Connection between organizational culture and climate and empowerment: The perspective of nurse managers

Health‐care organizations differ from other institutions due to their unique structure and management. Organizational culture and climate are the key constructs that compose the organizational social context, and might have an impact on employees, such as nurse managers, and the organization itself. The aim of this study was to analyze the connections between organizational culture and climate and work‐related empowerment, and also to present culture and climate profiles at team and organization levels. The research was carried out in Lithuania among 193 nurse managers in seven hospitals using a questionnaire that measured organizational culture and climate (Organizational Social Context instrument), and work‐related empowerment (Conditions for Work Effectiveness Questionnaire‐II and Work Empowerment Questionnaire). The findings showed that nurse managers were both structurally and psychologically empowered when the organizational culture was proficient and resistant, and the climate was engaged and functional. These results suggest that nurse managers are more likely to be empowered when there is an appropriate organizational culture and climate in the workplace. Creating an empowering work environment might have a positive impact on individual and organizational outcomes.     

The new ward manager: an evaluation of the changing role of the charge nurse

Changes in health service policy and in the structure of nursing have made charge nurses into ward managers with the autonomy and power to improve the quality and effectiveness of patient care. In a climate where clinical effectiveness and quality of care are seen as central to the provision of appropriate health care, this study explores the experiences of one National Health Service trust in implementing this change in the charge nurse's role, and in doing so highlights the importance of effective change management. Nurse managers were interviewed and all ward-based G grade (range A-I) charge nurses within the trust were sent a questionnaire to ascertain: the level of satisfaction with the way the changes had been introduced; whether they were in favour of the changes; and if they had sufficient time, knowledge, resources, preparation and support to enable them to undertake their new role. A random sample of charge nurses were also interviewed. It was found that the majority of charge nurses (61%) were in favour of the development of their role, believing it to be both inevitable and necessary. However, many felt that the change process had been managed ineffectively. There had been insufficient consultation during the change process, preparation and support were perceived as inadequate, the roles of the various protagonists were often unclear, and the lack of supernumerary status led to role conflict and confusion. As a consequence the new ward managers were often unable to fulfil the true potential of this demanding but exciting role.     

‘How do we get the managers we need and the leaders we want?’ A personal view

For most patients and the general public, their most significant interface within the hospital setting occurs at the ward level. Here, the professional abilities of the Ward Sister/Charge Nurse – as well as the ward environment – will have a major impact on the experience and outcome of the patient’s stay in hospital. It will also strongly influence the opinion of relatives and friends about the standards of care being delivered in that hospital. Ward managers are expected to demonstrate not only clinical leadership, but also be competent at dealing with the plethora of organisational issues which arise on their ward on a daily basis. As part of a professional response to the public’s concerns around the environment of care within our hospitals and the perception that nursing leadership is not what it was, Welsh Assembly Government have launched a new strategy to re‐empower Ward Sisters/Charge Nurses and develop and support the nurse managers/leaders of the future.     

Negative workplace behaviours: an ethical dilemma for nurse managers

Lindy c. & schaefer F . (2010) Journal of Nursing Management 18 , 285–292
Negative workplace behaviours: an ethical dilemma for nurse managers Aims To discover nurse managers’ perception of negative workplace behaviours (bullying) encountered by staff on their unit. Background Negative workplace behaviour is a worldwide phenomenon happening in all types of work settings. Absent from the literature were studies specific to the nurse managers’ perception on this topic. Methods A phenomenological qualitative research methodology was used to gain insight into the perceptions of nurse managers about negative workplace behaviours that they have observed or addressed. Results Nurse Managers described their perceptions of, and experiences pertaining to, instances of negative workplace behaviour. Six themes emerged from the data analysis: ‘that’s just how she is’, ‘they just take it’, ‘a lot of things going on’, ‘old baggage’, ‘three sides to a story’ and ‘a management perspective’. Conclusion Nurse Managers had observed, experienced and/or had received reports of negative workplace behaviours. While some felt comfortable addressing the behaviour, others experienced ethical dilemmas when trying to treat all fairly. Implications The results of the present study provide guidance for nurse managers to address negative workplace behaviours occurring on their units.     

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.     

Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey

Patrick A., Laschinger H.K.S., Wong C. & Finegan J. (2011) Journal of Nursing Management 19 , 449–460
Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey Aim To test the psychometric properties of a newly developed measure of staff nurse clinical leadership derived from Kouzes and Posner’s model of transformational leadership. Background While nurses have been recognized for their essential role in keeping patients safe, there has been little empirical research that has examined clinical leadership at the staff nurse level. Methods A non-experimental survey design was used to test the psychometric properties of the clinical leadership survey (CLS). Four hundred and eighty registered nurses (RNs) providing direct patient care in Ontario acute care hospitals returned useable questionnaires. Results Confirmatory factor analysis provided preliminary evidence for the construct validity for the new measure of staff nurse clinical leadership. Structural empowerment fully mediated the relationship between nursing leadership and staff nurse clinical leadership. Conclusion The results provide encouraging evidence for the construct validity of the CLS. Implications for nursing management Nursing administrators must create empowering work environments to ensure staff nurses have access to work structures which enable them to enact clinical leadership behaviours while providing direct patient care.     

