No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The Influence of Nursing Unit Empowerment and Social Capital on Unit Effectiveness and Nurse Perceptions of Patient Care Quality
Abstract
Objective:
This study tested a multilevel model examining the effects of work-unit structural empowerment and social capital on perceptions of unit effectiveness and nurses' ratings of patient care quality.
Background:
Structural empowerment and social capital are valuable resources for staff nurses that promote work effectiveness and high-quality patient care. No studies have examined social capital in nursing at the group level.
Methods:
A cross-sectional survey of 525 nurses in 49 nursing units in 25 acute care hospitals in Ontario was conducted to test the hypothesized multilevel model using structural equation modeling.
Results:
Both unit-level structural empowerment and social capital had significant effects on unit effectiveness (β = .05 and β = .29, P < .05, respectively). Unit-level predictors explained 87.5% of level 2 variance in individual nurses' ratings of patient care quality.
Conclusions:
This study provides a better understanding of how unit-level structural empowerment and social capital affect both unit- and individual-level outcomes.
... For instance, DiCicco-Bloom et al. (2007) constructed a "Social Capital Model" to facilitate understanding of the complex relationships in the operation of primary care work environment [1]. In 2013, Hofmeyer proposed a "Social Capital Framework", with the objective of illustrating the importance of developing team relational networks in effective nursing management [13]. Gilbert et al. (2017) introduced the "Conceptual Model of Organizational Intellectual Capital"; this conceptual model further cements the vital position of social capital in nursing leadership [14]. ...
... The attribute of relational network indicates the "doing" among people (structural component) who are weaving the fabric of workplace social capital, whereas the assets suggest the "feeling" among them (cognitive component) [2,38,39]. These theoretical notions have been adopted by researchers in the field of academic nursing, indicating their validity and applicability within the concept of nurses' workplace social capital [4,13,16,31,40]. The notion of a three-component workplace social capital (structural, relational and cognitive), suggested by the work of Nahapiet and Ghoshal [11], has been applied in some nursing studies [1,30,33]; however, we have opted for the two-component construction of workplace social capital, because, relational social capital (e.g. the assets of trust, reciprocity) can be classified into cognitive component [4]. ...
... Bonding and bridging describe relationships established within and/or among groups at the same professional and power level and, therefore, is regarded as horizontal social capital; in contrast, linking social capital represents relationships across different strata of power and is considered vertical social capital. The distinction of these three types of social capital enables different access and participation of a relational network at the workplace to be examined [13]. Finally, nurses' workplace social capital can be organized into two levels, individual and group. ...
Background
Research has confirmed the importance of workplace social capital in the nursing workforce. Integration of the empirical evidence about nurses’ workplace social capital into a scientific collection can provide a comprehensive presentation of this concept. This scientific collection can be a conduit for further research and advancement of nursing management and leadership. The purpose of this paper, therefore, is to discuss the process of developing a conceptual model of nurses’ workplace social capital, an effective and concise approach to illustrate a scientific phenomenon.
Methods
The model of nurses’ workplace social capital was developed following Walker and Avant’s strategy of theory synthesis. Empirical evidence relevant to nurses’ workplace social capital was synthesized by systematically examining the existing literature. PubMed, CINAHL, Web of Science and Google Scholar were searched periodically from October 2017 to July 2020.
Results
Our proposed conceptual model lays out the determinants and outcomes of nurses’ workplace social capital and specifies the relational statements among these concepts. Nurses’ workplace social capital is influenced by the organizational and individual determinants shaped by multiple layers of sub-concepts. The development and implementation of nurses’ workplace social capital has three themes of consequences: 1) nurses’ outcomes; 2) patients’ outcomes; and 3) organizational outcomes. All the concepts and statements have been organized and aligned with the principles of “inventory of determinants or results” and “theoretical blocks”.
Conclusion
Our theoretical synthesis offers a comprehensive picture of the current knowledge of nurses’ workplace social capital. Efforts should be dedicated to evaluating, revising, and revamping this newly developed model based on future empirical evidence. Our synthesized conceptual model is the segue to more comprehensive studies about nurses’ workplace social capital. Interventional programs for the development of social capital can be structured based on the identified determinants.
... An abundance of research ndings has illustrated the considerable in uence of nurses' workplace social capital on nurses' mental and physical well-being, quality and e ciency of patient management and the overall healthcare organizations [13][14][15]. Despite the extend of research on the workplace application, the theoretical work on this phenomenon is still in its infancy. ...
... "Patients' outcomes" is a summary of two sub-concepts. First, a higher nurses' workplace social capital leads to a better quality and more e cient delivery of care [13,15,32]. Second, nurses' self-report of patient safety also is indicative of the positive impacts of high nurses' workplace social capital on patients' outcomes [37]. ...
... Under the summary concept of "organizational outcomes" we have listed two distinct outcomes, better clinical risk management and improved unit effectiveness. Nurses' workplace social capital is positively correlated with the betterment of clinical risk management [43,44]; also, improved unit effectiveness, which has been de ned as the capability of a unit to effectively and timely provide healthcare services, is positively correlated with the nurses' workplace social capital [13]. ...
Background: Research has confirmed the importance of workplace social capital in the nursing workforce. It is necessary to integrate the mounting empirical evidences about nurses’ workplace social capital into a scientific collection to provide a comprehensive presentation of this concept which can be a conduit for furthering research and advancing the practice of nursing management and leadership. The purpose of this paper, therefore, is to discuss the process of developing a conceptual model of nurses’ workplace social capital, an effective and concise approach to illustrate a scientific phenomenon.
Methods: The model of nurses’ workplace social capital was developed following Walker and Avant’s strategy of theory synthesis. Empirical evidence relevant to nurses’ workplace social capital was synthesized by systematically examining the existing literature. PubMed, CINAHL, Web of Science and Google Scholar were searched periodically from October 2017 to July 2020.
Results: Our proposed conceptual model lays out the determinants and outcomes of nurses’ workplace social capital and specifies the relational statements among these concepts. Nurses’ workplace social capital is influenced by the organizational and individual determinants shaped by multiple layers of sub-concepts. The development and implementation of nurses’ workplace social capital has three themes of consequences: 1) nurses’ outcomes; 2) patients’ outcomes; and 3) organizational outcomes. All the concepts and statements have been organized and aligned with the principles of “inventory of determinants or results” and “theoretical blocks”.
Conclusion: Our theoretical synthesis offers a comprehensive picture of the current knowledge of nurses’ workplace social capital. Efforts should be dedicated to evaluating, revising, and revamping this newly developed model based on future empirical evidences. Our synthesized conceptual model is the segue to more comprehensive studies about nurses’ workplace social capital. Interventional programs for the development of social capital can be structured based on the identified determinants.
... All studies scored at least a moderate methodological quality; 5/12 studies scored high quality (Laschinger et al. 1999, 2014b, Manojlovich & DeCicco 2007, Armstrong et al. 2009, Armellino et al. 2010, Breau & R eaume 2014 (Table 3). The included studies all used a prospective design (12/12), and valid and reliable instruments to measure SE (12/12). ...
... The included studies all used a prospective design (12/12), and valid and reliable instruments to measure SE (12/12). However, only 2/12 studies had a response rate above 60% (Laschinger et al. 1999(Laschinger et al. , 2014b, 5/12 justified their sample size (Laschinger et al. 1999, 2014b, Armstrong et al. 2009, Armellino et al. 2010, Breau & R eaume 2014) and 3/16 described the protection of anonymity (Manojlovich & DeCicco 2007, Armellino et al. 2010, Breau & R eaume 2014. None of the studies provided information on the management of outliers. ...
... The included studies all used a prospective design (12/12), and valid and reliable instruments to measure SE (12/12). However, only 2/12 studies had a response rate above 60% (Laschinger et al. 1999(Laschinger et al. , 2014b, 5/12 justified their sample size (Laschinger et al. 1999, 2014b, Armstrong et al. 2009, Armellino et al. 2010, Breau & R eaume 2014) and 3/16 described the protection of anonymity (Manojlovich & DeCicco 2007, Armellino et al. 2010, Breau & R eaume 2014. None of the studies provided information on the management of outliers. ...
Aim:
To assess and synthesise studies reporting direct associations between the structural empowerment of frontline nurses and quality outcomes, and to identify gaps in the current literature.
Background:
The empowerment of nurses seems essential for delivering high-quality patient care. Understanding the relationship between empowerment and quality outcomes would enable nurse managers to make informed choices on improving the quality of care.
Methods:
A scoping review examining the relationship between the structural empowerment of nurses and the quality, effectiveness, safety, efficiency and patient-centredness of care in hospitals. Searching in MEDLINE, CINAHL, Business Source Premier and Embase identified 672 potentially relevant articles. Independent selection, quality assessment, data extraction and analysis were completed.
Results:
Twelve cross-sectional studies originating from North America were included. These studies showed a variety of quality outcomes and statistics used. All studies reported positive associations between the structural empowerment of nurses, nurse assessed quality of care and patient safety climate, and work and unit effectiveness.
Conclusions:
Nurses having access to empowering structures positively affects the quality outcomes, i.e. quality, effectiveness, safety, efficiency and patient-centredness of patient care in hospitals.
Implications for nursing management:
Nurse managers and leaders should ensure empowering work conditions for nurses in order to increase hospitals' quality of patient care.
... Nurses in practice often struggle to define and accurately be credited for all that they do each shift, which can lead to a low level of professional identity for a nurse. 9 Nurses with a keen sense of professional identity have the potential to provide a higher level of patient care, 10 and being viewed as a professional by others strengthens one's professional identity. 2 Empowered nurses can improve work satisfaction, reduce turnover, and lower hospital mortality rates through improved communication, confidence, and patient advocacy. ...
... 2 Empowered nurses can improve work satisfaction, reduce turnover, and lower hospital mortality rates through improved communication, confidence, and patient advocacy. 10 Currently, there is no way for a ...
... DiCicco-Bloom et al., 2007;Ernstmann et al., 2009;Firouzbakht et al., 2018;Hofmeyer, 2003Hofmeyer, , 2013Hofmeyer & Marck, 2008;Hsu et al., 2011;Jafari, Pourtaleb, & Khodayari-Zarnaq, 2018;Kowalski et al., 2010;Laschinger, Read, Wilk, & Finegan, 2014; Middleton et al., Tominaga & Nakanishi, 2018;Vagharseyyedin et al., 2018;Van Bogaert, Kowalski, Weeks, & Clarke, 2013;Vardaman et al., 2012) (Appendix A). However, five of these characteristics, Relational Network, Trust, Shared Understanding, Reciprocity and Social Cohesion, are the most frequently stated in the literature; thereby, these attributes have been considered as the essential determining attributes of nurses' workplace social capital(Walker & Avant, 2011).Relational network has been parsed into a range of terms, for example, the structure of relations, the social networks and networks of social relationships, the configuration of relationships, the pattern of relationships (Appendix A). ...
