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

BackgroundRecruitment 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.ObjectivesTo 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.DesignThis 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.ResultsNurses 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.ConclusionsThe 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.     

Workplace empowerment, job satisfaction and job stress among Italian mental health nurses: an exploratory study

Aim  The purpose of the present study was to investigate the relationship between staff nurses' structural empowerment, work stress and job satisfaction in two health care settings in Italy using Kanter's Empowerment Theory.
Background  With the current scarcity of economic resources and shortage of nurses, it is essential to empower nurses to perform at a high level to ensure high-quality patient care. Structural empowerment is a process that can optimize use of nursing skills and professional expertise, thereby increasing job satisfaction among nurses.
Method  A convenience sample of 77 nursing staff employed in the Department of Mental Health in central Italy was used in this study (return rate 64%).
Results  Structural empowerment was significantly related to their job satisfaction ( r  = 0.506, P  < 0.001), as was global empowerment ( r  = 0.62). Empowerment also had a significant negative relationship to nurses' work stress ( r  = −0.28, P  < 0.05).
Conclusion  The results of this study support Kanter's theory of structural empowerment in an Italian nursing sample – a previously unstudied population.
Implications for nursing management  Organizational administration must make every effort to create organizational structures and systems that empower nurses to practice according to professional standards and optimize the use of their knowledge and expertise.     

Magnet hospital characteristics and northern Canadian nurses' job satisfaction

Retention of health professionals is a serious problem in northern and rural Canada. Magnet hospital factors are known to increase job satisfaction, which contributes to retention. The purpose of this paper is to examine the extent to which magnet hospital characteristics (management support, nurse-doctor and nurse-manager relationships, professional autonomy and responsibility) contribute to northwestern Canadian hospital nurses' job satisfaction. Participants were 123 nurses from 13 hospitals in western Canada. They completed a survey and structured interview that provided data on their attitudes and perspectives about their hospital jobs. We found that some magnet hospital characteristics apply in northern and rural western Canadian hospitals. Our findings indicate that management support and nurse-manager relations are important to nurses' job satisfaction, but participants' views of management were fairly negative, an issue that management needs to address. Nurses' ability to work professionally and autonomously is also important to their satisfaction. There are indications that nursing supervisory skill sets need to be upgraded in some instances.     

The Nursing Worklife Model: extending and refining a new theory

AIMS: We tested a modification of Leiter and Laschinger's Nursing Worklife Model by examining the impact of structural empowerment on professional work environment factors that lead to nursing job satisfaction. BACKGROUND: The original model explains how five magnet hospital practice domains described by Lake (2002) interact to influence nurses' work lives by either contributing to or mitigating burnout. METHODS: A non-experimental design was used. Five hundred randomly selected nurses in Michigan were surveyed (response rate 66%, n = 332). Instruments included the Conditions for Work Effectiveness Questionnaire-II, the Practice Environment Scale of the Nursing Work Index, and the Index of Work Satisfaction. Path analysis was used to test the model. RESULTS: The final model fit the data well (chi2 = 96.4, d.f. = 10, NFI: 0.90, CFI: 0.43, RMSEA: 0.18), supporting both hypotheses. CONCLUSIONS: The expanded Nursing Worklife Model demonstrates the role of empowerment in creating positive practice conditions that contribute to job satisfaction.     

The mediating effects of structural empowerment on job satisfaction for nurses in long-term care facilities

Aims The purpose of this study was to explore the mediating effects of work empowerment on job satisfaction for nurses in long-term care facilities in Taiwan. Background Previous research has noted that job satisfaction is an important factor that reflects upon the work environment and the characteristics of the job itself. It is important to link work empowerment to job satisfaction among nurses. Methods This research study used a cross-sectional design. A total of 65 nurses participated in the study. Regression models and Sobel tests were fitted to evaluate the relationship between work empowerment and job satisfaction. Results Structural empowerment mediated the effects of psychological empowerment on job satisfaction (standardized β = 0.46, Sobel test: z = 2.69, P = 0.007). Conclusions Both psychological and structural empowerment positively correlated with job satisfaction among nurses in long-term care facilities. The structural empowerment had a mediating effect on job satisfaction. Implications for nursing management The managers of long-term care facilities should create an empowering work environment for nurses by providing them with available resources and by involving them in the developmental goals of the facilities. The critical structural components of an empowered workplace can contribute to the psychological empowerment of nurses and increase their job satisfaction.     

