Heather K. Spence Laschinger

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 (χ2 = 1140, df = 545, χ2/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.

The impact of workplace empowerment, organizational trust on staff nurses' work satisfaction and organizational commitment.

A predictive, nonexperimental design was used to test Kanters work empowerment theory in a random sample of 412 staff nurses selected from the professional registry list of a central Canadian province. Kanter argues that work environments that provide access to information, support, resources, and opportunity to learn and develop are empowering and influence employee work attitudes, productivity, and organizational effectiveness. Test results suggest that fostering environments that enhance perceptions of empowerment will have positive effects on organizational members and increase organizational effectiveness.

Nurse turnover: A literature review - An update

BACKGROUND Concerns related to the complex issue of nursing turnover continue to challenge healthcare leaders in every sector of health care. Voluntary nurse turnover is shown to be influenced by a myriad of inter-related factors, and there is increasing evidence of its negative effects on nurses, patients and health care organizations. OBJECTIVES The objectives were to conduct a comprehensive review of the related literature to examine recent findings related to the issue of nursing turnover and its causes and consequences, and to identify on methodological challenges and the implications of new evidence for future studies. DESIGN A comprehensive search of the recent literature related to nursing turnover was undertaken to summarize findings published in the past six years. DATA SOURCES Electronic databases: MEDLINE, CINAHL and PubMed, reference lists of journal publications. REVIEW METHODS Keyword searches were conducted for publications published 2006 or later that examined turnover or turnover intention in employee populations of registered or practical/enrolled or assistant nurses working in the hospital, long-term or community care areas. Literature findings are presented using an integrative approach and a table format to report individual studies. RESULTS From about 330 citations or abstracts that were initially scanned for content relevance, 68 studies were included in this summary review. The predominance of studies continues to focus on determinants of nurse turnover in acute care settings. Recent studies offer insight into generational factors that should be considered in strategies to promote stable staffing in healthcare organizations. CONCLUSIONS Nursing turnover continues to present serious challenges at all levels of health care. Longitudinal research is needed to produce new evidence of the relationships between nurse turnover and related costs, and the impact on patients and the health care team.

Workplace empowerment and magnet hospital characteristics: making the link.

Objective To test a theoretical model linking nurses’ perceptions of workplace empowerment, magnet hospital characteristics, and job satisfaction in 3 independent studies of nurses in different work settings. Background Strategies proposed in Kanter’s structural empowerment theory have the potential to result in work environments that are described in terms of magnet hospital characteristics. Identifying factors that contribute to work conditions that attract and retain highly qualified committed nurses, such as those found in magnet hospitals, that can be put in place by nursing administrators is extremely important for work redesign to promote professional nursing practice. Methods Secondary analyses of data from 3 studies were conducted—2 of staff nurses and 1 with acute care nurse practitioners working in Ontario, Canada. The Conditions of Work Effectiveness Questionnaire-II, the NWI-R, and measures of job satisfaction were used to measure the major study variables. Results The results of all 3 studies support the hypothesized relationships between structural empowerment and the magnet hospital characteristics of autonomy, control over practice environment, and positive nurse-physician relationships. The combination of access to empowering work conditions and magnet hospital characteristics was significantly predictive of nurses’ satisfaction with their jobs. Conclusions/implications These findings suggest that nursing leaders’ efforts to create empowering work environments can influence nurses’ ability to practice in a professional manner, ensuring excellent patient care quality and positive organizational outcomes.

The impact of civility interventions on employee social behavior, distress, and attitudes.

Although incivility has been identified as an important issue in workplaces, little research has focused on reducing incivility and improving employee outcomes. Health care workers (N = 1,173, Time 1; N = 907, Time 2) working in 41 units completed a survey of social relationships, burnout, turnover intention, attitudes, and management trust before and after a 6-month intervention, CREW (Civility, Respect, and Engagement at Work). Most measures significantly improved for the 8 intervention units, and these improvements were significantly greater than changes in the 33 contrast units. Specifically, significant interactions indicating greater improvements in the intervention groups than in the contrast groups were found for coworker civility, supervisor incivility, respect, cynicism, job satisfaction, management trust, and absences. Improvements in civility mediated improvements in attitudes. The results suggest that this employee-based civility intervention can improve collegiality and enhance health care provider outcomes.

Organizational trust and empowerment in restructured healthcare settings. Effects on staff nurse commitment.

In todays dramatically restructured healthcare work environments, organizational trust is an increasingly important element in determining employee performance and commitment to the organization. The authors used Kanters model of workplace empowerment to examine the effects of organizational trust and empowerment on two types of organizational commitment. A predictive, nonexperimental design was used to test Kanters theory in a random sample of 412 Canadian staff nurses. Empowered nurses reported higher levels of organizational trust, which in turn resulted in higher levels of affective commitment. However, empowerment did not predict continuance commitment--that is, commitment to stay in the organization based on perceived lack of other job opportunities. Because past research has linked affective commitment to employee productivity, these results suggest that fostering environments that enhance perceptions of empowerment and organizational trust will have positive effects on organizational members and increase organizational effectiveness.

The relationship of empowerment and selected personality characteristics to nursing job satisfaction

Purpose This study reports on a secondary data analysis undertaken to better understand the determinants of job satisfaction for hospital nurses. Both workplace and personal factors can contribute to job satisfaction. Theoretical Framework Kanter’s theory of structural empowerment and Spreitzer’s theory of psychological empowerment explain logical outcomes of managerial efforts to create structural conditions of empowerment. Selected personal attributes were also considered. Method and Sample Instruments used were 1) Conditions for Work Effectiveness Questionnaire; 2) psychological empowerment tool; 3) a mastery scale; 4) an achievement scale; and 5) a job satisfaction scale. The sample of 347 nurses (58% response rate) came from all specialty areas. Results Structural and psychological empowerment predicted 38% of the variance in job satisfaction. Achievement and mastery needs were not significant. Other personal attributes can be found in future research to improve job satisfaction. Conclusions Through careful manipulation of the hospital environment, both structural and psychological empowerment can be increased, resulting in greater job and patient satisfaction and, ultimately, improved patient outcomes.

A theoretical approach to studying work empowerment in nursing: A review of studies testing Kanter's theory of structural power in organizations

Although work empowerment is a common theme in the current nursing systems literature, few systematic programs of research have studies the phenomenon from an explicitly theoretical framework. The author summarizes the results of a series of studies in a program of research designed to test Rosabeth Moss Kanters Structural Theory of Organizational Behavior in the nursing population. Future directions for theory and research are proposed.

The Impact of Nurse Turnover on Patient, Nurse, and System Outcomes: A Pilot Study and Focus for a Multicenter International Study:

Research about the economic impact of nurse turnover has been compromised by a lack of consistent definitions and measurement. This article describes a study that was designed to refine a methodology to examine the costs associated with nurse turnover. Nursing unit managers responded to a survey that contained items relating to budgeted full-time equivalents, new hires, and turnover, as well as direct and indirect costs. The highest mean direct cost was incurred through temporary replacements, whereas the highest indirect cost was decreased initial productivity of the new hire. The study allowed the identification of the availability of data and where further refinement of data definition of variables is needed. The results provided significant evidence to justify increased emphasis on nurse retention strategies and the creation of healthy work environments for nurses.

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 Laschingers Nursing Worklife Model linking structural empowerment to Lakes 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 staThe purpose of this study was to test Leiter and Laschingers Nursing Worklife Model linking structural empowerment to Lakes 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.