Leader empowering behaviours, staff nurse empowerment and work engagement/burnout

Efforts to improve nursing working conditions are critical to retaining nurses currently in the system and attracting newcomers to the profession (Laschinger et al. 2003b). The nurse leader's empowering behaviours can be pivotal in the way nurses react to their work environment. The purpose of this study was to test a model examining the relationship between nurse leaders' empowerment behaviours, perceptions of staff empowerment, areas of work life and work engagement using Kanter's theory of structural power in organizations. A cross-sectional correlational survey design tested the model in a random sample of 322 staff nurses in acute care hospitals across Ontario. Overall, staff nurses perceived their leaders' behaviours to be somewhat empowering and their work environment to be moderately empowering. Fifty-three percent reported severe levels of burnout. Leader empowering behaviour had an indirect effect on emotional exhaustion (burnout) through structural empowerment and overall fit in the six areas of work life. The final model statistics revealed a good fit (chi(2)=30.4, chi=3, chi=0.96, chi=0.95, chi=0.95). These findings suggest that the Leader's empowering behaviours can enhance person-job fit and prevent burnout. These findings have important implications in the current nursing shortage.     

Relationships among structural empowerment,psychological empowerment,intent to stay and burnout in nursing field in mainland China—based on a cross‐sectional questionnaire research

The aim of the study was to explore the relationship among perceived structural empowerment, psychological empowerment, burnout and intent to stay by nurses in mainland China.With the shortage of nurses in many countries, including China, intent to stay is a dominant factor to influence the quality of care. Also, burnout is identified to negatively affect the quality of care. Empowered clinical nurse practical environment is related to intent to stay and burnout. In the current literature, there is a lack of data based on empowering environment discussing the relationship between burnout and intent to stay. The study used an anonymous questionnaire, filled voluntarily by 219 nurses from different sections in a city in mainland China, 2012.Structural equation modelling (SEM) was used to test the proposed hypotheses. Based on the SEM model, structural empowerment and psychological empowerment had significant positive effects on intent to stay of nurses and negative effects on burnout. Burnout had a significant negative effect on intent to stay. The final modified models yielded χ² = 58.580, P > 0.05, χ²/df = 1.046, root mean square error of approximation = 0.015, Tucker–Lewis Index = 0.996, comparative fit index = 0.998,which indicated good fit indices. Creating a positive empowering workplace can encourage nurses to stay long and prevent burnout. Therefore, higher level of empowering environment is required.     

Authentic leadership,empowerment and burnout: a comparison in new graduates and experienced nurses

Aim To examine the effect of authentic leadership and structural empowerment on the emotional exhaustion and cynicism of new graduates and experienced acute-care nurses. Background Employee empowerment is a fundamental component of healthy work environments that promote nurse health and retention, and nursing leadership is key to creating these environments. Method In a secondary analysis of data from two studies we compared the pattern of relationships among study variables in two Ontario groups: 342 new graduates with <2 years of experience and 273 nurses with more than 2 years of experience. Results A multi-group path analysis using Structural Equation Modelling indicated an acceptable fit of the final model (χ² = 17.52, df = 2, P < 0.001, CFI = 0.97, IFI = 0.97 and RMSEA = 0.11). Authentic leadership significantly and negatively influenced emotional exhaustion and cynicism through workplace empowerment in both groups. Conclusions The authentic behaviour of nursing leaders was important to nurses’ perceptions of structurally empowering conditions in their work environments, regardless of experience level, and ultimately contributed to lower levels of emotional exhaustion and cynicism. Implications for nursing management Leadership training for nurse managers may help develop the empowering work environments required in today’s health-care organizations in order to attract and retain nurses.     

Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter's model

OBJECTIVE: In this study, we tested an expanded model of Kanter's structural empowerment, which specified the relationships among structural and psychological empowerment, job strain, and work satisfaction. BACKGROUND: Strategies proposed in Kanter's empowerment theory have the potential to reduce job strain and improve employee work satisfaction and performance in current restructured healthcare settings. The addition to the model of psychological empowerment as an outcome of structural empowerment provides an understanding of the intervening mechanisms between structural work conditions and important organizational outcomes. METHODS: A predictive, nonexperimental design was used to test the model in a random sample of 404 Canadian staff nurses. The Conditions of Work Effectiveness Questionnaire, the Psychological Empowerment Questionnaire, the Job Content Questionnaire, and the Global Satisfaction Scale were used to measure the major study variables. RESULTS: Structural equation modelling analyses revealed a good fit of the hypothesized model to the data based on various fit indices (chi 2 = 1140, df = 545, chi 2/df ratio = 2.09, CFI = 0.986, RMSEA = 0.050). The amount of variance accounted for in the model was 58%. Staff nurses felt that structural empowerment in their workplace resulted in higher levels of psychological empowerment. These heightened feelings of psychological empowerment in turn strongly influenced job strain and work satisfaction. However, job strain did not have a direct effect on work satisfaction. CONCLUSIONS: These results provide initial support for an expanded model of organizational empowerment and offer a broader understanding of the empowerment process.     

Relationships between structural and psychological empowerment,mediated by person-centred processes and thriving for nursing home staff

Person-centred care has been shown to have positive outcomes for patients and for staff. However, the complexity of the link between structural conditions, work in a person-centred manner and outcomes for staff is insufficiently described. We tested the relationship between structural empowerment and psychological empowerment, as mediated by nursing home staff members’ self-ratings of working in a person-centred manner, the person-centred climate and thriving. Questionnaires were distributed to staff working in 12 nursing homes in Sweden. A serial mediation model was tested. The results showed that higher access to structural empowerment was related to higher psychological empowerment mediated by staff working in a more person-centred manner, improved person-centred climate, and improved staff ratings of thriving. These results point to the importance of strengthening the preconditions for staff to work in a person-centred manner and nursing home managers play an important role in this.     

护士心理授权状况与工作倦怠的相关性分析

目的：了解护士的心理授权现状和工作倦怠情况,分析两者间的相关性,探索预防和降低护士工作倦怠的新对策。方法整群抽取广州5家三甲医院的临床护士203人,采用心理授权量表及工作倦怠量表进行调查。结果护士的心理授权感知得分（4．75±0．67）分,为中等水平;其中自我效能得分最高为（5．34±0．73）分,工作影响得分最低为（3．64±0．11）分;护士有较严重的工作倦怠,其中个人成就感丧失维度（3．83±0．62）分,情绪枯竭维度（2．96±0．81）分,去人格化倾向维度（1．89±0．84）分;护士心理授权感知与工作倦怠关系密切,与情绪枯竭、去人格化倾向、个人成就感各维度呈负相关（r值分别为－0．436,－0．366,0．514;P＜0．01）。结论临床护士的心理授权处于中等水平,临床护理管理者应加强护士对心理授权的感知,以降低工作倦怠感的产生。     

Violence in hospitals and burnout among nursing staff

BackgroundNursing staff, especially in violence-prone emergency departments (ED), are at high risk of burnout. Frequently experienced violence is expected to have a strong impact on the nursing staff's burnout. This study aimed to examine the differences in the level of burnout between nursing staff who work in the ED and nursing staff who work in other inpatient departments, and its relationship with violence in various hospitals in Israel.MethodA cross-sectional study that utilized a three-part questionnaire: demographic data, degree of burnout, and frequency occurrence of violence events against nurses.Results150 nurses in EDs (N = 75) and inpatient departments (N = 75) were sampled. Significant differences were found between the two groups: Nurses in EDs experienced a higher degree of burnout than nurses in other hospital departments, and the degree of burnout was found to have a positive relationship with exposure to both verbal and physical workplace violence.ConclusionsNursing staff in EDs could develop a high degree of burnout, and exposure to workplace violence could exacerbate it. The physical and emotional safety of the staff is an important aspect in preventing burnout, and creating a secure work environment.     

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.     

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.     