... Terms Laschinger et al. (2014) The resources derived from the network of relationships; the pattern of relationships; the affective quality of relationships; trust; reciprocal interaction; shared understanding about the nature and goals of the work Read (2014) Defining attributes: networks of social relationships at work (relationships with other nurses, other healthcare professionals, or people in differential positions from oneself); shared assets (support, cooperation and teamwork, information and opportunities); shared ways of knowing and being (shared values, understandings, beliefs, practices, social norms and vision) Hofmeyer (2013) Relational norms; networks; mutual understanding; shared values; common goals; behaviours that bind the members of human networks; the structure of relationships; norms of trust; trust and solidarity; collective action and cooperation; information and communication; social cohesion and inclusion; empowerment; reciprocity; resilience to manage conflict; network ties; mutual understanding; shared aims and ethic values; team structure Sheingold and Sheingold (2013) The quality of relationships and networks; a sense of belonging; reciprocity; groups and network (group membership); trust and solidarity; collective action and cooperation; information and communication; social cohesion and inclusion; empowerment and political action; shared values; shared vision; external trust, solidarity and empowerment; participation and affiliation; internal trust, solidarity and harmony; social cohesion with co-workers; conflict management Hofmeyer (2003) Trust; cooperation; reciprocity; resilience to uncover social interaction; social cohesion; networks; generalized reciprocity and resilience; social connectedness; cooperation; a set of narratives of juxtaposed social interactions; resilience in effectively managing conflict, diversity and change Pesut (2002) The currency of relationship exchange; the stock of active connections; trust; mutual understanding; shared values; behaviours binding members of human networks and communities ...
Aim:
To provide an updated definition of the concept of nurses' workplace social capital that addresses changes in the contemporary nursing workforce.
Background:
Social capital explains the components of a constructive work environment. Advancements in psychology of workplace and changes in the demographic structure of nursing workforce call for a revised version of nurses' workplace social capital.
Method:
Walker and Avant's approach was implemented. Data were compiled from "Medline" and "CINAHL", "Google" search engine, book chapters and expertise of nursing academicians.
Results:
Nurses' workplace social capital is a relational network that is configured by interactions among healthcare professionals. Although, various attributes influence these interactions, Relational Network, Trust, Shared Understanding, Reciprocity and Social Cohesion are considered as the major attributes. A healthy relational network creates a healthy workplace which can be further fortified by effective communication, active group engagements and a supportive leadership.
Conclusions:
Results of our concept analysis should establish a theoretical groundwork for nurse leaders to better build and more effectively lead the contemporary nursing workforce.
Implication for nursing management:
Leaders' dedication to workplace social capital is the tenet of a constructive workplace, which in return can support nurses to flourish in their clinical and the other professional responsibilities.
... It should be emphasized that the assessment of work environment has a multi-aspect nature. Social and material aspects as well as interpersonal relations and taking up actions in favor of building this environment are the most important [13]. ...
... A larger number of qualified nurses than of lower educated nurses means the reduction of adverse events and patient deaths [24] and an optimal number of nursing staff (including caring personnel) is closely associated with the reduction of the number of adverse events [13,25]. ...
Background: At many Polish hospitals, insufficient attention is given to positive work environment. In many cases nurses, similarly to the representatives of other professional groups, are not provided with facilities or tools to perform their professional
tasks in safe conditions. The aspects of recruitment and retention of employees are often ignored. The aim of this study has been
to assess the chosen determinants of work environment of nurses in Poland using the concept of the Positive Practice Environments
(PPE). Material and Methods: The survey was carried out from 2008 to 2011 among 1049 nursing students of 3 randomly
selected public medical universities that provided nursing education at the graduate level of the Master of Science. All the people
qualified for the study group were practising nurses or midwives. The Polish Nursing Association coordinated the project, obtained
the tool, translated it and adjusted it to the Polish conditions. The areas covered in the survey were: a place of employment,
selected physical and social elements influencing the work conditions, and biographical information. Results: Access to as many as 8 factors identified as attributes of friendly environments was found unsatisfactory by over 50% of the nurses. For the purpose of objective assessment, the results were compared with the results obtained in the group of nurses in England. Conclusions: The majority of the surveyed nurses were not satisfied with their work environments. Polish nurse managers should ensure that aspects of recognized attributes of friendly, positive practice environments for nurses are established to support nurses’ satisfaction as a pre-condition for patients’ safety. Med Pr 2016;67(1):11–19
... The theory of structural empowerment, developed by Kanter in 1993, posits that opportunity and power in organizations are essential to empowerment and must be available to all employees for maximal organizational effectiveness and success (Manojlovich, 2007). Laschinger and her colleagues have done the bulk of the work on workplace empowerment in nursing (Laschinger et al., 2014;2006;2001). ...
... From the measurements obtained at one month after the psychological empowerment program, we found that nurses' workplace empowerment scores dropped in the study group, but increased at three months. Workplace empowerment has been reported to be associated with workplace environmental factors (Laschinger et al., 2014). Prolonged nightshift and work hours are also thought to have an effect on this result. ...
Objective:
Oncology nursing is stressful by its nature, and nurses in the field experience a high amount of stress and burnout. In order to cope with occupational stress, nurses need to employ flexible adjustment mechanisms that allow them the power to process their experiences. Failure of efficient stress management causes burnout, and burnout is closely related to powerlessness. It is therefore believed that the occurrence of burnout can be reduced by means of psychological empowerment of nurses. Our study was conducted to determine the effect of a "psychodrama-based psychological empowerment program" on (1) the perception of empowerment and (2) the levels of burnout in oncology nurses.
Method:
The sample was made up of 82 oncology nurses (38 nurses in the study group and 44 in the control/comparison group). Study data were collected using the Psychological Empowerment Scale, the Nurse Work Empowerment Scale, and Maslach's Burnout Inventory. The study group attended a "psychodrama-based psychological empowerment program" (2 hours, 1 day a week, for 10 weeks). For data assessment, we employed an independent t test and one-way analysis of variance.
Results:
The psychological empowerment and workplace empowerment scores of nurses in the study group increased and their burnout scores decreased following attendance in the psychodrama-based psychological empowerment program.
Significance of results:
We found that the psychodrama-based psychological empowerment program increased psychological empowerment and enhanced perception of workplace empowerment while decreasing levels of burnout in oncology nurses. The program is recommended and should allow oncology nurses to benefit from their personal experiences and thus increase self-empowerment, to enhance their perception of empowerment, and to prevent burnout.
... EC occurs when employees have access to "information, support, resources, and opportunities to learn and grow" (Laschinger, Finegan, Shamian, & Wilk, 2004, p. 528). On the other hand, PE occurs when employees have a heightened sense of self and motivation at work (Lee & Koh, 2010), which implies that managers can delegate duties and responsibilities down the hierarchy, but the act of delegation does not necessarily mean that the delegated employees will feel empowered (Wei, Yuan, & Di, 2010) In essence, EC describes empowering conditions in the work environment while PE refers to the reaction of employees to these empowering conditions (Kirkman & Shapiro, 2001;Laschinger, Read, Wilk, & Finegan, 2014;Menon, 2001). It is the resulting psychological state of empowerment that occurs when employees have a sense of motivation in relation to the work environment (Menon, 2001). ...
... The majority of the practice environment scales (4 of the 5) were less than 2.5. Recent studies emphasized that superior quality and patient safety outcomes are associated with favorable perceptions of nurse work environment (Laschinger, 2014;Van Bogaert et al., 2013. Our nursing leaders and hospital administrators should create a favorable nurse work environment to bring the quality of nursing care to the standard. ...
Background: Nurses play critical roles as patient advocates, regulating the quality of care and improve health care values. Data are scarce regarding the quality of nursing care in Ethiopia. Objective: To assess the quality of nursing care and convenience of the nurse working environment to provide quality nursing care in a tertiary hospital in Ethiopia. Methods: Data was collected prospectively using Quality of Nursing Care Questionnaires of Safford & Schlotfeldt and Practice Environment Scale of Nursing Work Index (PES-NWI). One hundred seventeen nurses and 51 physicians were included and data were analyzed using SPSS for windows version-20. Result: Four of the five PES-NWI variables had a mean score less than 2.5, suggesting the nursing environment and management were unfavorable to assure quality care. All nursing care performances were low. The highest score was in nurse carryout orders (66.7%) and lowest in nurse-physician collaboration (24.8%). Conclusion: The quality of nursing care is substandard. A favorable environment and nurse-physician relationship must be established to provide quality care.
... This theme represents an energizing way of working that shares control and eliminates hierarchical thinking between leaders and workers. Structural empowerment, that is, the extent to which a work environment provides access to support, resources, information, and opportunities to learn and grow, has been shown to be an important work-unit characteristic that has positive effects on nurses' job satisfaction and their ratings of the quality of care they are able to deliver [42]. The categories are: autonomy, decision-making latitude, and motivation. ...
Background:
Solutions that address the anticipated nursing shortage should focus on thriving at work: a positive psychological state characterized by a sense of vitality and learning, resulting in higher levels of work engagement, commitment, and wellbeing.
Purpose:
To synthesize international evidence on organizational factors that support hospital nurse wellbeing and to identify how the Social Embeddedness of Thriving at Work Model can support health managers to develop management approaches that enable nurses to thrive.
Method:
Conduct an integrative review of literature published between 2005-2019.
Results:
Thematic analysis identified five key themes: (1) Empowerment; (2) Mood of the organization; (3) An enabling environment; (4) Togetherness with colleagues; and (5) Leaders' connectivity.
Conclusions:
The Social Embeddedness of Thriving at Work Model supports managers to develop management approaches that enable their nurses to thrive. Health managers should consider strategies to support nurses to thrive at work to improve nurse work engagement and wellbeing.
... Therefore, good relationships with leaders, colleagues and patients, as well as a pleasant workplace atmosphere, can help relieve pressure on nurses and alleviate the harmful effects of perceived stress on professional identity (Kılıç & Altuntaş, 2019). Furthermore, a high-quality workplace social capital not only benefits clinical nurses, but also could improve the quality of patient care and promote changes in hospital management (Chang, Huang, Chiang, Hsu, & Chang, 2012;Ernstmann et al., 2009;Jafari, Pourtaleb, & Khodayari-Zarnaq, 2018;Shin & Lee, 2016;Spence Laschinger, Read, Wilk, & Finegan, 2014;Xu, Kunaviktikul, et al., 2020a). Thus, whether during COVID-19 outbreaks or in daily nursing management, workplace social capital is a useful resource that managers can implement and leverage to improve positive outcomes for both the department and its nurses. ...
Aim:
Workplace social capital refers to relationship networks formed by individuals in an organization through long-term mutually beneficial interactions and cooperation with members. These relationship networks can create value and resources for organizations and individuals. This current study aimed to explore the potential impact of workplace social capital on the association between perceived stress and professional identity in clinical nurses during the COVID-19 outbreak.
Methods:
In this cross-sectional study, 308 Chinese clinical nurses filled out the Chinese Workplace Social Capital Scale, the Chinese Perceived Stress Scale, and the Chinese Nurse's Professional Identity Scale. Descriptive analysis, independent samples t test, analysis of variance, Pearson correlation analyses, and bootstrap method were performed to analyze the data.
Results:
Perceived stress was negatively correlated with professional identity (r = -0.455, p < .001). Workplace social capital was not found to moderate the relationship between perceived stress and professional identity (95% CI -0.03 to- 0.06, p = .47 > .05). Instead, it mediated that relationship (95% CI -0.61 to -0.19, p < .05), and its mediating effect was -0.37.
Conclusions:
In the early stages of the COVID-19 outbreak, workplace social capital among the investigated clinical nurses failed to buffer the negative impact of perceived stress on professional identity, but it did play a part in mediating perceived stress and professional identity. A healthy workplace should be provided to clinical nurses to improve their professional identity, while lowering perceived stress.
