The effect of structural empowerment and perceived organizational support on middle level nurse managers' role satisfaction

BACKGROUND: The restructuring of Canadian health care organizations during the past decade has reduced the visibility of nursing leadership. This has resulted in job conditions that have disempowered nurse managers and influenced their ability to create positive work environments, mentor potential nurse leaders, and gain satisfaction in the leadership role. These conditions threaten the retention of a cadre of high quality nurse leaders in today's chaotic health care setting. OBJECTIVE: The purpose of this study was to examine the relationship between structural empowerment and perceived organizational support and the effect of these factors on the role satisfaction of middle level nurse managers. METHOD: A secondary analysis was conducted as part of a larger study of 126 middle level nurse managers working in Canadian acute care hospitals, randomly selected from the Ontario provincial registry. Eighty-four nurse managers responded to a questionnaire mailed to their home addresses. RESULTS: Structural empowerment was positively associated with middle level nurse managers' perceived organizational support. The combination of empowerment and perceptions of organizational support were significant predictors of middle level nurse managers' role satisfaction. CONCLUSIONS: The findings support R.M. Kanter's (1977, 1993; Men and Women of the Corporation. Basic Books, New York) contention that empowering work conditions have an impact on employees' feelings of support and sense of accomplishment at work. Positive perceptions of organizational support may play an important role in retaining current middle managers, and possibly attracting future leaders to management positions.     

Curbing the urge to care: A Bourdieusian analysis of the effect of the caring disposition on nurse middle managers’ clinical leadership in patient safety practices

BackgroundNurse managers play an important role in implementing patient safety practices in hospitals. However, the influence of their professional background on their clinical leadership behaviour remains unclear. Research has demonstrated that concepts of Bourdieu (dispositions of habitus, capital and field) help to describe this influence. It revealed various configurations of dispositions of the habitus in which a caring disposition plays a crucial role.ObjectivesWe explore how the caring disposition of nurse middle managers’ habitus influences their clinical leadership behaviour in patient safety practices.DesignOur paper reports the findings of a Bourdieusian, multi-site, ethnographic case study.SettingsTwo Dutch and two American acute care, mid-sized, non-profit hospitals.ParticipantsA total of 16 nurse middle managers of adult care units.MethodsObservations were made over 560 h of shadowing nurse middle managers, semi-structured interviews and member check meetings with the participants.ResultsWe observed three distinct configurations of dispositions of the habitus which influenced the clinical leadership of nurse middle managers in patient safety practices; they all include a caring disposition: (1) a configuration with a dominant caring disposition that was helpful (via solving urgent matters) and hindering (via ad hoc and reactive actions, leading to quick fixes and ‘compensatory modes’); (2) a configuration with an interaction of caring and collegial dispositions that led to an absence of clinical involvement and discouraged patient safety practices; and (3) a configuration with a dominant scientific disposition showing an investigative, non-judging, analytic stance, a focus on evidence-based practice that curbs the ad hoc repertoire of the caring disposition.ConclusionsThe dispositions of the nurse middle managers’ habitus influenced their clinical leadership in patient safety practices. A dominance of the caring disposition, which meant ‘always’ answering calls for help and reactive and ad hoc reactions, did not support the clinical leadership role of nurse middle managers. By perceiving the team of staff nurses as pseudo-patients, patient safety practice was jeopardized because of erosion of the clinical disposition. The nurse middle managers’ clinical leadership was enhanced by leadership behaviour based on the clinical and scientific dispositions that was manifested through an investigative, non-judging, analytic stance, a focus on evidence-based practice and a curbed caring disposition.     

Leadership practices and staff nurses' intent to stay: a systematic review

cowden t., cummings g. & profetto-mcgrath j (2011) Journal of Nursing Management 19 , 461–477
Leadership practices and staff nurses’ intent to stay: a systematic review Aim The aim of the present study was to describe the findings of a systematic review of the literature that examined the relationship between managers’ leadership practices and staff nurses’ intent to stay in their current position. Background The nursing shortage demands that managers focus on the retention of staff nurses. Understanding the relationship between leadership practices and nurses’ intent to stay is fundamental to retaining nurses in the workforce. Methods Published English language articles on leadership practices and staff nurses’ intent to stay were retrieved from computerized databases and a manual search. Data extraction and quality assessments were completed for the final 23 research articles. Results Relational leadership practices influence staff nurses’ intentions to remain in their current position. Conclusion This study supports a positive relationship between transformational leadership, supportive work environments and staff nurses’ intentions to remain in their current positions. Incorporating relational leadership theory into management practices will influence nurse retention. Advancing current conceptual models will increase knowledge of intent to stay. Clarifying the distinction between the concepts intent to stay and intent to leave is needed to establish a clear theoretical foundation for further intent to stay research. Implications for Nurse Managers Nurse managers and leaders who practice relational leadership and ensure quality workplace environments are more likely to retain their staff. The findings of the present study support the claim that leadership practices influence staff nurse retention and builds on intent to stay knowledge.     

