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.     

Leader behavior impact on staff nurse empowerment, job tension, and work effectiveness.

OBJECTIVE: The authors tested a model linking specific leader-empowering behaviors to staff nurse perceptions of workplace empowerment, occupational stress, and work effectiveness in a recently-merged Canadian acute care hospital. SUMMARY BACKGROUND DATA: An integration of Kanter's organizational empowerment theory and Conger and Kunungo's model of the leader empowerment process constituted the theoretical framework for the study. Few published studies were found in which specific leader behaviors were linked empirically to staff nurses' workplace empowerment. METHODS: Staff nurses (n = 537) were surveyed shortly after a merger of two large tertiary hospitals. Structural equation modeling techniques were used to test the proposed model. RESULTS: Leader-empowering behaviors significantly influenced employees perceptions of formal and informal power and access to empowerment structures (information support, resources, and opportunity). Higher perceived access to empowerment structures predicted lower levels of job tension and increased work effectiveness. The amount of explained variance in the final model was 42%. CONCLUSIONS: Support for the model tested in this study highlights the importance of nurse managers' leadership behaviors within current turbulent healthcare organizations.     

The impact of leader-member exchange quality, empowerment, and core self-evaluation on nurse manager's job satisfaction

OBJECTIVE: The purpose of this study is to test a theoretical model linking nurse managers' perceptions of the quality of the relationship with their supervisors, and empowerment to job satisfaction, and to examine the effect of a personal dispositional variable, core self-evaluation, on the relationships among these variables. BACKGROUND DATA: Nursing leadership roles have been transformed as a result of dramatic changes within healthcare in the past decade, yet research on the nature of nurse manager work life in current work environments is limited. METHODS: A nonexperimental, predictive design was used in a sample of 141 hospital-based nurse managers obtained from a provincial registry. RESULTS: Approximately 40.4% of the variance in job satisfaction was explained by leader-member exchange quality (LMX), empowerment, and core self-evaluation. CONCLUSION: Higher quality relationships with their immediate supervisor were associated with greater manager structural and psychological empowerment and, consequently, greater job satisfaction. Core self-evaluation played a strong significant role, affecting all components of the model. The results suggest that both situational and personal factors are important determinants of satisfying work environments for nurse managers.     

Nurse managers' conceptions of quality management as promoted by peer supervision

AIM: The aim of the study was to describe nurse managers' conceptions of quality management in their work as promoted by peer supervision. BACKGROUND: Quality management is one of the topical issues in a nurse manager's demanding and changing work. As first-line managers, they have a key role in quality management which is seen to create the system and environment for high quality services and quality improvement. Despite the official recommendations and definitions of quality management, several published reports have shown that there is no single solution for quality management. Peer supervision or the support provided by it to nursing managers have rarely been a subject of study. This study was carried out at Tampere University Hospital between 1996 and 1998. The peer supervision intervention was organized once a month, 2 hours at a time and in closed supervisor-led groups of nine nurse managers. METHODS: Data were collected by themed interviews. Fifteen nurse managers participated in the study. The data were analysed using the phenomenographic method. FINDINGS: Two main categories were formed of nurse managers' conceptions. The first described supportive and reflective characteristics of peer supervision. This main category was described by horizontal, hierarchical categories of support from peer group and reflection. The second main category described nurse managers' conceptions of individual development of leadership during peer supervision. This main category was also described by three horizontal categories: personal growth, finding psychological resources and internalization of leadership. CONCLUSION: The finding of this study show that peer supervision benefited nurse managers in quality management through reflection and support. The reflective and supportive characteristics of peer supervision promoted the nurse managers' individual development, but also that of leadership. It can be concluded that peer supervision promotes quality management in nurse managers' work.     

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.     

Decreasing Nurse Leader Work Role Overload Through Flexible Work Interventions

The nurse leader role is critical to ensure a quality work environment that influences clinical nurse satisfaction, decreased turnover, and patient outcomes. A primary source of stress in nurse leaders that contributes to burnout is organizational stress such as operational task-oriented activities. The purpose of this study was to evaluate how flexible workplace interventions influence nurse leaders perceptions of role overload and job satisfaction. It was found that flexible work interventions positively impact nurse leader satisfaction, perceived stress, and work role balance in an acute care hospital.     