Hospital nurses' job satisfaction, individual and organizational characteristics

Hospital nurses' job satisfaction, individual and organizational characteristics Using the Ward Organizational Features Scales (WOFS), relationships between aspects of the organization of acute hospital wards, nurses' personal characteristics and nurses' job satisfaction are examined among a nationally representative sample of 834 nurses in England. The analysis contributes to a growing body of evidence demonstrating the importance of interpersonal relationships to nurses' job satisfaction. In particular, the positive contribution of the cohesiveness of ward nursing staff is highlighted, but the potential for many current NHS staffing strategies and work environments to undermine the development of cohesive working relationships is also noted. Other influential factors are nurses' relationships with medical staff, perceptions of their workload and their evaluation of the appropriateness of the system of nursing being practised. The importance of measuring nurses' subjective assessments of their work environment is emphasized. A weak association was found between grade and job satisfaction. Individual nurse characteristics were found not to be associated with job satisfaction.     

Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes

Aim  The aim of this study was to examine the influence of empowering work conditions and workplace incivility on nurses' experiences of burnout and important nurse retention factors identified in the literature.
Background  A major cause of turnover among nurses is related to unsatisfying workplaces. Recently, there have been numerous anecdotal reports of uncivil behaviour in health care settings.
Method  We examined the impact of workplace empowerment, supervisor and coworker incivility, and burnout on three employee retention outcomes: job satisfaction, organizational commitment, and turnover intentions in a sample of 612 Canadian staff nurses.
Results  Hierarchical multiple linear regression analyses revealed that empowerment, workplace incivility, and burnout explained significant variance in all three retention factors: job satisfaction ( R ² = 0.46), organizational commitment ( R ² = 0.29) and turnover intentions ( R ² = 0.28). Empowerment, supervisor incivility, and cynicism most strongly predicted job dissatisfaction and low commitment ( P  < 0.001), whereas emotional exhaustion, cynicism, and supervisor incivility most strongly predicted turnover intentions.
Conclusions  In our study, nurses' perceptions of empowerment, supervisor incivility, and cynicism were strongly related to job satisfaction, organizational commitment, and turnover intentions.
Implications for nursing management  Managerial strategies that empower nurses for professional practice may be helpful in preventing workplace incivility, and ultimately, burnout.     

Effect of empowerment on professional practice environments, work satisfaction, and patient care quality: further testing the Nursing Worklife Model

The purpose of this study was to test Leiter and Laschinger's Nursing Worklife Model linking structural empowerment to Lake's 5-factor professional practice work environment model and work quality outcomes. A predictive, nonexperimental design was used to test the model in a random sample of 234 staff nurses. The analysis revealed that professional practice environment characteristics mediated the relationship between structurally empowering work conditions and both job satisfaction and nurse-assessed patient care quality.     

Effects of clinical practice environments on clinical teacher and nursing student outcomes

The purpose of this study was to use a cross-sectional survey design, with an integrated theoretical perspective, to examine clinical teachers' (n = 64) and nursing students' (n = 352) empowerment, teachers' and students' perceptions of teachers' use of empowering teaching behaviors, students' perceptions of nurses' practice behaviors, and students' confidence for practice in acute care settings. In this study, teachers and students were moderately empowered. Teachers reported using a high level of empowering teaching behaviors, which corresponded with students' perceptions of teachers' use of such behaviors. Teachers' empowerment predicted 21% of their use of empowering teaching behaviors. Students reported nurses as using a high level of professional practice behaviors. Students felt confident for professional nursing practice. The findings have implications for practice contexts related to empowering teaching-learning environments and self-efficacy.     