... communication, confidence, and patient advocacy. 9 Therefore, nurses who perceive themselves as empowered in their workplace have the potential to effect change and improve patient outcomes. However, nurses often struggle to effectively express the impact of their profession in a way that other professionals understand. ...
Introduction:
Nurses continue to struggle to define their role as professionals in the hospital-setting often being represented in media as less competent than other health care providers. Paradoxically, an annual poll of the public consistently identifies nursing as the most trusted profession. This dichotomy of simultaneously being considered incompetent yet holding a high level of trust leads nurses to question their own professional identity. A gap exists in the literature about the professional identity of nurses who work directly with patients in the hospital environment.
Methodology:
Therefore, the aim of this interpretive phenomenology study was to describe the lived experience of nurses working with patients in the hospital environment and the meaning of this phenomenon as it relates to their professional identity.
Results:
Four themes were identified: (a) being validated as an expert by providers within the healthcare system; (b) working well as a valued member of a team; (c) advocating for the patient's needs despite opposition; and (d) Valuing human-ness in the patient.
Implications:
The findings provide a deeper representation of the practice of hospital-based nurses and implications for Anchornurses to be empowered in their workplace.
... Support for nurses from the organisation is crucial for the promotion of research among nurses and enhancing the research culture (Laschinger, Read, et al. 2014). The nurses in this study linked the lack of resources and lack of organisation support as barriers to engaging them in the research process, as shown in the perception of unit and hospital management domains in the SAQ, administered in Phase One. ...
Medication administration errors are a problematic issue in Australia and worldwide, despite previous attempts to reduce medication errors. Most interventions to date focus on isolated, discrete elements and fail to involve nurses in developing solutions. Medications errors in children are of particular concern because they are more susceptible to harm than adults.
This research aimed to recruit nurses to participate in an Action Research Team (ART) to develop, implement and evaluate interventions to reduce medication errors in paediatric patients.
The action research methodology was used over three phases of the study. Phase One aimed to build an overall picture of medication practice in the participating ward. The results of practice observation, medication policy audits, the Safety Attitudes Questionnaire (SAQ), the incident data and focus groups showed that the medication error rate on the ward was higher than the average error rate across the hospital. The contributing factors for these results included busy-ness of the ward, lack of resources and small size of the physical environment, lack of feedback from management, impractical medication policy, and the nurse’s perception of medication errors.
Phase Two aimed to develop and implement targeted interventions in the participating ward. The multi-disciplinary research team recruited six clinical nurses to be part of this phase (ART nurses). Five interventions were developed and implemented, moving the medication administration time two hours earlier in the evening shift, introducing medication trollies, updating the medication policy, implementing Safety and Quality meetings (S&Q) and modifying the patient admission forms. Data from the ART meeting minutes and semi-structured interviews with ART nurses were collected to explore the influence of the nurse’s participation in this research. The results indicated that ART nurses changed from being stressed and worried about understanding research, to becoming more confident and enthusiastic about what the research could achieve.
The effectiveness of the interventions was evaluated in Phase Three with Phase One data repeated. Additionally, eight semi-structured interviews with the ward nurses were undertaken to explore their perception of the interventions and their experience during the research journey.
Nurses were able to contribute to the research when they were provided with the opportunity and support, which enabled them to take ownership of the research and the subsequent changes they led. The results indicated a noteworthy reduction in the medication administration errors by 57.4% and an increased parent/carer engagement in medication administration at the bedside.
... between Social Capital and turnover intent, nursing unit effectiveness, and nurse perception of quality of care (Laschinger, Read, Wilk, & Finegan, 2014;Shin & Lee, 2016). Nurse leaders influence the creation of Social Capital in the complex nursing work environment through creating structures and processes that allow for nurses to access, exchange, and synthesize information both within and among teams to improve patient and organizational outcomes (Gilbert, Von Ah, & Broome, 2017). ...
Background:
Implementation and sustainability of a culture of evidence-based practice (EBP) require a systematic approach. A baseline assessment of the organizational context can inform implementation efforts.
Aims:
To examine organizational hospital context and provider characteristics associated with EBP readiness and to describe EBP context across hospitals.
Methods:
A nonexperimental descriptive correlational design was used to conduct a web-based survey of direct-care registered nurses (N = 701) and nurse managers (N = 94) across a large Midwestern multisite healthcare system using the Alberta Context Tool (ACT).
Results:
Many significant relationships existed among nurse characteristics and ACT domains, including age (lower age had higher Leadership, Evaluation, and Formal Interactions), education (graduate education had lower Social Capital than a bachelor's or associate degree), role (direct-care nurses had lower Culture than managers and lower Social Capital), and work status (full-time employees had lower Evaluation and Social Capital). EBP context across type of hospitals is similar, with marginal differences in Social Capital and Organizational Slack (higher in critical access hospitals).
Linking evidence to action:
Assessing organizational context to support EBP is the first step in developing and enhancing a sustainable culture of inquiry. The ACT has been tested across countries, settings, and healthcare disciplines to measure perception of readiness of the practice environment toward EBP. Optimal organizational context is essential to support EBP and sustain the use of evidence in professional nursing practice. Nursing leaders can use baseline assessment information to identify strengths and opportunities to enhance EBP implementation. Enhancing organizational context across nurse characteristics (e.g., age, role, and work status) to acknowledge nurses' contributions, balance nurses' personal and work life, enhance connectedness, and support work culture is beneficial. Fostering development of Social Capital in nurses is needed to influence EBP readiness. A systematic and standardized approach to foster EBP across health systems is key to successful implementation.
... The majority of the practice environment scales (4 of the 5) were less than 2.5. Recent studies emphasized that superior quality and patient safety outcomes are associated with favorable perceptions of nurse work environment (Laschinger, 2014;Van Bogaert et al., 2013. Our nursing leaders and hospital administrators should create a favorable nurse work environment to bring the quality of nursing care to the standard. ...
Background: Nurses play critical roles as patient advocate, regulating quality of care and improve health care values. Data are scarce regarding quality of nursing care in Ethiopia. Objective: To assess quality of nursing care and convenience of the nurse working environment to provide quality of nursing care in a tertiary hospital in Ethiopia. Methods: Data was collected prospectively using Quality of Nursing Care Questionnaires of Safford & Schlotfeldt and Practice Environment Scale of Nursing Work Index (PES-NWI). One hundred seventeen nurses and 51 physicians were included and data was analyzed using SPSS for windows version-20. Result: Four of the five PES-NWI variables had mean score less than 2.5, suggesting the nursing environment and management was unfavorable to assure quality care. All nursing care performances were low. The highest score was in nurse carryout orders (66.7%) and lowest in nurse-physician collaboration (24.8%). Conclusion: The quality of nursing care is substandard. Favorable environment and nurse physician relationship must be established to provide quality care.
... In surgical ward the nurses' empowerment was 86% and patient satisfaction was 81% whereas the nurses' empowerment in dialysis center was 44% and patient satisfaction rate was 51%. This statistic shows that if leaner nurses are empowered enough the quality care for patient is also improved (Laschinger, Read, Wilk, & Finegan, 2014).There are three main components of nursing empowerment, at the one is power sharing on work place which means the opportunity to promote and provide empowerment, the sense of within a person to be get empowered and belief that there is a sense of power in the relationship and caring that nurse provides. These three components are at the utmost priority for setting up an environment where both the registered nurses and learning nurses have opportunity and urges to call upon their management skills (Goedhart, Oostveen, & Vermeulen, 2017). ...
INTRODUCTION: Empowerment is giving the freedom to a person to make decisions according to his own judgments. In nursing profession the empowerment is allowing a nurse to do whatever is best according to situation without taking prior permissions from senior management. Nursing students are the learners who are going to face tough real life situations in near future so it is recommended for nursing students that they start active participation in ward management. Especially for the third year students it is necessary to provide they ground while they are learning leadership and management.
METHODOLOGY: The instrument use for Data collection was adopted questionnaire and convenient sampling technique was used in this research study. Convenience sampling is a non-probability sampling technique where subjects are selected because of their convenient accessibility and proximity to the researcher Data were analyzed using SPSS-21 calculate relative frequencies and means.
RESULTS: Finding of this study of third year leaner nurses was between 18 to 26 years. This chapter include 2 portions of analysis First analysis was demographic variable and second analysis Empowerment of leaner nurses variable consist of 32specific questions.32 items (1-10) were questions of participation decision making in unit management, (11-27) power sharing in ward management and (28-32) of motivation strategies in the nursing unit. All questions were on Likert scale1=totallydisagree,2= strongly disagree,3=disagree,4=uncertain,5=agree,6=strongly agree,7=totally agree. The data was re categories from totally disagree to disagree into disagree (1-3=1), uncertain (4=2) and from totally agree to agree into agree (5-7=3) This chapter include 2 portions of analysis First analysis was demographic variable and second analysis Empowerment of leaner nurses variable consist of 32specific questions.32 items (1-10) were questions of participation decision making in unit management, (11-27)
power sharing in ward management and (28-32) of motivation strategies in the nursing unit. All questions were on Likert scale1=totallydisagree,2= strongly disagree,3=disagree,4=uncertain,5=agree,6=strongly agree,7=totally agree. The data was re categories from totally disagree to disagree into disagree (1-3=1), uncertain (4=2) and from totally agree to agree into agree (5-7=3)
KEYWORDS: Empowerment, Learner Nurses, Nurse Manager
... In surgical ward the nurses' empowerment was 86% and patient satisfaction was 81% whereas the nurses' empowerment in dialysis center was 44% and patient satisfaction rate was 51%. This statistic shows that if leaner nurses are empowered enough the quality care for patient is also improved (Laschinger, Read, Wilk, & Finegan, 2014).There are three main components of nursing empowerment, at the one is power sharing on work place which means the opportunity to promote and provide empowerment, the sense of within a person to be get empowered and belief that there is a sense of power in the relationship and caring that nurse provides. These three components are at the utmost priority for setting up an environment where both the registered nurses and learning nurses have opportunity and urges to call upon their management skills (Goedhart, Oostveen, & Vermeulen, 2017). ...
... The majority of the practice environment scales (4 of the 5) were less than 2.5. Recent studies emphasized that superior quality and patient safety outcomes are associated with favorable perceptions of nurse work environment (Laschinger, 2014;Van Bogaert et al., 2013. Our nursing leaders and hospital administrators should create a favorable nurse work environment to bring the quality of nursing care to the standard. ...
This work focused on the status of quality of nursing care and the nurse working environment and administration for nursing quality assurance in a tertiary center in Ethiopia
... Similarly, a study among 239 workers in 11 nursing homes in Belgium measured social capital by six items referring to vertical trust, justice and social community at work (drawn from the Copenhagen Psychosocial Questionnaire) [35]. Spence Laschinger and Read [36] developed a theoretical model where structural empowerment (defined as access to opportunities, resources, information, support and formal and informal power measured by the Conditions of Work Effectiveness Questionnaire) and social capital at unit-level were associated with unit effectiveness (ability to provide timely care) as well as perceived patient care quality. They measured social capital using 9 items that relate to structural, relational and cognitive aspects of social capital. ...