Power and Opportunity in Public Health Nursing Work Environments

Abstract Kanter's structural theory of power in organizations provided the conceptual framework for this comparative study on perceptions of power of two levels of nurses working in three public health agencies during a time of program transition. Forty-six public health nurses and 10 nurse managers were surveyed to examine their perceptions of the amount of power existing in their own and their counterparts' jobs. Propositions from Kanter's theory were supported by the data. Both groups rated their work environments to be somewhat low in power, although managers perceived themselves to be significantly more empowered in their work environments than did staff nurses. In addition, staff nurses perceived themselves to have significantly less access to empowerment structures (opportunity, information, support, and resources) than their managers perceived them to have. Staff nurse empowerment was found to be significantly related to perceptions of their immediate managers' power in the organization.     

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.     

Hospital nurses' perceptions of respect and organizational justice

OBJECTIVE: To test an exploratory model of the antecedents and consequences of nurses' perceptions of respect in hospitals. BACKGROUND: Although nurses in hospital settings often state that they do not receive the respect they deserve for their contribution to patient care, there is little empirical research on this phenomenon. Interactional organizational justice theory framed the analysis. METHODS: A random sample of 285 staff nurses from Ontario teaching hospitals completed measures of interactional justice, structural empowerment, perceived respect, work pressures, emotional exhaustion, and work effectiveness. RESULTS: More than half of the nurses felt that managers did not show concern or deal with them in a sensitive and truthful manner regarding decisions affecting their jobs. The strongest predictors of perceptions of respect were interactional organizational justice, followed by structural empowerment and job stress resulting from lack of recognition, poor interpersonal relationships and heavy workload. Consequences of nurses' feelings of respect included greater job satisfaction, trust in management, and lower emotional exhaustion, as well as higher nurse ratings of quality of care and perceived staffing adequacy. CONCLUSIONS: A positive organizational environment increases nurses' perceptions of respect, resulting in positive outcomes for both the nurse and the organization.     

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,collaborative work relationships,and job strain in nurse practitioners

PURPOSE: To test a theoretical model linking nurse practitioners' (NPs) perceptions of workplace empowerment, collaboration with physicians and managers, and job strain. DATA SOURCES: A predictive, nonexperimental design was used to test a model in a sample of 63 acute care NPs and 54 primary care NPs working in Ontario, Canada. The Conditions of Work Effectiveness Questionnaire, the Collaborative Behaviour Scale--Parts A (physicians) and B (managers), and the Job Content Questionnaire were used to measure the major study variables. CONCLUSIONS: The results of this study support the proposition that the extent to which NPs have access to information, support, resources, and opportunities in their work environment has an impact on the extent of collaboration with physicians and managers, and ultimately, the degree of job strain experienced in the work setting. Primary care NPs have significantly higher levels of workplace empowerment, collaboration with managers, and lower levels of job strain than acute care NPs. IMPLICATIONS: These findings will benefit NPs and nursing leaders in their efforts to create empowering work environments that enable NPs to provide excellent quality patient care and achieve organizational outcomes.     

The relationship between effective nurse managers and nursing retention

Hospital executives are challenged to recruit and retain clinical nurses in a time when the national hospital nurse turnover rates are averaging above 20%. This literature review outlines nursing research that studied characteristics of nurse managers' leadership styles that enhance hospital nurse retention. Five consistent themes provided evidence of leadership traits that lead to job satisfaction and nurse retention. These were transformational leadership style, extroverted personality traits, magnet hospital organizational structures that support nurse empowerment, autonomy and group cohesion, tenure, and graduate education. Data from these studies provide a foundation for directing strategic plans to increase nurse retention and job satisfaction.     

Nurse managers' work stressors and coping experiences: unravelling the evidence

This pilot study explored (a) front-line nurse managers' stressor experiences and (b) coping strategies used in order to respond to the myriad of challenges and demands of their role. The nurse managers who participated indicated that limited resources, ever-increasing challenges and work expectations contributed to the stressors they experience. Coping responses included support, cognitive, personal and social strategies, but findings indicated managers still lacked the ability to cope effectively. Managers faced considerable job stress and conflicting demands, often caught between focusing on staff relations and organizational productivity. Equipping managers with appropriate preparation and support may make the role of nurse manager more attractive and facilitate succession planning. These findings will assist senior nurse leaders in formulating directives for appropriate structures and processes in advancing a multidimensional approach to support managers. Resolving this issue is critical for creating reasonable and realistic work expectations for nurse managers and for supporting the pivotal role that managers play to achieve organizational outcomes while preserving their personal health and well-being.     