Predictors of nurses' professional burnout: a study in a university hospital

This study was designed to examine the level of burnout and to identify stressor among nurses in a teaching hospital. Based on a sample of 625 nurses, results show that burnout levels are moderate (M. = 24.3, SD = 9.3) and comparable to those observed in physicians (M. = 26.6, SD = 9.8) and in the administrative staff of the same hospital (M. = 25.1, SD = 11.9). Multiple regression analyses selected 11 predictors significantly associated with burnout. Some contributed positively to burnout (job strain, lack of social support, conflicts with other nurses, conflicts with physicians, presence of stressors related to private life, feeling that the job is threatened, full-time vs. part-time status), whereas others contributed negatively (perceived job control, hierarchical level, death and dying of patients, feeling protected against occupational hazards). It is worthy of noting that leadership dimensions were not significantly related to burnout, once stressors were included in the regression model. We also tested Karasek's (1979) model, according to which job demands interact with perceived job control in influencing burnout. For example, the worst situation is one in which job demands are high and perceived control is low. This is defined as a high-strain job. The results from this study confirm that perceived control reduces the effect of job strain on burnout. This suggests that if job strain is high, managers can reduce its effect by providing nurses with opportunities to control their work environment and relations with patients. Results also demonstrate that burnout is negatively correlated with job satisfaction and perceived unit effectiveness. Managers should invest in prevention programs, since burnout is as deleterious to individuals as to the organization. A limitation of this study is its focus on emotional exhaustion which is known to be the first step of the burnout process. Future research should examine whether the predictors identified here would also be relevant for explaining further stages of the burnout process, such as depersonalization and reduced personal accomplishment.     

Empowering nurses for work engagement and health in hospital settings

Employee empowerment has become an increasingly important factor in determining employee health and wellbeing in restructured healthcare settings. The authors tested a theoretical model which specified the relationships among structural empowerment, 6 areas of worklife that promote employee engagement, and staff nurses' physical and mental health. A predictive, non-experimental design was used to test the model in a random sample of staff nurses. The authors discuss their findings and the implication for nurse administrators.     

Empathy, experience of burnout and attitudes towards demented patients among nursing staff in geriatric care

A non-anonymous questionnaire was distributed to all nursing staff (n = 557) including RNs, LPNs (psychiatric), LPNs (somatic) and nurses' aides, in one nursing home, one somatic long-term care clinic and one psychogeriatric clinic. Scales measuring empathy, burnout experience and attitudes towards demented patients were included in the questionnaire. The aim of the study was to compare levels of empathy, burnout experience and attitudes among different categories of nursing staff and to examine connections between empathy, burnout and attitudes. The nursing staff showed an overall figure of moderately well-developed empathy and the RNs showed the highest empathy. The RNs had a significantly lower degree of burnout compared to the nurses' aides and the LPNs. Of all respondents, 27.4% were assessed at risk from burnout. Overall, the staff showed a moderately positive attitude towards demented patients and the RNs were most positive. No linear correlation was found between empathy, burnout experience and attitudes. However, a weak negative correlation between burnout and empathy is in accordance with other authors who are suggesting that burnout experience leads to lower empathy in the nursing staff. The fact that the RNs showed the most positive attitudes towards demented patients and had the highest level of empathy compared to LPNs and nurses' aides could be related to lower degree of burnout assessed in the RNs. Qualitative and quantitative overload among the LPNs and nurses' aides connected to the growing number of demented patients in the institutions examined are discussed.     

Job and career satisfaction and turnover intentions of newly graduated nurses

laschinger h.k. s. (2012) Journal of Nursing Management  20, 472–484 Job and career satisfaction and turnover intentions of newly graduated nurses Aim To describe new graduate nurses’ worklife experiences in Ontario hospital settings in the first 2 years of practice and to examine predictors of job and career satisfaction and turnover intentions. Background With a large cohort of nurses approaching retirement, every effort must be made to ensure that the work environments of new graduate nurses are positive, promoting job satisfaction and commitment to the profession to address the nursing workforce shortage. Method A cross-sectional analysis of data from a mail survey of new graduate nurses (n = 342) in their first and second year of experience was used to address the research objectives. Results Overall, new graduate nurses were positive about their working conditions and there were few differences between nurses in their first and second years of practice. Structural and personal factors explained significant amounts of variance (31–68%) in both job and career satisfaction and turnover intentions. Empowerment, work engagement and burnout were important significant predictors. Conclusions Modifiable workplace factors play an important role in influencing new graduates’ job and career satisfaction and turnover intentions. Implications for nursing management Managers can employ strategies to enhance quality work environments that promote retention of new graduates and lessen the nursing workforce shortage.     