Conflict coaching training for nurse managers: a case study of a two-hospital health system

brinkert r . (2011) Journal of Nursing Management 19, 80–91
Conflict coaching training for nurse managers: a case study of a two-hospital health system Aim This study evaluated the application of the Comprehensive Conflict Coaching model in a hospital environment. Background Conflict coaching involves a coach working with a client to improve the client’s conflict understanding, interaction strategies and/or interaction skills. The training of nurse managers as conflict coaches is an innovative continuing education programme that partially addresses conflict-related concerns in nursing. Method Twenty nurse managers trained as conflict coaches and each coached a supervisee. Qualitative data were gathered from nurse managers, supervisees and senior nursing leaders over an 8-month period and organized using standard programme evaluation themes. Results Benefits included supervisor conflict coaching competency and enhanced conflict communication competency for nurse managers and supervisees facing specific conflict situations. Challenges included the management of programme tensions. Additional benefits and challenges are discussed, along with study limitations. Conclusion Conflict coaching was a practical and effective means of developing the conflict communication competencies of nurse managers and supervisees. Additional research is needed. Implications for nursing management Conflict is common in nursing. Conflict coaching is a new conflict communication and supervision intervention that demonstrates initial promise. Conflict coaching seems to work best when supported by a positive conflict culture and integrated with other conflict intervention processes.     

An examination of senior nursing roles: challenges for the NHS

Wellhouse NHS Trust moved its inpatient services to the new Barnet General Hospital in 1997 and merged with Chase Farm Hospital NHS Trust in 1999. To assist with the trust's management of resulting changes in care provision, a short project was conducted to examine the nursing services provided by ward managers (20) and senior nurses (27), that is nurses who undertake specialist/ advanced nursing practice. The project also aimed to present the views of the stakeholders (66) with regard to nursing in the trust and nurse-led services. The project involved two stages of data collection--focus groups and postal questionnaires. The project provided a great deal of information about the nursing service within the trust: a profile of the senior nurses, roles and responsibilities, skills and competencies, training and development, and support needs for their roles. The findings considered a number of issues: (i) employment--diversity of grading for posts; (ii) work roles--conflicts in role composition; (iii) stakeholders--perspectives of stakeholders on nursing. It is anticipated that the findings are not unique to the one trust and that they will contribute to the development of new clinical career pathways for senior nurses within the trust.     

The changing training needs of clinical nurse managers: exploring issues for continuing professional development

AIMS OF THE STUDY: To identify areas where clinical nurse managers perceived that they would benefit from further training and to make recommendations for planning future programmes to meet their needs. BACKGROUND: The effectiveness of the clinical nurse manager has traditionally been associated with maintaining standards of care. Continuing professional development (CPD) is essential to ensure this important group feel adequately prepared to perform their role and has been recognized as an important factor in maintaining job satisfaction and reducing wasteful staff turnover. A review of the literature indicated that since the 1980s the CPD needs of clinical nurse managers have tended to be overlooked despite increasing complexity of the tasks expected of them. Thus it appeared that a fresh study to address these needs would be justified and should take into account sources of work-related stress and variables relating to job satisfaction. METHODS: The study involved clinical nurse managers employed in all four acute hospital National Health Service (NHS) trusts where training needs were served by a major inner city educational consortium. Data collection proceeded in two stages. Initially interviews were undertaken with a random sample of 15 clinical nurse managers to provide in-depth, qualitative data. This information was used to develop a survey questionnaire distributed to the remaining 182 clinical nurse managers in each of the trusts. RESULTS: Data from the interviews indicated that clinical nurse managers appeared to feel clinically competent but generally experienced lack of confidence when dealing with a range of issues, in particular; human resources, managing budgets, deputizing for senior colleagues across the trust ('acting up') and using information technology in everyday practice. Response rate to the survey was good (65%). The results corroborated the interview findings, indicating a need for updating in the same wide range of topics. There were few differences in training needs across all four trusts. Clinical nurse managers who perceived that they had been well-prepared for their role demonstrated higher levels of job satisfaction. Perceived preparation for clinical leadership was the same irrespective of the employing trust, length of time in post and other sociodemographic variables. CONCLUSIONS: The study findings confirm that CPD remains a major issue for clinical nurse managers in the United Kingdom (UK) and that providing opportunities for such development may be an important factor in enhancing job satisfaction. The study findings should help those providing CPD to plan more effectively for this group and have implications for staff recruitment and retention.     

The roles of the first‐line nurse manager: perceptions from four perspectives

Aim To study the perception of the first‐line nurse managers (FLNMs), registered nurses (RNs), assistant nurses (ANs) and head of departments (HDs) on the FLNM's current and desired roles. Background In the process of decentralization, the role of FLNM has changed from having overall responsibility for patients to having responsibility for the management of the ward. Method Interviews with five FLNMs, five RNs, five ANs, and one HD were used. Qualitative content analysis was used to analyse the transcribed text. Results When describing the current roles, the FLNMs, RNs and ANs focused on the coordination of activities that contributed to a well‐functioning service and care of patients as well as on the recruitment of, support to and development of the personnel. The HD focused on the FLNM's responsibilities towards the personnel, especially regarding empowerment and staff well‐being. When describing desired roles, the FLNMs, RNs and ANs emphasized service on the ward while the HD underlined the development of services and co‐operation with other nurse managers. Conclusion The perception of the current and desired roles of the FLNM varied among the groups. The FLNMs, RNs and ANs reported a similar understanding which in turn differed from that of the HD who described fewer roles and focused on other areas.