Background:
Social capital can been described as an individual or a collective attribute, with structural and cognitive components, and a bonding, bridging and linking typology. While extensively studied in the community, studies in occupational settings are sparse by comparison. Furthermore, there is no uniformity in its measurement. This study investigated the construct validity of a Workplace Social Capital questionnaire (WSC), originally developed in the Finnish Public Sector occupational cohort, in a different socio-cultural setting (Cyprus), language (Greek) and occupational group (Registered Nurses). It also explored its criterion concurrent validity according to observed association with self-rated health and psychological distress.
Methods:
Participants were 10% of all registered nurses (N = 362) who responded to the 8-item WSC scale during a nationwide educational programme. A unidimensional model was compared with the postulated two-factor (structural vs cognitive) and three-factor model (bonding, bridging, linking) in Confirmatory Factor Analyses. The association with self-rated health (0-100 Visual Analogue Scale) and mental distress (GHQ-12 ≥ 4) was assessed in linear and logistic regression models.
Results:
A bonding (Cronbach's a = 0.76), bridging (a = 0.78) and linking (a = 0.89) structure explained 77.6% of the variance and was a better fit as indicated by goodness of fit indices. Elevated odds of mental distress and poorer self-rated health were observed among participants with the lowest levels of perceived workplace social capital. In adjusted models, associations appeared stronger with bonding social capital (adjOR of mental distress = 2.71 95% CI = 1.08, 6.79) while those with the highest scores rated their health higher by 8.0 points on average (95% CI = 2.1, 13.8). Low linking social capital was also associated with poorer health but no consistent associations were observed with bridging.
Conclusion:
While associations appeared stronger with bonding and linking, this may reflect a weakness of the measure to fully capture bridging social capital. Even though, this aspect might need strengthening, the WSC showed good metric properties in a different setting, language and occupational group. Cross-national and cognitive validation studies are needed.
... Bu çalışmaya konu olan hemşireler üzerinde tükenmişlik ile yapılan çalışmalar, sosyal sermaye faktörlerinin tükenmeyi etkilediğini göstermiştir (Kowalski, et al..,2010, Farahbod, et al. 2015Khammarnia, et al. 2010;Boyas, et al. 2010;Farzianpour, et al. 2013). Sosyal sermayenin hasta bakım kalitesi ve hasta güvenliğini arttırdığını (Laschinger, 2014;Read,2014;Chang ve ark.2012;) bireylerin sağlığı açısından sosyal ağların ve bu güçlü sosyal bağların, yaş ilerledikçe beyin sağlığını koruyup geliştirdiği (Domínguez & Arford, 2010), çalışanların kaliteli iş yaptığını ve verimliliğini arttırdığı (Hasle, et al. 2007;Verbeke, et al. 2004) tespit edilmiştir. Ayrıca sosyal sermaye finansal sermaye gibi, beşeri sermayenin gelişmesinde etkili olmaktadır. ...
... Self-reported perception of care quality at hospitals predicts, for example, patient mortality, failure to rescue, patient satisfaction, and process of care measures (McHugh and Stimpfel 2012). In addition, leadership style, sufficient staffing, and the well-being of staff are related with the quality of care provided (see, e.g., Aiken et al. 2014;Bodenheimer and Sinsky 2014;Castle et al. 2007;Firth-Cozens and Mowbray 2001;Hunt et al. 2014;Laschinger and Leiter 2006;Laschinger et al. 2001Laschinger et al. , 2014Li et al. 2013). ...
PurposeThe aim of this study is to investigate whether organizational justice climate at the workplace level is associated with individual staff members’ perceptions of care quality and affective commitment to the workplace. Methods
The study adopts a cross-sectional multi-level design. Data were collected using an electronic survey and a response rate of 75% was obtained. Organizational justice climate and affective commitment to the workplace were measured by items from Copenhagen Psychosocial Questionnaire and quality of care by three self-developed items. Non-managerial staff working at dental clinics with at least five respondents (n = 900 from 68 units) was included in analyses. A set of Level-2 random intercept models were built to predict individual-level organizational affective commitment and perceived quality of care from unit-level organizational justice climate, controlling for potential confounding by group size, gender, age, and occupation. ResultsThe results of the empty model showed substantial between-unit variation for both affective commitment (ICC-1 = 0.17) and quality of care (ICC-1 = 0.12). The overall results showed that the shared perception of organizational justice climate at the clinical unit level was significantly associated with perceived quality of care and affective commitment to the organization (p < 0.001). Conclusions
Organizational justice climate at work unit level explained all variation in affective commitment among dental clinics and was associated with both the individual staff members’ affective commitment and perceived quality of care. These findings suggest a potential for that addressing organizational justice climate may be a way to promote quality of care and enhancing affective commitment. However, longitudinal studies are needed to support causality in the examined relationships. Intervention research is also recommended to probe the effectiveness of actions increasing unit-level organizational justice climate and test their impact on quality of care and affective commitment.
... These reductions jeopardize the presence of the tenets of a PPE and patient care quality. 37 The nurse leader_s ability to influence other key stakeholders and advocate for these requisite resources will ensure consistency and adequacy. The development of influential nurse leaders has been outlined as a key strategy for the reform of healthcare. ...
Objective:
The purpose of this study was to examine relationships between leaders' perceived influence over professional practice environments (PPEs) and clinical nurses' reported engagement in essential professional nursing practice.
Background:
There is little empirical evidence identifying impact of nurse leader influence or why nursing leaders are not perceived, nor do they perceive themselves, as influential in healthcare decision making.
Methods:
A nonexperimental method of prediction was used to examine relationships between engagement in professional practice, measured by Essentials of Magnetism II (EOMII) tool, and nurse leaders' perceived influence, measured by Leadership Influence over Professional Practice Environment Scale (LIPPES). A convenience sample of 30 nurse leaders and 169 clinical nurses, employed in a 247-bed acute care Magnet® hospital, participated.
Results:
Findings indicated that leaders perceived their influence presence from "often" to "always," with mean scores of 3.02 to 3.70 on a 4-point Likert scale, with the lowest subscale as "access to resources" for which a significant relationship was found with clinical nurses' reported presence of adequate staffing (P < .004). Clinical nurses reported more positive perceptions in adequacy of staffing on the EOMII when nurse leaders perceived themselves to be more influential, as measured by the LIPPES, in collegial administrative approach (P = .014), authority (P = .001), access to resources (P = .004), and leadership expectations of staff (P = .039). Relationships were seen in the outcome measure of the EOMII scale, nurse-assessed quality of patient care (NAQC), where nurse leaders' perception of their authority (P = .003) and access to resources (P = .022) positively impacted and was predictive of NAQC.
Conclusions:
Findings support assertion that nurse leaders are integral in enhancing PPEs and their influence links structures necessary for an environment that supports outcomes.
... Nursing care performance refers to evaluating nurses' belief that using an NIS influences the quality of clinical care and patient safety (Waneka & Spetz, 2010). Quality of clinical care refers to nurses' evaluation of high-quality care in regard to accurate prediction of patient outcomes, in addition to objective assessments of quality of patient care in wards (Spence Laschinger & Read, 2014). ...
... Social capital has been associated with lower levels of burnout (Kowalski et al. 2010), better risk management behaviour (Ernstmann et al. 2009) and organizational commitment and pro-social customer service behaviours (Hsu et al. 2011) among hospital nurses. In a recent multi-level analysis Laschinger et al. (2014) found significant relationships between unit-level empowerment, social capital, unit effectiveness, and individual nurses' perceptions of patient care quality. Laschinger (2012) found significant correlations between new graduate nurses' perceptions of the sense of community on their unit and their job and career satisfaction and turnover intentions. ...
To examine a theoretical model testing the effects of authentic leadership, structural empowerment and relational social capital on the mental health and job satisfaction of new graduate nurses over the first year of practice.
Relational social capital is an important interpersonal organizational resource that may foster new graduate nurses' workplace well-being and promote retention. Evidence shows that authentic leadership and structural empowerment are key aspects of the work environment that support new graduate nurses; however, the mediating role of relational social capital has yet to be explored.
A longitudinal survey design was used to test the hypothesized model.
One hundred ninety-one new graduate nurses in Ontario with <2 years of experience completed mail surveys in January-March 2010 and 1 year later in 2011. Path analysis using structural equation modelling was used to test the theoretical model.
Participants were mostly female, working full time in medicine/surgery or critical care. All measures demonstrated acceptable reliability and validity. Path analysis results supported our hypothesized model; structural empowerment mediated the relationship between authentic leadership and nurses' relational social capital, which in turn had a negative effect on mental health symptoms and a positive effect on job satisfaction. All indirect paths in the model were significant.
By creating structurally empowering work environments, authentic leaders foster relational social capital among new graduate nurses leading to positive health and retention outcomes.
© 2015 John Wiley & Sons Ltd.
... A large international study involving hospitals from the US and Europe confirmed the impact that the hospital work environment has on the quality of care delivered (Aiken et al., 2012). The merits of empowerment are irrefutable, including benefits to the organisation and to the individual nurse ( Laschinger et al., 2014). Despite this, the clinical environment in which nurses and nursing students practice has been described as hierarchical and submissive (Daiski, 2004); stressful (Coomber and Barriball, 2007); and open to domination and oppression (Witz, 1992;Davies, 1996). ...
Empowerment is an important concept worthy of attention in healthcare. The merits of empowerment are irrefutable including benefits to the organisation and to the individual nurse. Empowered nurses contribute to the clinical learning environment in a positive way. There is a dearth of literature on how or indeed if nursing students are empowered. The process of empowering registered staff/nursing students is not clear. Ward environment and culture are important contributors to patient care, patient safety and staff well-being. It is therefore necessary to address how empowerment can contribute positively to improving the environment in which care is provided.
Copyright © 2014 Elsevier Ltd. All rights reserved.
Objective: To determine the effects of workplace social capital (WSC) on preventive health behaviors and illness coping behaviors of nurses.
Methods: A self-administered questionnaire was completed by nurses working in a hospital. Descriptive statistics were conducted on basic characteristics, health literacy, and WSC. The effects of WSC on preventive health behavior and illness coping behavior were examined using logistic regression analysis.
Results: The data of 600 nursing professionals were analyzed. Health literacy showed a difference in WSC mean values. The WSC of the subjects tended to maintain good lifestyle habits in eating breakfast, nutritional balance, and salt intake in preventive health behaviors. The illness coping behaviors of the subjects with high WSC tended to consult with medical staff or friends when feeling unwell, and to make time to visit a hospital. When the exclusionary workplace culture increased, there was a tendency to not seek medical examination.
Conclusion: The WSC of nurses with a health literate human environment may have a positive influence on preventive health behaviors and illness coping behaviors, such as lifestyle, counseling, and medical consultation. On the other hand, exclusionary workplace culture may hinder the maintenance of health because of the tendency of not receiving medical examinations.
