Heather Spence Laschinger

New graduate nurses' experiences of bullying and burnout in hospital settings.

AIMnThis paper is a report of a study conducted to test a model linking new graduate nurses perceptions of structural empowerment to their experiences of workplace bullying and burnout in Canadian hospital work settings using Kanters work empowerment theory.nnnBACKGROUNDnThere are numerous anecdotal reports of bullying of new graduates in healthcare settings, which is linked to serious health effects and negative organizational effects.nnnMETHODSnWe tested the model using data from the first wave of a 2009 longitudinal study of 415 newly graduated nurses (<3 years of experience) in acute care hospitals across Ontario, Canada. Variables were measured using the Conditions of Work Effectiveness Questionnaire, Negative Acts Questionnaire-Revised and Maslach Burnout Inventory-General Survey.nnnRESULTSnThe final model fit statistics revealed a reasonably adequate fit (χ² = 14·9, d.f. = 37, IFI = 0·98, CFI = 0·98, RMSEA = 0·09). Structural empowerment was statistically significantly and negatively related to workplace bullying exposure (β = -0·37), which in turn, was statistically significantly related to all three components of burnout (Emotional exhaustion: β = 0·41, Cynicism: β = 0·28, EFFICACY: β = -0·17). Emotional exhaustion had a direct effect on cynicism (β = 0·51), which in turn, had a direct effect on efficacy (β = -0·34). Conclusion.u2002 The results suggest that new graduate nurses exposure to bullying may be less when their work environments provide access to empowering work structures, and that these conditions promote nurses health and wellbeing.

A Psychometric Analysis of the Patient Satisfaction With Nursing Care Quality Questionnaire: An Actionable Approach to Measuring Patient Satisfaction

Patient satisfaction with nursing care quality is an important indicator of the quality of care provided in hospitals. This study tested a newly developed patient-centered measure of patient satisfaction with nursing care quality within a random sample of 14 hospitals in Ontario, Canada. Results of this study revealed that the newly developed instrument had excellent psychometric properties. Total scores on satisfaction with nursing care were strongly related to overall satisfaction with the quality of care received during hospitalization. The results of this study yielded actionable, patient-focused results that can be used by managers to address areas requiring improvement.

The mediating effect of burnout on the relationship between structural empowerment and organizational citizenship behaviours

AIMnWe used Kanters (1977) structural empowerment theory to examine the influence of structural empowerment and emotional exhaustion on healthcare professionals use of organizational citizenship behaviours directed at the organization (OCBO) and peers (OCBI).nnnBACKGROUNDnOrganizational citizenship behaviours (OCB) are discretionary behaviours that are not rewarded directly by the organization but have been linked to positive outcomes, such as increased job satisfaction and lower turnover intentions. Promoting OCB can help employees and organizations flourish despite current challenges in the healthcare system. Structural empowerment may influence the frequency and type of OCB by reducing burnout.nnnMETHODnWe conducted multiple mediated regression analyses to test two hypothesized models about relationships between empowerment, emotional exhaustion and two types of OCB (OCBI and OCBO) in a sample of 897 healthcare professionals in five Canadian hospitals.nnnRESULTSnEmotional exhaustion was found to be a significant mediator of the relationship between empowerment and OCBO. The predicted mediation of the empowerment/OCBI relationship by emotional exhaustion was not supported.nnnCONCLUSIONSnExhaustion was an important mediator of empowering working conditions and OCBO, but was not significantly related to OCBI. Empowerment was significantly related to both OCBO and OCBI.nnnIMPLICATIONS FOR NURSING MANAGEMENTnPromoting empowerment among healthcare workers may decrease burnout and promote OCB. Specific managerial strategies are discussed in the present study.

Nursing-sensitive outcomes data collection in acute care and long-term-care settings.

Background: Most administrative databases do not contain good information about nursing-sensitive outcomes. Objectives: To determine (a) the reliability of the instruments measuring nursing-sensitive outcomes, (b) whether the outcome measures are sensitive to changes in patients health, and (c) whether the outcome measures are associated with nursing interventions. Methods: The sample consisted of 890 patients from acute care hospitals and long-term-care facilities. A repeated measures design was used. Functional status was assessed on admission and discharge using Minimum Data Set 2.0 items. Symptom (pain, nausea, dyspnea, fatigue) frequency and severity were assessed with 4-point and 11-point numeric scales, respectively. Therapeutic self-care was assessed on discharge from acute care. Nursing interventions were assessed by documentation review. Results: The outcome measures demonstrated very good interrater reliability with weighted Kappa ranging from .64 to .93. The internal consistency reliability was high for functional status and therapeutic self-care. The outcome tools were sensitive to change in patient condition. Select nursing interventions were related to functional status, therapeutic self-care, and symptom outcomes. Discussion: The findings suggest that nurses are able to collect data on nursing-sensitive patient outcomes in a reliable and valid way.

