Content uploaded by Arla Day
Author content
All content in this area was uploaded by Arla Day on Aug 14, 2018
Content may be subject to copyright.
Workplace empowerment, incivility, and burnout: impact on staff
nurse recruitment and retention outcomes
HEATHER K. SPENCE LASCHINGER
RN, PhD, FCAHS
1
, MICHAEL LEITER
PhD
2
, ARLA DAY
PhD
3
and DEBRA
GILIN
PhD
4
1
Distinguished University Professor and Associate Director Nursing Research, Arthur Labatt Family School of
Nursing, The University of Western Ontario, London, Ontario, Canada,
2
Professor, Canada Research Chair in
Occupational Health and Well-Being, Acadia University, Wolfville, NS, Canada,
3
Professor, Canada Research Chair
in Industrial/Organizational Psychology and
4
Associate Professor, Department of Psychology, Saint MaryÕs
University, Halifax, NS
Correspondence
Heather K. Spence Laschinger
Distinguished University Professor
and Associate Director Nursing
Research
Arthur Labatt Family School of
Nursing
The University of Western Ontario
1151 Richmond Street
London
Ontario
Canada
N6A 5C1
E-mail: hkl@uwo.ca
SPENCE LASCHINGER H.K., LEITER M., DAY A. & GILIN D.
(2009) Journal of Nursing
Management 17, 302–311
Workplace empowerment, incivility, and burnout: impact on staff nurse
recruitment and retention outcomes
Aim The aim of this study was to examine the influence of empowering work
conditions and workplace incivility on nursesÕexperiences of burnout and impor-
tant nurse retention factors identified in the literature.
Background A major cause of turnover among nurses is related to unsatisfying
workplaces. Recently, there have been numerous anecdotal reports of uncivil
behaviour in health care settings.
Method We examined the impact of workplace empowerment, supervisor and
coworker incivility, and burnout on three employee retention outcomes: job satis-
faction, organizational commitment, and turnover intentions in a sample of 612
Canadian staff nurses.
Results Hierarchical multiple linear regression analyses revealed that empower-
ment, workplace incivility, and burnout explained significant variance in all three
retention factors: job satisfaction (R
2
= 0.46), organizational commitment
(R
2
= 0.29) and turnover intentions (R
2
= 0.28). Empowerment, supervisor inci-
vility, and cynicism most strongly predicted job dissatisfaction and low commitment
(P< 0.001), whereas emotional exhaustion, cynicism, and supervisor incivility most
strongly predicted turnover intentions.
Conclusions In our study, nursesÕperceptions of empowerment, supervisor incivil-
ity, and cynicism were strongly related to job satisfaction, organizational commit-
ment, and turnover intentions.
Implications for nursing management Managerial strategies that empower nurses
for professional practice may be helpful in preventing workplace incivility, and
ultimately, burnout.
Keywords: burnout, empowerment, incivility, recruitment, retention
Accepted for publication: 7 February 2009
Journal of Nursing Management, 2009, 17, 302–311
DOI: 10.1111/j.1365-2834.2009.00999.x
302 ª2009 The Authors. Journal compilation ª2009 Blackwell Publishing Ltd
Background
With many nurses nearing retirement and fewer indi-
viduals entering the profession, nursing is experiencing a
critical workforce shortage (Keenan 2003). Thus, it is
critical that nursing work environments are structured in
ways that ensure that nurses feel engaged in their work
and want to remain in their jobs. According to World
Health Organization (2006), there is a shortage of 4.3
million healthcare workers worldwide, which is ex-
pected to increase by 20% in the next two decades. The
shortage is particularly acute in the nursing profession,
which is the largest group of health professionals in
hospital settings (McMullin & Cooke 2004). A major
cause of turnover among nurses is related to unsatisfying
workplaces (Hayes et al. 2006). Recently, there have
been numerous anecdotal reports of uncivil behaviour in
health care settings, although few empirical studies of it
exist in the literature. In non-healthcare settings, Cortina
et al. (2001) linked workplace incivility to important
organizational outcomes, such as work distress, job
dissatisfaction, and withdrawal behaviours, and this
highlights the importance of preventing incivility in
work settings. Workplace empowerment has been
shown to be an important precursor of employeesÕpo-
sitive relationships with their work, and an important
factor in burnout, and subsequent turnover intentions
(Laschinger et al. 2004b, 2006, Nedd 2006). The aim of
this study was to examine the influence of empowering
work conditions and workplace incivility on nursesÕ
experiences of burnout and important nurse retention
factors identified in the literature (i.e. job satisfaction,
commitment, and turnover intentions).
Organizational empowerment
Organizational empowerment is a popular construct in
current organizational theory and practice (Bartenak &
Spreitzer 2006, Conger & Kanungo 1988, Kirkman &
Rosen 1999, Koberg et al. 1999, Spreitzer & Doneson
2005). Empowerment strategies are designed to increase
employeesÕcontrol over their work, thereby improving
job satisfaction and enhancing organizational commit-
ment. Seventy percent of the organizations surveyed by
Lawler et al. (2001) reported the use of empowerment
strategies of some kind in the past 15 years. Rosabeth
Moss KanterÕs (1977, 1993) model of workplace
empowerment has been used to study empowering
work conditions in a variety of settings, including
nursing workplaces.
According to KanterÕs model of structural empower-
ment (1977, 1993), structural factors within the work
environment have a greater impact on employee work
attitudes and behaviour than personal predispositions
or socialization experiences. Kanter (1979) describes
four organizational empowerment structures: access to
information, access to support, access to resources
needed to do the job, and opportunities to learn and
grow. Access to information means having knowledge
of organizational decisions, policies, and goals; as well
as having technical knowledge and expertise required to
be effective within the broader context of the organi-
zation. Information provides a sense of purpose and
meaning for employees, and enhances their ability to
make decisions that contribute to organizational goals.
