and relationships between the key variables of interest. Results indicate that there is a direct and positive relationship between PPL organizational power and achievement of PPL role functions, as well as an indirect, partially mediated effect of PPL influence tactics on PPL role function. There is also a direct and positive relationship between PPL role functions and nurses' perceptions of their practice environment. The evidence generated from this study highlights the importance of organizational power and personal influence as significantly contributing to the ability of those in PPL roles to achieve desired outcomes. This information can be used by administrators, researchers, and clinicians regarding the factors that can optimize the organizational and systematic strategies for enhancing the practice environment for nursing and other health care professionals.

Building empowering work environments that foster civility and organizational trust: testing an intervention.

BACKGROUND: Creating supportive and empowering workplace conditions is important, not only because these conditions are related to improved nurse health and well-being but also because they are important for retaining top performing nurses. The current nursing shortage emphasizes the need to create such conditions. OBJECTIVES: The aim of this study was to examine the impact of a workplace intervention (Civility, Respect, and Engagement in the Workplace [CREW]) on nurses' empowerment, experiences of supervisor and coworker incivility, and trust in nursing management. METHODS: Registered nurses (Time 1, n = 755; Time 2, n = 573) working in 41 units across five hospitals in two provinces completed measures of workplace empowerment, supervisor and coworker incivility, and trust in management before and after a 6-month intervention. Eight units participated in the intervention, and 33 units were control groups. Multilevel modeling was used to test the impact of the intervention. RESULTS: A significant interaction of time by intervention was found for the access to support and resources empowerment structures, total empowerment, supervisor incivility, and trust in management. DISCUSSION: Compared with the control group, nurses who experienced the intervention program reported significant improvements in empowerment, supervisor incivility, and trust in management. Despite methodological challenges experienced in this study, the CREW process appears to be a promising intervention approach to enhance quality of nursing work environments, which may contribute to the retention of the nursing workforce.

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.

The influence of leadership practices and empowerment on Canadian nurse manager outcomes.

AIM: To examine the influence of senior nurse leadership practices on middle and first-line nurse managers' experiences of empowerment and organizational support and ultimately on their perceptions of patient care quality and turnover intentions. BACKGROUND: Empowering leadership has played an important role in staff nurse retention but there is limited research to explain the mechanisms by which leadership influences nurse managers' turnover intentions. METHODS: This study was a secondary analysis of data collected using non-experimental, predictive mailed survey design. Data from 231 middle and 788 first-line Canadian acute care managers was used to test the hypothesized model using path analysis in each group. RESULTS: The results showed an adequate fit of the hypothesized model in both groups but with an added path between leadership practices and support in the middle line group. CONCLUSIONS: Transformational leadership practices of senior nurses empower middle- and first-line nurse managers, leading to increased perceptions of organizational support, quality care and decreased intent to leave. IMPLICATIONS FOR NURSING MANAGEMENT: Empowered nurse managers at all levels who feel supported by their organizations are more likely to stay in their roles, remain committed to achieving quality patient care and act as influential role models for potential future leaders.

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.

Authentic leadership and nurses' voice behaviour and perceptions of care quality.

AIM: The purpose of the present study was to test a theoretical model linking authentic leadership with staff nurses' trust in their manager, work engagement, voice behaviour and perceived unit care quality. BACKGROUND: Authentic leadership is a guide for effective leadership needed to build trust and healthier work environments because there is special attention given to honesty, integrity and high ethical standards in the development of leader-follower relationships. METHODS: A non-experimental, predictive survey design was used to test the hypothesized model in a random sample of 280 (48% response rate) registered nurses working in acute care hospitals in Ontario. RESULTS: The final model fitted the data acceptably (χ(2)=17.24, d.f.=11, P=0.10, IFI=0.99, CFI=0.99, RMSEA=0.045). Authentic leadership significantly and positively influenced staff nurses' trust in their manager and work engagement which in turn predicted voice behaviour and perceived unit care quality. CONCLUSIONS: These findings suggest that authentic leadership and trust in the manager play a role in fostering trust, work engagement, voice behaviour and perceived quality of care. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders can improve care quality and workplace conditions by paying attention to facilitating genuine and positive relationships with their staff.