Predictors of nurse manager stress: A dominance analysis of potential work environment stressors

Background

Nurse managers have important but stressful jobs. Clinical or bedside nurse predictors of stress have been studied more frequently, but less has been done on work environment predictors for those in this first-line leadership role. Understanding the relative importance of those work environment predictors could be used to help identify the most fruitful areas for intervention, potentially improving recruitment and retention for nurse managers.

Objective

Using Role Stress Theory and the Job Demands-Resources Theory, a model was tested examining the relative importance of five potential predictors of nurse manager stress (i.e., stressors). The work environment stressors included role ambiguity, role overload, role conflict, organizational constraints, and interpersonal conflict.

Design and settings

A quantitative, cross-sectional survey study was conducted with a convenience sample of 36 hospitals in the Southwestern United States.

Participants

All nurse managers working in these 36 hospitals were invited to participate. Of the 636 nurse managers invited, 480 responded, for a response rate of 75.5%.

Methods

Questionnaires were distributed during nursing leadership meetings and were returned in person (in sealed envelopes) or by mail.

Results

Because work environment stressors were correlated, dominance analysis was conducted to examine which stressors were the most important predictors of nurse manager stress. Role overload was the most important predictor of stress, with an average of 13% increase in variance explained. The second- and third-most important predictors were organizational constraints and role conflict, with an average of 7% and 6% increase in variance explained, respectively.

Conclusion

Because other research has shown deleterious effects of nurse manager stress, organizational leaders are encouraged to help nurse managers reduce their actual and/or perceived role overload and organizational constraints.     

Leadership behaviour of nurse managers in relation to job satisfaction and work climate

Aim  This study examines how nurse managers' leadership behaviour relates to job satisfaction and a creative work climate.
Background  The nursing shortage is a challenge for managers all over the world. Leadership is a core element of management and it is important to elucidate leadership behaviour in order to increase knowledge about attracting and retaining talented staff.
Method  We studied 770 subordinates at a large university hospital. Three questionnaires for assessing perceived leadership behaviour, creative work climate and job satisfaction were used.
Results  Subordinates with a manager perceived as 'super' have the highest rates on job satisfaction. The correlation between leadership and creative work climate is stronger than between leadership and job satisfaction. Between job satisfaction and work climate the correlation is strong.
Conclusions  The study shows that the relationship between a creative work climate and job satisfaction is strong. A managers' ability to lead has a major affect on work climate.
Implication for nursing management  Nurse managers must work on developing their leadership behaviour towards being an all-round leader that cares about people, is concerned about productivity and can handle changes. Support of ideas and initiatives are important in order to enable subordinates to perceive their work as challenging.     

Leadership styles of Finnish nurse managers and factors influencing it

Aim  The purpose of the present study was to explore nurse managers' perceptions of their leadership styles and factors influencing it.
Background  It is a challenge for nurse managers to retain nurses in hospitals and to ensure a high quality of care in nursing practice. Leadership style is an important part of leadership. Knowledge concerning nurse managers' resonant and non-resonant leadership styles provides nurse managers with tools to reflect on their own leadership style.
Method  Open-ended, tape-recorded interviews were conducted with 13 nurse managers from five Finnish hospitals and two long-term care facilities. The data were analysed using qualitative content analysis.
Results  Five categories of leadership style were discerned: visionary, coaching, affiliate, democratic, commanding. Factors that influence leadership style were identified: earlier superiors, values, information, cooperation, employees and education.
Conclusions  The results of this study show that Finnish nurse managers use both resonant and non-resonant leadership styles.
Implications for nursing management  The findings of this study show that nurse managers use a variety of leadership styles. The study demonstrates the importance of knowledge about leadership styles and factors influencing it among nurse managers providing future leadership and management education.