Access to support includes feedback and guidance re-
ceived from superiors, peers, and subordinates as well
as the emotional support, helpful advice, or hands-on
assistance others can provide. Access to resources refers
to the ability of the individual to access the materials,
money, supplies, time, and equipment required to
accomplish organizational goals. Access to opportunity
for mobility and growth entails access to challenges,
rewards, and professional development opportunities to
increase knowledge and skills. This opportunity for
growth may be accomplished through participation on
committees, task forces and inter-departmental work
groups.
Numerous studies have established links between
structural empowerment and important organizational
attitudes and behaviours, including job satisfaction,
commitment, productivity, and burnout (Hatcher &
Laschinger 1996, Laschinger et al. 2001a,b, 2003).
Research has identified numerous mechanisms, such as
trust in management, autonomy, organizational justice,
and positive working relationships with colleagues,
through which empowerment affects these outcomes
(Laschinger & Finegan 2005, Laschinger et al. 2006).
Although not conceptualized within KanterÕs frame-
work, workplace factors reflective of structural
empowerment, such as, lack of information, organiza-
tional resources, and support, have been found to be
enabling factors for workplace bullying (Einarsen et al.
1994, Salin 2003, Spector 1997, Vartia 1996).
Workplace incivility
Workplace incivility has received increased attention in
the general management and work stress literature
(Cortina et al. 2001, Pearson et al. 2001). There are
numerous anecdotal reports of uncivil behaviour in
nursing and health care settings although few empirical
studies exist in the literature. Workplace incivility
is defined as Ôlow-intensity deviant behavior with
Outcomes of empowerment and workplace incivility
ª2009 The Authors. Journal compilation ª2009 Blackwell Publishing Ltd, Journal of Nursing Management,17, 302–311 303
ambiguous intent to harm the target, in violation of
workplace norms for mutual respect. Uncivil behav-
iours are characteristically rude, discourteous, display-
ing a lack of respect for othersÕ(Anderson & Pearson
1999, p. 457). Pearson and Porath (2005) found that
employees who experienced uncivil behaviours at work
intentionally reduced their work efforts and the quality
of their work, thereby diminishing overall unit effec-
tiveness. Cortina et al. (2001) also linked workplace
incivility to decreased job performance and job dissat-
isfaction. Lim et al. (2008) found significant relation-
ships between incivility and employee health and
wellbeing as well as turnover intentions. In a study of
staff nurses, Dion (2006) found that perceptions of
workplace incivility were significantly related to feeling
supported by their supervisor and positively related to
feelings of occupational stress and turnover intentions.
Burnout/engagement
Maslach (2004) defined burnout as Ô…a psychological
syndrome of exhaustion, cynicism and inefficacy which is
experienced in response to chronic job stressorsÕ(p. 93).
Leiter and Maslach (2004) argued that burnout is char-
acterized by emotional exhaustion, cynicism, and pro-
fessional inefficacy. Emotional exhaustion is considered
to be the core element of burnout, resulting in cynicism
toward oneÕs work and colleagues and low efficacy levels
(Leiter et al. 1998, Leiter & Maslach 2004, Maslach &
Leiter 1997). Burnout has been studied extensively in
health care settings. Aiken et al. (2002) linked high levels
of emotional exhaustion to lower levels of staff nurse job
satisfaction and Vahey et al. (2004) found that the sup-
portive practice environments and low burnout jointly
predicted greater job satisfaction and better patient out-
comes. Balogun et al. (2002) found significant relation-
ships between allied health professionalsÕrelationships
with peers and supervisors and two key elements of
burnout. They found that support from supervisors ex-
plained 7% of the variance in emotional exhaustion,
whereas support from colleagues accounted for 9.6% of
the variance in cynicism.
Work satisfaction, organizational commitment,
and turnover intentions
Job satisfaction, organizational commitment, and
turnover intention are important quality of worklife
outcomes in nursing settings (McGillis Hall 2003). In
separate meta-analyses, Blegen (1993) and Irvine and
Evans (1995), found that nursesÕjob satisfaction was
consistently predicted by autonomy, good communica-
tion with supervisors and peers, organizational com-
mitment, and job stress. In a longitudinal study of over
1000 nurses, Price and Mueller (1981) found that job
satisfaction had an indirect effect on turnover through
employeesÕintentions to stay. This pattern of results is
also found in the general management literature (Spec-
tor 1997). Meta-analyses by Griffeth et al. (2000) and
Hellman (1997) established job dissatisfaction as a
consistent predictor of voluntary turnover behaviour
across a variety of occupational groups.
Organizational commitment is an important predic-
tor of nurse turnover and another important outcome
considering the high costs associated with turnover
(Ingersoll et al. 2002, Wagner 2007). Affective com-
mitment refers to an employeeÕs attachment, identifi-
cation, and involvement with the organization and has
been positively related to job performance, job satis-
faction, and turnover (Allen & Meyer 1996). A meta-
analysis by Wagner (2007) found that organizational
commitment was a stronger predictor of turnover than
job satisfaction. Ingersoll et al. (2002) linked higher
turnover intentions to lower organizational commit-
ment, a finding corroborated by Tourangeau and
Cranley (2006).
Job satisfaction, organizational commitment, and
turnover have been shown to be related to health-
related psychosocial factors. Cass et al. (2003) con-
ducted a meta-analysis of over 500 studies and found
that job satisfaction was significantly correlated with
overall health, burnout, depression, anxiety, self-esteem,
and general mental health. King and Sethi (1997) found
that organizational commitment moderated the effect of
job stressors on information systems professionalsÕ
experiences of emotional exhaustion. Lee and Ashforth
(1996) linked organizational commitment to lower
levels of burnout in several studies in their meta-analysis.
Thus, there is considerable evidence in both the
nursing and management literature to support links
between frequently studied turnover related organiza-
tional attitudes and behaviours, such as, empowerment,
workplace incivility, and burnout.