Reasons to leave: the motives of first-line nurse managers' for leaving their posts

OBJECTIVE: To study the reasons for first-line nurse managers to resign, their perceptions of difficult situations, experience of support and satisfaction with work. BACKGROUND: The intentions of first-line nurse managers' to stay at their posts varied between 45% and 75% in different studies. METHODS: Data were collected by questionnaire and letters from 32 first-line nurse managers who had left their posts. Qualitative content analysis was used to analyse the letters. RESULTS: Eleven first-line nurse managers resigned due to reorganization or other changes and 19 due to their own accord. Reasons to leave were personal, organizational, as well as lack of support from and relations to the head of department. Difficult situations were unclear conditions, lack of support from supervisors and, implementation of changes, staff matters and economy. Important support was personal, organizational, practical and to have opportunities for development and education. The perception of work satisfaction was higher after resignation. CONCLUSIONS: The dominant reason to leave was reorganization and other changes. The relation to the head of department influenced the first-line nurse managers' overall work situation.     

Understanding rebel nurse leadership-as-practice: Challenging and changing the status quo in hospitals

Some nurses are responding rebelliously to the changing healthcare landscape by challenging the status quo and deviating from suboptimal practices, professional norms, and organizational rules. While some view rebel nurse leadership as challenging traditional structures to improve patient care, others see it as disruptive and harmful. These diverging opinions create dilemmas for nurses and nurse managers in daily practice. To understand the context, dilemmas, and interactions in rebel nurse leadership, we conducted a multiple case study in two Dutch hospitals. We delved into the mundane practices to expand the concept of leadership-as-practice. By shadowing rebel nurse practices, we identified three typical leadership practices which present the most common “lived” experiences and dilemmas of nurses and nurse managers. Overall, we noticed that deviating acts were more often quick fixes rather than sustainable changes. Our research points to what is needed to change the status quo in a sustainable manner. To change unworkable practices, nurses need to share their experienced dilemmas with their managers. In addition, nurse managers must build relationships with other nurses, value different perspectives, and support experimenting to promote collective learning.     

The influence of nursing leadership on nurse performance: a systematic literature review

brady germain p. & cummings g.g. (2010) Journal of Nursing Management 18, 425–439
The influence of nursing leadership on nurse performance: a systematic literature review Aim The aim was to explore leadership factors that influence nurse performance and particularly, the role that nursing leadership behaviors play in nurses’ perceptions of performance motivation. Background Nurse performance is vital to quality patient care outcomes and nursing leadership behaviors have been linked to nurse performance. Evaluations A review of research articles that examined the factors that nurses perceived as influencing their motivation and performance was conducted. Eight studies were included in the final analysis. Key issues Nurses’ perceptions of factors that affect their motivation and ability to perform were grouped into five categories using content analysis: autonomy, work relationships, resource accessibility, nurse factors, and leadership practices. Nursing leadership behaviors were found to influence both nurses’ motivations directly and indirectly via other factors. Conclusion The review suggests that nurse performance may be improved by addressing nurse autonomy, relationships among nurses, their colleagues and leaders, and resource accessibility. Implications for nursing management Nursing managers and leaders may enhance their nurses’ performance by understanding and addressing the factors that affect their ability and motivation to perform.     

The link between leadership and safety outcomes in hospitals

squires m., tourangeau a., spence laschinger h.k. & doran d . (2010) Journal of Nursing Management 18, 914–925
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.     

Nurse managers don’t get the corner office

Aim To provide an original perspective on the power and status of first-line nurse managers by observing their working environment. Background The role of first-line nurse managers includes clinical, administrative and managerial components, with their responsibilities not always reflected in their level of organizational power. The business literature suggests that an appropriately resourced workspace is not merely functional, it also confers power and status. Method Twenty Australian rural nurse managers’ workspaces were observed, as part of a larger qualitative study that explored their role and organizational power using semi-structured interviews. The observational data consisted of detailed researcher notes that were analysed thematically. Results The nurse managers’ workspaces were suboptimal and did not provide sufficient physical space or resources for the participants’ to manage tasks effectively. These results were considered using Kanter’s theory of organizational power. Implications for nursing management The findings support those reported in the business literature that inadequate physical workspaces are counterproductive in terms of both functionality and organizational power. Suggestions are made regarding the workspace needs of first-line nurse managers, based on a closer alignment between the work environment and their role responsibilities. These findings have implications for decisions regarding organizational support of first-line nurse managers.     

Leadership: the key to quality outcomes

Nurse executives are charged with creating a workforce that provides quality care in a creative and cost-effective manner. Style of leadership determines how nurse executives relate to their professional nurses and ultimately how successful their health care institutions will be. The practice-based theory of nursing leadership called the Integrated Leadership Practice Model can be practiced by nurse executives to promote employee satisfaction, assure that quality care is provided based on standards and competencies, and promote an organizational culture committed to quality. This article proposes the application of integrated leadership to the practice of nurse executives and demonstrates how they can foster and support this model for nursing leadership within their nurse managers.     