Workplace social capital positively influences the quality but reduces the cost of healthcare services. Academic research suffers from limited and inadequate culturally sensitive nurses’ workplace social capital instruments. Here we report on the design and protocol of a culturally focused instrument development study in China. The overarching objective of our dual phase study is to develop and validate a questionnaire measuring nurses’ workplace social capital tailored toward Chinese cultural values and norms. In the first phase of INSTRUMENT DEVELOPMENT, the qualitative phase, we will conduct interviews with purposefully sampled nurses from five geographically diverse regions capturing 16 provinces in China to formulate the initial version of the Nurses’ Workplace Social Capital Questionnaire (NWSCQ). Data collection will be stopped at the saturation point and content analysis will be performed for interview data in parallel. The initial version of the NWSCQ will be evaluated and confirmed by two-rounds of expert consultation (target N = 20) and pre-tested among 70 nurses. During the second phase of INSTRUMENT VALIDATION or the quantitative phase, we will validate the psychometric properties of the NWSCQ. The validity and reliability of the questionnaire will be examined and validated through three cross-sectional surveys among nurses (target N = 1154) randomly selected from 12 tertiary hospitals. We have reported our study protocol with the intention of sharing our experience with researchers in other countries who are striving to advance the phenomenon of culturally sensitive and social normatively appropriate nurses’ workplace social capital. Findings from our study should advance the development of culturally appropriate and valid instrument of nurses’ workplace social capital, another important step toward recognition and incorporation of cultural diversity in the daily operation of healthcare industry.
Background:
Patient safety is a priority in health care systems. Nurses' safety competence along with environmental and personal factors plays a role in patient safety.
Purpose:
The purpose of this study was to explore the relationships among safety competency, structural empowerment, systems thinking, level of education, and certification.
Methods:
A cross-sectional exploratory design was used to collect data from nurses (n = 163) practicing in a large Midwestern hospital system.
Results:
There were significant positive correlations between safety competency and (a) structural empowerment, (b) systems thinking, and (c) certification. Systems thinking explained 12.9% of the variance in the knowledge component of safety competency and 6.8% of the variance in the skill component of safety competency. Certification explained 2.4% of the variance in the skill component of safety competency.
Conclusions:
Understanding factors that affect safety competency supports the development of effective interventions that may improve safety.
Aim
To develop and evaluate psychometric property of quality nursing care scale (QNCS) from nurses’ perspective in the Chinese context.
Design
A cross‐sectional survey design.
Methods
This study was conducted in two phases. In Phase I, literature review and interviews were conducted to develop the items. In Phase II, content validity was evaluated by five experts. Construct validity was tested through exploratory factor analysis (EFA) among 302 nurses and confirmatory factor analysis (CFA) among 510 nurses from October 2014 to January 2015. Additionally, internal consistency reliability was tested.
Results
The EFA extracted six factors including staff characteristics, task‐oriented activities, human‐oriented activities, physical environment, patient outcomes and precondition. All six factors accounted for 74.78% of the total variance to explain quality nursing care. The modified measurement model of the final version of QNCS was supported by the CFA with 48 items in six dimensions. The internal consistency reliability of final QNCS was acceptable.
Aim:
To identify the effects of authentic leadership, structural empowerment and forms of communication as antecedent factors of workplace social capital in nursing.
Background:
Enhancing workplace social capital for nurses by management requires identifying antecedent factors of workplace social capital focusing on work environment and relationships between members.
Methods:
In 2019, self-administered questionnaires were sent to all nurses working on the general wards of two university hospitals in Japan. A multilevel analysis was conducted to evaluate relationships between perceived workplace social capital-the dependent variable-and authentic leadership, structural empowerment and forms of communication-the individual- and ward-level independent variables.
Results:
Data from 463 nurses and 28 nurse managers were analysed (valid response rates = 38.0% and 58.3%, respectively). Their average age was 28.64 years (standard deviation: 7.00), and 93.5% were female. Ward-level authentic leadership and semi-formal communication were found to be significantly related to workplace social capital.
Conclusion:
More authentic leadership and communication to promote mutual understanding between members can foster workplace social capital among hospital nurses. These findings can help inform effective workplace training in hospitals.
Implications for nursing management:
Workplace social capital can be produced by improved management, environment and communication opportunities.
مقدمه: از مهمترین مولفه هایی که بر کیفیت خدمات تاثیر گذار است میزان رضایت پرسنل از شغل، امکانات و شرایط رفاهی می باشد. اما تاکنون مطالعه ای در زمینه بررسي رضايت پرسنل اورژانس پیش بیمارستانی از شرايط و امكانات رفاهي آمبولانس و اعزام در ایران انجام نشده است. بر این مبنا پژوهش حاضر با هدف ارزیابی سطح رضایت پرسنل از شرایط و امکانات رفاهی آمبولانس اعزام تبیین گردید. روش کار: در پژوهش مقطعی حاضر 68 نفر از پرسنل اورژانس پیش بیمارستانی بیمارستانهای استان خراسان شمالی، به طور تصادفی ساده انتخاب و سطح رضایتمندی آن بر اساس یک پرسشنامه 23 سوالی مورد ارزیابی قرار گرفت. سپس سطح رضایت نمونه های مورد بررسی به دو گروه مطلوب و نامطلوب تقسیم و یافته ها به صورت فراوانی و درصد گزارش گردید. يافته ها: کمترین میزان رضایت از امکانات و تجهیزات آمبولانس در زمینه عدم دسترسی به پزشک (7/14 درصد)، وجود کمکی (0/27 درصد)، راحتی صندلی پرستار (8/29 درصد) و پوزیشن گرفتن تخت بیمار (3/32 درصد) گزارش گردید. حداقل رضایتمندی نیز در زمینه شرایط رفاهی در بخش زمان وصول حق الزحمه (4/4 درصد) و محل استراحت (9/5 درصد) مشاهده شد. بر اساس طبقه بندی انجام شده تنها 22 (4/32 درصد) فرد از امکانات اعزام و 5 (4/7 درصد) نفر از شرایط رفاهی اعزام رضایت داشتند. نتيجه گيری: یافته های پژوهش حاضر نشان داد میزان رضایتمندی پرسنل اورژانس پیش بیمارستانی از امکانات و شرایط رفاهی آمبولانس پایین می باشد. تمامی عوامل تاثیر گذار بر کاهش سطح رضایتمندی پرسنل قابل رفع و پیشگیری بود لذا مداخله در این موارد می تواند باعث بهبود سطح رضایت پرسنل اعزام گردد.
The concept of social capital appears in the literature of multiple disciplines as a social determinant of health, an important aspect of human interaction, and a means to support population health capacity. Little is known about the use of social capital within the context of nursing. This article's aim provides insight into the concept of social capital and nursing. Avant and Walker methodology was used to analyze a sample of 78 articles. Along with a variety of articles and content themes, findings from this concept analysis include critical attributes, an operational definition, and reflections regarding future use.
Background:
When staffing legislation was introduced, New Jersey nurse leaders recognized from the research and their years of clinical leadership experience that the work environment is a multidimensional concept and that staffing is not the only variable related to nurse and patient outcomes. Thus, an understanding of what nurses need in their hospital environment to practice nursing effectively was sought.
Aims:
The aim of this study was to examine the evidence regarding clinical nurses' perception of what they need to practice nursing effectively in the acute care hospital environment.
Methods:
The following population, intervention, comparison, outcome question was used to search the literature databases PubMed, CINAHL, Johanna Briggs, and the Sigma Theta Tau Henderson Library: In the hospital environment what do nurses perceive as needed to practice nursing effectively? Specific search criteria and the Johns Hopkins nursing guidelines and tools were used to identify relative studies.
Results:
The final review, which addressed what nurses in the hospital environment need to practice nursing effectively, included 25 articles: 20 were an evidence level III, and five were evidence level II. From this review, five key concepts were identified: Leadership, autonomy/decision making, respect/teamwork, resources/staffing, and organizational commitment to nursing.
Linking evidence to action:
This integrative review, which explored nurses' perceptions of what is needed to provide effective quality care, identified that providing quality care is multifactorial in nature. Resources, including but not limited to staffing, and leadership were identified as important by nurses as a key factor in supporting quality care. Nurses must be provided with resources and infrastructure to do their jobs, in an environment supported by authentic transformational leadership.
Importance
Rapid response teams (RRTs) are foundational to hospital response to deteriorating conditions of patients. However, little is known about differences in RRT organization and function across top-performing and non–top-performing hospitals for in-hospital cardiac arrest (IHCA) care.
Objective
To evaluate differences in design and implementation of RRTs at top-performing and non–top-performing sites for survival of IHCA, which is known to be associated with hospital performance on IHCA incidence.
Design, Setting, and Participants
A qualitative analysis was performed of data from semistructured interviews of 158 hospital staff members (nurses, physicians, administrators, and staff) during site visits to 9 hospitals participating in the Get With The Guidelines–Resuscitation program and consistently ranked in the top, middle, and bottom quartiles for IHCA survival during 2012-2014. Site visits were conducted from April 19, 2016, to July 27, 2017. Data analysis was completed in January 2019.
Main Outcomes and Measures
Semistructured in-depth interviews were performed and thematic analysis was conducted on strategies for IHCA prevention, including RRT roles and responsibilities.
Results
Of the 158 participants, 72 were nurses (45.6%), 27 physicians (17.1%), 27 clinical staff (17.1%), and 32 administrators (20.3%). Between 12 and 30 people at each hospital participated in interviews. Differences in RRTs at top-performing and non–top-performing sites were found in the following 4 domains: team design and composition, RRT engagement in surveillance of at-risk patients, empowerment of bedside nurses to activate the RRT, and collaboration with bedside nurses during and after a rapid response. At top-performing hospitals, RRTs were typically staffed with dedicated team members without competing clinical responsibilities, who provided expertise to bedside nurses in managing patients who were at risk for deterioration, and collaborated with nurses during and after a rapid response. Bedside nurses were empowered to activate RRTs based on their judgment and experience without fear of reprisal from physicians or hospital staff. In contrast, RRT members at non–top-performing hospitals had competing clinical responsibilities and were generally less engaged with bedside nurses. Nurses at non–top-performing hospitals reported concerns about potential consequences from activating the RRT.
Conclusions and Relevance
This qualitative study’s findings suggest that top-performing hospitals feature RRTs with dedicated staff without competing clinical responsibilities, that work collaboratively with bedside nurses, and that can be activated without fear of reprisal. These findings provide unique insights into RRTs at hospitals with better IHCA outcomes.
Purpose
This study sought to identify the relationships between structural empowerment and patient identification behaviors of nurses.
Design/methodology/approach
The present study was a descriptive survey using a self-reported questionnaire, following a quality improvement (QI) project at a hospital in South Korea. The participants included 984 registered nurses, who administer medication and transfusions to patients in the hospital. Data were analyzed using the t-test, ANOVA, Scheffé’s test, Pearson correlation coefficients, and multiple regression analysis.
Findings
The patient identification behaviors of nurses were significantly correlated with opportunity, support, information, resources, formal power, and informal power of structural empowerment. The support, information, and informal power of structural empowerment, as well as the age and gender of the participants explained 10.7% of the variance in patient identification behaviors of nurses.
Research limitations/implications
The present study has limitations. Although the data collected by the cross-sectional survey were analyzed, causal analysis could not have been conducted.
Practical implications
Nursing managers can promote safety by creating a work environment that facilitates access to the support, information, and resources needed for nurses to perform their duties effectively; providing opportunities for nurses to learn and develop professionally; acknowledging the achievements of nurses; and expanding their duties, so that nurses can demonstrate greater work flexibility.
Originality/value
The present study confirms that structural empowerment influences the patient identification behaviors of nurses.
Aim
The aim of the present study is to clarify the relationship between perception of job empowerment and organizational commitment and trust among nurses in teaching hospitals of Khorramabad (Iran).
Background
Lack of power has been widespread among nurses in their workplaces due to uneven distribution of power among hospital staffs. Giving power to only a few individuals at the top of hospital hierarchy may often make nurses feel weak in their workplaces and causes reduction in the patients’ quality care.