Model tested in the study
We tested a model derived from a review of the litera-
ture integrating theory and research relating to
empowering working environments, workplace incivil-
ity, and burnout and their relationship to retention
outcomes frequently identified in the literature. NursesÕ
perceptions of structural empowerment in their work
setting are hypothesized to be foundational to nurse
retention outcomes. Lack of empowerment has been
H. K. Spence Laschinger et al.
304 ª2009 The Authors. Journal compilation ª2009 Blackwell Publishing Ltd, Journal of Nursing Management,17, 302–311
shown to be an enabling factor for workplace incivility,
which has been linked to burnout. Therefore, we
hypothesized that empowerment, incivility, and burn-
out are related to the retention outcomes in this study,
job satisfaction, organizational commitment, and turn-
over intentions (Figure 1). To our knowledge, this study
is one of the first to examine these relationships within a
single theoretical model.
Method
Hospital employees (N= 1106) from five organizations
in two provinces completed surveys that assessed their
wellbeing, work environments, and social relationships
at work. Following ethical approval, all employees
received a questionnaire through the hospital mail. A
modified Dillman Total Design Methodology (Dillman
2000) was used to increase return rates (overall return
rate was 40%). A reminder letter was sent three weeks
following the initial survey package. Employees were
assured of the confidentiality of their responses. Of the
1106, 612 were staff nurses. We focused on this sample
in this study. Participants were predominantly female
(574, 95%; male: 31, 5.1%, 7 not responding), with an
average age of 41.3 years (SD = 10.6). Their employ-
ment status varied, including fulltime (390, 64.3%),
part time (162, 26.7%), casual (52, 8.6%), and tem-
porary (3, 0.5%), with 5 not responding. They worked
in their current hospital for varying lengths of time:
<6 months (10, 1.8%), 6–24 months (37, 6.6%),
2–5 years (125, 22.3%), 6–10 years (113, 20.1%),
11–15 years (66, 11.8%), 16–20 years (82,14.6%),
21–30 years (96, 17.1%), and more than 30 years (32,
5.7%), with 51 not responding.
Instrumentation
Structural empowerment was measured by the four
subscales of the CWEQ-II (Laschinger et al. 2001a,b), a
short form of the Conditions for Work Effectiveness
Questionnaire (CWEQ) (Chandler 1986). The CWEQ-
II measures employee access to work empowerment
structures described in KanterÕs theory (opportunity,
information, support, and resources). Each subscale
contains three items, rated on a 5-point scale which are
summed and averaged. The construct validity of the
CWEQ-II was established by Laschinger et al. (2001b)
in a second-order confirmatory factor analysis that re-
vealed a good fit of the hypothesized factor structure
and acceptable subscale reliabilities. In this study, we
focused on the core elements of empowerment: access
to opportunity, information, support, and resources.
Cronbach alphas ranged from a= 0.74 to a= 0.89 in
this study. The item-total correlations ranged from
0.443 to 0.852 across subscales.
EmployeesÕencounters with workplace incivility over
the previous month were measured by the Workplace
Incivility Scale (Cortina et al. 2001). Following sug-
gestions from Caza and Cortina (2007), we asked for
specific ratings for encounters with coworkers to pro-
duce a score for coworker work incivility and encoun-
ters with the immediate supervisor to produce a score
for supervisor work incivility (e.g. ÔPaid little attention
to your statement or showed little interest in your
opinionÕ;ÔAddressed you in unprofessional terms either
publicly or privatelyÕ). Participants rated items on a 7-
point Likert scale ranging from ÔneverÕ(0) to ÔdailyÕ(6).
Blau and Andersson (2005) established internal consis-
tency for coworker incivility (a= 0.89). In the current
study, the internal consistency for each subscale was
high: supervisor incivility (a= 0.84); coworker incivil-
ity (a= 0.85). The item-total correlations ranging from
r= 0.28 to r= 0.69.
The Emotional Exhaustion and Cynicism subscales of
the Maslach Burnout Inventory-General Survey (MBI-
GS) (Schaufeli et al. 1996) were used to measure
burnout. Items are rated on a 7-point Likert scale
ranging from 0 (never) to 6 (every day). Leiter and
Maslach (2004) argued that a high score on these scales
(>3.0) is indicative of burnout. Cronbach alpha
(a> 0.70) coefficients for the scales across numerous
studies have been acceptable (Schaufeli et al. 1996). In
this study, the Cronbach alpha reliability coefficient for
emotional exhaustion was a= 0.91, and cynicism was
a= 0.82. The item-total correlations ranging from
r= 0.74 to r= 0.83 for emotional exhaustion and
r= 0.43–0.69 for cynicism.
Job satisfaction was measured by five items in which
participants rated their level of satisfaction with: (i)
coworkers, (ii) supervisors, (iii) pay and benefits, (iv)
the feeling of accomplishment from doing the job, and
Structural
empowerment
Workplace
incivility
Supervisor
Coworker
Burnout
Exhaustion
Cynicism
Retention outcomes
Job Satisfaction
Organizational
Commitment
Turnover Intentions
Figure 1
Hypothesized model tested in the study.
Outcomes of empowerment and workplace incivility
ª2009 The Authors. Journal compilation ª2009 Blackwell Publishing Ltd, Journal of Nursing Management,17, 302–311 305
(v) job overall (Hackman & Oldham 1975, Tsui et al.
1992). Respondents rated items on a 7-point Likert
scale ranging from 1 = very dissatisfied to 7 = very
satisfied. In the current study, the internal consistency of
satisfaction was acceptable (a= 0.71), with item-total
correlations ranging from r= 0.31 to r= 0.67.
Organizational commitment was measured using two
items from the Affective Commitment Scale (Meyer
et al. 1993). The items were rated on a 7-point scale
ranging from 1 (strongly disagree) to 7 (strongly agree).
Acceptable reliability and construct validity for the
original subscale has been reported by Meyer et al.
(1993). In this study, the reliability coefficient was
marginally acceptable (0.65).