Agency characteristics most valued by home care nurses: findings of a nationwide study

The demand for home care services is continuing to rise at such a rate that the home care nursing workforce will need to double by 2020. Struggling to recruit and retain an adequate clinician supply in the midst of a severe shortage, administrators may find help in the magnet hospital approach, which focuses on creating a professional practice environment. This study identified, in a national sample of home care nurses, organizational traits reported most important in supporting nurses' professional practice and job satisfaction.     

Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses.

BACKGROUND: High levels of stress and the challenges of meeting the complex needs of critically ill children and their families can threaten job satisfaction and cause turnover in nurses. OBJECTIVE: To explore the influences of nurses' attributes, unit characteristics, and elements of the work environment on the job satisfaction of nurses in pediatric critical care units and to determine stressors that are unique to nurses working in pediatric critical care. METHOD: A cross-sectional survey design was used. The sample consisted of 1973 staff nurses in pediatric critical care units in 65 institutions in the United States and Canada. The following variables were measured: nurses' perceptions of group cohesion, job stress, nurse-physician collaboration, nursing leadership, professional job satisfaction, and organizational work satisfaction. RESULTS: Significant associations (r = -0.37 to r = -0.56) were found between job stress and group cohesion, professional job satisfaction, nurse-physician collaboration, nursing leadership behaviors, and organizational work satisfaction. Organizational work satisfaction was positively correlated (r = 0.35 to r = 0.56) with group cohesion, professional job satisfaction, nurse-physician collaboration, and nursing leadership behaviors. Job stress, group cohesion, job satisfaction, nurse-physician collaboration, and nursing leadership behaviors explained 52% of the variance in organizational work satisfaction. Dealing with patients' families was the most frequently cited job stressor. CONCLUSIONS: Job stress and nursing leadership are the most influential variables in the explanation of job satisfaction. Retention efforts targeted toward management strategies that empower staff to provide quality care along with focal interventions related to the diminishment of stress caused by nurse-family interactions are warranted.     

Recruitment and retention of nurses: challenges facing hospital and community employers

Understanding nurses' perceptions of their workplaces underpins successful recruitment and retention initiatives, particularly in this time of global nursing shortage. The American Nurses Association and the American Academy of Nursing have identified "magnet characteristics"--organizational factors that support excellent practice and working conditions in hospital settings. Using selected magnet characteristics, this exploratory study examined nurses' perceptions of their work experiences in both hospital and community settings. Mail surveys were completed by community and hospital nurses (n = 1248) selected randomly from a provincial registry in Ontario, Canada. Scales measured organizational factors (organizational and immediate supervisor support, decentralized decision-making, nurse-physician relationships and work-group cohesiveness) and job-related factors (autonomy, job challenge, work demands, fair treatment, work-status congruence; satisfaction with career, salary, working conditions) of nurses' experiences in their work settings. Nurses in both sectors wanted more opportunities to participate in decision-making and recognition for their contributions to their organizations. In the hospital sector, nurses reported significantly lower levels of perceived organizational and supervisory support and autonomy, and were less satisfied with working conditions and scheduling. Nurses in the community sector were most dissatisfied with salary. No cross-sector differences were reported on nurse-physician relationships, degree of job challenge or career satisfaction. Successful recruitment and retention initiatives hinge on the ability (and willingness) of healthcare organizations to attend to the concerns expressed by nurses and create work settings that are attractive to both new recruits and nurses currently in their employ.     