The link between leadership and safety outcomes in hospitals.

AIM: To test and refine a model examining relationships among leadership, interactional justice, quality of the nursing work environment, safety climate and patient and nurse safety outcomes. BACKGROUND: The quality of nursing work environments may pose serious threats to patient and nurse safety. Justice is an important element in work environments that support safety initiatives yet little research has been done that looks at how leader interactional justice influences safety outcomes. METHOD: A cross-sectional survey was conducted with 600 acute care registered nurses (RNs) to test and refine a model linking interactional justice, the quality of nurse leader-nurse relationships, work environment and safety climate with patient and nurse outcomes. RESULTS: In general the hypothesized model was supported. Resonant leadership and interactional justice influenced the quality of the leader-nurse relationship which in turn affected the quality of the work environment and safety climate. This ultimately was associated with decreased reported medication errors, intentions to leave and emotional exhaustion. CONCLUSIONS: Quality relationships based on fairness and empathy play a pivotal role in creating positive safety climates and work environments. IMPLICATIONS FOR NURSING MANAGEMENT: To advocate for safe work environments, managers must strive to develop high-quality relationships through just leadership practices.

Generational differences in distress, attitudes and incivility among nurses.

AIMS: The first research objective was to replicate the finding of Leiter et al. [(2008)Journal of Nursing Management, 16, 100-109.] of Generation X nurses (n=338) reporting higher levels of distress than Baby Boomer nurses (n=139). The second objective was to test whether Generation X nurses reported more negative social environments at work than did Baby Boomer nurses. BACKGROUND: Negative social environments can influence the quality of work and the experience of distress for nurses. Generational differences in the experience of distress and collegiality have implications for the establishment of healthy workplaces, recruitment and retention. METHODS: A questionnaire survey of nurses was organized by generation. Analyses of variance contrasted the scores on burnout, turnover intention, physical symptoms, supervisor incivility, coworker incivility and team civility. RESULTS: The results confirmed the hypotheses of Generation X nurses reporting more negative experiences than did Baby Boomer nurses on all measures. CONCLUSIONS: The negative quality of social encounters at work contributes to nurses' experience of distress and suggest conflicts of values with the dominant culture of their workplaces. IMPLICATIONS FOR NURSING MANAGEMENT: Proactive initiatives to enhance the quality of collegiality can contribute to retention strategies. Building collegiality across generations can be especially useful.

Effects of workplace incivility and empowerment on newly-graduated nurses' organizational commitment.

AIM: The purpose of the present study was to test an expanded model of Kanter's theory by examining the influence of structural empowerment, psychological empowerment and workplace incivility on the organizational commitment of newly-graduated nurses. BACKGROUND: The first years of practise represent an important confidence-building phase for newly-graduated nurses, yet many new nurses are exposed to disempowering experiences and incivility in the workplace. METHOD: A predictive non-experimental design was used to examine the impact of structural empowerment, psychological empowerment and workplace incivility on the affective commitment of newly-graduated nurses (n=117) working in acute care hospitals. RESULTS: Controlling for age, 23.1% of the variance in affective commitment was explained by structural empowerment, psychological empowerment and workplace incivility [R²=0.231, F(5,107) =6.43, P=0.000]. Access to opportunity was the most empowering factor, with access to support and formal power perceived as least empowering. Perceived co-worker incivility was greater than perceived supervisor incivility. CONCLUSION: Results offer significant support for the use of Kanter's theory in the newly-graduated nurse population. IMPLICATIONS FOR NURSING MANAGEMENT: Without specific strategies in place to combat incivility and disempowerment in the workplace, attempts to prevent further organizational attrition of new members may be futile.