We used three items from the Turnover Intentions
measure (Kelloway et al. 1999) to measure health pro-
fessionalsÕintention to quit (ÔI plan on leaving my job
within the next year,ÕÔI have been actively looking for
other jobs,Õand ÔI want to remain in my jobÕ). Items
were rated on a 5-point Likert scale (1 = strongly dis-
agree, 5 = strongly agree). Reliability testing of the
original scale indicated that it is internally consistent
both at Time 1 (a= 0.92) and 6 months later at Time 2
(a= 0.93). In the current study, the internal consistency
was high (a= 0.82). The item-total correlations ranging
from r= 0.57 to r= 0.63.
Data analysis
The Statistical Package for Social Sciences (
SPSS
) version
16.0 for windows (SPSS, Inc., Chicago, IL, USA) was
used to conduct descriptive and inferential statistical
analyses. Hierarchical multiple linear regression analy-
ses were used to test the influence of empowerment,
incivility, and burnout on three retention outcomes (job
satisfaction, organizational commitment, and turnover
intentions). Blocks of variables were entered into three
separate analyses for each retention outcome, based on
a logical theoretical sequence. Structural empowerment
was entered first because this variable describes the
extent to which basic empowering structures are per-
ceived to be in place in the work environment. Super-
visor and coworker incivility variables were added in
the second step as additional worklife variables/stres-
sors, to assess their incremental validity after control-
ling for empowerment. The burnout variables were
entered in the last step to assess their incremental
validity after controlling for the worklife variables.
Results
Descriptive results
The means and standard deviations for major study
variables are presented in Table 1. Nurses perceived
their work environment to have moderate levels of
empowerment (M= 12.0, SD = 2.18), similar to previ-
ous results with nurses (Laschinger 1996).
Interestingly, workplace civility ratings were low for
both supervisor and coworkers (M= 0.66, SD = 0.89
and M= 0.81, SD = 0.82 respectively). There was wide
variation on these scores, however, with scores ranging
from 0 to 5.00 for supervisor incivility and from 0 to
5.8 for coworker incivility. Most (67.5%) nurses
experienced some sort of incivility from their supervi-
sors and 77.6% reported some level of coworker inci-
vility. However, only a small percentage reported
regular to very frequent exposure to incivility in their
workplaces (4.4 and 2.7% from supervisors and
coworkers, respectively). This finding is encouraging
although contrary to many anecdotal reports in the
literature about high levels of coworker incivility in
health care settings.
Nurses in this study reported relatively high levels of
emotional exhaustion (M= 2.99, SD = 1.42). Almost
half (47.3%) scored >3.0, the cut point for severe
burnout according to Maslach et al. (1996). These
results are somewhat lower than recent studies of staff
Table 1
Means, standard deviations, CronbachÕs Alphas, and correlations of variables
Variable M SD Alpha 1 2 3 4 5 6 7 8
1 Total empowerment** 12.03 2.18 0.79 –
2 Incivility-supervisor
+
0.66 0.89 0.90 )0.256 –
3 Incivility-coworkers
+
0.81 0.82 0.86 )0.181 0.344 –
4 Emotional exhaustion
+
2.99 1.42 0.91 )0.235 0.332 0.235 –
5 Cynicism
+
1.77 1.26 0.82 )0.376 0.410 0.304 0.562 –
6 Job satisfaction*** 5.19 0.96 0.71 0.476 )0.475 )0.325 )0.407 )0.553 –
7 Commitment* 3.14 0.89 0.65 0.435 )0.312 )0.266 )0.257 )0.407 0.501 –
8 Intent to leave* 2.36 0.98 0.83 )0.268 0.347 0.190 0.402 0.462 )0.448 )0.398 –
Score Range: *1–5, **4–20, ***1–7,
+
0–6.
All correlations significant at P< 0.05.
H. K. Spence Laschinger et al.
306 ª2009 The Authors. Journal compilation ª2009 Blackwell Publishing Ltd, Journal of Nursing Management,17, 302–311
nurses: Cho et al. (2006) found that 66% of new
graduate nurses were in the severe burnout category
(exhaustion), and Laschinger et al. (2004a) found that
58% of nurse managers reported severe exhaustion
levels as well. Cynicism levels for nurses in the
current study were lower than exhaustion (M= 1.78,
SD = 1.27), with only 19% scoring above the 3.0 cut
point.
Finally, nurses were relatively positive in terms of the
retention factors measured in this study. They reported
moderately high levels of job satisfaction (M= 5.2,
SD = 0.96), moderate levels of organizational commit-
ment (M= 3.14, SD = 0.90), and low levels of turnover
intentions (M= 2.36, SD = 0.98).
The hierarchical multiple linear regression analyses
revealed that empowerment, workplace incivility, and
burnout jointly explained a significant amount of
variance in all three retention outcomes: job satisfac-
tion (R
2
= 0.46; P< 0.001), organizational commit-
ment (R
2
= 0.29; P< 0.001) and turnover intentions
(R
2
= 0.28; P< 0.001). The results for each model are
described in the following paragraphs (Table 2).
The predictor variables accounted for 46% of the
variance in job satisfaction. Each block of predictors
explained a significant amount of variance: empower-
ment explained 22.8% of the variance when entered
first, supervisor and coworker incivility added a further
15% on the second step, and the burnout variables an
additional 8.3%. In the final model, cynicism
(b=)0.28, P< 0.001), empowerment (b= 0.28,
P< 0.001), and supervisor incivility (b=)0.22,
P< 0.001) were the strongest predictors of job satis-
faction. Coworker incivility and exhaustion were
weaker although significant predictors (b=)0.09,
P< 0.01 and b=)0.09, P< 0.05, respectively).
The predictor variables accounted for 29%
(P< 0.001) of the variance in organizational commit-
ment. Empowerment explained 19.2% (P< 0.001) of
the variance in commitment in the first step, incivility
explained 6% (P< 0.001) of variance in the second
step, and burnout explained another 3.75% (P< 0.001)
of the variance in the last step. In the final model, all
predictors with the exception of emotional exhaustion
explained significant unique variance in commitment.
The strongest predictor was empowerment (b= 0.31,
P< 0.001), followed by cynicism (b=)0.22, P<
0.001) and supervisor and coworker incivility
(b=)0.10, P< 0.05 and b=)0.11, P< 0.001,
respectively).