Methods
This is a descriptive cross‐sectional study which included 160 officially employed nurses in four teaching hospitals of Khorramabad (west Iran) selected by stratified random sampling. The instruments used were: The Conditions of Work Effectiveness Questionnaire –II (C.W.E.Q‐II), which measures nurses’ empowerment, the Pressure Management Indicator, which measures organizational commitment and the Trust in Management Scale, which measures Organizational Trust. The data was analyzed by the SPSS software using the descriptive and analytic statistical tests employing chi‐square, Fisher's test, and the Spearman–Brown correlation coefficient.
Results
The results showed that the nurses had a below moderate score in their perception of job empowerment (x̄= 2.38 ± 0.70), with the highest score in their perception of access to “opportunity” subscale (x̄= 3.11 ± 0.95), and the lowest score in their perception of access to “formal power” (x̄= 2.43 ±0.95). Additionally, moderate “organizational commitment” and “organizational trust” were reported with x̄= 4.5 ± 0.90 and x̄= 4.01 ± 1.11 respectively. The highest and the lowest perception scores were found for “continuous commitment” and “affective commitment” with x̄= 4.94 ± 0.97 and x̄= 4.26 ± 1.21 respectively. There were positive significant relationships between the three major variables of the study (p<0.001).
Conclusion
The results showed that there was a positive and significant relationship between nurses’ perception of job empowerment, organizational commitment and trust.
Implications for nursing management
Nursing managers can increase the motivating factors among their nurses through evaluating organizational variables like empowerment and organizational trust. In fact, through recognition of the relationship between empowerment and organizational trust, one can design the interventions of structural empowering for the improvement of professional nursing practice, nurses’ workplace well‐being and safe quality care.
This article is protected by copyright. All rights reserved.
Objective:
This study explored the types of decisions and differences in decision making that nurses made in different types of hospital units.
Background:
The relationship between nurses' participation in decision making and the different types of hospital units where they work is not well understood.
Methods:
Nurses' participation in decision making was explored using the Participation in Decision Activities Questionnaire. The final sample included 307 nurses in 24 nursing units in 6 hospitals.
Results:
Nurses overall participated more in clinical than administrative decisions, and there were significant differences based on unit type. Critical care nurses had the highest and general care units the lowest levels of participation in decision making.
Conclusions:
Nurses in critical care units participated in higher amounts and at higher levels of clinical decisions overall than either intermediate or general care units. Nurse leaders should determine barriers to decision making in general care units and explore mechanisms to increase participation by clinical nurses.
Uvod: Zaradi hitrega razvoja znanosti in hitro spreminjajočega se okolja je izobraževanje in učenje v vseh obdobjih človekovega življenja nujno. Z raziskavo smo želeli ugotoviti, kako študenti magistrskega študija vzgoje in menedžmenta v zdravstvu dojemajo svoje novopridobljeno znanje.
Metode: Raziskava je temeljila na kvantitativni metodi raziskovanja. Podatke smo zbrali s pomočjo spletnega anketnega vprašalnika. V raziskavo smo vključili tri generacije študentov, vpisanih na magistrski študijski program vzgoje in menedžmenta v zdravstvu (n = 61). Vrnjenih je bilo 39 (63,9 %) anketnih vprašalnikov. Za analizo zanesljivosti anketnega vprašalnika smo uporabili Cronbachov koeficient alfa, ki je znašal 0,86. Statistična značilnost je bila preverjena na ravni 5% tveganja (p = 0,05). Za testiranje domnev o razliki aritmetičnih sredin smo uporabili enofaktorsko analizo variance in za ugotavljanje jakosti korelacij med spremenljivkami Pearsonov korelacijski koeficient (r).
Rezultati: Anketirani se ne glede na mesto zaposlitve (bolnišnica, zdravstveni dom, socialnovarstveni zavod, zasebnik, izven zdravstva, brez zaposlitve) najbolj strinjajo s trditvama, da jim znanje daje strokovno moč (x = 4,7) in da se z znanjem krepi profesija zdravstvene nege (x = 4,7). Najmanj se strinjajo s trditvijo, da bodo po zaključku študija prerazporejeni na drugo delovno mesto (x = 2,1). Statistično pomembna razlika se nanaša na trditev, da jih bodo člani zdravstvenega tima bolj spoštovali, ker bodo imeli višji naziv (F* = 5,059, p = 0,012).
Diskusija in zaključek: Zaradi krizne situacije zavodi novopridobljenega znanja svojih zaposlenih ne bodo mogli izkoristiti v celoti; magistrski študenti pa ga bodo po dokončanju študija lahko koristno uporabili pri obravnavi pacientov, s čimer bodo prispevali k razvoju in profesionalizaciji stroke zdravstvene nege.
Creating supportive and empowering workplace conditions is important, not only because these conditions are related to improved nurse health and well-being but also because they are important for retaining top performing nurses. The current nursing shortage emphasizes the need to create such conditions.
The aim of this study was to examine the impact of a workplace intervention (Civility, Respect, and Engagement in the Workplace [CREW]) on nurses' empowerment, experiences of supervisor and coworker incivility, and trust in nursing management.
Registered nurses (Time 1, n = 755; Time 2, n = 573) working in 41 units across five hospitals in two provinces completed measures of workplace empowerment, supervisor and coworker incivility, and trust in management before and after a 6-month intervention. Eight units participated in the intervention, and 33 units were control groups. Multilevel modeling was used to test the impact of the intervention.
A significant interaction of time by intervention was found for the access to support and resources empowerment structures, total empowerment, supervisor incivility, and trust in management.
Compared with the control group, nurses who experienced the intervention program reported significant improvements in empowerment, supervisor incivility, and trust in management. Despite methodological challenges experienced in this study, the CREW process appears to be a promising intervention approach to enhance quality of nursing work environments, which may contribute to the retention of the nursing workforce.
As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses' reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses' responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance. © 2012 Wiley Periodicals, Inc. Res Nurs Health.
This research focuses on creating a theory of the "organizational advantage," a new concept identified within business and management. Using social capital research as a foundation for this theory, three of the study's objectives are identified: 1) incorporate different aspects of social capital to identify three common dimensions; 2) explain the role of each dimension in the process of creating and exchanging knowledge; and 3) maintain the belief that organizations are capable of creating extraordinary amounts of social capital on all three dimensions. Additionally, the relationship between social capital and intellectual capital is explored, as is the impact of this relationship upon a firm's perceived organizational advantage. In order for exchange and combination of resources to occur as a means of creating value, the research identifies three necessary conditions, including the opportunity for exchange and combination to occur, the expectation that exchange and combination generates value, and the motivation that exchange and combination in some way will be productive. This research further identifies a fourth condition, combination capability, as a significant factor in value creation. Due to social capital's influence upon the conditions needed for exchange and combination, social capital aids in the creation of intellectual capital. The research further hypothesizes that a firm's ability to create and utilize social capital contributes to performance differences among firms. Several limitations are identified, including omission of the negative impact of social capital upon a firm and the costs associated with creating and preserving a firm's social capital. The findings of the study are generalized to other institutional situations, and areas for future research are identified. (AKP)
To determine the effect of hospital work environments on hospital outcomes across multiple countries.
Primary survey data using a common instrument were collected from separate cross sections of 98 116 bedside care nurses practising in 1406 hospitals in 9 countries between 1999 and 2009.
Nurse burnout and job dissatisfaction, patient readiness for hospital discharge and quality of patient care.
High nurse burnout was found in hospitals in all countries except Germany, and ranged from roughly a third of nurses to about 60% of nurses in South Korea and Japan. Job dissatisfaction among nurses was close to 20% in most countries and as high as 60% in Japan. Close to half or more of nurses in every country lacked confidence that patients could care for themselves following discharge. Quality-of-care rated as fair or poor varied from 11% in Canada to 68% in South Korea. Between one-quarter and one-third of hospitals in each country were judged to have poor work environments. Working in a hospital with a better work environment was associated with significantly lower odds of nurse burnout and job dissatisfaction and with better quality-of-care outcomes.
Poor hospital work environments are common and are associated with negative outcomes for nurses and quality of care. Improving work environments holds promise for nurse retention and better quality of patient care.
The aim of this study is to examine the relationship between a hospital's social capital, individual decision latitude, workload and emotional exhaustion in nurses, controlling for age, sex, years of professional experience and job tenure.
In western countries between 15-45% of nurses working in hospitals suffer from burnout, characterised by emotional exhaustion, depersonalisation and decreased personal performance. The prevention of burnout constitutes a great challenge to those responsible for the health care system, not least because burnout may cause increasing turnover rates in nurses and lead to medical mistakes.
Survey.
A questionnaire was mailed to 1325 nurses working at four hospitals in east and west Germany in 2002. Nine hundred and fifty nine nurses responded (response rate: 72.4%).
Logistic regression identified three significant predictors of emotional exhaustion in nurses: workload (OR: 4.523, CI: 3.230-6.333) was positively associated with emotional exhaustion. Decision latitude (OR: 0.376, CI: 0.254-0.557) and social capital in the hospitals (OR: 0.549, CI: 0.403-0.746) were negatively associated with emotional exhaustion. Emotional exhaustion was not affected by age, sex, years of professional experience and job tenure. Nagelkerke's Pseudo R(2) was 0.225.
The findings underline the importance of social capital and organisational development in hospital management.
Efforts to create a good working atmosphere with readiness to provide mutual support and the pursuit of joint values in a hospital, the reduction of workload and increased decision latitude may prevent the development of emotional exhaustion in nurses.
The aim of this study was to examine the influence of empowering work conditions and workplace incivility on nurses' experiences of burnout and important nurse retention factors identified in the literature.
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.
We examined the impact of workplace empowerment, supervisor and coworker incivility, and burnout on three employee retention outcomes: job satisfaction, organizational commitment, and turnover intentions in a sample of 612 Canadian staff nurses.
Hierarchical multiple linear regression analyses revealed that empowerment, 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 incivility, 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.
In our study, nurses' perceptions of empowerment, supervisor incivility, and cynicism were strongly related to job satisfaction, organizational commitment, and turnover intentions.
Managerial strategies that empower nurses for professional practice may be helpful in preventing workplace incivility, and ultimately, burnout.
The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.
To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention.
Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.
Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout.
After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction.
In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.
To test a theoretical model of professional nurse work environments linking conditions for professional nursing practice to burnout and, subsequently, patient safety outcomes.
The 2004 Institute of Medicine report raised serious concerns about the impact of hospital restructuring on nursing work environments and patient safety outcomes. Few studies have used a theoretical framework to study the nature of the relationships between nursing work environments and patient safety outcomes.
Hospital-based nurses in Canada (N = 8,597) completed measures of worklife (Practice Environment Scale of the Nursing Work Index), burnout (Maslach Burnout Inventory-Human Service Scale), and their report of frequency of adverse patient events.
Structural equation modeling analysis supported an extension of Leiter and Laschinger's Nursing Worklife Model. Nursing leadership played a fundamental role in the quality of worklife regarding policy involvement, staffing levels, support for a nursing model of care (vs medical), and nurse/physician relationships. Staffing adequacy directly affected emotional exhaustion, and use of a nursing model of care had a direct effect on nurses' personal accomplishment. Both directly affected patient safety outcomes.