The impact of nurse empowerment on job satisfaction

Title. The impact of nurse empowerment on job satisfaction. Aim. This paper is a report of a study conducted to test Kanter’s organizational empowerment theoretical model specifying the relationships among demographics, structural empowerment, and job satisfaction. Background. Empowerment has become an increasingly important factor in determining nurses’ job satisfaction in current restructured work environments in China. Methods. A correlational, cross‐sectional design was used to test Kanter’s organizational empowerment model with a sample of 650 full‐time nurses employed in six Chinese hospitals in 2007, with a response rate of 92% (n = 598). The instruments used were the Demographic Data Questionnaire, Conditions of Work Effectiveness Questionnaire‐II, and Job Satisfaction Scale. Results. The three lowest scoring items for Conditions of Work Effectiveness Questionnaire‐II were resources, opportunity and informal power. The job satisfaction items revealing most dissatisfaction were workload and compensation, professional promotion, amount of work responsibility, work environments, and organizational policies. A statistically significant positive correlation was found between empowerment and job satisfaction (r = 0·547, P < 0·01). The demographic factors influencing empowerment were work objectives and age. The influencing factors for job satisfaction were work objectives and education level. Conclusion. The results provide support for Kanter’s organizational empowerment theory in the Chinese nurse population. Nurses who view their work environments as empowering are more likely to provide high quality care. Enhancing empowerment in a supportive environment would allow nurses to experience satisfaction with their jobs.     

Job satisfaction in a Norwegian population of nurses: a questionnaire survey

BACKGROUND: Although job satisfaction is a factor that influences retention, turnover and quality of nursing care globally, there are few studies exploring these factors in European countries. OBJECTIVES: To describe job satisfaction among hospital nurses in Norway, to explore the relationship between nurses' job satisfaction and participation in a clinical ladder program and to explore relationships between several variables and intent to stay. A secondary purpose was to investigate the use of a job satisfaction instrument in a different culture than its origin. DESIGN: In a survey, 2095 nurses in four different hospitals answered a questionnaire that included demographic data, intent to stay and a job satisfaction instrument covering the importance of and actual satisfaction with different job factors. RESULTS: Interaction, followed by pay and autonomy were the most important job factors for Norwegian nurses. Actual job satisfaction was similar to nurses in other countries. There was no significant difference in job satisfaction between participants and non-participants in a clinical ladder. Nurses intending to stay more than a year were significantly more satisfied in their job. Further education and 1 day or more scheduled for professional development were factors that were positively related to intent to stay in the hospital. CONCLUSIONS: Norwegian nurses' views on the importance of different job factors mirrored views of the importance ascribed to working milieu in the Norwegian society. As such, the instrument used seemed sensitive to cultural differences. Nurses' actual satisfaction with their job was similar to respondents in many other countries and may imply that structures and content defining nurses' working situation are similar in many parts of the world. Participation in a clinical ladder did not increase nurses' overall job satisfaction. However, further education and the opportunity for professional development increased nurses' intention to stay in the organization.     

Linking the Practice Environment to Nurses'' Job Satisfaction Through Nurse-Physician Communication

PURPOSE: To investigate direct and indirect relationships among the practice environment, nurse-physician (RN-MD) communication, and job satisfaction, as is posited in the nursing role effectiveness model (NREM). DESIGN: Survey. METHODS: Surveys were sent to a random sample of 500 hospital nurses throughout Michigan, and 332 (66%) responded. Main study instruments were the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II), the Practice Environment Scale of the Nursing Work Index (PES-NWI), the ICU Nurse-Physician Questionnaire, and the Index of Work Satisfaction (IWS), Part B. Inferential statistical tests included multiple regression, t tests, and one-way analysis of variance. FINDINGS: Practice environment (PES-NWI) and empowerment (CWEQ-II) scales explained 20% of the variance in RN-MD communication. The combination of both environment scales (PES-NWI and CWEQ-II) and RN-MD communication explained 61% of the variance in nursing job satisfaction scores. RN-MD communication was also a significant mediating variable in the relationship between structure (practice environment and empowerment scales) and outcome (nursing job satisfaction). CONCLUSIONS: Factors in the practice environment contributed both directly to nursing job satisfaction and also indirectly through RN-MD communication. Study findings showed that a practice environment favorable to nurses improved both nurses' perceptions of their communications with physicians and their job satisfaction.     