The predictor variables accounted for 28%
(P< 0.001) of the variance in turnover intentions. All
blocks of variables explained significant increments in
variance explained in turnover intentions (empower-
ment = 7%, P< 0.001, incivility = 8.5%, P< 0.001,
and burnout = 11.8%, P< 0.001). Interestingly, the
burnout and incivility variables had a relatively stronger
influence than in the previous two models. In the final
model, the strongest predictors of turnover intentions
were cynicism (b= 0.27, P< 0.001), emotional
exhaustion (b= 0.19, P< 0.001) and supervisor incivil-
ity (b= 0.16, P< 0.001). Empowerment also was sig-
nificant (b=)0.08 P< 0.05), but it was weaker than in
the previous models. Interestingly, the beta associated
with coworker incivility was essentially zero and non-
significant (b= 0.01).
Discussion
The analyses provided support for the hypothesized
models. An empowering practice environment and low
Table 2
Hierarchical multiple regression
results for job satisfaction, organiza-
tional commitment and turnover
intentions
Retention related outcomes
Job satisfaction Commitment
Turnover inten-
tions
Step bDR
2
bDR
2
bDR
2
Empowerment 0.28 0.23
à
0.31 0.19
à
)0.08 0.07
à
Incivility – 0.15
– 0.06
– 0.09
Supervisor )0.22
–)0.10
– 0.16
–
Coworker )0.09
–)0.11
– 0.01
–
Burnout – 0.08
– 0.04
– 0.12
Emotional Exhaustion )0.09* – )0.01* – 0.19* –
Cynicism )0.28* – 0.22 – 0.27* –
Total R
2
0.46
à
0.29
à
0.28
à
*P< 0.05.
P< 0.01.
à
P< 0.001.
N= 105.
Outcomes of empowerment and workplace incivility
ª2009 The Authors. Journal compilation ª2009 Blackwell Publishing Ltd, Journal of Nursing Management,17, 302–311 307
levels of incivility and burnout were significant pre-
dictors of nursesÕexperiences of job satisfaction and
organizational commitment and their intentions to
leave their workplaces. These results support previous
evidence of the importance of positive working envi-
ronments in retaining health professionals in hospital
settings. Nedd (2006) found a significant relationship
between structural empowerment and nurse turnover.
Numerous studies have linked empowerment directly
and indirectly to job satisfaction and commitment.
Our results add to this knowledge by demonstrating
the positive effect of working in collegial work settings
in which employees treat each other respectfully and
refrain from uncivil behaviors in their day to day
work.
Empowerment, incivility, and burnout explained al-
most twice as much variance in job satisfaction in
comparison to organizational commitment and intent
to leave. This result is not surprising given the multi-
plicity of factors affecting turnover intentions and
organizational commitment. People can be dissatisfied
with their jobs but may have limited opportunities for
other jobs, particularly in the currently constrained
health care sector. Similarly, nurses who feel they are
working in unsupportive work environments may
transfer their organizational commitment to profes-
sional or occupational commitment as a means of
dealing with their situations (Meyer & Allen 1997).
This phenomenon was frequently observed in the period
of downsizing in the 1990Õs (Baruch 1998, Knudsen
et al. 2003). Job satisfaction may be considered one
antecedent of turnover intentions and commitment.
Future research should examine these temporal rela-
tionships using a longitudinal design.
In all models, supervisor civility was an important
predictor of retention outcomes. Coworker incivility
had a smaller unique influence than did supervisor
incivility, except in the commitment model, in which it
was equally important as supervisor incivility. It may be
that employees feel that they had little control over
supervisor behaviour in their setting, and experience a
power imbalance, which had a stronger impact on their
jobs and turnover intentions in particular. Past research
has shown the negative effect of supervisors on subor-
dinate commitment and turnover because they have the
power over subordinates that coworkers do not have.
On the other hand, feeling committed to the organiza-
tion as a whole may depend on having civil relation-
ships with both supervisors and colleagues.
Organizational commitment entails feeling that one is
part of family and a desire to remain in the organization
until retirement (Meyer & Allen 1997). Thus, positive
relationships with colleagues are as important as those
with their supervisors.
Burnout played an important role in predicting
retention outcomes, explaining 4–12% of incremental
variance in job satisfaction, organizational commit-
ment, and turnover intentions. Cynicism was a strong
predictor in all retention models, even when other
worklife factors were taken into consideration. Cyni-
cism has been linked to job satisfaction and commit-
ment in previous research in non-nursing settings
(Abraham 2000, Bernerth et al. 2007, Wanous et al.
2000). To a lesser degree, emotional exhaustion was
also important except in the commitment model. The
lower degree of relationship between emotional
exhaustion and commitment than between cynicism
and commitment may be due to the nature of the blocks
of variables. That is, some nurses may be exhausted
from being overworked and have low commitment.
However, some nurses may still be exhausted but like
what they are doing, and therefore, they still can be
committed to the organization. When nurses experience
high cynicism, they may be more disgruntled with the
people and working environment, and thus, be much
more prone to lower commitment.
Models that consider the relationship of exhaustion
and cynicism consider their strong correlation to reflect
the importance of personal energy in maintaining
employeesÕinvolvement in their work (Leiter 1993,
2008). That is, exhausted employees simply lack the
energy necessary for enthusiastic participation in
worklife. The psychologically distant relationship with
work reflected in cynicism is consistent with low com-
mitment, dissatisfaction, and turnover intentions. From
this perspective, cynicism mediates the relationship of
exhaustion with these three outcomes. That is, chronic
exhaustion discourages nursesÕpsychological involve-
ment in work that in turn prompts dissatisfaction and
withdrawal reflected in low organizational commitment
and intentions to quite their jobs.