Relationship between perceived empowerment care and quality of life among elderly residents within nursing homes in Taiwan: a questionnaire survey

BACKGROUND: It is essential for nurses to have a solid understanding of what may influence the quality of life (QOL) among elderly residents within nursing homes. Although many factors have been demonstrated to be related to the QOL among elderly people, the relationship between perceived empowerment care and QOL among elderly residents within nursing homes has not been investigated thoroughly. OBJECTIVES: The aim of this study is to explore how demographic characteristics, perceived empowerment care and functional status affect perceived QOL among the elderly residents who reside in nursing homes. DESIGN: This study employed a cross-sectional design. SETTINGS: Eight nursing homes throughout southern Taiwan were recruited into this study. PARTICIPANTS: One hundred and two residents aged 65 years or older residing in nursing homes for at least 6 months, who did not have moderate to severe obstacles in cognitive ability, were recruited as participants. METHODS: A questionnaire including demographic data, a physical function scale, an activity of daily living (ADL) scale, a patient empowerment scale, and a QOL index was used in this study. RESULTS: The results showed a medium rating level of QOL among elderly residents. Elderly residents did not feel excessively disempowered care. Perceived empowering care, ADLs and marital status were significant predictors of QOL, which explained 45.3% of the total amount of variance in QOL. Perceived empowering care was the most important predictor of QOL. CONCLUSIONS: Nurses should pay attention to the effect of empowering care on QOL of elderly residents within nursing homes. Empowering care should be considered as a strategy of nursing care in nursing homes.     

Relationships among leadership practices, work environments, staff communication and outcomes in long-term care

tourangeau a., cranley l., laschinger h. & pachis j. (2010) Journal of Nursing Management 18, 1060–1072
Relationships among leadership practices, work environments, staff communication and outcomes in long-term care Aim To examine the role that work relationships have on two long-term care outcomes: job satisfaction and turnover intention. Background It is easy to overlook the impact that human relations have in shaping work environments that are conducive to organizational effectiveness. Employee job satisfaction and retention are important organizational outcomes. Methods Six hundred and seventy-five nursing and other staff from 26 long-term care facilities were surveyed about their work environments, work group relationships, observed leadership practices, organizational support, job satisfaction and turnover intention. Results Higher job satisfaction was associated with lower emotional exhaustion burnout, higher global empowerment, higher organizational support, higher psychological empowerment, stronger work group cohesion and higher personal accomplishment. Higher turnover intention was associated with lower job satisfaction, higher emotional exhaustion burnout, more outside job opportunities, weaker work group cohesion, lower personal accomplishment and higher depersonalization. Conclusions No relationship was found between leadership practices and job satisfaction or turnover intention. Stronger work group relationships, stronger sense of personal accomplishment and lower emotional exhaustion have direct effects on increasing job satisfaction and lowering turnover intention. Implications To retain long-term care staff, attention should be paid to fostering positive work group cohesion, supporting and acknowledging staff accomplishments and minimizing staff burnout.     

Empowerment and staff nurse decision involvement in nursing work environments: Testing Kanter's theory of structural power in organizations

Work redesign initiatives have transformed approaches to patient care that will require increased control of nurses over both the content and context of their practice. A secondary analysis of two studies linking perceived work empowerment with two aspects of staff nurse decisional involvement using Kanter's (1977, 1993) theory of structural power in organizations is described. In these studies, the pattern of relationships among variables in Kanter's theory and two different facets of work decisional involvement (control over the content and context of nursing practice) were examined using structural equation modeling techniques. Consistent with theoretical expectations, perceptions of formal and informal power significantly influenced perceived access to work empowerment structures. Informal power was found to mediate the relationship between formal power and access to work empowerment structures. Formal and informal power and access to empowerment structures, in combination, were found to be significant predictors of the extent of involvement in decisions related to the content and context of nursing practice, respectively. The results provide empirical support for propositions derived from Kanter's theory of work empowerment, and provide potential guidance for theory-based management practices to enhance nurses' involvement in professional and organizational decision making. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 341–352, 1997