Faces of the nursing shortage: influences on staff nurses' intentions to leave their positions or nursing

OBJECTIVE: The objective of this study was to examine the relationship between organizational commitment, job satisfaction, and nurses' intention to leave their current position or nursing. BACKGROUND: Because retention of nurses is a critical issue for acute care institutions, study of the predictors of nurses' intention to leave (position or nursing) is essential. Of interest in predicting intention to leave are both organizational commitment and job satisfaction. METHODS: A mailed survey was conducted in which 787 respondents completed measures of satisfaction, organizational commitment, and personal and institutional demographics. All instruments had reliability estimates ranging from alpha = .76 to .92. RESULTS: Predictive relationships were found between financial status, organizational commitment, job and professional satisfaction, and intent to leave their current position (R = 0.42) and between financial status, professional satisfaction, and intention to leave nursing (R = 0.45) CONCLUSIONS: Organizational commitment has implications for nurses' intention to leave their current position but not nursing. Aspects of work and professional satisfaction predict both the intention to leave current position and nursing. Retention programs need to be focused on both organizational commitment and work and professional satisfaction.     

The relationship between nursing leadership and nurses' job satisfaction in Canadian oncology work environments

Background  Current Canadian oncology work environments are challenged by the same workforce statistics as other nursing specialties: nurses are among the most overworked, stressed and sick workers, and more than 8% of the nursing workforce is absent each week due to illness.
Aim  To develop and estimate a theoretical model of work environment factors affecting oncology nurses' job satisfaction.
Methods  The sample consisted of 515 registered nurses working in oncology settings across Canada. The theoretical model was tested as a structural equation model using LISREL 8.54.
Results  The final model fitted the data acceptably ( χ ² = 58.0, d.f. = 44, P  =   0.08). Relational leadership and physician/nurse relationships significantly influenced opportunities for staff development, RN staffing adequacy, nurse autonomy, participation in policy decisions, support for innovative ideas and supervisor support in managing conflict, which in turn increased nurses' job satisfaction.
Conclusions  These findings suggest that relational leadership and positive relationships among nurses, managers and physicians play an important role in quality oncology nursing environments and nurses' job satisfaction.
Implications for nursing management  Oncology nursing work environments can be improved by focusing on modifiable factors such as leadership, staff development and staffing resources, leading to better job satisfaction and hopefully retention of nurses.     

Client-centred empowering partnering in nursing

AIM: This paper explores nurses' experiences 1 year after an organization's commitment to providing a client-centred and client-empowering partnering approach to care. BACKGROUND: Historically, nurses' approach to providing care in all nursing contexts has been one of doing for clients, and previous studies have focused more on in-hospital care than on home care. However, the isolation inherent in in-home nursing and nurses' limited professional autonomy and power associated with physician control over patients in home care have been reported, as has their difficulty in finding the meaning and satisfaction of human connectedness and mutuality in nurse-client relationships. Overall, research to date does not inform us about how nurses might make a change toward a more client-centred and client-empowering approach to nursing. METHODS: An interpretive phenomenological design was used to elicit in-depth understanding about Registered Nurses' experiences of providing care using this innovative empowerment model. A purposefully selected sample of eight Registered Nurses participated in in-depth interviews. Data were generated during 2002. Hermeneutic analysis was used to elicit themes and patterns emerging from the data. FINDINGS: Caring, client-centredness and the context of in-home care were important in implementing the new partnering approach. Barriers encountered at system, organizational and personal levels distracted nurses from fully comprehending and enacting the approach. After a year, they had begun to contemplate potential strategies for partnering with clients, but had not yet explored the power of their professional autonomy. CONCLUSION: Nurses are inclined to practise within the expert model of service delivery. They need to work through issues of professional autonomy and rise to the challenge of exercising their autonomy within the current healthcare context if they are to attend more consistently to client-centred empowering partnering. The home care setting offers an excellent environment for achieving these aims.