The significant impact of empowerment and incivility
on nursesÕexperiences of burnout suggests that mana-
gerial strategies that empower them for professional
practice may be helpful in preventing workplace inci-
vility, and ultimately, burnout. Research in nursing has
shown that when work environments are structured in
this way, nurses experience lower levels of burnout,
which, in turn, result in greater job satisfaction and
fewer adverse patient events (Leiter & Laschinger 2006,
Laschinger & Leiter 2006, Manojlovich & Laschinger
2007). In our study, nursesÕperceptions of empower-
ment, supervisor incivility, and cynicism were strongly
related to both job satisfaction and organizational
H. K. Spence Laschinger et al.
308 ª2009 The Authors. Journal compilation ª2009 Blackwell Publishing Ltd, Journal of Nursing Management,17, 302–311
commitment. These results highlight the importance of
managersÕleadership behaviour in preventing burnout,
thereby ensuring higher quality of worklife and lower
turnover intentions.
Given evidence linking burnout to work satisfaction
and turnover, as well as poor employee and physical
health, strategies to prevent burnout are important for
health care workers, organizations and patients. Leiter
et al. (1998) and Vahey et al. (2004) linked nurse
burnout to negative patient outcomes, reinforcing the
need for creating positive work environments for both
providers and their patients. Maslach and Leiter (1997)
emphasized the need to create organizational interven-
tions to prevent burnout and promote engagement at
work (in contrast to focusing exclusively on enhancing
coping skills). Management plays a key role in sup-
porting the implementation of these interventions in
their work settings.
Nurses in this study did not report high levels of
workplace incivility, contrary to anecdotal reports in the
literature. However, the majority of nurses experienced
some uncivil behaviours, and their perceptions of work-
place incivility were significantly related to feelings of
empowerment, burnout, and all retention outcomes.
This is the first study we know of to link structural
empowerment and burnout with staff nursesÕexperiences
of incivility in the workplace. The results highlight the
importance of establishing and monitoring anti-bullying
policies in the workplace as a retention strategy. Health
care managers play a key role in ensuring that such pol-
icies are implemented and reinforced.
Limitations and future research
The cross-sectional nature of the original study pre-
cludes strong claims of causal effects. The study should
be replicated using a larger more representative sample
of nurses to further validate the model. However, sup-
port for our a priority model derived from theory and
research is encouraging and suggests that further re-
search is warranted. A longitudinal study to examine
changes over time would also be valuable.
Conclusions
The results suggest that working in environments that
empower nurses to practice according to professional
standards and that also are free of uncivil behaviors
from supervisors and colleagues may protect them from
burning out and may promote retention in the nursing
work settings. Given the current workforce shortage in
health care, every effort must be made to ensure that
nurses are exposed to high quality work environments
that engage them with their work. There are many
anecdotal reports of workplace incivility in current fast
paced health care settings. Our results suggest that
workplace incivility is related to health professionalsÕ
experiences of burnout and important retention factors.
Supervisor incivility and burnout were particularly
important determinants of turnover intentions. The
results further highlight the need to ensure that
professional practice environments foster high quality
supervisory and collegial working relationships to
ensure that highly skilled nurses remain engaged in their
work and that adequate resources are in place for high
quality patient care in todayÕs chaotic health care
settings.
Acknowledgements
This study was funded by Canadian Institute of Health
Research: Partnerships for Health System Improvement
Program, Nova Scotia Health Research Fund, Ontario
Ministry of Health and Long Term Care, and funding support
from the hospitals involved in the study.
References
Abraham R. (2000) Organizational cynicism: Bases and conse-
quences. Genetic, Social, and General Psychology Mono-
graphs,126, 269–292.
Aiken L.H., Clarke S.P., Sloane D.M., Sochalski J. & Silber J.H.
(2002) Hospital nurse staffing and patient mortality, nurse
burnout, and job dissatisfaction. Journal of American Medical
Association,288, 1987–1993.
Allen N.J. & Meyer J.P. (1996) Affective, continuance and nor-
mative commitment to the organization: an examination of
construct validity. Journal of Vocational Behaviour,49, 252–
276.
Anderson L.M. & Pearson C.M. (1999) The spiraling effect of
incivility in the workplace. Academy of Management Review,
24, 452–471.
Balogun J.A., Titiloye V., Balogun A., Oyeyemi A. & Katz J.
(2002) Prevalence and determinants of burnout among physical
and occupational therapists. Journal of Allied Helath,31 (3),
131–139.
Bartenak J.M. & Spreitzer G.M. (2006) The interdisciplinary
career of a popular construct used in management: empower-
ment in the late 20th century. Journal of Management Inquiry,
15 (3), 255–273.
Baruch Y. (1998) The rise and fall of organizational commitment.
Human Systems Management 17 (2), 135–143.
Bernerth J.B., Armenakis A., Field H.S. & Walker H.J. (2007)
Justice, cynicism, and commitment: a study of important
organizational change variables. Journal of Applied Behavioral
Science,43, 303–326.
Blau G. & Andersson L.M. (2005) Testing a measure of instigated
workplace incivility. Journal of Occupational and Organiza-
tional Psychology,78, 595–614.
Outcomes of empowerment and workplace incivility
ª2009 The Authors. Journal compilation ª2009 Blackwell Publishing Ltd, Journal of Nursing Management,17, 302–311 309
Blegen M.A. (1993) NursesÕjob satisfaction: a meta-analysis of
related variables. Nursing Research,42, 36–41.
Cass M.H., Ling S.O., Faragher E.B. & Cooper C.L. (2003) A
meta-analysis of the relationship between job satisfaction and
employee health in Hong Kong. Stress and Health,19, 79–95.
Caza B. & Cortina L.M. (2007) From insult to injury: explaining
the impact of incivility. Basic and Applied Social Psychology,
29, 335–350.
Chandler G. (1986) The Relationship of Nursing Work Envi-
ronment to Empowerment and Powerlessness. Unpublished
Doctoral Dissertation, University of Utah, Salt Lake City, Utah,
USA.
Cho J., Laschinger H.K.S. & Wong C. (2006) Workplace
empowerment, work engagement and organizational commit-
ment of new graduate nurses. Canadian Journal of Nursing
Leadership,19 (3), 43–60.