Factors influencing job satisfaction of front line nurse managers: a systematic review

Aim The purpose of this study was to systematically review the research literature that examined the determinants of front line nurse managers’ job satisfaction. Background Front line managers are the vital link between senior management and clinical nurses. They influence organizational culture and outcomes for patients and staff so their job satisfaction and ultimately retention is of importance. Evaluations A review of research articles that examined the determinants of front line nurse managers’ job satisfaction was conducted. These managers supervise staff nurses and have direct responsibility for the management of a nursing unit or team in any type of healthcare facility. Fourteen studies were included in the final analysis. Key issues Evidence of significant positive relationships were found between span of control, organizational support, empowerment and the job satisfaction of front line nurse managers. Conclusion The review suggests that job satisfaction of front line managers may be improved by addressing span of control and workload, increasing organizational support from supervisors and empowering managers to participate in decision‐making. Implications for Nursing Management Healthcare organizations may enhance the recruitment, retention and sustainability of future nursing leadership by addressing the factors that influence job satisfaction of front line managers.     

Rationing nurses: Realities,practicalities, and nursing leadership theories

In this paper, we examine the practicalities of nurse managers’ work. We expose how managers’ commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We learned how nurse managers’ responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers’ responsibilities are shaped to conform to institutional purposes.     

护理管理者的辱虐管理行为与护士离职意愿相关性研究

[目的]探讨护理管理者的辱虐管理水平以及对护士离职意愿的影响.[方法]采用方便抽样方法选取284名护士进行辱虐管理行为及离职意愿测量,并对二者进行相关性研究.[结果]护理人员感知到的辱虐管理行为得分为（2.350士1.497）分,离职意愿得分为（4.519士1.620）分,护理管理者的辱虐管理行为与护士离职意愿呈正相关（β=0.323,P＜0.01）.[结论]护理管理者的辱虐管理程度较低,离职意愿处于中等水平,护理管理者长期的情感辱虐让护士产生了离职想法.医院管理者应密切关注护理管理者的领导方式,及时发现和干预护理管理者的破坏性领导行为,进而稳定护士队伍,提高护理服务质量.     

Factors influencing intentions to stay and retention of nurse managers: a systematic review

Aims This systematic review aimed to explore factors known to influence intentions to stay and retention of nurse managers in their current position. Background Retaining staff nurses and recruiting nurses to management positions are well documented; however, there is sparse research examining factors that influence retention of nurse managers. Evaluations Thirteen studies were identified through a systematic search of the literature. Eligibility criteria included both qualitative and quantitative studies that examined factors related to nurse manager intentions to stay and retention. Quality assessments, data extraction and analysis were completed on all studies included. Twenty-one factors were categorized into three major categories: organizational, role and personal. Key issues Job satisfaction, organizational commitment, organizational culture and values, feelings of being valued and lack of time to complete tasks leading to work/life imbalance, were prominent across all categories. Conclusion These findings suggest that intentions to stay and retention of nurse managers are multifactoral. However, lack of robust literature highlights the need for further research to develop strategies to retain nurse managers. Implications for nurse management Health-care organizations and senior decision-makers should feel a responsibility to support front-line managers in relation to workload and span of control, and in understanding work/life balance issues faced by managers.     

Teaching and community hospital work environments

The Institute of Medicine report suggests that nursing work environments experience threats to patient safety related to organizational management and workforce deployment practices, work design, and organizational culture. Organizational factors contribute to nursing and potentially patient outcomes, yet few studies have examined the differences in practices perceived by nurses employed in different settings. Nurses from 16 medical and surgical units in eight randomly selected acute care hospitals representing teaching and community organizations participated in this project. Nurses working in teaching hospitals reported lower levels of role tension, yet their perceptions of the quality of work, the work environment, nursing unit leadership, quality of care, and levels of job stress and job satisfaction were higher than their colleagues in the community sites. This study highlights some important differences between teaching and community hospitals that can inform nurse executives and policy makers of the unique work-life issues for different groups of nurses.     

Power sharing. A transformational strategy for nurse retention, effectiveness, and extra effort

Power sharing with staff nurses is an essential strategy for organizational transformation. The current competitive health care environment requires a powerful team of participants, including staff at all levels, to provide health care in mutual partnership. The challenges of today's competitive and global environment call for collegial relationships among nurse executive leadership, middle nurse managers, and staff nurses. Research has demonstrated that middle nurse managers maintain primary responsibility for staff nurse retention. A higher retention rate was reported among nurses who were very satisfied with their nurse managers. Nurses considered favorably nurse managers who value staff contributions, promote information sharing, and exert influence for a stable work environment. Furthermore, as staff nurse satisfaction increased, effectiveness and extra effort also increased when staff nurses perceived transformational leadership strategies. Strategies for power sharing include serving as role models and mentors, energizing staff, resisting attitudes of staff ownership, reducing staff nurse stress of leader presence, and information sharing and commendations at meetings.