Antecedents and consequences of intra-group conflict among nurses

AIMnTo test a theoretical model linking selected antecedent variables to intra-group conflict among nurses, and subsequently conflict management style, job stress and job satisfaction.nnnBACKGROUNDnA contributing factor to the nursing shortage is job dissatisfaction as a result of conflict among nurses. To develop strategies to reduce conflict, research is needed to understand the causes and outcomes of conflict in nursing work environments.nnnMETHODnA predictive, non-experimental design was used in a random sample of 277 acute care nurses. Structural equation modelling was used to analyse the hypothesised model.nnnRESULTSnNurses core self-evaluations, complexity of care and relationships with managers and nursing colleagues influenced their perceived level of conflict. Conflict management style partially mediated the relationship between conflict and job satisfaction. Job stress had a direct effect on job satisfaction and core self-evaluation had a direct effect on job stress.nnnCONCLUSIONnConflict and its associated outcomes is a complex process, affected by dispositional, contextual and interpersonal factors. How nurses manage conflict may not prevent the negative effects of conflict, however, learning to manage conflict using collaboration and accommodation may help nurses experience greater job satisfaction.nnnIMPLICATIONS FOR NURSING MANAGEMENTnStrategies to manage and reduce conflict include building interactional justice practices and positive interpersonal relationships.

Positive Working Relationships Matter for Better Nurse and Patient Outcomes

Positive working relationships are a key success factor in today s rapidly changing high paced health care environments. High quality patient care requires a team of health professionals who value each other s contributions to the patient care process and who work effectively with each other. Nonsupportive collegial relations interfere with optimal delivery of care and create stress among team members. Thus, positive working relationships among colleagues, both supervisors and co-workers, are fundamental to retaining satisfied and engaged nurses to ensure that high quality patient care continues to be available for patients and their families. This issue reports the results of recent research related to working relationships in nursing settings by scholars in both nursing and organizational psychology. The papers address a variety of aspects of working relationships in nursing settings that can be clustered into three categories: the impact of leadership in creating positive working relationships, the effects of working relationship quality within health care teams, and the impact of negative interactions at work, such as conflict and workplace incivility. Several studies in this issue investigated leadership influences on working relationships in clinical settings. Wong et al. s study showed that when leaders are authentic, nurses are more likely to trust them, to be more engaged at work, more comfortable about voicing concerns, and to rate patient care quality highly in their units. Similarly, Giallonardo et al. found preceptors authentic leadership behavior to be important for new graduate nurses work engagement and job satisfaction, and Spiers et al. found that resonant leadership style and fairness were important predictors of both nurse and patient outcomes. These studies provide evidence to support the importance of relational styles of leadership, as opposed to a command and control style, in creating positive work attitudes and behavior. On the other hand, Tourangeau et al. did not find a direct effect of transformational leadership practices on nurses job satisfaction and turnover intentions over and above other worklife predictors. They suspect that leadership may affect workplace outcomes more indirectly through a variety of factors not included in their study. However, they did find that leadership behaviours were positively correlated to group cohesion and work group communication. Two studies report the effects of leadership interventions designed to promote positive healthcare work environments. MacPhee et al. described a project designed to increase shared decision making between managers and staff members. They found that the critical factor for success was the quality of relationships between the unit leaders and their staff that developed during the process. Cummings et al. showed that a leadership development program had a positive impact on nurse managers self-reported use of leadership practices and resulted in a greater sense of community among the managers in the study. However, their qualitative results revealed that many manager participants became more cynical at the completion of the program. This is counterintuitive finding and suggests the need for further investigation. Leadership programs are costly and labor intensive initiatives and every effort should be made to ensure that participants are able to integrate leadership perspectives into their daily practice. Taken together, these studies highlight the importance of leadership in creating supportive work environment for nurses and suggest new ways of conceptualizing and developing leadership competencies in health care settings. The notion of authentic leadership is a promising area for development in today s resource constrained health care settings. Several papers in this issue report the effects of work relationships among groups or teams on a variety of organizational outcomes. Havens et al. examined Gittel s notion of relational coordination among health care teams, defined as, a combination of high quality relationships and communication among team members. They found that high levels of relational coordination were related to fewer adverse events, highlighting the importance of high quality team relationships for patient outcomes. Purdy et al. illustrated the importance of workplace empowerment structures Journal of Nursing Management, 2010, 18, 875–877