The results suggest that patient safety outcomes are related to the quality of the nursing practice work environment and nursing leadership's role in changing the work environment to decrease nurse burnout.
Scholars of the theory of the firm have begun to emphasize the sources and conditions of what has been described as “the organizational advantage,” rather than focus on the causes and consequences of market failure. Typically, researchers see such organizational advantage as accruing from the particular capabilities organizations have for creating and sharing knowledge. In this article we seek to contribute to this body of work by developing the following arguments: (1) social capital facilitates the creation of new intellectual capital; (2) organizations, as institutional settings, are conducive to the development of high levels of social capital; and (3) it is because of their more dense social capital that firms, within certain limits, have an advantage over markets in creating and sharing intellectual capital. We present a model that incorporates this overall argument in the form of a series of hypothesized relationships between different dimensions of social capital and the main mechanisms and processes necessary for the creation of intellectual capital.
Context The worsening hospital nurse shortage and recent California legislation
mandating minimum hospital patient-to-nurse ratios demand an understanding
of how nurse staffing levels affect patient outcomes and nurse retention in
hospital practice.Objective To determine the association between the patient-to-nurse ratio and
patient mortality, failure-to-rescue (deaths following complications) among
surgical patients, and factors related to nurse retention.Design, Setting, and Participants Cross-sectional analyses of linked data from 10 184 staff nurses
surveyed, 232 342 general, orthopedic, and vascular surgery patients
discharged from the hospital between April 1, 1998, and November 30, 1999,
and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.Main Outcome Measures Risk-adjusted patient mortality and failure-to-rescue within 30 days
of admission, and nurse-reported job dissatisfaction and job-related burnout.Results After adjusting for patient and hospital characteristics (size, teaching
status, and technology), each additional patient per nurse was associated
with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12)
increase in the likelihood of dying within 30 days of admission and a 7% (OR,
1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After
adjusting for nurse and hospital characteristics, each additional patient
per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase
in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in
the odds of job dissatisfaction.Conclusions In hospitals with high patient-to-nurse ratios, surgical patients experience
higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses
are more likely to experience burnout and job dissatisfaction.
Objective: To test a theoretical model of professional nurse work environments linking conditions for professional nursing practice to burnout and, subsequently, patient safety outcomes. Background: The 2004 Institute of Medicine report raised serious concerns about the impact of hospital restructuring on nursing work environments and patient safety outcomes. Few studies have used a theoretical framework to study the nature of the relationships between nursing work environments and patient safety outcomes. Methods: Hospital-based nurses in Canada (N = 8,597) completed measures of worklife (Practice Environment Scale of the Nursing Work Index), burnout (Maslach Burnout Inventory-Human Service Scale), and their report of frequency of adverse patient events. Results: Structural equation modeling analysis supported an extension of Leiter and Laschinger's Nursing Worklife Model. Nursing leadership played a fundamental role in the quality of worklife regarding policy involvement, staffing levels, support for a nursing model of care (vs medical), and nurse/physician relationships. Staffing adequacy directly affected emotional exhaustion, and use of a nursing model of care had a direct effect on nurses' personal accomplishment. Both directly affected patient safety outcomes. Conclusions: The results suggest that patient safety outcomes are related to the quality of the nursing practice work environment and nursing leadership's role in changing the work environment to decrease nurse burnout.
To develop, field test and analyse a social capital survey instrument for measuring the nursing work environment.
The concept of social capital, which focuses on improving productive capacity by examining relationships and networks, may provide a promising framework to measure and evaluate the nurse work environment in a variety of settings.
A survey instrument for measuring social capital in the nurse work environment was developed by adapting the World Bank's Social Capital - Integrated Questionnaire (SC-IQ). Exploratory factor analysis and multiple regression analyses were applied to assess the properties of the instrument.
The exploratory factor analysis yielded five factors that align well with the social capital framework, while reflecting unique aspects of the nurse work environment.
The results suggest that the social capital framework provides a promising context to assess the nurse work environment. Further work is needed to refine the instrument for a diverse range of health-care providers and to correlate social capital measures with quality of patient care.
Social capital measurement of the nurse work environment has the potential to provide managers with an enhanced set of tools for building productive capacity in health-care organisations and achieving desired outcomes.
Schmidt and Hunter (1989) critiqued the within-group interrater reliability statistic (r(wg)) described by James, Demaree, and Wolf(1984). Kozlowski and Hattrup (1992) responded to the Schmidt and Hunter critique and argued that r(wg) is a suitable index of interrater agreement. This article focuses on the interpretation of r(wg) as a measure of agreement among judges' ratings of a single target. A new derivation of r(wg) is given that underscores this interpretation.
Most research to date has approached employee empowerment as an individual-level phenomenon. In this study we proposed a work-unit-level construct, empowerment climate, and tested a multiple-level model integrating macro and micro approaches to empowerment. Empowerment climate was shown to be empirically distinct from psychological empowerment and positively related to manager ratings of work-unit performance. A cross-level mediation analysis using hierarchical linear modeling showed that psychological empowerment mediated the relationships between empowerment climate and individual performance and job satisfaction.
F. L. Schmidt and J. E. Hunter (1989) critiqued the within-group interrater reliability statistic (
rwg) described by L. R. James et al (1984). S. W. Kozlowski and K. Hattrup (1992) responded to the Schmidt and Hunter critique and argued that
rwg is a suitable index of interrater agreement. This article focuses on the interpretation of
rwg as a measure of agreement among judges' ratings of a single target. A new derivation of
rwg is given that underscores this interpretation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Multilevel data-analytic techniques are rarely simultaneously employed and directly contrasted with each other. In this special issue of The Leadership Quarterly, hierarchical linear models (HLM), within-and-between analysis (WABA), and random group resampling (RGR) are compared and contrasted by testing the hypothesis that leadership moderates the relationship between stressors and well-being—a hypothesis that has important practical implications for the U.S. Army. This first article plays the groundwork for subsequent comparisons by testing for moderating effects using data collected from 2042 U.S. Army soldiers deployed to Haiti in November and December of 1994. Raw-score or individual-level analyses failed to find evidence of moderating effects. However, a preliminary set of group-level analyses indicated that the data had significant group-level properties that had not been modeled in the individual-level analyses. The group-level properties of the data set the stage for the three multilevel data-analytic approaches (HLM, WABA, and RGR) that are employed in three articles that follow and that are then compared and contrasted in the final article of this special issue.
Unit-level leadership and structural empowerment play key roles in creating healthy work environments, yet few researchers have examined these contextual effects on nurses' well-being.
The aim of this study was to test a multilevel model of structural empowerment examining the effect of nursing unit leadership quality and structural empowerment on nurses' experiences of burnout and job satisfaction and to examine the effect of a personal dispositional variable, core self-evaluation, on these nurse experiences.
Nurses (n = 3,156) from 217 hospital units returned surveys that included measures of leader-member exchange, structural empowerment, burnout, core self-evaluation, and job satisfaction. Multilevel structural equation modeling was used to test the model.
Nurses' shared perceptions of leader-member exchange quality on their units positively influenced their shared perceptions of unit structural empowerment (Level 2), which resulted in significantly higher levels of individual nurse job satisfaction (Level 1). Unit-level leader-member exchange quality also directly influenced individual nurse job satisfaction. Unit leader-member exchange quality and structural empowerment influenced emotional exhaustion and cynicism differentially. Higher unit-level leader-member exchange quality was associated with lower cynicism; higher unit-level structural empowerment was associated with lower emotional exhaustion. At Level 1, higher core self-evaluation was associated with lower levels of both emotional exhaustion and cynicism, both of which were associated with lower job satisfaction.
This study provides a theoretical understanding of how unit leadership affects both unit- and individual-level outcomes.
To determine the relationship between nurses' perceptions of their work environment and quality/risk outcomes for patients and nurses in acute care settings.
Nurses are leaving the profession as a result of high levels of job dissatisfaction arising from current working conditions. To gain organizational support for workplace improvements, evidence is needed to demonstrate the impact of the work environment on patient care.
A multi-level design was used to collect data from nurses (n=679) and patients (n=1005) within 61 medical and surgical units in 21 hospitals in Canada.
Using multilevel structural equation modelling, the hypothesized model fitted well with the data [χ(2)=21.074, d.f.=10, Comparative Fit Index (CFI)=0.985, Tucker-Lewis Index (TLI)=0.921, Root Mean Square Error of Approximation (RMSEA)=0.041, Standardized Root Mean Square Residual (SRMR) 0.002 (within) and 0.054 (between)]. Empowering workplaces had positive effects on nurse-assessed quality of care and predicted fewer falls and nurse-assessed risks as mediated through group processes. These conditions positively impacted individual psychological empowerment which, in turn, had significant direct effects on empowered behaviour, job satisfaction and care quality.
Empowered workplaces support positive outcomes for both nurses and patients.
Managers employing strategies to create more empowered workplaces have the potential to improve nursing teamwork that supports higher quality care, less patient risk and more satisfied nurses.
About 30% of doctors working in inpatient and outpatient departments suffer from burnout, characterized, for example, by emotional exhaustion. The prevention of burnout constitutes a great challenge for those responsible for the healthcare system.
Research into the relationship between social capital in hospitals and the occurrence of emotional exhaustion in clinicians is still at an early stage. The aim of the current study is to examine the effects of social capital in the workplace on the emotional exhaustion of clinicians.
A questionnaire was posted to 2,644 employees working in four German hospitals, and 1,645 responded. Responses from the 277 clinicians (61%) are analyzed here. The questionnaire looked at symptoms of emotional exhaustion and levels of organizational social capital.
Logistic regression identified two significant predictors of emotional exhaustion in clinicians: low self-efficacy and subjectively perceived lower levels of social capital in the hospitals where they worked. The model accounted for 26 % of Nagelkerke's R(2).
Efforts to create a good working atmosphere, with the readiness to provide mutual support and the pursuit of joint values and objectives within a hospital, may reduce the development of, or even prevent, emotional exhaustion in clinicians.
Many people working in human services in Western countries suffer from burnout, characterized by emotional exhaustion, depersonalization, and decreased personal performance. Prevention of emotional exhaustion (the first phase of burnout) constitutes a great challenge because emotional exhaustion may cause increasing turnover rates in staff and lead to a lesser quality of care. Prevention of emotional exhaustion requires knowledge of its predictors. The aim of this study was to investigate the associations between emotional exhaustion, social capital, workload, and latitude in decision-making among German professionals working in the care of persons with intellectual and physical disabilities.
The study was based on a survey in a sheltered workshop and 5 homes for disabled persons with 175 professionals. Burnout was measured with the German version of the Maslach Burnout Inventory-General Survey (MBI-GS). A multivariate logistic regression analysis was computed.
Logistic regression identified the following three significant predictors of emotional exhaustion in the sample: workload (OR, 4.192; CI, 2.136-8.227), latitude in decision-making (OR, 0.306; CI, 0.115-0.811), and male gender (OR, 4.123; CI, 1.796-9.462). Nagelkerke's Pseudo-R(2) was 0.344.
The results of this study demonstrate that specific factors in work organization are associated with emotional exhaustion. Taking into account sociodemographic changes and the upcoming challenges for human services professionals, the results underline the importance of considering aspects of organization at the workplace to prevent burnout. Specific circumstances of male employees must be considered.
We examined the impact of empowering work conditions on nurses' work engagement and effectiveness, and compared differences among these relationships in new graduates and experienced nurses.
