Nora E. Warshawsky

The influence of interpersonal relationships on nurse managers' work engagement and proactive work behavior

OBJECTIVE: This study tested the effects of interpersonal relationships on nurse managers’ work engagement and proactive work behavior. BACKGROUND: An engaged workforce may help healthcare organizations improve performance. In healthcare, nurse managers are responsible for creating motivating work environments. They also need to be engaged, yet little is known about what influences nurse managers’ performance. METHODS: A self-administered electronic survey was used to collect data from 323 nurse managers working in acute care hospitals. Instruments included the Relational Coordination Scale, Utrecht Work Engagement Scale, and Proactive Work Behavior Scale. RESULTS: Interpersonal relationships with nurse administrators were most predictive of nurse managers’ work engagement. Interpersonal relationships with physicians were most predictive of nurse managers’ proactive work behavior. CONCLUSION: Organizational cultures that foster quality interpersonal relationships will support the job performance of nurse managers.

The effect of nurse manager turnover on patient fall and pressure ulcer rates

AIMS The purpose of this study was to explore the effects of nurse manager turnover on the occurrence of adverse events. BACKGROUND Nurse managers create professional nurse practice environments to support the provision of quality patient outcomes. Inconsistent findings were reported in the literature testing the relationship between nurse managers and patient outcomes. All prior studies assumed stable nursing management. METHODS A longitudinal quasi-experimental study of 23 nursing units in two hospitals was used to determine whether unit characteristics, including nurse manager turnover, have an effect on patient falls or pressure ulcers. Statistical analyses included repeated measures and hierarchical modelling. RESULTS Patients in medical/surgical units experienced more falls than in intensive care units (F1,11 = 15.9, P = 0.002). Patients in units with a nurse manager turnover [odds ratio: 3.16; 95% confidence interval: 1.49-6.70] and intensive care units (odds ratio: 2.70; 95% confidence interval: 1.33-5.49) were more likely to develop pressure ulcers. CONCLUSIONS Nurse manager turnover and intensive care unit status were associated with more pressure ulcers. Medical/surgical unit status was associated with more falls. The study was limited by a small sample size. IMPLICATIONS FOR NURSE MANAGERS Nurse manager turnover may negatively impact patient outcomes. Stable nursing management, strategic interim management and long-term succession planning may reduce adverse patient events.

The nurse manager practice environment scale: development and psychometric testing.

OBJECTIVES: The objectives of this study were to develop and test a scale designed to describe and assess nurse managers’ practice environments. BACKGROUND: Creating practice environments supporting workers at all levels is critical to achieving excellent patient, staff, and organizational outcomes. Scales are available to assess staff nurses’ practice environment; however, no comparable scale for nurse managers exists. METHODS: A cross-sectional design using an electronic survey was administered to nurse managers in 25 hospitals in 9 health systems from 6 states. RESULTS: Exploratory factor analysis with a varimax rotation produced a final solution of 44 items loading in 8 domains. Cronbach’s &agr;’s ranged from .72 to .97. Mean scores ranged from 3.92 to 4.99 on a 6-point Likert scale. CONCLUSIONS: The scale demonstrated adequate psychometric properties and warrants further use and testing. Understanding the nurse manager practice environment may reveal insights to guide opportunities to improve organizational performance.

Nursing Administration Research Priorities: Findings From a Delphi Study.

OBJECTIVE: The aim of this study is to determine the priorities for nursing administration research (NAR) in the United States. BACKGROUND: Previously known as the Council of Graduate Educators in Administrative Nursing, CGEAN provides an avenue for researchers and educators focused on NAR to partner, dialogue, obtain funding resources, and present their findings at a biennial International Nursing Administration Research Conference (INARC). In late 2013, with a goal of building consensus, CGEAN convened an INARC postconference to initiate the process of establishing critical NAR priorities for the future. METHODS: Data from a 3-staged Delphi study were used to identify relevant research topics and determine administrative research priorities. RESULTS: Eight final categories of NAR were determined. CONCLUSIONS: This study found economic valuing of nursing and designing effective future healthcare delivery systems to be high priorities for NAR.

The nursing practice environment in rural hospitals: Practice Environment Scale of the Nursing Work Index assessment.

Acute-care rural hospitals comprise 41% of US community hospitals, yet little is known about the quality of nursing practice environments (PEs) in these settings. Thus, there is little evidence for rural nurse leaders to access in organizing nursing practice to support quality staff and patient outcomes. The Practice Environment Scale of the Nursing Work Index (PES-NWI) has not been tested with a rural nurse sample and the literature does not provide reference scores for this group. This article presents findings to support the PES-NWI as a measure to describe rural acute-care nurse PEs and provides reference values for nurse leaders to use to implement evidence based nursing practice.

The Influence of the Practice Environment on Nurse Managers' Job Satisfaction and Intent to Leave.

OBJECTIVE: The aim of this study was to explore the influence of the practice environment on nurse managers’ (NMs’) job satisfaction and intent to leave. BACKGROUND: Nurse managers are a ready pool of talent to fill impending strategic leadership vacancies. Job satisfaction as an NM is a deciding factor for senior leadership aspirations. METHODS: This study used a secondary analysis of 2012 survey data of 355 NMs. The Nurse Manager Practice Environment Scale was used to identify organizational features that influence NMs’ job satisfaction and intent to leave. RESULTS: Mean (SD) job satisfaction was 4.5 (1.1) on a 6-point scale. Mean (SD) intent to leave was 5.0 (2.1) on a scale ranging from 3 to 9. The Nurse Manager Practice Environment Scale was a significant predictor of both job satisfaction and intent to leave. CONCLUSIONS: Features of the organizational context can be modified to improve job satisfaction and reduce intent to leave among NMs.

Nursing administration research: an evolving science.

The nature and focus of nursing administrative research have evolved over time. Recently, the research agenda has primarily reflected the national health policy agenda. Although nursing research has traditionally been dominated by clinical interests, nursing administrative research has historically addressed the interface of reimbursement, quality, and care delivery systems. This article traces the evolution of nursing administrative research to answer questions relevant to scope, practice, and policy and suggests future directions.

Pioneering through chaos.

The 2014 International Nursing Administration Research Conference, “Pioneering Through Chaos: Leadership for a Changing World,” was held at the Texas Woman’s University in Dallas, Texas, in the fall of 2014. The program drew more than 100 attendees from 4 countries. The conference informed attendees from both academe and practice about the role of nursing administration in navigating the dynamic healthcare climate. This article will report on the insights from the conference presenters.

Leading in the Healthcare Vortex

The 2016 International Nursing Administration Research Conference, Leading in a Healthcare Vortex, was held in Orlando, Florida. The program drew 116 attendees with representation from Canada and Brazil. Participants from practice, education, and research discussed leadership in our turbulent healthcare climate, which are highlighted in this column. The conference was dedicated to the memory of Dr Heather S. Laschinger in recognition of her distinguished research legacy of empowering nursing work environments and mentorship of prominent nursing administration researchers.

Application of CGEAN's Research Priorities: PhD, DNP Scholarship.

The Accountable Care Act of 2010 is stimulating rapid transformations of healthcare systems. The shift from a focus on providing healthcare in a closed system to improving the health of communities demands rapid innovation by nurse leaders. Nurse leaders prepared at the doctorate of nursing practice level and PhD-prepared nursing health services researchers are needed to develop and evaluate best practices as they emerge. This column expands on the findings from CGEANs Delphi study.