Conger J.A. & Kanungo R.N. (1988) The empowerment process:
integrating theory and practice. Academy of Management Re-
view,13, 471–482.
Cortina L.M., Magley V.J., Williams J.H. & Langhout R.D.
(2001) Incivility in the workplace: incidence and impact.
Journal of Occupational Health Psychology,6, 64–80.
Dillman D.A.. (2000) Mail and Internet Surveys: The Tailored
Design Method 2nd edn. Wiley, New York.
Dion M.J. (2006). The impact of workplace incivility and occu-
pational stress on the job satisfaction and turnover intention of
acute care nurses. ETD Collection for University of Connecti-
cut. Available at: http://digitalcommons.uconn.edu/disserta-
tions/AAI3221535, accessed 1 September 2008.
Einarsen S., Raknes B.I. & Matthiesen S.B. (1994) Bullying and
harassment at work and their relationships to work environ-
ment quality. European Work and Organizational Psycholo-
gist,4, 381–401.
Griffeth R.W., Hom P.W. & Gaertner S. (2000) A meta-analysis
of antecedents and correlates of employee turnover: update,
moderator tests, and research implications for the next mil-
lennium. Journal of Management,26, 463–488.
Hackman J.R. & Oldham G.R. (1975) Development of the job
diagnostic survey. Journal of Applied Psychology,60, 159–170.
Hatcher S. & Laschinger H.K.S. (1996) Staff nursesÕperceptions
of job empowerment and level of burnout: a test of KanterÕs
theory of structural power in organizations. Canadian Journal
of Nursing Administration,9(2), 74–94.
Hayes L.J., Orchard C.A., Hall L.M., Nincic V., OÕBrien-Pallas L.
& Andrews G. (2006) Career intentions of nursing students and
new nurse graduates: a review of the literature. International
Journal of Nursing Education Scholarship,3, 1–15.
Hellman C.M. (1997) Job satisfaction and intent to leave. Journal
of Social Psychology,137 (6), 677–689.
Ingersoll G.L., Olsan T., Drew-Cates J., DeVinney B.C. & Davies
J. (2002) NursesÕjob satisfaction, organizational commitment,
and career intent. Journal of Nursing Administration,32, 250–
263.
Irvine D.M. & Evans M.G. (1995) Job satisfaction and turnover
among nurses: Integrating research findings across studies.
Nursing Research,44 (4), 246–253.
Kanter R.M. (1977) Men and Women in the Corporation. Basic
Books, New York.
Kanter R.M. (1979) Power failure in management circuits. Har-
vard Business Review,57 (4), 65–75.
Kanter R.M. (1993) Men and Women of the Corporation, 2nd
edn. Basic Books, New York.
Keenan P.. (2003). The nursing workforce shortage: causes,
consequences, proposed solutions. Retrieved January 12, 2009
from http://www.commonwealthfund.org/usr_doc/Keenan_
nursing.pdf?section=4039.
Kelloway E.K., Gottlieb B.H. & Barham L. (1999) The source,
nature, and direction of work and family conflict: a longitudi-
nal investigation. Journal of Occupational Health Psychology,
4, 337–346.
King R.c. & Sethi V. (1997) The moderating effect of organiza-
tional commitment or burnout in information systems profes-
sion. European Journal of Information Systems,6(2), 86–96.
Kirkman B.L. & Rosen B. (1999) Beyond self-management:
antecedents and consequences of team empowerment. Academy
of Management Journal,42, 58–74.
Knudsen H.K., Johnson J.A., Martin J.K. & Roman P.M. (2003)
Downsizing survival: the experience of work and organiza-
tional commitment. Sociological Inquiry,73, 265–283.
Koberg C.S., Boss R.W., Senjem J.C. & Goodman E.A. (1999)
Antecedents and outcomes of empowerment: empirical evi-
dence from the health care industry. Group & Organization
Management,24 (1), 71–91.
Laschinger H.K.S. (1996) A theoretical approach to studying
work empowerment in nursing: a review of studies testing
KanterÕs theory of structural power in organizations. Nursing
Administration Quarterly,20 (2), 25–41.
Laschinger H.K.S. & Finegan J. (2005) Empowering nurses for
work engagement and health in hospital settings. Journal of
Nursing Administration,35, 439–449.
Laschinger H. & Leiter M. (2006) The impact of nursing work
environments on patient safety outcomes: the mediating role of
burnout/engagement. The Journal of Nursing Administration,
36 (5), 259–267.
Laschinger H.K.S., Finegan J. & Shamian J. (2001a) Promoting
nursesÕhealth: effect of empowerment on job strain and work
satisfaction. Nursing Economics,19, 42–53.
Laschinger H.K.S., Finegan J., Shamian J. & Wilk P. (2001b)
Impact of structural and psychological empowerment on job
strain in nursing work settings: expanding KanterÕs Model.
Journal of Nursing Administration,31, 260–272.
Laschinger H.K.S., Finegan J., Shamian J. & Wilk P. (2003)
Workplace empowerment as a predictor of nurse burnout in
restructured health care settings. Longwoods Review,1(3), 2–
11. [Insert] Hospital Quarterly, 6(4).
Laschinger H.K.S., Almost J., Purdy N. & Kim J. (2004a) Pre-
dictors of nurse managersÕhealth in Canadian restructured
healthcare settings. Canadian Journal of Nursing Leadership,
17 (4), 88–105.
Laschinger H.K.S., Finegan J., Shamian J. & Wilk P. (2004b) A
longitudinal analysis of the impact of workplace empowerment
on staff nursesÕwork satisfaction. Journal of Organizational
Behavior,25 (4), 527–545.
Laschinger H.K.S., Wong C. & Greco P. (2006) The impact of staff
nurse empowerment on person-job fit and work engagement/
burnout. Nursing Administration Quarterly,30, 358–367.
Lawler E.E., Mohrman S.A. & Benson G. (2001) Organizing for
High Performance: Employment Involvement, TQM, Reengi-
neering, and Knowledge Management in the Fortune 1000.