As many nurses near retirement, every effort is needed to retain nurses and to ensure that work environments are attractive to new nurses. Experience in the profession and generational differences may affect how important work factors interact to affect work behaviours.
We conducted a secondary analysis of survey data from two studies and compared the pattern of relationships among study variables in two groups: 185 nurses 2 years post-graduation and 294 nurses with more than 2 years of experience.
A multi-group SEM analysis indicated a good fit of the hypothesized model. Work engagement significantly mediated the empowerment/effectiveness relationship in both groups, although the impact of engagement on work effectiveness was significantly stronger for experienced nurses.
Engagement is an important mechanism by which empowerment affects nurses feelings of effectiveness but less important to new graduates' feelings of work effectiveness than empowerment. Implications for nursing management Managers must be aware of the role of empowerment in promoting work engagement and effectiveness and differential effects on new graduates and more seasoned nurses.
The aim of this study was to test a multilevel model linking unit-level leader-member exchange quality and structural empowerment to nurses' psychological empowerment and organizational commitment at the individual level of analysis.
Few studies have examined the contextual effects of unit leadership on individual nurse outcomes. Workplace empowerment has been related to retention outcomes such as organizational commitment in several studies, but few have studied the impact of specific unit characteristics within which nurses work on these outcomes.
We surveyed 3,156 nurses in 217 hospital units to test the multilevel model.
A multilevel path analysis revealed significant individual and contextual effects on nurses' organizational commitment. Both unit-level leader-member exchange quality and structural empowerment had significant direct effects on individual-level psychological empowerment and organizational commitment. Psychological empowerment mediated the relationship between core self-evaluations and organizational commitment at the individual level of analysis.
The contextual effects of positive supervisor relationships and their influence on empowering working conditions at the unit level and, subsequently, nurses' organizational commitment highlight the importance of leadership for creating conditions that result in a committed nursing workforce.
Health Services Research has a growing need for reliable and valid measures of managerial practices and organizational processes. A national study of 42 intensive care units involving over 1,700 respondents provides evidence for the reliability and validity of a comprehensive set of measures related to leadership, organizational culture, communication, coordination, problem solving-conflict management and team cohesiveness. The data also support the appropriateness of aggregating individual respondent data to the unit level. Implications for further research are discussed.
A meta-analytic study investigated the causal relationships among job satisfaction, behavioral intentions, and nurse turnover behavior. A theoretical model was proposed in which behavioral intentions were viewed as a direct antecedent to turnover behavior. Job satisfaction was expected to be indirectly related to turnover by virtue of the mediating role of behavioral intentions. Consistent with these expectations, a strong positive relationship was indicated between behavioral intentions and turnover; a strong negative relationship between job satisfaction and behavioral intentions; and a small negative relationship between job satisfaction and turnover. The results of the modifier analysis suggested that effect sizes are fairly robust to differences in study designs, response rates, and methods of measuring job satisfaction, but the manner in which behavioral intentions were operationalized appeared to moderate the relationship between behavioral intentions and turnover and job satisfaction. Of variables related to nursing job satisfaction, work content and work environment had a stronger relationship with job satisfaction than economic or individual difference variables.
The objective of this study is to investigate whether hospitals known to be good places to practice nursing have lower Medicare mortality than hospitals that are otherwise similar with respect to a variety of non-nursing organizational characteristics. Research to date on determinants of hospital mortality has not focused on the organization of nursing. We capitalize on the existence of a set of studies of 39 hospitals that, for reasons other than patient outcomes, have been singled out as hospitals known for good nursing care. We match these "magnet" hospitals with 195 control hospitals, selected from all nonmagnet U.S. hospitals with over 100 Medicare discharges, using a multivariate matched sampling procedure that controls for hospital characteristics. Medicare mortality rates of magnet versus control hospitals are compared using variance components models, which pool information on the five matches per magnet hospital, and adjust for differences in patient composition as measured by predicted mortality. The magnet hospitals' observed mortality rates are 7.7% lower (9 fewer deaths per 1,000 Medicare discharges) than the matched control hospitals (P = .011). After adjusting for differences in predicted mortality, the magnet hospitals have a 4.6% lower mortality rate (P = .026 [95% confidence interval 0.9 to 9.4 fewer deaths per 1,000]). The same factors that lead hospitals to be identified as effective from the standpoint of the organization of nursing care are associated with lower mortality among Medicare patients.
Occupational mental health has been linked to productivity and other desired organizational outcomes, such as commitment and satisfaction. Kanter's model of work empowerment was used to examine the relation between 62 staff nurses' perceptions of empowerment in their work settings and their occupational mental health. The authors discuss their findings and suggest organizational interventions that can be used by nurse administrators to ameliorate work stress and improve work effectiveness.
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.
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.
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.
Structural equation modelling analyses revealed a good fit of the hypothesized model to the data based on various fit indices (chi 2 = 1140, df = 545, chi 2/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.
These results provide initial support for an expanded model of organizational empowerment and offer a broader understanding of the empowerment process.
The objective of this study was to examine the effects of nurse staffing and process of nursing care indicators on assessments of the quality of nursing care.
This study examined the variation in inpatient hospital staff nurses' assessments of the quality of nursing care and the effects of nurse staffing (patient workload), patient safety problems (medication errors and patient falls with injuries), and unfinished care (number of nursing tasks left undone) on the variation in those assessments. Secondary analysis of a survey of nurses using multivariate regression models was undertaken.
Data were derived from a 1999 statewide survey of 8670 inpatient staff nurses working in acute care hospitals in Pennsylvania.
Quality of nursing care ratings were significantly associated with the number of patients who nurses care for, rates of unfinished care for those patients, and the frequency of patient safety problems. The effect of patient workload on quality ratings was attenuated substantially by the effects of unfinished care and patient safety problems. Unfinished care had the strongest relationship of all, with over 40% of the variation in quality ratings associated with the number of tasks left undone.
Assessments of the quality of nursing are associated with both structural (workload) and process of care indicators (unfinished clinical care and patient safety problems), with the relationship strongest between process of care and quality. Explicating the interrelationship between structure and process of care is key to understanding the influence of both on quality. Studies that assess the causal influence of these features on quality of care and patient outcomes are warranted.
Employee empowerment has become an increasingly important factor in determining employee health and wellbeing in restructured healthcare settings. The authors tested a theoretical model which specified the relationships among structural empowerment, 6 areas of worklife that promote employee engagement, and staff nurses' physical and mental health. A predictive, non-experimental design was used to test the model in a random sample of staff nurses. The authors discuss their findings and the implication for nurse administrators.
Nurse managers are seeking ways to improve patient safety in their organizations. At the same time, they struggle to address nurse recruitment and retention concerns by focusing on the quality of nurses' work environment. This exploratory study tested a theoretical model, linking the quality of the nursing practice environments to a culture of patient safety. Specific strategies to increase nurses' access to empowerment structures and thereby increase the culture of patient safety are suggested.
To examine the effect of nursing practice environments on outcomes of hospitalized cancer patients undergoing surgery.
Secondary analysis of cancer registry, inpatient claims, administrative and nurse survey data collected in Pennsylvania for 1998-1999.
Nurse staffing (patient to nurse ratio), educational preparation (proportion of nurses holding at least a bachelor's degree), and the practice environment (Practice Environment Scale of the Nursing Work Index) were calculated from a survey of nurses and aggregated to the hospital level. Logistic regression models predicted the odds of 30-day mortality, complications, and failure to rescue (death following a complication).
Unadjusted death, complication, and failure to rescue rates were 3.4, 35.7, and 9.3 percent, respectively. Nurse staffing and educational preparation of registered nurses were significantly associated with patient outcomes. After adjusting for patient and hospital characteristics, patients in hospitals with poor nurse practice environments had significantly increased odds of death (odds ratio, 1.37; 95 percent confidence interval, 1.07-1.76) and of failure to rescue (odds ratio, 1.48; 95 percent confidence interval, 1.07-2.03). Receipt of care in National Cancer Institute-designated cancer centers significantly decreased the odds of death, which can be explained partly by better nurse practice environments.
This study is one of the first to examine the predictive validity of the National Quality Forum's endorsed measure of the nurse practice environment. Improvements in the quality of nurse practice environments could reduce adverse outcomes for hospitalized surgical oncology patients.
The purpose of this study was to test Leiter and Laschinger's Nursing Worklife Model linking structural empowerment to Lake's 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.
The aim of this study was to examine the impact of nurses' perceived professional practice environment on their quality of nursing conflict management approaches and ultimately their perceptions of unit effectiveness from the perspective of Deutsch's theory of constructive conflict management.
Rising reports of hostility and conflict among Canadian nurses are a concern to nurses' health and the viability of effective patient care delivery. However, research on the situational factors that influence nurses' ability to apply effective conflict resolution skills that lead to positive results in practice is limited.
A nonexperimental, predictive design was used in a sample of 678 registered nurses working in community hospitals within a large metropolitan area in Ontario.
The results supported a modified version of the hypothesized model [chi2(1) = 16.25, Goodness of Fit = 0.99, Comparative Fit Index = 0.98, Root-Mean-Square Error of Approximation = 0.15] linking professional practice environment and core self-evaluation to nurses' conflict management and, ultimately, unit effectiveness. Professional practice environment, conflict management, and core-self evaluation explained approximately 46.6% of the variance in unit effectiveness.
Positive professional practice environments and high core self-evaluations predicted nurses' constructive conflict management and, in turn, greater unit effectiveness.
Nursing professional practice environments: setting the stage for constructive conflict resolution and work effectiveness
- H Siu
- Hks Laschinger
- J Finegan
Siu H, Laschinger HKS, Finegan J. Nursing professional practice environments: setting the stage for constructive conflict resolution and work effectiveness. J Nurs Adm. 2008;8:250-257.
A moral imperative to improve the quality of work-life for nurses: building inclusive social capital capacity.
- Hoffmeyer
Hoffmeyer A. A moral imperative to improve the quality of
work-life for nurses: building inclusive social capital capacity.
Contemp Nurse. 2001;15(1-2):9-19.
On average deviation indexes for estimating interrater agreement
- Lr James
- Rg Demaree
- G Wolf
James LR, Demaree RG, Wolf G. On average deviation indexes
for estimating interrater agreement. J Appl Psychol. 1993;78:
306-309.
Investing in human relations for healthy nursing practice environment, nurses job satisfaction and quality of nursing care.
- Siddiqui
Siddiqui N. Investing in human relations for healthy nursing
practice environment, nurses' job satisfaction and quality of
nursing care. Am J Nurs Res. 2013;1(1):10-19.
Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes
- Hks Laschinger
- M Leiter
- A Day
- D Gilen
Laschinger HKS, Leiter M, Day A, Gilen D. Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes. J Nurs Manag. 2009;17(3):
302-311.
Exploring Positive Relationships at Work: Building a Theoretical and Research Foundation
- W Baker
- J Dutton
Baker W, Dutton J. Enabling positive social capital in organizations. In: Dutton E, Ragins BR. Exploring Positive
Relationships at Work: Building a Theoretical and Research
Foundation. Mahwah, NJ: Lawrence Erlbaum Associates
Publishers; 2007:325-345.
Nursing professional practice environments: setting the stage for constructive conflict resolution and work effectiveness.
- Siu
On average deviation indexes for estimating interrater agreement.
- James