Jossey-Bass, San Francisco.
H. K. Spence Laschinger et al.
310 ª2009 The Authors. Journal compilation ª2009 Blackwell Publishing Ltd, Journal of Nursing Management,17, 302–311
Lee R.T. & Ashforth B.E. (1996) A meta-analytic examination of
the correlates of the three dimensions of job burnout. Journal of
Applied Psychology,81, 123–133.
Leiter M.P. (1993) Burnout as a developmental process: con-
sideration of models. In Professional burnout: Recent
Developments in Theory and Research (W. Schaufeli, C.
Maslach & T. Marek eds), pp. 237–250. Taylor & Francis,
Washington.
Leiter M.P. (2008) A Two Process Model of Burnout and Work
Engagement: Distinct Implications of Demands and Values.
Applied Psychology in Work and Rehabilitation Medicine,30,
1–7.
Leiter M.P. & Laschinger H.K.S. (2006) Relationships of work
and practice environment to professional burnout: testing a
causal model. Nursing Research,55, 137–147.
Leiter M.P. & Maslach C. (2004) Areas of worklife: A structured
approach to organizational predictors of job burnout. In
Research in Occupational Stress and Well-Being (P.L. Perrewe
& D.C. Ganster eds.), (Vol. 3, pp. 91–134). Elsevier, Oxford.
Leiter M., Harvie P. & Frizzel C. (1998) The correspondence of
patient satisfaction and nurse burnout. Social Science & Med-
icine,47, 1611–1617.
Lim S., Cortina L.M. & Magley V.J. (2008) Personal and work-
group incivility: impact on work and health outcomes. Journal
of Applied Psychology,93, 95–107.
Manojlovich M. & Laschinger H.K.S. (2007) The nursing
worklife model: extending and refining a new theory. Journal
of Nursing Management,15, 256–263.
Maslach C. (2004) Different perspectives on job burnout. Con-
temporary Psychology: APA Review of Books,49 (2), 168–
170.
Maslach C. & Leiter M.P. (1997) The Truth about Burnout: How
Organizations Cause Personal Stress and What to Do About It.
Jossey-Bass, San Francisco, California.
Maslach C., Jackson S.E. & Leiter M.P. (1996) Maslach Burnout
Inventory: Manual. Consulting Psychologists Press, Palo Alto,
CA.
McGillis Hall L. (2003) Nursing intellectual capital: a theoretical
approach for analysing nursing productivity. Nursing
Economics,21 (1), 14–20.
McMullin J.A. & Cooke M. (2004) Labor Force Ageing and Skill
Shortages in Canada and Ontario. Canadian Policy Research
Networks Inc, Ottawa, Ontario, Canada.
Meyer J.P. & Allen N.J. (1997) Commitment in the Workplace:
Theory, Research, and Application. Sage, Thousand Oaks, CA.
Meyer J.P., Allen N.J. & Smith C.A. (1993) Commitment to
organizations and occupations: extension and test of a three-
component conceptualization. Journal of Applied Psychology,
78, 538–551.
Nedd N. (2006) Perceptions of empowerment and intent to stay.
Nursing Economics,24 (1), 13–18.
Pearson C.M. & Porath C.L. (2005) ‘‘On the Nature, Conse-
quences and Remedies of Workplace Incivility: No Time for
ÔNiceÕ? Think Again,’’ Academy of Management Executive,19,
1–12.
Pearson C.M., Anderson L.M. & Wegner J.W. (2001) When
workers flout convention: a study of workplace incivility. Hu-
man Relations,54, 1387–1419.
Price J.L. & Mueller C.W. (1981) A causal model of turnover for
nurses. Academy of Management Journal,24 (3), 543–565.
Salin D. (2003) Ways of explaining bullying: a review of
enabling, motivating, and precipitating structures and processes
in the work environment. Human Relations,56 (10), 1213–
1232.
Schaufeli W.B., Leiter M.P., Maslach C. & Jackson S.E. (1996)
Maslach Burnout Inventory-General Survey. In The Maslach
Burnout Inventory – Test manual, (C. Maslach, S.E. Jackson &
M.P. Leiter eds.), (3rd edn). pp A1–A2, Consulting Psycholo-
gists Press, Palo Alto, CA.
Spector P.E. (1997) Job satisfaction: Application, Assessment,
Causes, and Consequences. Sage, Thousand Oaks, CA.
Spreitzer G. & Doneson D. (2005) Musings on the Past and Fu-
ture of Employee Empowerment. Forthcoming in T. Cum-
mings, Handbook of Organizational Development. Sage,
Thousand Oaks.
Tourangeau A.E. & Cranley L.A. (2006) Nurse intention to re-
main employed: understanding and strengthening determi-
nants. Journal of Advanced Nursing,55, 497–509.
Tsui A.S., Egan T.D. & OÕReilly C.A. (1992) Being different:
relational demography and organizational attachment.
Administrative Science Quarterly,37, 547–579.
Vahey D.C., Aiken L.H., Sloane D.M., Clark S.P. & Vargas D.
(2004) Nurse burnout and patient satisfaction. Medical Care,
42 (2), 57–66.
Vartia M. (1996) The sources of bullying – psychological work
environment and organizational climate. European Journal of
Work and Organizational Psychology,5, 203–214.
Wagner C.M. (2007) Organizational commitment as a predictor
variable in nursing turnover research: literature review. Journal
of Advanced Nursing,60, 235–247.
Wanous J.P., Reichers A.E. & Austin J.T. (2000) Cynicism about
organizational change: measurement, antecedents, and corre-
lates. Group and Organization Management,25, 132–153.
World Health Organization. (2006). World health report 2006:
working together for health. WHO, Geneva. http://
www.who.int/whr/2006/en.
Outcomes of empowerment and workplace incivility
ª2009 The Authors. Journal compilation ª2009 Blackwell Publishing Ltd, Journal of Nursing Management,17, 302–311 311
